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Search Results (3,218)

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23 pages, 3799 KB  
Article
Intelligent Unmanned Aerial Vehicle Swarm Control Under Electronic Warfare: A Cognitive–Intent Dual-Stream Reinforcement Learning Framework
by Yang Chen and Jinglong Niu
Drones 2026, 10(5), 342; https://doi.org/10.3390/drones10050342 (registering DOI) - 2 May 2026
Abstract
Multi-unmanned aerial vehicle (UAV) platforms integrate radio-frequency (RF) sensing, datalinks, and onboard embedded compute; adversarial electronic warfare (EW) degrades these subsystems through jamming and forces decentralized control policies to act on fragmented observations—a setting aligned with intelligent electronic systems and autonomous robotics in [...] Read more.
Multi-unmanned aerial vehicle (UAV) platforms integrate radio-frequency (RF) sensing, datalinks, and onboard embedded compute; adversarial electronic warfare (EW) degrades these subsystems through jamming and forces decentralized control policies to act on fragmented observations—a setting aligned with intelligent electronic systems and autonomous robotics in contested spectrum. Cooperative swarms then face two compounding failure modes: loss of coherent situational awareness, and reward-driven passive survival that suppresses mission completion. Memory-based multi-agent reinforcement learning (MARL) partially addresses the first but tends to reinforce the second; dense intent shaping addresses the second but becomes unreliable when observations are incomplete. We propose CIDA (Cognitive–Intent Dual-Stream Architecture), a reinforcement learning framework that decouples belief reconstruction from tactical intent at the representation level while coupling them through a unified actor–critic update. The cognitive stream encodes a 64-step observation history with a pre-normalized Transformer to reconstruct threat belief; the intent stream supplies a hierarchical potential field (reconnaissance, threat-weighted engagement, and approach incentives). A steady-state training mechanism (dynamic reward scaling and adaptive gradient clipping) stabilizes Transformer-based on-policy learning under non-stationary multi-agent dynamics. In a complex terrain scenario with SAM, AAA, and jammer assets, CIDA reaches 96.15% task success versus 12.21% (memoryless PPO) and 25.28% (MAPPO+RNN), with ablations showing nonlinear coupling and emergent tactics such as jammer bypass and weak-sector traversal. Results are robust to a four-fold sweep of the intent-shaping weight (above 90% success). Full article
(This article belongs to the Section Artificial Intelligence in Drones (AID))
21 pages, 2079 KB  
Article
SDN-Assisted Deep Q-Learning Framework for Adaptive Mobility and Handover Optimization in Hybrid 5G Networks
by Yahya S. Junejo, Faisal K. Shaikh, Bhawani S. Chowdhry and Waleed Ejaz
Telecom 2026, 7(3), 49; https://doi.org/10.3390/telecom7030049 (registering DOI) - 2 May 2026
Abstract
In the evolving landscape of next-generation wireless networks, ensuring seamless mobility and high-quality service delivery for millions of devices and end users in dynamic scenarios, where the speed of a wireless device keeps changing with time, is important. The mobility, seamless and continuous [...] Read more.
In the evolving landscape of next-generation wireless networks, ensuring seamless mobility and high-quality service delivery for millions of devices and end users in dynamic scenarios, where the speed of a wireless device keeps changing with time, is important. The mobility, seamless and continuous connectivity, and ultra-dense deployment of wireless networks pose a significant challenge. Seamless and successful transition of a wireless device from point A to point B in variable-speed scenarios is one of the major challenges in future networks. This paper presents a novel Deep Q-Network (DQN)-based reinforcement learning (RL) framework integrated with Software-Defined Networking (SDN) for intelligent mobility management in hybrid 5G cellular networks consisting of macro and small base stations. The proposed system architecture utilizes a SDN controller to receive real-time user measurement reports, including Reference Signal Received Power (RSRP), Signal-to-Interference Noise Ratio (SINR), and user velocity, thereby classifying user mobility into distinct subclasses and dynamically determining optimal handover parameters. Leveraging the DQN’s capability to learn adaptive strategies, the model enables seamless transitions between macro and small cells based on mobility profiles, thereby enhancing Quality of Service (QoS) metrics such as latency, throughput, and handover efficiency. Simulation results demonstrate consistent performance improvements over baseline and existing models in ultra-dense network environments, with handover success rates 10–15% higher across SINR and different speed scenarios, while maintaining a packet failure rate of 9% across different speed scenarios, allowing more users to transition during various environmental changes seamlessly. Our proposed model is compared with our previous work and Learning-based Intelligent Mobility Management (LIM2) models. Specifically, our previous work focused on adaptive handover management primarily for high-speed train scenarios using a learning-assisted approach tailored to fixed high-mobility scenarios, with a limitation to single mobility conditions. This work contributes to the field of merging SDN’s centralized control with the predictive power of RL, paving the way for more resilient and responsive mobile networks in high-mobility scenarios. The proposed approach incorporates subclass-based mobility action abstraction, joint optimization of TTT and hysteresis margin, and dynamic target cell selection using global network information available at the SDN controller. Full article
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22 pages, 2095 KB  
Article
Transfemoral Valve-in-Valve TAVI with MyVal for Failed Surgical Aortic Bioprostheses: Procedural Outcomes, Serial Hemodynamics, and Anatomy-Based Determinants of Residual Gradient
by Georgios E. Papadopoulos, Ilias Ninios, Sotirios Evangelou, Andreas Ioannides, Athinodoros Nikitopoulos and Vlasis Ninios
J. Clin. Med. 2026, 15(9), 3462; https://doi.org/10.3390/jcm15093462 - 1 May 2026
Abstract
Background/Objectives: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is an established treatment for failed surgical aortic bioprostheses, but dedicated data on the MyVal platform remain limited. We evaluated outcomes, hemodynamics, residual gradient, and an exploratory matched comparison with ACURATE neo2. Methods: This prospective, single-center [...] Read more.
Background/Objectives: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is an established treatment for failed surgical aortic bioprostheses, but dedicated data on the MyVal platform remain limited. We evaluated outcomes, hemodynamics, residual gradient, and an exploratory matched comparison with ACURATE neo2. Methods: This prospective, single-center cohort included consecutive patients with failed surgical aortic bioprostheses treated with MyVal ViV-TAVI between July 2022 and June 2025. Outcomes were reported according to VARC-3. Results: Sixty-eight patients were included (age 77 ± 7 years; 51.5% women; EuroSCORE II 7.3 ± 1.8%). Technical success was 100%, with no 30-day death, stroke, myocardial infarction, second-valve implantation, or emergency surgical conversion. Mean gradient decreased from 38.0 ± 9.5 mmHg at baseline to 6.7 ± 2.1 mmHg post-procedure and remained low at 1 year (8.1 ± 2.5 mmHg; overall p < 0.001). AVA increased from 0.80 ± 0.23 cm2 to 1.98 ± 0.19 cm2 post-procedure and was 1.86 ± 0.23 cm2 at 1 year (overall p < 0.001). Smaller true internal diameter independently predicted elevated 1-year gradient (adjusted OR per 1-mm decrease 1.33, 95% CI 1.04–1.78; p = 0.028). In the exploratory matched comparison, safety and hemodynamic outcomes did not differ significantly between MyVal and ACURATE neo2. At a median follow-up of 12.8 months, all-cause mortality and heart failure hospitalization were each 4.4%. Conclusions: In this prospective single-center cohort, MyVal ViV-TAVI was associated with high procedural success and favorable 1-year hemodynamic outcomes, with residual gradient driven mainly by small surgical valve true internal diameter. Full article
(This article belongs to the Special Issue Current Advances in Aortic Valve Stenosis)
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15 pages, 1795 KB  
Systematic Review
Anterolateral Thigh Flap and Bone Plate for Mandibular Reconstruction in Patients over 55 Undergoing Ablative Oral Surgery: A Systematic Review and Meta-Analysis
by Riccardo Nocini, Giacomo Papi, Giulia Gobbo, Athena Eliana Arsie, Gianluca Colapinto, Funda Goker, Matteo Seno, Valerio Arietti and Massimo Del Fabbro
J. Clin. Med. 2026, 15(9), 3457; https://doi.org/10.3390/jcm15093457 - 1 May 2026
Abstract
Background/Objectives: Mandibular reconstruction following ablative oral surgery is particularly challenging in elderly patients due to comorbidities and reduced physiological healing potential. While vascularized bone flaps represent the gold standard, the combination of an anterolateral thigh (ALT) flap and a bone reconstruction metallic [...] Read more.
Background/Objectives: Mandibular reconstruction following ablative oral surgery is particularly challenging in elderly patients due to comorbidities and reduced physiological healing potential. While vascularized bone flaps represent the gold standard, the combination of an anterolateral thigh (ALT) flap and a bone reconstruction metallic plate may be considered as a less invasive alternative. This systematic review aimed to evaluate the effectiveness of such reconstructive techniques, in terms of success rate and complication rate, in patients aged over 55. Methods: Studies were included if the sample size consisted of at least 20 patients undergoing mandibular reconstruction with an ALT flap and plate following oral cavity resection for benign or malignant conditions. Studies were excluded if relevant outcomes were not reported and the mean age was <55 years. An electronic search was conducted in PubMed, Scopus, Web of Science and Embase. The last search was made on 26 February 2026. Data extracted included patient demographics, clinical outcomes and postoperative plate-related and overall complications. Risk of bias assessment was undertaken using the Joanna Briggs Institute tool for cohort studies and case series. Proportional meta-analysis was conducted to estimate the overall clinical success and the complication rate. Results: Of the 525 studies initially screened, four studies including a total of 329 patients (292 males, 37 females) with an overall mean age > 55 years were included. Mean hospital stay ranged from 10 to 24 days. The overall clinical success rate of the ALT flap procedure was 97% (95% confidence intervals (CIs): 92%, 99%). Flap-related complications were rare, with flap loss reported in only one patient and partial necrosis or failure affecting up to 6.6% of cases. Conversely, the overall plate-related complications rate was 28% (95% CI: 15%, 41%), with plate exposure rates ranging from 10% to 38.7% in the included studies. Wound complications, including infection and fistula formation, ranged from 20% to 38.7% of patients. Conclusions: In patients over 55, despite the not negligible rate of complications, the use of ALT flaps and reconstruction plate represents a viable alternative to vascularized bone flaps for mandibular reconstruction, particularly when comorbidities or frailty preclude more complex procedures. Further studies with a large sample size are needed to validate these findings and guide clinical decision-making. Full article
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16 pages, 594 KB  
Review
Clinical Outcomes, Success/Failure Patterns, and Complications of Microscrew-Assisted Rapid Palatal Expansion in Post-Pubertal Transverse Maxillary Deficiency: A Scoping Review
by Claudia Butrón-Téllez Girón, Juan Carlos Flores-Arriaga, Daniel Oliva-Buhaya, Alan Martínez-Zumarán, Amaury Pozos-Guillén and Arturo Garrocho-Rangel
Dent. J. 2026, 14(5), 261; https://doi.org/10.3390/dj14050261 - 1 May 2026
Abstract
Background/Objectives: A non-surgical orthodontic treatment strategy for transverse maxillary deficiencies, especially in late adolescents and young adults, is microscrew-assisted rapid palatal expansion (MARPE). The literature indicates several concerns regarding its long-term efficacy and potential complications. Recent studies have provided valuable insights into [...] Read more.
Background/Objectives: A non-surgical orthodontic treatment strategy for transverse maxillary deficiencies, especially in late adolescents and young adults, is microscrew-assisted rapid palatal expansion (MARPE). The literature indicates several concerns regarding its long-term efficacy and potential complications. Recent studies have provided valuable insights into the MARPE technique, particularly focusing on its efficacy, potential complications, and treatment failures. The present scoping review aims to synthesize and critically appraise clinical evidence on MARPE in post-pubertal patients, with a specific focus on treatment outcomes, mechanisms of failure, and local and systemic adverse effects to inform risk–benefit assessment and clinical decision-making. Methods: A systematic search was conducted across four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to identify English-language clinical trials, observational studies, and systematic reviews published between January 2015 and December 2025. The search strategy employed controlled vocabulary (MeSH terms) and Boolean operators targeting MARPE, treatment failure, and adverse effects in patients aged ≥ 16 years. After title/abstract screening and full-text assessment using predetermined inclusion criteria, 15 studies (3 systematic reviews with meta-analysis, 2 umbrella reviews, 4 systematic/scoping reviews, 2 randomized controlled trials, and 4 observational studies) were selected for qualitative synthesis. Results: Fifteen studies were finally included, which demonstrated significant heterogeneity in methodological design, sample characteristics, outcome measurement protocols, and MARPE device specifications. Mean success rates of 92.5% for maxillary transverse expansion were reported, with mean expansion duration ranging between 20 and 126 days. Key adverse effects comprised dentoalveolar tipping (buccal inclination of maxillary molars and premolars), periodontal complications (buccal bone resorption of 0.6–0.9 mm, gingival recession, papilla recession in 18% of cases), root resorption, miniscrew loosening, midpalatine/circummaxillary sutures, and potential but minimally documented intracranial effects. Conclusions: MARPE appears to be a valid non-surgical option for selected post-pubertal patients, but its success depends on careful case selection and monitoring for dentoalveolar, periodontal, sutural, and rare intracranial adverse effects. Full article
(This article belongs to the Topic Oral Health Management and Disease Treatment)
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17 pages, 10361 KB  
Article
Stage and Run-Up Amplification in Three-Cascade Landslide-Dam Systems: Evidence from a Large-Scale Flume Experiment
by Hongyi Zhang, Yanwei Zhai, Zhiyuan Gu, Chunyao Hou, Chuke Meng, Dawen Tan and Weiyang Zhao
Water 2026, 18(9), 1080; https://doi.org/10.3390/w18091080 - 30 Apr 2026
Viewed by 40
Abstract
Cascading failures of clustered landslide dams can intensify downstream hazards not only by increasing peak flood magnitude but also by accelerating the rise of water level immediately upstream of successive dams, thereby shortening the available response time before overtopping. This study reports large-scale [...] Read more.
Cascading failures of clustered landslide dams can intensify downstream hazards not only by increasing peak flood magnitude but also by accelerating the rise of water level immediately upstream of successive dams, thereby shortening the available response time before overtopping. This study reports large-scale flume experiments on a three-dam cascade built with identical geometry and similar soil gradation, while systematically varying longitudinal spacing and inflow discharge. The principal measured variable, Cw(t), is defined here as the local forebay run-up/water-level record measured at a fixed gauge position immediately upstream of each dam. The run-up hydrographs were summarized using peak run-up Cwmax, threshold-arrival time ta defined at 0.1 Cwmax, time to peak tp, maximum rising-stage rate Smax, and above-threshold duration T. Across ten tests (five spacing configurations under low/high discharge), peak run-up at both downstream dams consistently exceeded that at Dam1, with amplification factors relative to Dam1 of 1.11–1.45 at Dam2 and 1.13–1.42 at Dam3; Dam3 was not always higher than Dam2. Amplification was much stronger in the rising-stage dynamics: Smax increased relative to Dam1 by factors of 1.56–11.0 at Dam2 and 2.27–14.0 at Dam3, demonstrating pronounced downstream wavefront steepening. Higher discharge produced earlier threshold arrivals and peaks throughout the cascade, whereas shorter spacing generally produced more impulsive downstream responses with sharper peaks and larger rate amplification. Overall, the dataset provides stage/run-up-based constraints on cascade amplification and indicates that, within the present experimental matrix, dam spacing is the dominant geometric control on flood propagation and downstream hazard escalation. Full article
(This article belongs to the Special Issue Water-Related Disaster Assessments and Prevention)
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16 pages, 4488 KB  
Article
Living with the Void: Coexistence, Adaptation, and Acceptance of Urban Emptiness
by Tímea Žolobaničová, Zuzana Vinczeová, Roberta Štěpánková and Attila Tóth
Urban Sci. 2026, 10(5), 235; https://doi.org/10.3390/urbansci10050235 - 30 Apr 2026
Viewed by 66
Abstract
Urban emptiness is a recurring spatial condition across contemporary cities, resulting from long-term planning decisions, functional transformations, and shifting socio-economic dynamics. Urban voids are often interpreted as signs of failure or neglect; however, they also represent flexible and open-ended spaces embedded within everyday [...] Read more.
Urban emptiness is a recurring spatial condition across contemporary cities, resulting from long-term planning decisions, functional transformations, and shifting socio-economic dynamics. Urban voids are often interpreted as signs of failure or neglect; however, they also represent flexible and open-ended spaces embedded within everyday urban environments. This study develops and tests the Adaptive Void Assessment Framework (AVAF), a five-dimensional typological instrument applied to n = 33 urban voids identified through a systematic grid-based field survey (100 × 100 m resolution) in the central urban zone of Nitra, Slovakia (March 2025–January 2026). The framework evaluates sites across nine indicators spanning openness, social appropriation, ecological succession, temporal persistence, and institutional flexibility, yielding composite Adaptivity Index scores and four dominant adaptive regimes. The findings demonstrate that 34% of identified voids function in a socially active regime while 14% exhibit ecological dominance, with a moderate positive correlation identified between temporal persistence and adaptive capacity (r = 0.46, p < 0.05). This challenges conventional deficit-based classifications and reframes urban voids as active components of the urban metabolism capable of enhancing ecological connectivity and spatial flexibility within post-industrial urban landscapes. This reframes urban voids from residual outcomes of urbanization to spaces with potential for green integration within sustainable contemporary cities. Full article
(This article belongs to the Special Issue Risk and Resilience of Social–Ecological Systems in Urban Areas)
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15 pages, 300 KB  
Article
Outpatient Parenteral Antimicrobial Therapy for Pseudomonas aeruginosa Infections: Effectiveness and Safety
by Paloma Suárez-Casillas, Marta Mejías-Trueba, Iris Martínez Alemany, Lola Navarro Amuedo, Julia Praena Segovia, Arístides de Alarcón González, Rafael Luque Márquez, Zaira R. Palacios-Baena, Juan Manuel Carmona-Caballero, José Manuel Sánchez Oliva, María Victoria Gil-Navarro, Manuel García Gutiérrez, Laura Herrera-Hidalgo, Manuel Poyato Borrego, Luis E. López-Cortés and José M. Cisneros
Pharmaceutics 2026, 18(5), 549; https://doi.org/10.3390/pharmaceutics18050549 - 29 Apr 2026
Viewed by 186
Abstract
Objective: Given the increasing use of outpatient parenteral antimicrobial therapy (OPAT) and the clinical challenges posed by Pseudomonas aeruginosa infections, this study aimed to evaluate the effectiveness and safety of OPAT for the treatment of P. aeruginosa infections in a real-world cohort. Methods: [...] Read more.
Objective: Given the increasing use of outpatient parenteral antimicrobial therapy (OPAT) and the clinical challenges posed by Pseudomonas aeruginosa infections, this study aimed to evaluate the effectiveness and safety of OPAT for the treatment of P. aeruginosa infections in a real-world cohort. Methods: We conducted a prospective observational study with retrospective analysis including adult patients with P. aeruginosa infections treated within a multidisciplinary OPAT program shared by two tertiary hospitals between November 2012 and December 2024. Clinical characteristics, infection type, antimicrobial therapy, resistance patterns, source control, and clinical outcomes were recorded. Primary outcomes were treatment failure during OPAT and within 30 days after OPAT completion. Secondary outcomes included adverse events and vascular access complications. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with treatment failure. Results: A total of 290 patients were included. The most frequent infections were bronchiectasis exacerbations (39.7%) and complicated urinary tract infections (15.2%). Most patients received monotherapy (72.8%), mainly ceftazidime, while 27.2% received combination therapy with a beta-lactam plus an aminoglycoside. Treatment failure occurred in 7.6% of patients during OPAT and in 15.5% within 30 days after OPAT completion, with an overall clinical success rate of 77%. Male sex and chronic obstructive pulmonary disease (COPD) were independently associated with failure during OPAT. At 30 days, higher Charlson comorbidity index, COPD exacerbation, and endovascular infection were associated with failure, whereas combination therapy was associated with a lower risk of failure. Antimicrobial-related adverse events were rare (3.2%). Conclusions: Our results support OPAT as an effective and safe strategy for managing P. aeruginosa infections in clinically stable patients. Patients with COPD, either as a comorbidity or during an exacerbation, and those with a higher Charlson score may require closer follow-up. Full article
(This article belongs to the Section Clinical Pharmaceutics)
17 pages, 1414 KB  
Review
Analgosedation During the Use of Non-Invasive Respiratory Supports: A Synthesis of Clinical Evidence and Best Practices
by Giovanni Misseri, Matteo Piattoli, Alice Mirasola and Cesare Gregoretti
J. Clin. Med. 2026, 15(9), 3418; https://doi.org/10.3390/jcm15093418 - 29 Apr 2026
Viewed by 94
Abstract
Non-invasive respiratory support (NRS) has become a cornerstone in the management of acute respiratory failure (ARF), offering an alternative or a bridge between conventional oxygen therapy (COT) and invasive mechanical ventilation (iMV). While NRS techniques—including non-invasive ventilation (NIV), continuous positive airway pressure (CPAP), [...] Read more.
Non-invasive respiratory support (NRS) has become a cornerstone in the management of acute respiratory failure (ARF), offering an alternative or a bridge between conventional oxygen therapy (COT) and invasive mechanical ventilation (iMV). While NRS techniques—including non-invasive ventilation (NIV), continuous positive airway pressure (CPAP), and high-flow nasal oxygen (HFNO)—have demonstrated efficacy in reducing intubation rates and improving outcomes, patient tolerance and synchrony remain critical determinants of success. Analgosedation, the strategic use of analgesics and sedatives, has emerged as an important adjunctive therapy to optimise NRS delivery, reduce patient–ventilator asynchrony, and improve comfort. However, the delicate balance between adequate sedation and the preservation of spontaneous breathing, airway protection, and hemodynamic stability presents unique challenges. This comprehensive narrative review synthesises current evidence on analgosedation strategies during NRS use, examining pharmacological agents, their pharmacokinetic and pharmacodynamic properties, comparative studies, indications, monitoring parameters, clinical settings, and safety considerations. We also review existing guidelines, discuss special considerations in paediatric populations, and propose practical clinical approaches. Understanding the nuanced application of analgosedation is essential for clinicians to maximise therapeutic benefit while minimising risks of NRS treatment failure and adverse outcomes. Full article
22 pages, 2125 KB  
Article
A Stochastic Approach for Evaluating the Reliability of a MASS and Assessing the Compliance with the IMO Regulatory Framework
by Pietro Corsi, Sergej Jakovlev, Massimo Figari and Vasilij Djackov
J. Mar. Sci. Eng. 2026, 14(9), 814; https://doi.org/10.3390/jmse14090814 - 29 Apr 2026
Viewed by 180
Abstract
The introduction of Maritime Autonomous Surface Ships (MASSs) requires reliable engineering methods to demonstrate safety levels comparable to those of conventional manned vessels. This paper presents a mission-based stochastic reliability framework for the comparative assessment of manned and unmanned ship configurations, with a [...] Read more.
The introduction of Maritime Autonomous Surface Ships (MASSs) requires reliable engineering methods to demonstrate safety levels comparable to those of conventional manned vessels. This paper presents a mission-based stochastic reliability framework for the comparative assessment of manned and unmanned ship configurations, with a focus on engineering design and verification. The methodology is based on Reliability Block Diagrams (RBDs), where ship missions are decomposed into critical functional subsystems and evaluated over mission-limited operational profiles. To address the uncertainty inherent in component failure data for autonomous systems, Mean Time to Failure (MTTF) values are treated as stochastic variables rather than fixed parameters. A Monte Carlo simulation approach is used to propagate uncertainty from component level to overall mission reliability, producing probability distributions of mission success. The proposed framework is applied to a Search and Rescue Patrol Vessel, comparing manned and unmanned configurations under identical mission scenarios and durations. Results indicate that, for moderate uncertainty levels, the unmanned configuration achieves equal or higher mission reliability, while increasing uncertainty reduces the statistical separation between the two solutions. The approach provides a practical and replicable tool to support reliability-driven design decisions for autonomous marine systems. Full article
(This article belongs to the Section Ocean Engineering)
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22 pages, 1191 KB  
Systematic Review
Valve-in-Valve TAVR in Surgical Stentless Aortic Bioprostheses, a Challenging Scenario
by Sara Saltarocchi, Mizar D’Abramo, Emmanouela Chourda, Paolo De Orchi, Flaminia Spunticchia, Marco Totaro, Mattia Vinciguerra, Silvia Romiti, Gabriele Giunti, Ernesto Greco and Fabio Miraldi
Medicina 2026, 62(5), 844; https://doi.org/10.3390/medicina62050844 - 28 Apr 2026
Viewed by 116
Abstract
Background and objectives: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an established treatment for failed surgical bioprostheses in patients at high surgical risk. However, procedures performed in degenerated stentless aortic valves remain particularly challenging because of the absence of a [...] Read more.
Background and objectives: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an established treatment for failed surgical bioprostheses in patients at high surgical risk. However, procedures performed in degenerated stentless aortic valves remain particularly challenging because of the absence of a radiopaque frame, variable surgical implantation techniques, and a potentially increased risk of coronary obstruction. Evidence in this specific setting is limited. We conducted a systematic review of the literature to identify studies reporting ViV TAVI in degenerated stentless surgical bioprostheses. Materials and methods: Case reports and case series were included when patient-level or clearly identifiable data were available. Baseline characteristics, anatomical features, procedural strategies, and clinical outcomes were extracted and analyzed using a descriptive approach. A total of 54 studies were included, encompassing 294 ViV TAVI procedures performed in failed stentless aortic valves. Results: The mean patient age was 73.9 years, and the average STS-PROM score was 13.45%, reflecting a high-risk population. The most frequently treated prosthesis was the Medtronic Freestyle valve, and the predominant mechanism of failure was regurgitation. Transfemoral access represented the most common approach, while balloon-expandable and self-expanding transcatheter valves were used with similar frequency. Coronary protection strategies were adopted in a minority of procedures, whereas adjunctive procedural techniques such as pre- or post-dilation were relatively common. Device-related complications were mainly driven by coronary obstruction, while cardiac complications included myocardial infarction and unplanned coronary intervention. Overall, VARC-3 device success was achieved in the majority of procedures, with acceptable short-term mortality despite the complexity of the treated population. Conclusions: ViV TAVR in degenerated stentless bioprostheses appears feasible and generally effective but remains associated with specific procedural challenges, particularly related to coronary obstruction risk. Careful anatomical assessment and tailored procedural planning are essential, and larger contemporary studies are needed to better define optimal management strategies in this complex setting. Full article
(This article belongs to the Special Issue Recent Progress in Cardiac Surgery)
27 pages, 625 KB  
Review
Progressive Resistance Training in Parkinson’s Disease: An Umbrella Review Examining the Role of Methodological Adherence and Training Progression Principles in Clinical Outcome
by Ya’ara Rozenbaum, Yeshayahu Hutzler and Sharon Barak
J. Funct. Morphol. Kinesiol. 2026, 11(2), 178; https://doi.org/10.3390/jfmk11020178 - 28 Apr 2026
Viewed by 94
Abstract
Objective: The goal was to investigate the relationship between methodological adherence and clinical outcomes in Progressive Resistance Training (PRT) for Parkinson’s Disease (PD), specifically identifying why findings of “superiority” over active controls remain inconsistent. Methods: This umbrella review utilized a multi-stage process to [...] Read more.
Objective: The goal was to investigate the relationship between methodological adherence and clinical outcomes in Progressive Resistance Training (PRT) for Parkinson’s Disease (PD), specifically identifying why findings of “superiority” over active controls remain inconsistent. Methods: This umbrella review utilized a multi-stage process to identify a sample of the primary literature for methodological analysis. An initial search identified 38 systematic reviews published within the specified timeframe. From the reference lists of these reviews, a subset of 34 primary clinical studies was purposefully selected. Inclusion was prioritized for studies providing comprehensive methodological data on PRT protocols and standardized clinical outcomes. Interventions were evaluated using a three-tiered framework: (1) training protocol with specifications of Frequency, Intensity, Time, Type, Volume, and Progression (FITT-VP) (General Exercise), (2) FITT-VP integrated with the American College of Sports Medicine (ACSM) Supplementary Guidelines (Integrated Guidelines), and (3) principles of progression (mechanistic growth). Studies were categorized by control type (active (e.g., aerobic or balance), n = 26; passive (e.g., standard care or no exercise), n = 8). Results: In trials that compared PRT with an active control group, PRT achieved clinical superiority in 57% (n = 15) of trials and 46% (n = 12) when focusing on trials with an effect on specific functional or balance outcomes. Among these successful interventions, 75% maintained high adherence (≥70%) to the Integrated Guidelines, and 58% maintained high adherence to the principles of progression. In the 53% (n = 14) of studies where PRT was found non-superior (equivalent or inferior in functional or balance outcomes) to an active control, 0% met the high adherence threshold for progression. While general FITT-VP compliance remained high (78%), the failure to implement systematic load, specificity, and variation served as a definitive barrier to competitive superiority. In the 100% of studies where PRT outperformed passive controls, high progression was present in 57% of cases. This may suggest that while a baseline resistance stimulus outperforms inactivity, it is fundamentally insufficient to outperform other active clinical therapies. Conclusions: This umbrella review indicates that adherence to the principles of progression may be an important factor influencing the clinical outcomes of PRT in individuals with PD. The variability observed in the current literature suggests that inconsistent application of established exercise frameworks—rather than the failure of the modality itself—could be a contributing element to the reported “inconclusiveness.” To potentially enhance functional outcomes and the comparative effectiveness of PRT, future research should consider prioritizing structured adherence to FITT-VP, Integrated Guidelines, and progression-based frameworks. Establishing a 70% adherence threshold is proposed as a potential benchmark to improve protocol consistency and support rehabilitation efficacy in this population. Full article
12 pages, 549 KB  
Article
Trabecular Meshwork Thickness Measured by Swept-Source AS-OCT as a Predictor of Surgical Outcomes After Trabecular Micro-Bypass Stent Implantation
by Heejin Yoon, Jiwoong Lee, Seung Min Lee, Ji Eun Lee, Su Jin Kim and Sangwoo Moon
J. Clin. Med. 2026, 15(9), 3341; https://doi.org/10.3390/jcm15093341 - 27 Apr 2026
Viewed by 117
Abstract
Background: Although minimally invasive glaucoma surgery (MIGS), including trabecular micro-bypass stent implantation, is safe, its surgical outcomes remain variable, with limited reliable success predictors. We evaluated whether preoperative trabecular meshwork (TM) thickness is associated with surgical outcomes after iStent inject® W implantation. [...] Read more.
Background: Although minimally invasive glaucoma surgery (MIGS), including trabecular micro-bypass stent implantation, is safe, its surgical outcomes remain variable, with limited reliable success predictors. We evaluated whether preoperative trabecular meshwork (TM) thickness is associated with surgical outcomes after iStent inject® W implantation. Methods: Patients with open-angle glaucoma (n = 28) who underwent iStent inject® W implantation were included. Preoperative AS-SS-OCT was used to measure TM thickness and conventional angle parameters, including angle opening distance, angle recess area, trabecular–iris space area, and trabecular–iris angle. Surgical success was IOP ≤ 15 mmHg with ≥25% reduction or final IOP ≤ 12 mmHg under specified conditions. Logistic regression analyses were performed to identify factors associated with surgical outcomes. Results: At 12 months, 22 eyes (78.6%) achieved surgical success. Mean TM thickness was significantly greater in the unsuccessful than in the successful group (250.62 ± 32.05 μm vs. 180.75 ± 30.61 μm, p = 0.001), with similar findings for nasal and temporal TM thickness. Conventional angle parameters were not associated with surgical outcomes. In univariable analysis, both mean and nasal TM thickness were significantly associated with an increased risk of failure (per 10 μm increase; mean TM: OR = 2.77, 95% CI = 1.12–6.86, p = 0.027; nasal TM: OR = 1.64, 95% CI = 1.04–2.58, p = 0.034). Conclusions: Increased preoperative mean and nasal TM thickness was significantly associated with surgical failure following iStent inject® W implantation. TM’s microstructural properties are more relevant than angular configuration in determining MIGS outcomes. Preoperative assessment of TM thickness using AS-SS-OCT may serve as a useful imaging biomarker for optimizing patient selection. Full article
(This article belongs to the Special Issue Glaucoma Surgery: Current Challenges and Future Perspectives)
15 pages, 663 KB  
Article
Fitness Consequences of Urban Green Space Management in Eurasian Tree Sparrow (Passer montanus) in Madrid, Spain
by Beatriz Martínez-Miranzo, Alejandro López-García, Ana Payo-Payo, José I. Aguirre and Eva Banda
Urban Sci. 2026, 10(5), 229; https://doi.org/10.3390/urbansci10050229 - 25 Apr 2026
Viewed by 288
Abstract
In urban areas, green spaces have become the main refuge for biodiversity, providing essential habitat and resources for urban-adapted species. However, scientific evidence on the fitness consequences of urban green space management for urban populations remains scarce, limiting our ability to design successful [...] Read more.
In urban areas, green spaces have become the main refuge for biodiversity, providing essential habitat and resources for urban-adapted species. However, scientific evidence on the fitness consequences of urban green space management for urban populations remains scarce, limiting our ability to design successful conservation and management strategies. Here, we assess the fitness consequences of different levels of management practices in green spaces (i.e., high for areas with continuous intervention such as regular mowing and irrigation, and low for areas with minimal, sporadic maintenance) based on a 19-year long-term monitoring of the Eurasian Tree Sparrow (Passer montanus), a species with high behavioural plasticity in response to human-altered habitats. We formulated a unistate capture–mark–recapture model to estimate age-dependent survival while accounting for uncertainty in recapture probability. Furthermore, by means of GLMMs, we tested if the level of management influences reproductive parameters (i.e., breeding failure, number of eggs, nestlings, fledglings, brood number from the same year, breeding success). We found that high urban green space management caused a decline in adult survival, but we found no effect on juvenile survival. We also found lower breeding failure, a greater number of eggs, and larger brood numbers in the low management areas, but no differences were found in the number of nestlings and fledglings. Consequently, we found no differences in overall breeding success. Our results highlight the reduction in survival in a near-threatened passerine species due to routine green urban space management, in addition to differences in reproductive parameters depending on the degree of green urban space management. Overall, we confirm that the same species show several reproductive strategies with different breeding effort to reach similar breeding success, whatever the human context is. However, birds pay the cost in adult survival, and probably in shortening life span. Therefore, the management of urban green spaces has a negative impact on biodiversity in cities. It is necessary to review the management practices of these urban areas and promote practices that are friendly to biodiversity. Full article
(This article belongs to the Special Issue Biodiversity in Urban Landscapes)
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36 pages, 1268 KB  
Article
Securing Tool-Using AI Agents Against Injection and Authority Misuse
by Hasan Kanaker, Hussam Fakhouri, Nader Abdel Karim, Maher Abuhamdeh, Nurul Halimatul Asmak Ismail and Sandi Fakhouri
Computation 2026, 14(5), 98; https://doi.org/10.3390/computation14050098 - 25 Apr 2026
Viewed by 210
Abstract
Tool-using AI agents couple a language model with controller logic, memory, and external tools such as browsers, email, calendars, file systems, and transaction APIs. This architecture expands capability, but it also enlarges the security boundary: agents routinely ingest untrusted content while holding privileges [...] Read more.
Tool-using AI agents couple a language model with controller logic, memory, and external tools such as browsers, email, calendars, file systems, and transaction APIs. This architecture expands capability, but it also enlarges the security boundary: agents routinely ingest untrusted content while holding privileges that can reveal private data and trigger external side effects. The resulting failures are not limited to poor text generation; they include prompt injection, indirect injection through tool outputs, confused-deputy behavior, unauthorized actions, and misleading claims about the tool state. Because large-scale testing on deployed products is difficult, vendor-specific, and ethically sensitive, we present a transparent, theoretical simulation-based framework for evaluating user-facing risk in tool-using agents. The methodological contribution is a formal threat model that separates compromise, harm, and severity, and a Monte Carlo evaluation pipeline that maps architectural choices (permissions, retrieval, memory exposure, and approvals) and defensive controls to comparable outcome metrics. We instantiate the framework for six representative threat scenarios and nine defense configurations, reporting attack success rate (ASR), benign task success, latency overhead, and severity-weighted harm. Across scenarios, the least-privilege tool design is the strongest single broad control, human-in-the-loop approvals sharply reduce high-impact actions and exports but degrade under user error and habituation, retrieval allowlisting nearly eliminates indirect injection while leaving other channels largely unaffected, and rate limiting reduces tail severity more than ASR. These results position agent safety as an architectural and operational problem and because they arise from an assumption-explicit simulator rather than field measurements, should be read as comparative design guidance rather than incident-rate estimates for any deployed product. Full article
(This article belongs to the Section Computational Engineering)
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