This single center retrospective observational study of serial plasma metagenomic next-generation sequencing testing shows that >95% of serial testing was without meaningful clinical impact. Only 5/173 cases were adjudicated as having significant clinical impact.

We report two adult patients who had rare systemic artery lesions with a history of Kawasaki disease, with a review of the literature. A 39-year-old male with Kawasaki disease at the age of 2 months underwent coronary artery bypass grafting to the right coronary artery and left anterior descending artery because of coronary artery stenoses. In the screening by thoracic-abdominal CT before the operation, calcification of the distal abdominal aorta was detected, and an abdominal aortic aneurysm with stenosis was diagnosed. He had been asymptomatic, and there were no differences in his extremities’ blood pressure. Although a slight dilatation of the distal abdominal aorta had existed in his aortogram at 2 years 9 months old, the abnormal finding had been unnoticed. A 26-year-old female with coronary artery bypass grafting at the age of 23 months had hypertension. A stenosis of the orifice at the right renal artery was detected by two-dimensional echocardiography and a magnetic resonance angiogram. Her hypertension in adulthood was suspected to result from her renal artery stenosis, which acute Kawasaki vasculitis underlies. Although coronary artery lesions in both patients were diagnosed in their childhood, systemic artery lesions were not realised until adulthood. Because abdominal aortic aneurysms and renal artery stenosis are extremely rare, they were not recognised as systemic artery lesions caused by Kawasaki disease. Their lesions can occur in patients with severe acute vasculitis at a significantly younger age, less than 6 months. Systemic artery lesions in such adult patients must be carefully evaluated.

Primary pulmonary malignancies in single-ventricle patients are rare. Improved survival following surgical palliation has resulted in a growing Fontan population whose malignancy risk remains undefined. Standard oncologic approaches, especially for adenocarcinoma of the lung, need to be considered within the context of Fontan physiology. We present our management of primary lung adenocarcinoma in an adult with tricuspid atresia status postlateral tunnel Fontan palliation, highlighting considerations for this unique scenario.

Nussloch (Germany) is a distinctive site of interest, particularly as a reference sequence for Late Pleistocene European loess, because it provides a comprehensive record of millennial climate variability. A notable feature of this site is its location within an active quarry. Consequently, the stratigraphic profiles documented constitute an ephemeral record, susceptible to rapid disappearance or brief accessibility, contingent on the operational status of the quarry. In order to guarantee the maintenance of a complete record of the sequence, three separate cores were collected and labelled S1, S2, and S3. The results of core S2, which is the most complete and thoroughly examined, are presented here. A comparison is drawn with the most recent P8 profile that is currently available. XRF measurements, conducted after the cores had been opened and described, are also presented. Borehole logging was carried out in the field after core retrieval, and the resulting measurements are also presented. The findings of this study demonstrate that a high degree of correlation can be established between the records from outcrop investigations and core studies, demonstrating the importance of preserving such archives for future research.

We prove an André–Oort-type result for a family of hypersurfaces in ${\mathbb{C}}^n$ that is both uniform and effective. Let $K_*$ denote the single exceptional imaginary quadratic field which occurs in the Siegel–Tatuzawa lower bound for the class number. We prove that, for $m, n \in {\mathbb{Z}}_{\gt0}$, there exists an effective constant $c(m, n)\gt0$ with the following property: if pairwise distinct singular moduli $x_1, \ldots, x_n$ with respective discriminants $\Delta_1, \ldots, \Delta_n$ are such that $a_1 x_1^m + \cdots + a_n x_n^m \in {\mathbb{Q}}$ for some $a_1, \ldots, a_n \in {\mathbb{Q}} \setminus \{0\}$ and $\# \{ \Delta_i \;:\; {\mathbb{Q}}(\sqrt{\Delta_i}) = K_*\} \leq 1$, then $\max_i \lvert \Delta_i \rvert \leq c(m, n)$. In addition, we prove an unconditional and completely explicit version of this result when $(m, n) = (1, 3)$ and thereby determine all the triples $(x_1, x_2, x_3)$ of singular moduli such that $a_1 x_1 + a_2 x_2 + a_3 x_3 \in {\mathbb{Q}}$ for some $a_1, a_2, a_3 \in {\mathbb{Q}} \setminus \{0\}$.

During World War II, condom consumption increased in both belligerent and non-belligerent countries, including Sweden. Yet the relationship between state-led initiatives and commercial marketing in driving this trend has received little scholarly attention. The main sources in this article consist of wartime public health campaigns and condom advertisements. Applying the concepts of social and consumer engineering, the article examines how government interventions, specifically through public health measures, influenced condom marketing practices. The findings show that wartime campaigns sought to engineer citizens’ sexual behavior and that businesses strategically aligned their messaging with government propaganda. This convergence was instrumental in positioning condoms as essential tools for public health and facilitated a more permissive attitude toward condoms as prophylactics, bridging state-led public health efforts with commercial objectives. By examining this dynamic, the article contributes to understanding how wartime policies shaped consumer behavior and forged enduring connections between public health and market strategies.

In this article, I explore how the mental health and mental capacity laws in England and Wales can be used for suicide prevention. I criticise the use of compulsion for persons diagnosed with a mental disorder who nonetheless retain decision-making capacity and argue for a greater reliance upon capacity as a distinguisher between autonomous decision-making about the end of life and the risk to life posed by symptoms of mental illness. The label of ‘suicide’ is also criticised as an outdated legal notion carrying pejorative meaning. Although focused on the law in England and Wales, the arguments apply much more broadly to all jurisdictions seeking to reconcile the demands of respect for life and respect for autonomy.

Legged robots have demonstrated remarkable potential for dynamic locomotion and terrain adaptability, making them a prominent focus of research. However, achieving robust and agile bipedal running remains challenging due to the complex dynamics of legged locomotion. In this paper, we propose a reinforcement learning framework for robust bipedal running, incorporating a simple reference trajectory generator and an asymmetric actor-critic architecture. The reference generator, based on kinematics, provides diverse trajectory references while preserving key gait characteristics, facilitating efficient policy exploration. To mitigate the simulation-to-reality gap, we extract latent variables encoding environmental and motion information from dual historical observations. Our method simplifies the trajectory generation process while maintaining effective guidance for learning. Extensive simulation and physical experiments demonstrate that, compared to model-based and learning-based baselines, our approach achieves higher agility, more accurate velocity tracking, and stronger disturbance rejection while preserving gait stability. The resulting controller exhibits spring–mass running dynamics that remain robust on both flat and uneven terrains.

La espelunca La Espiral, en la provincia Artemisa, presenta varias pinturas de las que sobresalen círculos concéntricos y una espiral. Para conocer la composición química de sus pinturas y obtener la fracción orgánica, que resulta la más difícil de estudiar a causa del comprensible proceso de degradación en el tiempo, se emplearon la microscopía electrónica de barrido y microanálisis de energía dispersiva por rayos-X, la microespectroscopía Raman y la cromatografía de gases acoplada a espectrometría de masas. El estudio nos muestra una comunidad de bajos niveles productivos con la capacidad técnica de crear una mezcla compleja con huevo, leche, ácido elágico y, como colorante principal, guano de murciélago. El hallazgo de residuos de aminoácidos de triptófano de huevo y leche en la mezcla pictórica resulta la primera evidencia arqueológica concreta del empleo de ambos productos en Cuba y las Antillas. Se propone la propuesta de la posible cadena operativa vinculada a la preparación de la pintura, a una aproximación a la inversión laboral y al número de miembros implicados en la ejecución de los gestos técnicos. Se teoriza sobre la relevante presencia femenina en su manufactura.

Malnutrition is highly prevalent among oncology patients, with large-scale studies reporting involuntary weight loss in 31–87%, depending on tumour site and disease stage. A combination of nutrition-impact symptoms, reduced oral intake and systemic inflammation lead to poor tolerance to treatment, diminished quality of life and reduced survival. Systemic inflammation is a hallmark of cancer-associated malnutrition and contributes to loss of lean mass and abnormal body composition phenotypes (sarcopenia, cachexia and low muscle density) which may coexist with overweight and obesity. Malnutrition screening tools are widely used to identify patients at risk; however, traditional weight and BMI-based instruments such as the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) frequently misclassify patients with cancer as well-nourished. These tools fail to account for nutrition-impact symptoms, inflammation and muscle wasting. Although obesity is an established cancer risk factor, 40–60% of patients with metastatic disease remain overweight or obese during treatment. When screening tools are BMI-based, high fat stores mask muscle wasting, leading to misclassification of nutritional risk and delayed dietetic referrals. To improve detection, screening tools should incorporate patient-reported symptoms, inflammatory markers and body composition assessment, enabling earlier, proactive nutritional care. Alternatively, it may be time to acknowledge that all cancer patients are inherently ‘at-risk’ of malnutrition and to prioritise universal access to dietetic support from diagnosis through treatment. This review summarises current malnutrition screening and assessment practices in oncology and outlines key considerations for future research and clinical practice.