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Abstract Young children receiving outpatient cancer care are vulnerable to undermanaged pain. App‐based solutions that provide pain treatment advice to parents in real‐time and in all environments may improve access to quality pain care. We used a parent co‐design approach involving iterative rounds of user testing and software modification to develop a usable Pain Caregiver Resource (PainCaRe) real‐time pediatric cancer pain management app. Parents of children (2–11 years) with cancer completed three standardized modules using a PainCaRe prototype. App usability and acceptability were evaluated using the validated System Usability Scale and a thematic analysis of app testing sessions and interviews. Iterative testing sessions were conducted until data saturation. Interview themes were synthesized into action items that guided revisions to PainCaRe and additional testing rounds were conducted as necessary. Twenty‐two parents participated in three testing cycles. Overall, parents described PainCaRe as an acceptable and potentially clinically useful pain management tool. Mean system usability scores were in the acceptable scale range during each testing cycle. Usability issues identified and resolved included those related to software malfunction, complicated app navigation logic, lack of clarity on pain assessment questions, and the need for pain management advice specifically tailored to child developmental stage. Using co‐design methods, the PainCaRe cancer pain management app was successfully refined for its acceptability and utility to parents. Next steps will include a PainCaRe pilot study before evaluating the impact of the app on younger children's pain outcomes in a randomized controlled trial.

Background The role of rescue stenting (RS) in acute ischemic strokes due to intracranial atherosclerotic disease–related large vessel occlusion is an area of active investigation. This study evaluates the efficacy and safety of RS under these circumstances. Methods A systematic literature review, conforming to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, was conducted across PubMed, EMBASE, Cochrane, and OVID databases. Common and random effects analyses were conducted to compare outcomes including modified Rankin Scale score, 90‐day mortality, and symptomatic intracranial hemorrhage between patients receiving and those not receiving RS after failed endovascular thrombectomy within posterior circulation. Results Ten studies comprising 1202 patients (730 RS, 472 control) were analyzed. RS was associated with a statistically significant improvement in functional outcomes, evidenced by a higher proportion of patients achieving modified Rankin Scale score ≤2 at 90 days (32.74% versus 21.19% in controls; P

Abstract Background Balance impairments, that lead to falls, are one of the main symptoms of Parkinson’s disease (PD). Telerehabilitation is becoming more common for people with PD; however, balance is particularly challenging to assess and treat virtually. The feasibility and efficacy of virtual assessment and virtual treatment of balance in people with PD are unknown. The present study protocol has three aims: I) to determine if a virtual balance and gait assessment (instrumented L-shape mobility test) with wearable sensors can predict a gold-standard, in-person clinical assessment of balance, the Mini Balance Evaluation Systems Test (Mini-BESTest); II) to explore the effects of 12 sessions of balance telerehabilitation and unsupervised home exercises on balance, gait, executive function, and clinical scales; and III) to explore if improvements after balance telerehabilitation transfer to daily-life mobility, as measured by instrumented socks with inertial sensors worn for 7 days. Methods The TelePD Trial is a prospective, single-center, parallel-group, single-blind, pilot, randomized, controlled trial. This trial will enroll 80 eligible people with PD. Participants will be randomized at a 1:1 ratio into receiving home-based balance exercises in either: 1) balance telerehabilitation (experimental group, n = 40) or 2) unsupervised exercises (control group, n = 40). Both groups will perform 12 sessions of exercise at home that are 60 min long. The primary outcome will be Mini-BESTest. The secondary outcomes will be upper and lower body gait metrics from a prescribed task (instrumented L-shape mobility test); daily-life mobility measures over 7 days with wearable sensors in socks, instrumented executive function tests, and clinical scales. Baseline testing and 7 days of daily-life mobility measurement will occur before and after the intervention period. Conclusion The TelePD Trial will be the first to explore the usefulness of using wearable sensor-based measures of balance and gait remotely to assess balance, the feasibility and efficacy of balance telerehabilitation in people with PD, and the translation of balance improvements after telerehabilitation to daily-life mobility. These results will help to develop a more effective home-based balance telerehabilitation and virtual assessment that can be used remotely in people with balance impairments. Trial registration This trial was prospectively registered on ClinicalTrials.gov (NCT05680597).

For a communication control system in a disaster area where drones (also called unmanned aerial vehicles (UAVs)) are used as aerial base stations (ABSs), the reliability of communication is a key challenge for drones to provide emergency communication services. However, the effective configuration of UAVs remains a major challenge due to limitations in their communication range and energy capacity. In addition, the relatively high cost of drones and the issue of mutual communication interference make it impractical to deploy an unlimited number of drones in a given area. To maximize the communication services provided by a limited number of drones to the ground user equipment (UE) within a certain time frame while minimizing the drone energy consumption, we propose a multi-agent proximal policy optimization (MAPPO) algorithm. Considering the dynamic nature of the environment, we analyze diverse observation data structures and design novel objective functions to enhance the drone performance. We find that, when drone energy consumption is used as a penalty term in the objective function, the drones—acting as agents—can identify the optimal trajectory that maximizes the UE coverage while minimizing the energy consumption. At the same time, the experimental results reveal that, without considering the machine computing power required for training and convergence time, the proposed key algorithm demonstrates better performance in communication coverage and energy saving as compared with other methods. The average coverage performance is 10–45% higher than that of the other three methods, and it can save up to 3% more energy.

Introduction Intracranial atherosclerotic disease (ICAD) is associated with up to 32% of posterior circulation strokes.1 ICAD‐related strokes are at high risk for re‐occlusion following MT. Rescue treatment with stenting, balloon angioplasty, and/or intraarterial thrombolysis or antiplatelets are often required to treat the underlying stenosis. However, these rescue treatments are associated with their own risks.2,3 The SAMMPRIS trial reported that percutaneous transluminal angioplasty and stenting (PTAS) was associated with inferior outcomes compared to aggressive medical management alone but it is unclear whether these findings are generalizable to LVO strokes.4 Recent literature has reported clinical benefits associated with rescue stenting in the setting of ICAD‐related MT‐refractory strokes.5 However, most of the existing literature focuses on anterior circulation. This meta‐analysis aims to analyze the literature regarding the efficacy and safety of post‐thrombectomy PTAS in ICAD‐related posterior circulation strokes. Methods The search strategy was developed following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines.6 Using the common evidence medicine framework PICOS (Patient Population, Intervention, Control/Comparison, Outcome, and Study type), we specified our research question: “In patients with posterior circulation AIS who underwent endovascular thrombectomy but failed to recanalize or who had severe stenosis, is PTAS an effective and safe rescue treatment option?” An electronic search of PubMed, EMBASE, Cochrane and OVID databases was performed from date of database inception to March 2023. Data was collected and analyzed using “Meta” package in RStudio.7 Outcomes of interest included 90 day modified Rankin score (mRS) and 90‐day mortality. Results A total of 10 studies were collected, but only 7 double‐arm studies involving 965 participants were included in this analysis. Among these patients, 544 underwent rescue stenting, while 421 were control patients. In a common effects meta‐analysis, patients who underwent stenting were more likely to have an mRS ≤ 2 at 90 days (OR 1.73, 95% CI [1.25 – 2.37]; p < 0.001) and lower odds of mortality at 90 days (OR 0.31, 95% CI [0.23 – 0.42]; p < 0.001). Additionally, patients undergoing stenting were less likely to have symptomatic intracranial hemorrhage (sICH) (OR 0.34, 95% CI [0.17 ‐ 0.67]; p = 0.002). Furthermore, the stenting group showed significantly higher odds of achieving a modified treatment in cerebral ischemia score (mTICI) of 2b‐3 when compared to the control group (OR 11.32, 95% CI [6.54 ‐ 19.59]; p < 0.001). Conclusion PTAS appears to be an effective and safe treatment for ICAD after MT in the posterior circulation both improving likelihood of good outcomes and overall survival. Given the uncertainty of applying the results of the SAMMPRIS trial to LVOs, further research is needed to better assess the efficacy and safety of PTAS in this patient population.

New Zealand government’s Rural Broadband Initiative (RBI) aims to invest 400 million New Zealand dollar to provide 99% of New Zealanders with access to 50 Mbps peak broadband speed, with the remaining 1% at 10 Mbps by 2025. By 2017, stage 1 of the RBI has been completed, and research is needed to find out the level of usage, proficiency, and productivity achieved by then. Therefore, a survey was carried out to learn whether the rural residents and their communities are making good use of the new fast broadband connection. The survey collected data from 217 rural residents from North Island, and the results indicate that about half of the interview respondents are satisfied with the new broadband speed and the reliability which is offered by RBI stage 1. However, there is about 28% of the respondents disagreed with them. The majority of the Internet uses for rural residents are information searching, reading news, online entertainment, and online banking. Besides that, only a small proportion of respondents know how to utilize the Internet in their work/business and benefit/profit from it, e.g., using cloud technology capabilities and online marketing campaigns, etc. by then. Therefore, we argue that information and communications technologies (ICT) adoption is not only the availability of the infrastructure but also the beneficial outcomes of Internet availability. In other words, Internet skills in-depth training and education need to catch up with the infrastructure deployment, which is useful to fuel the digital productivity and inclusion for booming rural economies. The survey data-driven findings presented in this paper could serve as a reference to inform government policymakers and those who wish to create, invest, and take actions to speed up the economic and social growth of rural communities in Aotearoa New Zealand through the Internet while shifting from the Internet speed and traffic volume-driven to a more effective Internet connectivity and value-added driven rural economy.

Abstract Background Neuroblastoma is the most common extracranial solid malignancy in childhood which, despite the current progress in radiotherapy and chemotherapy protocols, still has a high mortality rate in high risk tumors. Nanomedicine offers exciting and unexploited opportunities to overcome the shortcomings of conventional medicine. The photocatalytic properties of Fe3O4 core-TiO2 shell nanocomposites and their potential for cell specific targeting suggest that nanoconstructs produced using Fe3O4 core-TiO2 shell nanocomposites could be used to enhance radiation effects in neuroblastoma. In this study, we evaluated bare, metaiodobenzylguanidine (MIBG) and 3,4-Dihydroxyphenylacetic acid (DOPAC) coated Fe3O4@TiO2 as potential radiosensitizers for neuroblastoma in vitro. Results The uptake of bare and MIBG coated nanocomposites modestly sensitized neuroblastoma cells to ionizing radiation. Conversely, cells exposed to DOPAC coated nanocomposites exhibited a five-fold enhanced sensitivity to radiation, increased numbers of radiation induced DNA double-strand breaks, and apoptotic cell death. The addition of a peptide mimic of the epidermal growth factor (EGF) to nanoconjugates coated with MIBG altered their intracellular distribution. Cryo X-ray fluorescence microscopy tomography of frozen hydrated cells treated with these nanoconjugates revealed cytoplasmic as well as nuclear distribution of the nanoconstructs. Conclusions The intracellular distribution pattern of different nanoconjugates used in this study was different for different nanoconjugate surface molecules. Cells exposed to DOPAC covered nanoconjugates showed the smallest nanoconjugate uptake, with the most prominent pattern of large intracellular aggregates. Interestingly, cells treated with this nanoconjugate also showed the most pronounced radiosensitization effect in combination with the external beam x-ray irradiation. Further studies are necessary to evaluate mechanistic basis for this increased radiosensitization effect. Preliminary studies with the nanoparticles carrying an EGF mimicking peptide showed that this approach to targeting could perhaps be combined with a different approach to radiosensitization – use of nanoconjugates in combination with the radioactive iodine. Much additional work will be necessary in order to evaluate possible benefits of targeted nanoconjugates carrying radionuclides. Graphic abstract

With conjunction observations of electromagnetic fields and plasma from Time History of Events and Macroscale Interactions during Substorm (THEMIS) in the near-Earth magnetotail, we investigate the spatial and temporal properties of substorm dipolarizations in the near-Earth plasma sheet (NEPS) during a substorm at 03:23 UT on 12 February 2008. Substorm dipolarizations with different features are detected by three near-Earth THEMIS probes (THA (P5), THD (P3) and THE (P4)) in the magnetotail. In the current sheet with a large plasma beta value (β > 2, where β is the ratio of the plasma thermal pressure to the magnetic pressure), the dipolarization within the substorm onset region, (−10.4, 2.8, −2.6)RE_gsm, has a large initial magnetic field elevation angle, θ > 60°, θ = arctan (Bz/(Bx2+By2)1/2), and is accompanied by energetic ion (tens to hundred keV) dispersionless injection detected by THD (P3). This substorm onset dipolarization is characterized by Bx and By components around 0 nT with significant fluctuations. The Bz component increases sharply and its subsequent magnitude approaches the total magnetic field, Bt. The maximum value of the elevation angle approaches 85° during the later substorm expansion phase. In the NEPS with β ~ 1, the dipolarization outside the substorm onset region is characterized by a magnetic elevation angle with a small beginning value of θ < 45° and following multi-step enhancements during the substorm expansion phase. The maximum value of the elevation angle approaches to 70° during the later substorm expansion phase. Our observation results indicate that characteristics of dipolarization with a large beginning elevation angle within the substorm onset region provide a new indicator to identify substorm onset location.

In vivo biomechanical characterization of the cornea remains a challenge. We have developed a high-frequency ultrasound elastography method, the ocular pulse elastography (OPE), to measure corneal axial displacement (CAD) induced by the ocular pulse. Here we compared CAD and a stiffness index derived from CAD between keratoconus patients and normal controls. We also explored the trend of these parameters with keratoconus grade. Twenty normal subjects and twenty keratoconus patients were recruited in this study. Corneal topography, tomography, intraocular pressure (IOP) and ocular pulse amplitude (OPA) were obtained in each measured eye. The cornea's heartbeat-induced cyclic axial displacements were measured by high-frequency (50 MHz) ultrasound. A corneal stiffness index (CSI) was derived from CAD normalized against OPA. CAD and CSI were compared between normal and keratoconus groups, and across keratoconus grades. Keratoconus corneas had significantly greater CAD and lower CSI than normal controls (p's