Abstract: Background/Objectives: Pediatric tracheotomy has evolved from an emergency procedure for acute infections to a planned intervention for chronic conditions requiring prolonged airway support. This study aims to describe the clinical characteristics, indications, and outcomes of pediatric tracheotomy over a 21-year period at a tertiary care center. Methods: A retrospective observational case series was conducted including 246 pediatric patients (0–18 years) who underwent tracheotomy between 2004 and 2024. Data were collected from medical records and included demographics, indications, procedural details, complications, decannulation, and mortality. Patients were categorized into airway obstruction (AO) and respiratory support (RS) groups. Statistical analyses were performed using the Mann–Whitney U test, Chi-square and Fisher’s exact test. Results: A significant increase in tracheotomy procedures was observed over time. Respiratory support was the predominant indication (75.2%), mainly due to neurological disorders, while airway obstruction accounted for 24.8%. Patients in the AO group were significantly younger and more likely to undergo urgent procedures (p < 0.001). Complication rates were comparable between groups (AO 16.4% vs. RS 21.1%; p = 0.295). Decannulation was significantly more successful in the AO group (16.4% vs. 5.4%; p = 0.012). Mortality did not differ significantly between groups and was associated with underlying comorbidities. Conclusions: Pediatric tracheotomy is increasingly performed for chronic respiratory support. While procedural safety is high, outcomes vary by indication, with better decannulation rates in airway obstruction cases. Multidisciplinary, individualized management is essential for optimizing patient outcomes.

Abstract: In recent years, the rapid expansion of low-temperature facilities—such as cold storage and indoor ice and snow venues—has underscored their pronounced vulnerability to fire, as evidenced by multiple severe incidents. Due to their distinct environmental conditions, existing theoretical frameworks, technical approaches, and standards exhibit limited applicability. Consequently, the fire risk characteristics of such facilities remain insufficiently defined, and systematic methods for hazard identification and assessment are lacking. This study conducts a detailed analysis of fire incident data from representative low-temperature facilities to identify the fire risks characteristics across all lifecycle stages, including construction, renovation and expansion, operation, maintenance, and demolition. An integrated framework combining the WBS/RBS matrix and CN methods is then proposed to establish a structured methodology for full lifecycle fire hazard identification and classification. The results address critical gaps, including the absence of clearly defined lifecycle fire risk profiles and a robust scientific basis for hazard identification, and provide a technical foundation for lifecycle fire risk management in low-temperature facilities.

Abstract: This study supports the use of human skin explants as a versatile and translational model for evaluating pharmacologic skin responses and topical bioactivity. The approach allows mechanistic insight beyond single biomarkers and may serve as a scalable pharmacologic platform for efficacy testing, particularly when expanded to include multiple donors and broader readouts.

Abstract: Purpose: With the growing interest in multimodal large language models (MLLMs) for medical image analysis, expanding the application scope of the unimodal TAIDE large-scale language model has emerged as a prominent and significant research direction. Methods: This study employed the SkinCAP multimodal dataset, which consists 4,000 images of skin lesions along with their associated textual descriptions. Two approaches for model training and evaluation are proposed: (1) A visual retrieval-augmented generation (RAG) method, which leverages transfer learning for image feature extraction and cosine similarity for image retrieval. Retrieved results are used to generate prompts that guide the TAIDE model to produce diagnostic descriptions in traditional Chinese. (2) A fine-tuning-based method that integrates the MiniGPT-V2 framework with the TAIDE model to develop a multimodal system capable of automatically generating diagnostic descriptions. Results: Model performance was evaluated using BLEU, ROUGE-L, METEOR, CIDEr, and SPICE metrics. The results demonstrate that the fine-tuning-based approach—integrating MiniGPT-V2 with the TAIDE model—achieves superior performance compared to the visual RAG-based method, which combines transfer learning-based retrieval with the TAIDE model for description generation. Conclusion: This study presents an empirical comparison of two methodologies for extending unimodal large language models into multimodal applications for the automatic generation of diagnostic descriptions of skin lesions. The findings provide valuable technical insights and serve as a reference for the development of future AI-based medical systems.

Abstract: Environmental noise exposure has become an increasingly prevalent public health con-cern, with effects extending beyond the auditory system. Accumulating evidence indicates that chronic noise exposure induces both structural and functional alterations in the cen-tral nervous system, ultimately affecting cognitive and emotional processes. This review summarizes the impact of noise on key brain regions, including the hippocampus, pre-frontal cortex, and auditory cortex. Structurally, noise exposure is associated with reduced neurogenesis, dendritic remodeling, synaptic loss, alterations in white matter and changes in glial activity. Functionally, it disrupts synaptic plasticity mechanisms—such as long-term potentiation and long-term depression—as well as neuronal connectivity, lead-ing to impairments in higher-order cognitive and behavioral functions. These effects are mediated by interconnected mechanisms, including activation of the hypothalamic–pituitary–adrenal axis, neuroinflammation, oxidative stress, and alterations in neu-rotrophic signaling.

Abstract: We propose an observationally motivated effective framework for the gravitationally relevant vacuum sector, in which only a spectrally bounded subset of quantum fluctuations contributes to the vacuum energy density. The construction is defined by two physically motivated scales: a short-wavelength ultraviolet bound associated with confinement-scale physics, and a long-wavelength infrared scale arising from thermodynamic and entropic structuring in the late-time universe. Within this bounded spectral domain, the vacuum energy density is governed by a characteristic geometric scale defined by the ultraviolet and infrared bounds, leading to a robust inverse fourth-power scaling that is largely insensitive to the detailed form of the spectral kernel.This effective description provides a structured interpretation of the observed smallness of vacuum energy in terms of spectral selection rather than ultraviolet cancellation. The model yields testable predictions at low redshift, including percent-level deviations in the equation of state and in the growth of structure, offering a falsifiable alternative to a purely phenomenological cosmological constant.

Abstract: The human spinal cord is increasingly recognized as an active and adaptable compo-nent of sensorimotor function, contributing to motor control, pain modulation, and recovery after neurological injury. Within this framework, the Hoffmann reflex (H-reflex) has evolved from a classical electrophysiological phenomenon into a useful probe of spinal circuit function. Rather than reflecting motoneuron excitability alone, H-reflex amplitude and modulation arise from the interaction of Ia afferent transmis-sion, presynaptic inhibition, homosynaptic depression, and interneuronal networks that regulate sensorimotor gain in a state-dependent manner. This review synthesizes classical and contemporary evidence to position the H-reflex as an indirect measure of spinal inhibitory function in humans. We integrate physiological mechanisms with findings from studies in chronic pain syndromes, spasticity, Parkinson's disease, and recovery after central nervous system injury, where alterations in spinal inhibitory processes have been described. We further discuss methodological and conceptual challenges that limit clinical translation, including state dependence, protocol hetero-geneity, and the lack of normative reference frameworks. Finally, we outline directions for integrating H-reflex paradigms with complementary approaches to improve the interpretation of spinal circuit function and its relation to clinical phenomena. Framed in this context, the H-reflex can be considered a valuable experimental and transla-tional tool, whose utility depends on careful methodological implementation and physiologically informed interpretation.

Abstract: Background: Variation in suspected adverse drug reactions (SARs) linked to different batches of COVID-19 vaccines has been reported in several countries, including the Czech Republic, Denmark, Sweden, and the USA. However, SAR data from spontaneous reporting systems are subject to under-reporting and other biases. To investigate the potential association between vaccine batches and adverse reactions using an unequivocal endpoint, we examined the temporal relationship between all-cause mortality (ACM) and COVID-19 vaccine type and batch up to three months after vaccination.Methods: We analysed nationwide data from the Czech Republic on vaccine type and batch, together with corresponding three-month ACM data. Cluster analysis was used to assess age- and sex-specific differences in ACM within and across vaccine batches and types. We also investigated the relationship between ACM and SAR rates for the same batches.Results: During a 21-month period (December 2020 to September 2022), vaccine batches clustered according to their three-month age- and sex-adjusted ACM rates for the four products administered (Comirnaty, Spikevax, Vaxzevria, and Jcovden). For Comirnaty, Spikevax, and Vaxzevria, a clear temporal pattern was observed, with earlier batches showing significantly higher ACM rates. A strong correlation was found between batches that clustered by ACM and those previously identified as clustering by SARs, across all vaccine products except Jcovden.Conclusions: Data from the Czech Republic show a clear association between administered COVID-19 vaccine batches and 3-month ACM rates for Comirnaty, Spikevax, and Vaxzevria, with earlier batches linked to notably higher ACM. A strong correlation between batch-associated ACM and SAR rates for Comirnaty and Spikevax supports the validity of these batch-related safety signals and warrants further investigation using individual-level patient data.

Abstract: Background: Autism spectrum disorder (ASD) affects approximately 1–2% of children worldwide, yet its etiology remains incompletely understood. Emerging evidence suggests that offspring of parents with autoimmune diseases show elevated autism prevalence. Notably, children of parents with psoriasis (OR 1.59), type 1 diabetes (OR 1.49–2.36), and rheumatoid arthritis (OR 1.51) demonstrate particularly strong associations. Hypothesis: I propose that autism may be conceptualized as an immune-metabolic disorder in which TNF-α-mediated mitochondrial dysfunction contributes to cerebral energy deficiency. This energy deficit may impair three critical processes: (1) synaptic pruning during neurodevelopment, (2) real-time social cognition including gaze processing and emotion recognition, and (3) protein synthesis of critical synaptic scaffolding molecules. The proposed mechanism is TNF-α pathway dysregulation arising from inherited inflammatory susceptibility and/or direct fetal exposure to elevated maternal TNF-α during pregnancy. I further propose that the well-documented “firstborn effect” in autism reflects maternal immune maladaptation during primigravid pregnancies. Additionally, for cases without parental autoimmune history, a speculative secondary mechanism is proposed: mitonuclear immune conflict, in which paternal immune genes may partially recognize maternal mitochondria as non-self, generating endogenous TNF-α. A newly expanded component of the model is the decidua basalis–placenta–fetal brain transmission pathway, in which disruption of the decidual tolerogenic circuit, placental amplification of inflammatory signals, and fetal microglial reprogramming may together contribute to altered neurodevelopment during sensitive gestational windows. The model further proposes that this process may occur even in the setting of a clinically silent, chronic low-to-intermediate pro-inflammatory cytokine state that is insufficient to endanger maternal or fetal survival, yet sufficient to disrupt fetal brain development. Implications: This framework may provide an integrative account of disparate observations about autism pathophysiology and suggests that TNF-α-related pathways merit further investigation for potential risk modification, particularly in pregnancies identified as high-risk through parental autoimmune or inflammatory disease.

Abstract: Background. Saudi Arabia implemented mandatory premarital screening and genetic counseling (PMSGC) for sickle cell disease and β-thalassaemia in February 2004. Over two decades the programme has screened more than eight million individuals, yet its cumulative outcomes have never been synthesized. We assessed the long-term impact of the PMSGC programme on at-risk marriage detection, marriage cancellation, regional heterogeneity, and hemoglobinopathy burden from 2004 to 2024. Methods.We conducted a systematic review and meta-analysis following PRISMA 2020. Six databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane CENTRAL, Saudi Digital Library) were searched from January 2004 to December 2024 without language restrictions. Studies reporting outcomes of the Saudi PMSGC programme — prevalence, at-risk couples, marriage cancellation rates, knowledge/attitudes/practices, or cost — were eligible. Two reviewers screened and extracted data independently in Rayyan. Risk of bias was assessed with Joanna Briggs Institute checklists. Random-effects meta-analysis pooled proportions using the Freeman–Tukey double arcsine transformation. Meta-regression tested temporal trends and regional moderators. The review was registered with PROSPERO (CRD420261378326). Findings. Of 3,008 records identified from databases and 145 from other sources, 62 studies met inclusion criteria, with 47 contributing to the meta-analysis. The pooled prevalence of sickle cell trait was 45.4 per 1,000 (95% CI 42.5–48.4; I² = 99.7%; 10 studies, >9.6 million individuals), with marked regional gradient (Eastern Province 134 per 1,000 vs Northern regions 13–14 per 1,000; ~10-fold). Pooled β-thalassaemia trait prevalence was 21.0 per 1,000 (95% CI 17.4–24.8; I² = 99.9%). Marriage cancellation rate among at-risk couples rose from 9.2% in 2004 to 51.9% in 2009 (Era 1 pooled 24.9%, 95% CI 13.0–39.2), to 60.5% in 2010–2019 (95% CI 49.6–70.9), to 76.7% in 2020–2024 (95% CI 63.1–87.9). Meta-regression on year midpoint showed a significant positive trend (β = +3.28 percentage points per year, P < 0.001). Decision-tree cost analysis indicated approximately 73% healthcare cost reduction attributable to the programme for sickle cell disease (~US$29.7 million annual saving). Interpretation. The Saudi PMSGC programme has achieved substantial population-level impact on hemoglobinopathy prevention over two decades, with marriage cancellation rates rising eight-fold and persistent — though narrowing — regional heterogeneity. Gaps remain in expanding the screening panel (spinal muscular atrophy, cystic fibrosis, phenylketonuria), in cost-effectiveness evidence, and in standardized outcome reporting. These findings support Saudi Vision 2030 health transformation goals and inform regional neighbours considering similar programmes.

Abstract: This work introduces a compact multi-resonant metamaterial absorber designed to achieve efficient electromagnetic absorption over several microwave frequency bands. The proposed configuration is based on a hybrid resonator arrangement that promotes strong electromagnetic interaction and enables multiple resonant modes within a single unit cell. Consequently, six distinct absorption peaks are obtained at 2.4, 5.21, 6.88, 9.77, 12.61, and 14.99~GHz, covering S-, C-, X-, and Ku-band applications. The absorber exhibits high absorption performance, exceeding 97\% across most operating frequencies, which indicates effective impedance matching with free space and efficient energy dissipation mechanisms. The absorption characteristics are further examined through surface current distributions, electric field confinement, and effective medium analysis, demonstrating that the multi-band response originates from the interaction of multiple resonant elements and intrinsic material losses. Moreover, the proposed structure maintains stable performance for different polarization angles and oblique wave incidence, confirming its polarization-insensitive and angularly stable behavior. To validate the design, a prototype is fabricated and experimentally characterized using a free-space measurement setup, showing close agreement with the simulated results. The compact geometry, low fabrication cost, and scalability of the proposed absorber make it a promising candidate for applications such as electromagnetic interference mitigation, radar cross-section reduction, and modern wireless communication systems.

Abstract: (Background) Aiming to reduce synthetic fertilizer dependence and enhance soil fertility, this study isolated and characterized nitrogen-fixing bacteria from the maize rhizosphere. (Methods) Nitrogen-free selective media were used for bacterial isolation, followed by detection of the nifH gene and nitrogenase activity. Phylogenetic identification was conducted via 16S rRNA sequencing. Growth-promoting traits, stress tolerance, and pot-based plant inoculation effects were assessed. Genetic modification of strain GN8811 was performed to improve nitrogen fixation and growth promotion. (Results) Seven isolates that carried the nifH gene and exhibited nitrogenase activity were closely related to four genera. Several isolates showed phosphate solubilization, iron chelation, IAA production, or potassium solubilization, with GN2003 and GN8811 tolerating high salinity and variable pH. Inoculation with GN8811 promoted maize growth comparable to nitrogen fertilization, and its genetically modified derivative (ΔnifL::PrpoD) showed further improvement even under high nitrogen conditions. (Conclusions) These findings highlight the potential of combining microbial screening with genetic engineering to develop efficient bioinoculants for sustainable maize cultivation.

Abstract: Nitrate contamination of groundwater is a growing concern in tropical island settings, where shallow aquifers serve as the primary drinking water source. This study assessed nitrate concentrations, spatial distribution patterns, and compliance with drinking water guidelines across 35 sampling wards in five districts of Unguja Island, Zanzibar. Groundwater samples were collected from wells and boreholes (depths 1.03-28.43 m) and analyzed for nitrate using ion spectrophotometry alongside physicochemical parameters (pH, electrical conductivity, temperature and chloride). Nitrate concentrations ranged from 0.3 to 331.6 mg/L (overall mean: 34.7 mg/L). While the overall mean fell below the World Health Organization (WHO) and Tanzania Bureau of Standards (TBS) threshold of 50 mg/L, it exceeded the U.S. Approximately 22.9% of sites exceeded the WHO limit, and 65.7% exceeded the EPA limit. Approximately 22.9% of sites exceeded the WHO limit, and 65.7% exceeded the EPA limit. The highest concentrations were recorded at Kivunge (170.1 ± 132.89 mg/L), Mtoni (134.9 ± 131.8 mg/L), and Pwani Mchangani (112.58 ± 97.28 mg/L). North A district had the highest mean concentration (65.5 mg/L), followed by West (42.1 mg/L) and South (40.5 mg/L). Statistical analysis revealed significant inter-district differences (p &lt; 0.05) but weak correlations between nitrate and well depth (r = -0.012) or electrical conductivity (r = 0.104), suggesting localized anthropogenic sources rather than natural hydrogeological controls. The results call for district-specific monitoring programs, improved sanitation infrastructure, and regulation of fertilizer use to protect public health in Zanzibar. The results call for district-specific monitoring programs, improved sanitation infrastructure, and regulation of fertilizer use to protect public health in Zanzibar.

Abstract:

Objectives: This study aimed to investigate the phytochemical content of the endemic plant Thymus fedtschenkoi var. handelii (Ronniger) Jalas and, for the first time, to examine its anticancer potential on various cancer cell lines. Methods: The plant was collected from natural habitat and the essential oils (EOs) composition was analyzed using GC-MS. The anticancer efficacy and cytotoxicity of plant extracts and the EOs were evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and lactate dehydrogenase (LDH) methods on lung (A549, Calu1, H1650), bone (SW1353, MG63, Saos2), prostate (PC3, DU145, LNCaP) and brain (A172, B35, C6) cancer cell lines, as well as normal cell lines (Beas2B, FL, HC). Results: The main components of the EOs were determined to be high amounts of carvacrol (51.12%), γ-gamma-terpinene (16.87%), and p-cymene (14.76%). Both the extract (GI50: 1.10–3.28 µg/mL) and the EOs (GI50: 1.05–2.03 µg/mL) exhibited strong antiproliferative activity. However, EOs demonstrated markedly superior growth suppression, with TGI values of 1.97–9.19 µg/mL, whereas the extract required substantially higher concentrations (110.6–261.5 µg/mL). The LC50 values of all samples exceeded 500 µg/mL in all cell lines tested, indicating that the natural compounds predominantly had a cytostatic effect. Normal cells showed comparable reduced sensitivity, supporting selectivity. Morphological analyses further confirmed treatment-induced cellular alterations consistent with antiproliferative and apoptotic processes. Overall, EOs emerged as the most potent fraction, combining low TGI values with moderate cytotoxicity, indicating strong therapeutic potential. Conclusions: The potent and selective antiproliferative activity of T. fedtschenkoi var. handelii may hold significant therapeutic potential in the pharmaceutical industry.

Abstract: Real-time scheduling of large-scale electric vehicle (EV) charging stations is essential for improving service efficiency, operational profitability, and grid coordination. However, most existing studies formulate charging scheduling as a single-stage unified decision problem that jointly handles discrete service access and continuous power control. Such a formulation fails to capture the inherently hierarchical operating mechanism of large-scale charging stations and often suffers from limited interpretability, enlarged action spaces, and reduced scalability under stochastic arrivals, dynamic departures, and time-varying resource constraints. To address these issues, this study reformulates the real-time charging scheduling problem as a two-stage collaborative decision process and proposes a Supervised Service Matching and Reinforcement Power Dispatch (SMPD) framework. In the first stage, a supervised bipartite matching network is developed to determine the service access relationships between waiting EVs and available chargers. In the second stage, a Soft Actor-Critic (SAC)-based continuous control strategy is employed to optimize charging power allocation for connected EVs under charger-level and station-level constraints. Experimental results demonstrate that the proposed framework effectively reduces waiting time while improving charger utilization, charging-demand satisfaction, and economic performance. Comparative and robustness analyses further verify its superior scheduling effectiveness, training stability, and adaptability under different infrastructure scales and random disturbance scenarios.

Abstract: Fatty acids serve dual roles in cardiac physiology: as energy substrates and precursors of bioactive lipid mediators (prostaglandins, leukotrienes, oxylipins) from n-3/n-6 PUFAs that regulate inflammation, thrombosis, and remodeling. Saturated, monounsaturated, and trans fatty acids modulate metabolism and membrane function, shaping these pathways.Clinically, n-3 long-chain PUFAs (EPA and DHA) reduce cardiovascular mortality and aid postischemic remodeling, yet high doses increase the risk of atrial fibrillation. By contrast, trans and saturated fatty acids promote dyslipidemia, dysfunction, and higher rates of coronary artery disease and heart failure. Mechanistically, fatty acid uptake via FABPpm, CD36 (FAT), and FATPs, β-oxidation, and PPAR signaling regulate metabolism, while COX/LOX/CYP pathways generate eicosanoids and resolvins that influence inflammation and repair. This review synthesizes evidence on the roles of fatty acids and oxylipins in lipotoxicity, heart failure, ischemia-reperfusion, and arrhythmias, and evaluates dietary and supplemental interventions to optimize cardiac lipid metabolism—aligning with fatty acid signaling.

Abstract: This position paper argues that delegated AI must be evaluated and governed by transaction closure, rather than mere task completion. Agent economies emerge when AI systems execute externally binding commitments—such as purchases, bookings, or procurement orders—on behalf of authorized principals. Safe delegation at this boundary requires environments that support bounded mandates, reversible lifecycle states, verifiable receipts, and contestable failures. While AI-native platforms rapidly advance action closure, mature super-app ecosystems and enterprise suites currently offer the clearest testbeds for the payment, refund, and liability semantics required for true transaction closure. This work contributes a formal definition of transaction closure, minimal schema objects for transaction-ready delegation, a comparative ecosystem analysis, a principal-facing mandate-card model, and ClosureBench—a benchmark design for evaluating authorization, split states, recovery, and portability. The long-run goal is contestable transaction closure: portable infrastructure where delegated commitments can be inspected, challenged, and repaired beyond any single host.

Abstract: Background/Objectives: Promoting psychological well-being is a central goal in healthy aging research. While leisure has been widely recognized as an important contributor to well-being in later life, the underlying psychological mechanisms remain insufficiently understood. This study aims to examine the relative roles of cognitive and experiential mechanisms in shaping psychological well-being among older adults. Methods: A cross-sectional survey was conducted with 200 older adults participating in community-based leisure programs in South Korea. Data were analyzed using confirmatory factor analysis and structural equation modeling. A dual-pathway model was tested, in which leisure attitude represents a cognitive mechanism and leisure satisfaction reflects an experiential mechanism. Results: Leisure attitude significantly influenced both leisure satisfaction and psychological well-being, while leisure satisfaction also had a positive but comparatively weaker effect on well-being. Mediation analysis confirmed that leisure satisfaction partially mediates the relationship between leisure attitude and psychological well-being. Notably, the direct effect of leisure attitude (β = 0.368) was substantially stronger than that of leisure satisfaction (β = 0.150), supporting an asymmetrical du-al-pathway structure. Conclusions: These findings highlight the dominant role of cognitive appraisal in shaping well-being in later life and suggest a shift from experience-centered to cognition-centered frameworks in aging research. Interventions aimed at promoting healthy aging should therefore focus not only on improving the quality of leisure experiences but also on fostering positive cognitive orientations toward leisure.

Abstract: The proliferation of high-speed railway (HSR) networks necessitates frequent construction activities adjacent to operational lines, posing significant risks to the structural integrity and safety of existing infrastructure. This study addresses the critical need for a comprehensive framework to assess and monitor the deformation of HSR piers throughout the entire construction process of a new, nearby bridge, which includes the cumulative effects of both substructure and superstructure construction. A hybrid methodology integrating quantitative risk assessment and real-time, non-contact monitoring was developed and implemented. A risk evaluation model was established using the Analytic Hierarchy Process (AHP) to structure the problem, combined with Triangular Fuzzy Numbers to handle the inherent uncertainties in expert judgments. The Fuzzy Comprehensive Evaluation method was then employed to quantify the risk levels of various construction stages. Concurrently, a vision-based monitoring system utilizing Digital Image Correlation (DIC) technology was deployed to capture the three-dimensional deformation of adjacent HSR piers with high precision and frequency. The case study, focusing on the construction of a new bridge crossing the operational Beijing-Shanghai HSR, demonstrated the application of this framework. The risk assessment model identified the pile cap and pier construction phase as the highest-risk stage, with a risk weight of 0.311. The DIC monitoring system, validated against total station measurements with a relative error of less than 5%, recorded the cumulative pier deformations throughout 31 distinct construction stages. The maximum recorded deformations in the transverse, longitudinal, and vertical directions were all maintained within the early warning threshold of ±1.2 mm stipulated by railway regulations. The study confirms that the integrated AHP-Fuzzy and DIC framework provides a robust paradigm for proactive risk management in adjacent-line construction projects. The risk model accurately predicted the most critical construction phase, and the DIC system offered a reliable and efficient solution for real-time safety assurance. The findings validate that with appropriate risk-informed monitoring, the impact of new bridge construction on existing HSR infrastructure can be effectively controlled within safe limits, offering a valuable reference for similar engineering projects globally.

Abstract: Current variant interpretation frameworks, including those proposed by the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) and ClinGen, rely on implicit assumptions regarding allele frequencies, linkage disequilibrium (LD), and independence of variables. These assumptions are largely derived from European populations and are not valid in highly admixed populations. Here, we argue that the Brazilian population constitutes a natural stress test for these frameworks, not merely due to the extent of admixture, but due to its qualitative structure, characterized by recent tri-hybrid admixture (European, African, Indigenous American) and extensive recombination generating novel haplotypic configurations. We further highlight the instability of borderline variants of uncertain significance (VUS) under Bayesian classification and propose a reformulation explicitly incorporating haplotype structure and local ancestry.