Fibroadenomas are common benign lesions that are typically managed conservatively. However, transformation into malignant phyllodes tumor is a rare but critical progression that demands a shift from surveillance to surgical intervention. We present the case of a patient who underwent multiple core-needle biopsies over several years, all confirming a fibroadenoma, yet the mass demonstrated progressive growth, ultimately exceeding 7 cm. Ultimately, surgical excision revealed a malignant phyllodes tumor characterized by stromal overgrowth, cellular atypia, increased mitotic activity, and infiltrative margins. This case highlights the diagnostic limitations of core-needle biopsy in fibroepithelial lesions. Although the vast majority of fibroadenomas remain benign, a minority may undergo malignant transformation. Physicians must maintain a high degree of clinical suspicion and closely monitor longstanding lesions for any signs of growth or change. Early distinction between fibroadenomas and phyllodes tumors is essential, as management strategies differ substantially.
Lasers and light sources are effective treatment modalities for numerous vascular conditions of the skin, including rosacea and port-wine capillary malformations. While they are widely accepted as effective therapies for sporadic idiopathic telangiectasias, there is limited data regarding their efficacy in treating telangiectasias that occur due to connective tissue diseases (CTD) of systemic sclerosis (SSc) and lupus erythematosus (LE). The primary objective of this review is to analyse data on the effectiveness of lasers and light sources in treating SSc and LE associated telangiectasias. Ultimately, we hope that this will help guide physicians in managing these telangiectasias. A PubMed search was conducted March 2025 on the efficacy of lasers and light based devices known to help with vascular lesions in treating telangiectasias associated with a variety of connective tissue diseases including SSc, LE, dermatomyositis, mixed CTD, and morphea. Ultimately, 10 full-text articles met inclusion criteria. Available studies only investigated the use of either pulsed dye laser (PDL) or intense pulsed light (IPL) for telangiectasias within the context of SSc and LE, and thus these conditions became the focus of our review. All 10 articles demonstrated that PDL or IPL resulted in an improvement in telangiectasias associated with SSc and LE. In seven of the studies, there was both a reduction in the number of telangiectasias and overall visual improvement after PDL treatment. In all 4 studies that accounted for patient perspective, all subjects reported satisfaction with treatment and endorsed a better quality of life after PDL. Two studies suggested that telangiectasias secondary to SSc or LE may be more recalcitrant than sporadic telangiectasias, necessitating a greater number of treatments. One study found that PDL may be more effective than IPL when comparing clinical photographs and dermoscopic findings. All adverse events were transient and have also been seen in treatment of sporadic telangiectasias. No studies reported exacerbation of the underlying SSc or LE. Overall, PDL and IPL appear to be relatively safe and effective treatments for managing SSc and SLE-associated telangiectasias. More treatment sessions may be required compared to sporadic idiopathic telangiectasias. Future randomized controlled studies with more objective outcomes would help better characterize the effect of light-based devices in this unique patient population.
We report a rare case of actinomycosis arising in the tongue. A female patient in her 70s presented to our department with swelling of the tongue. Despite only minimal mucosal change, a submucosal indurated mass was observed. Contrast-enhanced magnetic resonance imaging revealed a well-circumscribed mass-like lesion within the tongue muscle. Ultrasonography showed punctate hyperechoic foci within a hypoechoic lesion. As there were few signs of infection, a benign tumorous lesion was suspected, and an excisional biopsy was performed. Histopathological examination indicated sulfur granules in the mass, and no neoplastic lesion was observed. The mass was ultimately diagnosed as tongue actinomycosis. Three years after surgery, there was no evidence of recurrence at the wound site. This case highlights the diagnostic difficulty of lingual actinomycosis and suggests that internal punctate hyperechoic foci on ultrasonography may provide a useful clue to the diagnosis.
Polydimethylsiloxane confers stretchability, enhanced brightness, mechanical responsivity and self-charging capability to mechanoluminescence materials, yet its intrinsic low toughness and crack resistance pose a major obstacle to the practical application of ML devices. Herein, high-toughness silicone-rubber layers were introduced to slice the ZnS:Cu@Al2O3/PDMS matrix into a multilayer architecture that mimics the hinged microstructure of clam. The modified composite exhibits a dramatic enhancement in stretchability, with fracture strain increasing from approximately 100% to 500%. This improvement is accompanied by more than a four-fold boost in ultimate ML intensity, along with sustained durability demonstrated over 30 000 cycles at the tensile limit. The reduced layer thickness and suppressed crack propagation by the high-toughness silicone-rubber interlayer raise toughness from 0.95 to 4.93 MJ/m3. This work provides an effective strategy for enhancing the performance of PDMS-based flexible ML composites, advancing their practicality and offering new insights for applications in stress visualization, intelligent information display, and mechanics sensing.
This study aimed to systematically evaluate and compare the effects of different types of prenatal exercise on neonatal outcomes, and to assess their relative effects and rankings for birth weight, gestational age, 1-minute Apgar score, and 5-minute Apgar score. We searched PubMed, the Cochrane Library, Embase, Scopus, and Web of Science for studies examining the effects of prenatal exercise on pregnancy and neonatal outcomes, from database inception to January 2026. According to exercise type, the interventions were classified into aerobic exercise (AE), resistance exercise (RE), mind-body exercise (MBE, referring to exercise modalities such as yoga and Pilates that emphasize breathing regulation, postural control, and mind-body coordination), and combined exercise (CE, referring to interventions composed of two or more exercise components, such as combined aerobic and resistance exercise). A network meta-analysis (NMA) was performed to synthesize the evidence. A total of 61 studies involving 11,036 pregnant women were ultimately included. For the 1-minute Apgar score, mind-body exercise was associated with a higher score compared with no intervention (MD = 0.33, 95% CI: 0.18 to 0.47). In the network comparison, mind-body exercise showed a higher 1-minute Apgar score than combined exercise (MD = 0.24, 95% CI: 0.06 to 0.42). For the 5-minute Apgar score, a statistically significant increase was observed only for mind-body exercise compared with no intervention (MD = 0.18, 95% CI: 0.04 to 0.32). Regarding birth weight, mind-body exercise was associated with a higher birth weight than combined exercise (MD = 104.41, 95% CI: 1.28 to 207.54). For gestational age, no statistically significant differences were observed between any intervention and no intervention or among different interventions. The cumulative ranking probability plots showed that mind-body exercise had the highest probability of ranking first across all four outcomes. The CINeMA assessment indicated that the confidence in the evidence for this network meta-analysis was mainly moderate to low. The effects of different types of prenatal exercise on neonatal outcomes were not consistent. Mind-body exercise showed a relative advantage in improving Apgar scores and may have a potential effect on birth weight; however, there is insufficient evidence to indicate that it can significantly improve gestational age. https://www.crd.york.ac.uk/prospero/CRD420251241770, identifier CRD420251241770.
Continuous tobacco cropping leads to reduced nutrient bioavailability, severe autotoxicity, and disrupts the rhizosphere microbial balance, ultimately reducing leaf yield and quality. Inoculation with arbuscular mycorrhizal fungi (AMF) can promote plant growth by enhancing nutrient uptake and modulating soil microbial communities. This study investigated the mechanisms underlying growth inhibition in consecutively cropped soils and evaluated the potential of AMF to alleviate such cropping stress through a pot experiment. Compared with non-inoculated plants, AMF inoculation significantly improved photosynthetic parameters, agronomic traits, and biomass during the vigorous growth stage. It also increased antioxidant enzyme activities in both leaves and roots, elevated soil enzyme activities (catalase, sucrase, polyphenol oxidase), and enhanced soil nitrogen, phosphorus, and potassium content. Furthermore, AMF inoculation enriched soil microbial diversity, particularly increasing the abundance of Lysobacter, and exerted stronger effects on the fungal community than bacteria. AMF inoculation also reduced concentrations of allelopathic compounds in soil, including hydroxybenzoic acid, vanillic acid, p-coumaric acid, ferulic acid, and myristic acid. In contrast, tobacco grown in consecutively cropped soils exhibited decreased photosynthetic performance, root growth, biomass, and reduced enzyme activities, including CAT, PAL and SOD in leaves and SOD, CAT, PAL and POD in roots. Overall, continuous cropping negatively affects tobacco growth and soil homeostasis, whereas AMF inoculation promotes plant growth, mitigates allelopathic stressors associated with continuous cropping, and significantly improves soil chemical properties and microbial abundance and functionality.
Doxorubicin (Dox) has limited clinical application due to its cardiotoxicity. Berberine (Ber) counteracts Dox-induced myocardial injury. This study uncovers molecular mechanisms through which Ber mitigates Dox-induced myocardial damage by modulating the long non-coding RNAs small nucleolar RNA host gene 14 (SNHG14). To construct Dox-induced cardiotoxicity models in vitro (AC16 cells) and in vivo (male adult rats) for assessing the effects of Ber. Echocardiography was performed to assess the severity of cardiac injury in the rats. RT-qPCR analysis was performed to examine SNHG14 expression. CCK-8, flow cytometry, ELISA and other kits were used to evaluate cell viability, apoptosis, inflammation, oxidative stress and myocardial damage markers. Dox boosted SNHG14 and PDK4 in rat myocardial tissues and cultured cardiomyocytes, while suppressing miR-9-5p. Ber reversed the situation, lowering SNHG14 and PDK4 expression and raising miR-9-5p levels. Mechanistically, SNHG14 acts as a miR-9-5p sponge, which leads to the attenuation of miR-9-5p-mediated inhibition of PDK4, ultimately promoting PDK4 expression. The Ber significantly attenuated Dox-induced diastolic dysfunction in rats. It also attenuated apoptosis, inflammation and oxidative stress in AC16 cells; however, this attenuation was substantially reversed by SNHG14, which was partially abolished by miR-9-5p. Ber may alleviate Dox-induced cardiac toxicity by inhibiting the SNHG14/miR-9-5p/PDK4 axis and reducing the apoptosis, inflammation and oxidative stress in cardiomyocytes.
Cancer of unknown primary (CUP) represents a heterogeneous group of metastatic malignancies in which the primary site remains unidentified despite comprehensive clinical, laboratory, radiological, and pathological evaluation. CUP is generally characterized by aggressive biological behavior, poor prognosis, and the absence of standardized treatment strategies. Tumor-associated blood eosinophilia (TABE) is relatively uncommon and typically occurs after tumor dissemination, often indicating an unfavorable prognosis. SMARCB1 (INI-1) is a core subunit of the switch/sucrose non-fermentable (SWI/SNF) chromatin remodeling complex, and its functional loss can drive tumorigenesis through epigenetic dysregulation. However, cases of SMARCB1-deficient carcinoma presenting as CUP with marked TABE are exceedingly rare, posing significant diagnostic and therapeutic challenges. A 71-year-old man presented with a painless mass in the left side of the neck accompanied by generalized pruritus. Laboratory evaluation revealed persistent peripheral blood eosinophilia, and imaging studies demonstrated multiple enlarged lymph nodes in the left supraclavicular region and abdominal cavity. Histopathological examination of a lymph node biopsy showed poorly differentiated carcinoma. Immunohistochemistry revealed loss of nuclear SMARCB1 expression. A final diagnosis of SMARCB1-deficient undifferentiated carcinoma was established, and comprehensive systemic evaluation failed to identify a primary tumor. The patient received paclitaxel combined with cisplatin and a programmed cell death protein 1 (PD-1) inhibitor. Immunotherapy was discontinued due to the development of immune-related cutaneous adverse events. Despite subsequent management, the disease progressed rapidly, with the development of brainstem metastasis, and the patient ultimately died. We report a case of SMARCB1-deficient undifferentiated carcinoma presenting as CUP, predominantly with cervical lymph node metastases, accompanied by marked TABE. The benefit of current empirical treatment strategies appears limited. Future prospective clinical studies targeting the epigenetic vulnerabilities of this entity are warranted to improve patient outcomes.
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by pulmonary arterial wall remodeling, right ventricular (RV) hypertrophy, and interstitial fibrosis, ultimately culminating in RV failure. The latter is the strong predictor of mortality in PAH. While current therapies primarily target the pulmonary vasculature and reduce RV afterload, they do not directly address the metabolic and structural maladaptation of the RV. Emerging evidence indicates that cardiometabolic reprogramming occurs in the RV of PAH patients, encompassing dysregulated glucose, lipid, and amino acid metabolism. These metabolic dysregulations are mirrored in preclinical models, where cardiomyocytes, endothelial cells, and fibroblasts exhibit reduced fatty acid oxidation, enhanced glycolysis, and altered mitochondrial function. Such alterations may promote cardiomyocyte lipotoxicity, impair contractile efficiency, disrupt endothelial barrier integrity, facilitate monocyte recruitment, and drive fibroblast proliferation and activation, collectively contributing to RV inflammation, fibrosis, and functional decline. Understanding these cell-specific metabolic reprogramming is critical, as they may represent both compensatory and pathogenic mechanisms during the progression from RV adaptation to maladaptation. This review provides a comprehensive overview of recent advances in elucidating metabolic dysregulation in the RV of PAH patients and relevant in vivo and in vitro models. The therapeutic potential of targeting these pathways using metabolic modulators, small molecules, and natural products is also discussed, with the goal of developing RV-directed therapies that complement existing PAH treatments and improve patient outcomes.
There is substantial quantitative evidence in support of exercise as beneficial for trauma recovery, particularly in targeting the neurobiological mechanisms disrupted by trauma. It is therefore important to understand the circumstances under which individuals may avoid exercise, ultimately preventing them from accessing the wellbeing benefits. Some qualitative articles have identified the factors which may prevent an individual from choosing to engage in exercise outside of a structured intervention (self-initiated exercise), but there lacks a synthesis across these differing articles. This systematic review aimed to synthesise qualitative evidence on trauma survivors' experience of barriers to self-initiated exercise. A systematic search of six databases was conducted to identify peer-reviewed qualitative findings on the perceived barriers to self-initiated exercise engagement, with six articles meeting the inclusion criteria. Thematic synthesis revealed three key themes: Searching for Safety, Staying With The Trauma, and Costs of Exercise and Trauma. In their decision to exercise, trauma survivors negotiate many barriers: the physiological, social, and environmental threats to their safety, trauma-related dissociation, and the costs of both exercise and trauma weighed against competing recovery needs. The small number of included studies reflects the emerging nature of research in this area, but it may limit the transferability of the findings. Nonetheless, as the first of its kind, this systematic review collates the experience of barriers as a first meaningful, exploratory step towards addressing them in future research. Taken together, the findings underscore the importance of a trauma-informed approach to ensure exercise remains unimpeded for trauma survivors.
Tissue engineering holds significant promise for advancing pediatric reconstructive surgery by overcoming the limitations of conventional autografts and static implants while harnessing the unique regenerative potential of developing tissues. This review aims to synthesize recent progress and ongoing challenges in pediatric tissue engineering, with a primary focus on the development, design, and clinical translation of biomaterial scaffolds. We examine how scaffold architecture, material composition, and fabrication strategies can be tailored to accommodate pediatric growth, dynamic mechanical demands, and long-term biological integration. While complementary approaches such as stem cell therapies, computational modeling, and disease-specific platforms are acknowledged, the central emphasis remains on scaffold-based solutions that address the distinct anatomical and physiological requirements of children. By moving beyond adult-centric treatment paradigms, the field is gradually shifting toward a more integrated regenerative surgery framework that prioritizes adaptive tissue remodeling and functional recovery. Ultimately, this review highlights how purpose-built scaffolds and emerging biofabrication techniques are paving the way for safer, more effective reconstructive options in pediatric care, while identifying the key translational and regulatory barriers that must be addressed to realize their full clinical potential.
Synaptic dysfunction is the earliest and most critical pathological feature of Alzheimer's disease (AD), directly contributing to cognitive decline. This review provides an integrative overview of the molecular and biochemical modulators governing synaptic plasticity and their disruption in AD. We discuss how the collective impairment of Aβ aggregation, tau pathology, calcium imbalance, oxidative stress, and neuroinflammation affects dendritic spine morphology and synaptic connectivity. Particular attention is given to neurotrophins such as brain-derived neurotrophic factor and TrkB signaling, hormonal influences, likewise glucocorticoids, estrogens, testosterone, endocannabinoid pathways, lipid and cholesterol regulators like ApoE and lipid rafts, and epigenetic mechanisms that modulate synaptic resilience. We further evaluate the therapeutic potential of pharmacological agents, including cholinesterase inhibitors, NMDA receptor modulators, and multi-target directed ligands alongside nutraceuticals such as resveratrol, curcumin, omega-3 fatty acids, Withania somnifera, and Bacopa monnieri. Emerging technologies, including iPSC-derived neuronal models, optogenetics, and advanced neuroimaging biomarkers like SV2A PET, cerebrospinal fluid/plasma neurogranin, are also highlighted for their role in elucidating and monitoring synaptic integrity. Ultimately, targeting the biochemical modulators of synaptic plasticity offers a promising avenue for AD therapy, especially through combinatorial and precision-medicine strategies aimed at restoring synaptic function and cognitive performance.
The prevalent presence of dyes, mycotoxins, and marine toxins in aquatic environments and food products presents significant threats to environmental sustainability and public health. Adsorption has become an effective and adaptable method for pollutant removal owing to its simplicity, high efficiency and adaptability to complicated water and food matrices. This review systematically assesses the efficacy of bio-based and nanostructured adsorbents in the remediation of dyes, mycotoxins, and marine toxins, focusing on adsorption processes, kinetics, and structure-performance correlations. Bio-based materials, comprising biopolymers, agricultural residues, and biohybrid systems are examined in conjunction with nanostructured adsorbents, including carbon nanomaterials, metal oxides and nanocomposites. This review bridges a critical gap in the existing literature by offering a comprehensive cross-disciplinary assessment of aqueous systems and food matrices. It emphasizes how transitions within these matrices influence the efficacy of specific classes of adsorbents across various biological contexts. Ultimately, new trends, existing problems, and prospective research avenues are delineated to facilitate the advancement of sustainable, high-performance adsorbents for applications in water and food safety.
Professional stigma toward forensic mental healthcare service users may compromise care quality and negatively affect treatment and rehabilitation outcomes. Reliable role- and context-specific instruments are needed to assess professional stigma in settings where therapeutic and security responsibilities intersect. This study examined the psychometric properties of the newly developed PROfessional Forensic Stigma (PROFS) scale, a multidimensional measure assessing stereotypes, prejudices, and discriminatory behaviors among professionals working with forensic populations. In this cross-sectional study, 219 mental healthcare professionals from forensic and community services in Spain (n = 79), Belgium (n = 83), and the Netherlands (n = 57) completed the initial PROFS (36 items; 7-point Likert scale), and measures of negative stereotypes (ATMIO), affective reactions (APDQ), social distance (SDS), empathy (IRI), and social desirability (BIDR-16). Psychometric evaluation used classical test theory and Rasch analysis (Partial Credit Model). Item functioning, dimensionality, reliability, and construct validity were assessed. Convergent and divergent validity were examined using Spearman correlation coefficients. The initial PROFS demonstrated a three-domain structure (Stereotypes, Prejudice, Discrimination). Rasch-based item refinement and correction of disordered response thresholds resulted in a final 30-item version with a 5-point response format. The refined PROFS showed acceptable to good reliability (total scale PSI = 0.86-0.90; subscale PSI = 0.67-0.84). Convergent validity was supported by moderate to strong correlations between Stereotypes and negative stereotypes (ρ = 0.58), Prejudice and affective reactions (ρ = 0.40-0.55), and Discrimination and social distance (ρ = 0.36; all p < 0.01). Weak associations with empathy and social desirability supported divergent validity. Floor effects were observed for Discrimination items. The PROFS shows satisfactory psychometric performance and provides evidence for its reliability and construct validity as a measure of professional stigma among mental health care professionals working with forensic service users. The scale may support research and evaluation of stigma-related outcomes and can be used to identify professional stigma in teams or services and to inform the development and evaluation of stigma-reduction initiatives, with the ultimate aim of improving care and rehabilitation prospects for forensic service users.
Listeria monocytogenes is a foodborne, intracellular Gram-positive bacillus that typically causes mild gastrointestinal illness or flu-like symptoms in healthy hosts but can lead to invasive disease, including bacteremia and central nervous system infection. Although classically associated with immunocompromised states, advanced age has emerged as an independent risk factor for invasive listeriosis. We report a case of an otherwise healthy elderly male patient who presented with nonspecific systemic symptoms and was subsequently found to have Listeria monocytogenes bacteremia and meningitis. Initial presentation was atypical for bacterial meningitis, contributing to diagnostic uncertainty. Blood cultures and cerebrospinal fluid analysis ultimately confirmed the diagnosis of invasive listeriosis. The patient was treated with targeted antimicrobial therapy, including ampicillin-based treatment, with clinical management guided by the susceptibility of Listeria species. This case report highlights the importance of having a high clinical suspicion of invasive listeriosis in the geriatric population given atypical meningitis symptoms, high mortality rate, and need for appropriate and time-sensitive antibiotic coverage.
Morbidity and mortality in idiopathic pulmonary arterial hypertension (iPAH) are linked to right ventricular failure (RVF), a condition characterized by a metabolic shift from fatty acid oxidation (FAO) to glycolysis. Eisenmenger Syndrome (ES), a unique form of PAH, is associated with a mortality paradox, yet the mechanism for better survival in this condition remains poorly understood. We postulated that beneficial changes in long chain fatty acid (LCFA) utilization may support right ventricular (RV) adaptations in ES, and therefore ssupport favorable RV function and improved morbidity and mortality when compared to iPAH. We examined clinical and metabolomic data to identify potential mechanistic clues about RV function and morbidity/mortality in controls, iPAH, and ES subjects. In a small cohort with iPAH (n = 3) or ES (n = 3) clinical data demonstrated worse hemodynamic disease in ES (mean pulmonary artery/mPA pressure 90 ± 6 vs. 50 ± 4 mmHg, p < 0.001), with better clinical compensation (resting heart rate 81 ± 6 vs. 105 ± 6 bpm, p ≤ 0.05 and lower brain natriuretic peptide levels 11 ± 6 pg/dL vs. 71 ± 18 pg/dL, p < 0.01). Metabolomic analysis demonstrated that 97 circulating lipids were significantly different between iPAH and ES. Plasma concentration of LCFAs (Stearate, Palmitate, Oleate, Lineolate) were significantly reduced in ES compared to iPAH, and all but Lineolate were also reduced when compared to non-PAH control samples, suggesting there may be an advantageous compensatory increase in LCFA utilization (FAO) in ES. Plasma tricarboxylic acid (TCA) cycle metabolites were significantly increased in ES compared to iPAH, supporting that compensatory augmentation of FAO occurs in ES, but not likely in RV failure from iPAH. Our preliminary data in ES differs importantly and unexpectedly from left ventricular and RV failure, in that circulating LCFA utilization appears to be increased. Further, TCA cycle activity is increased in ES, supporting that mechanisms which preserve or enhance LCFA utilization may ultimately preferentially support FAO for energy production. Further study of the impact of LCFA utilization on RV function in ES and other cohorts will be important to determine the role that metabolic substrates may play in long-term preservation of heart function in unique groups.
Luminescent coinage metal clusters (CMCs) hold great promise for bioimaging and optical applications, but long-lived room-temperature phosphorescence (RTP) with high quantum yield remains challenging. Herein, a Förster resonance energy transfer (FRET) glue strategy using Ag+ to bridge donor-acceptor (D/A) pairs is adopted to synthesize a series of clusters in CH3CN (Ag4), CH3OH [Ag4(CH3OH)2], C2H5OH [Ag4(C2H5OH)], and i-C3H7OH [Ag2(i-C3H7OH)2] realizing near-unity FRET efficiency. Among them, Ag4(CH3OH)2 delivers superior thermally activated delayed phosphorescence with a high photoluminescence quantum yield of 96% and an ultralong RTP lifetime of around 100 ms, which are 5.6 times and 400 times higher than those of Ag4, respectively. Mechanistic studies reveal that isolated Ag+ as single-point linkers circumvent the overly strong spin-orbit coupling of larger Ag cores while retaining an appropriate heavy-atom effect to facilitate effective phosphorescence emission. In addition, hydrogen bonds from coordinating solvents can adjust the spatial position of ligand, optimizing D/A arrangement, which enhances FRET efficiency and suppresses nonradiative deactivation, ultimately achieving high-efficiency luminescence of silver clusters. Leveraging the solvent-mediated regulation of cluster structure and performance, this system enables reversible single-crystal-to-single-crystal transformation and subsequent time-solvent-temperature-gated multilevel information encryption. This work provides a general design principle for CMCs with high-performance RTP.
The safe deployment of autonomous driving systems (ADSs) relies on comprehensive testing and evaluation. However, safety-critical scenarios that can effectively expose system vulnerabilities are extremely sparse in the real world. Existing scenario generation methods face challenges in efficiently constructing long-tail scenarios that ensure fidelity, criticality, and interactivity, while particularly lacking real-time dynamic response capabilities to the vehicle under test (VUT). To address these challenges, this paper proposes a safety-critical testing scenario generation framework that integrates the high-level semantic understanding capabilities of Vision Language Models (VLMs) with the fine-grained generation capabilities of adaptive guided diffusion models. The framework establishes a three-layer hierarchical architecture comprising a strategic layer for VLM-directed scenario generation objective determination, a tactical layer for guidance function formulation, and an operational layer for guided diffusion execution. We first establish a high-quality fundamental diffusion model that learns the data distribution of real driving scenarios. Next, we design an adaptive guided diffusion method that enables real-time, precise control of background vehicles (BVs) in closed-loop simulation. The VLM is then incorporated to autonomously generate scenario generation objectives and guidance functions through deep scenario understanding and risk reasoning, ultimately guiding the diffusion model to achieve VLM-directed scenario generation. Experimental results demonstrate that the proposed method can efficiently generate realistic, diverse, and highly interactive safety-critical testing scenarios. Compared with original scenarios, the generated critical scenarios increase the average at-fault collision rate of the AUTs by approximately 4.2×. Furthermore, case studies demonstrate the adaptability, VLM-directed generation performance, as well as the robustness to VLM hallucination of the proposed method.
Identifying autism early is critical for ensuring timely access to appropriate educational and clinical supports. Current autism screening practices primarily focus on toddlers; universal practices for identifying the substantial portion of autistic children who arrive at school age without a diagnosis are lacking. This study evaluates the preliminary reliability and validity of the Modified Checklist for Autism in Toddlers-School Age version (M-CHAT-S), a novel screener designed for early school-age children, with separate versions for verbally fluent and minimally verbal children. A total of 165 caregivers and 107 educators completed the M-CHAT-S, along with the Social Responsiveness Scale, Second Edition (SRS-2), to test convergent validity, and the Child Behavior Checklist (CBCL), to test discriminant validity. Findings demonstrate strong internal consistency across versions (Cronbach's α = .79-.92) and robust construct validity. Children with preexisting autism diagnoses scored higher on the M-CHAT-S than nonautistic children. Both test-retest reliability and interrater reliability were in the moderate range. Despite these limitations, the M-CHAT-S demonstrates promise as a screening tool that could facilitate earlier identification of autistic children in school settings. Future research will involve a partnership with school districts to support school-based validation and implementation.Lay AbstractChildren with disabilities have a right to a free and appropriate public education in the United States. Children who are not identified by the time of school entry are likely to miss out on appropriate services and supports to which they would otherwise be legally entitled. Many studies show that a large portion of individuals who are ultimately diagnosed with autism are not identified until by the time they start school.Screening tools can help identify children who may be on the autism spectrum. Universal autism screening is currently recommended for toddlers, but not school-age children. To address this gap, we developed the Modified Checklist for Autism in Toddlers-School Age version (M-CHAT-S) for children in early elementary school. This study tested the consistency and accuracy of the M-CHAT-S for both verbally fluent and minimally verbal children.We asked 165 caregivers and 107 educators to complete the M-CHAT-S and compared their responses to other well-established measures of autism traits and behavior. Overall, we found that the M-CHAT-S had good reliability, meaning that the items in the measure were consistent with each other. Children with a known autism diagnosis scored higher on the M-CHAT-S than non-autistic children. M-CHAT-S scores were more strongly related to another autism screening tool (the SRS-2) than to a survey of general behavior (the CBCL). However, test-retest reliability (whether the same rater's score stayed consistent over time) and interrater reliability (whether two different raters agreed on scores) were lower than expected.These results suggest that the M-CHAT-S may be a useful tool for identifying autistic children in early school years. Future research will involve partnering with school districts to be able to reach as many children as possible, including autistic children who have not yet been identified. If validated further, this tool could help schools and families recognize children who need autistic support, leading to earlier access to services.
Biomimetic polymers have emerged as a powerful class of materials that are capable of replicating biological processes, functions, properties, or structures found in natural systems. While extensive reviews are available due to the significant progress in synthetic biomimetic materials, this review focuses exclusively on sustainable, naturally derived biomimetic polymers, as the global focus has shifted towards low-carbon footprint remedies. Biomimicry can only be reliably evaluated using appropriate characterization techniques, and selecting the ideal technique depends on several factors: the specific biomimetic feature of interest, the relevant length scale, the condition of the sample, and whether qualitative or quantitative assessment is required. Hence, we critically survey how complementary chemical, mechanical, structural, and morphological methods are able to span different length scales. We highlight both established and emerging characterization techniques which belong to four broad categories: spectroscopy, microscopy, diffraction/scattering, and thermo-mechanical analysis. Ultimately, this review guides the rational design for next-generation biomimetic materials, bridging the gap between biomimicry, material characterization, and sustainable materials.