Nanoscale ductility in c ‐plane Al 2 O 3 : Dislocation and twinning mechanisms via nanoindentation and molecular dynamics

Abstract Brittle oxides, such as α‐Al 2 O 3 , i.e., sapphire, are traditionally unsuitable for ductile applications, yet exhibit enhanced plasticity at nanoscale. This study explores the mechanical behavior of c ‐plane‐oriented, dislocation‐free monocrystalline α‐Al 2 O 3 via molecular dynamics (MD) simulations and experiments, including nanoindentation and post‐indentation TEM analysis. The results demonstrate high strength with homogeneous, extensive deformation without failure. Plasticity is dominated by basal (0001) dislocations and rhombohedral [10 1 ¯ $ 1$ 2] twins, which nucleate at deformation onset, as confirmed by MD and TEM. Generalized stacking fault energy (GSFE) and twinning fault energy (TFE) calculations elucidate mechanisms that mitigate crack initiation and propagation on the c ‐plane, aligning simulations with observations. These insights advance the understanding of nanoscale ductility in oxides, broadening the utility of sapphire in load‐bearing micro/nano devices.

Performance Enhancement of Ca 3 Co 4 O 9 ‐based Transverse Multilayer Thermoelectric Generators for Low‐Power Applications

ABSTRACT Transverse thermoelectric generators (TTEG) enable conversion of thermal into electrical energy with perpendicular directions of the applied temperature gradient and the induced thermoelectric voltage. We report on the fabrication of transverse multilayer thermoelectric generators (TMLTEG) based on p‐type Ca 3 Co 4 O 9 (CCO) ceramic tapes and printed silver which were conventionally sintered (CS) in air at 920°C or using pressure‐assisted sintering (PAS) at 920°C and 1.5 MPa. The thermoelectric performance of TMLTEGs was evaluated using analytical calculations and simulations. The transverse thermoelectric power factor PF tr and thermoelectric figure‐of‐merit ZT tr of an artificial layered structure composed of CCO and silver were calculated and simulated as functions of layers tilt angle φ and metal‐to‐ceramic thickness ratio ν t . TMLTEG devices with various CCO layer thicknesses of 150 µm, 100 µm, or 33 µm were fabricated and cofired at 920°C in air, which exhibit power outputs of 2.3 mW, 3.2 mW, and 4.1 mW at Δ T   =  160 K, respectively. TMLTEGs which were cofired using PAS show a higher power density of 16.4 mW/cm 3 at Δ T  = 225 K. This enhancement in power (≈ 80%) is crucial for thermoelectric modules comprising multiple TMLTEG devices. The device measurements were compared with 3D simulations.

Exploring society‐to‐cells resilience among community members: A multidisciplinary study in outpatient clinics with diverse participant demographics

Abstract Aim This study explores and understands community members' resilience in outpatient clinics, considering various dimensions and types of resilience. Design A cross‐sectional study. Methods This study was conducted in Saudi outpatient clinics from September to December 2023 and included 384 individuals chosen through systematic random sampling. Various tools were used, such as Social Cohesion and Trust Scale, Community Resilience Assessment Tool, Community Assessment of Psychic Experiences, Environmental Resilience Assessment, Economic Resilience Index, Connor‐Davidson Resilience Scale, Brief Resilience Scale, Resilience Scale for Adults and Healthcare Resilience Index. Results Participants displayed a robust overall resilience level, as indicated by Total Connor–Davidson Resilience Scale score of 63.0 ± 9.0. Additionally, they demonstrated commendable levels of resilience in Total Brief Resilience Scale (56.04 ± 8.6), Resilience Scale for Adults (82.5 ± 7.2) and Healthcare Resilience Index (45.8 ± 5.5). These findings offer significant insights into psychological and emotional well‐being of the study population, highlighting their adaptive capacities and coping mechanisms across various life domains. Conclusion This study provides valuable insights into the multidimensional nature of resilience in outpatient settings. The cross‐sectional design sets the groundwork for future longitudinal investigations, highlighting the need for a holistic approach to understanding and promoting resilience. Impact This study holds immediate implications for participants and their communities. It underscores the adaptive capacities and coping mechanisms prevalent in the outpatient population by revealing commendable resilience levels. This insight enhances individuals' psychological and emotional well‐being, contributing positively to the overall resilience and communal strength. Additionally, this study sheds light on how resilience among community members in Saudi Arabia relates to international advanced nursing communities, providing insight into their work. Patient or Public Contribution Patients who have received outpatient services in the past 6 months were purposively chosen to ensure a diverse representation across age, gender and socio‐economic backgrounds in this study.

Response to “Atrioventricular Conduction Abnormalities Amid Armed Conflict: Beyond the Electrophysiological Perspective”

Time to Benefit of Epicardial Ablation in Malignant Forms of Brugada Syndrome: A Reconstructed Individual Patient Data Meta‐Analysis

ABSTRACT Background Brugada syndrome (BrS) significantly contributes to sudden cardiac death in otherwise healthy individuals, primarily due to life‐threatening ventricular fibrillation (VF). Traditional treatment prevents SCD but does not eliminate the risk of recurrent VF episodes. Recent developments in catheter ablation techniques targeting the arrhythmogenic substrate in the right ventricular epicardium have emerged as promising alternatives; however, there is a lack of randomized controlled trials (RCTs). To address this, we conducted a reconstructed individual patient data (IPD) meta‐analysis to synthesize RCT evidence and estimate the time to benefit (TTB) of epicardial ablation in malignant BrS. Methods We systematically searched major databases for RCTs comparing epicardial ablation versus ICD only in patients with malignant forms of BrS. IPD were reconstructed from Kaplan–Meier curves. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using Cox regression, and Weibull models were applied to calculate TTB. Results Two RCTs (Nademandee et al; and Pappone et al.) including 90 patients (mean age 43.5 years) were included. Epicardial ablation therapy reduced the risk of VF recurrence (HR 0.17; 95% CI: 0.07–0.43; p  < 0.001). The TTB to prevent one VF per 100 patients was 0.2 months (97.5% CI: 0.1–8.1 months). Conclusions In patients with malignant forms of BrS, epicardial ablation was linked to a reduction in VF. These findings indicate that, for selected patients, adjunctive ablation procedures may provide a more favorable benefit profile than relying solely on ICDs.

Response to Letter Regarding “Sodium–Glucose Cotransporter‐2 Inhibitors and Stroke Risk in Patients With Atrial Fibrillation”

Increased C‐reactive protein is associated with corneal nerve loss and painful neuropathic symptoms in Type 2 diabetes mellitus

ABSTRACT Aims/Introduction To investigate the association between C‐reactive protein (CRP) with sensory symptoms and deficits and measures of small fiber damage. Materials and Methods Adults with and without T2D underwent corneal confocal microscopy (CCM) and assessment of vibration perception threshold (VPT), DN4 symptom questionnaire, and fasting blood tests for CRP and metabolic markers. Results Of the 122 participants, 77 had T2D of whom 23 (29.9%) had DPN, and 45 were controls. CRP levels were significantly higher in those with T2D without and with DPN compared to controls (5.6 ± 2.9 and 5.4 ± 4.0 vs 3.8 ± 2.9 mg/L, P  = 0.008 and P  = 0.046, respectively), with no difference between those with and without DPN ( P  = 0.894). Higher CRP was independently associated with lower corneal nerve fiber density (CNFD) (β = −5.5 fibers/mm 2 per 10 mg/L increase, P  = 0.036), after adjusting for diabetes duration, BMI, HbA1c, and triglycerides. In the DPN group, those with positive symptoms (burning, painful cold, and electric shocks) had higher CRP levels compared to those with negative symptoms (6.5 ± 4.7 vs 3.8 ± 1.9 mg/L, P  = 0.039). Conclusions Elevated CRP is associated with small nerve fiber loss and positive neuropathic symptoms in T2D. These findings suggest that CRP may help identify individuals with inflammation‐driven DPN who could benefit from targeted interventions.

Allogeneic haematopoietic cell transplant in cutaneous T‐cell lymphomas: Recommendations from the EBMT PH &G Committee

Abstract This manuscript provides expert recommendations on the role of allogeneic haematopoietic cell transplantation (allo‐HCT) for cutaneous T‐cell lymphoma (CTCL), specifically mycosis fungoides (MF) and Sezary syndrome (SS). Critical aspects such as patient selection, timing, and bridging therapy are addressed, as well as donor source, conditioning regimens and post‐transplant management. These consensus guidelines are based on a thorough literature review and discussions among leading dermatologists and haematologists. These recommendations aim to harmonize clinical practice towards improving patient outcomes in these rare but aggressive lymphomas. It is of critical importance to consider allo‐HCT early in the management of eligible patients with high‐risk disease. Advanced stage, large‐cell transformation, relapsed or refractory disease following systemic treatment, and N3‐stage lymph node involvement are indicators that should trigger consultation with a transplant haematologist in parallel with a donor search. Early interaction between dermatologists and transplant haematologists is vital to avoiding delays, which can significantly impact post‐transplant outcomes and survival.

Six Entrenched Misconceptions About Meta‐Analysis Models

ABSTRACT Meta‐analysis has become central to evidence‐based medicine, yet persistent misconceptions continue to distort how models are selected and interpreted. This paper identifies and clarifies six entrenched misconceptions that have shaped the practice of meta‐analysis for decades. It first challenges the belief that the choice of parameter assumption determines whether inference can extend beyond the included studies, emphasizing that conditional or unconditional inference arises from the analyst's scientific objective—not from the model or its assumptions. Second, it corrects the notion that the fixed‐effect (FE) model is the only model under the common parameters assumption (aCP), noting that several modern models within this framework can accommodate heterogeneity. Third, it dispels the idea that only random‐effects (RE) models can address heterogeneity, showing that this property exists under any parameter assumption. Fourth, it refutes the practice of letting observed heterogeneity dictate model choice, arguing that parameter assumptions and inferential purpose must guide decisions instead. Fifth, it challenges the claim that RE estimators best handle overdispersion, demonstrating persistent error‐estimation flaws and inflated type I error rates. Finally, it contests the view that heterogeneity renders aCP‐based models unrealistic, highlighting that recent aCP models handle such diversity effectively. By disentangling these misconceptions, the paper proposes a purpose‐driven, assumption‐aware framework for model selection that prioritizes conceptual clarity, analytical validity, and reproducibility in evidence synthesis.

Overcoming Big Data Interoperability Challenges Generated by Ubiquitous Devices Outside Traditional Health Systems: A Systematic Review Protocol

ABSTRACT Rationale Ubiquitous devices such as smartphones, wearables, and personal gadgets generate large volumes of personalized health data outside of traditional health systems. Despite its abundance, differences in data formats and semantics across hardware, platforms and sectors keep information siloed. As a result, valuable precision health and social insights are lost when training or validating predictive health models. Interoperable data pipelines that operate across non‐clinical settings are needed so this data can be responsibly translated into actionable information for personal and public health. Aims and Objectives This systematic review protocol aims to evaluate existing methodologies that address the interoperability challenges when integrating multimodal health data from ubiquitous devices into non‐clinical health infrastructures. The systematic review seeks to identify primary barriers (technical, semantic, organizational, and regulatory), describe current solutions, and pinpoint gaps that hinder seamless exchange and use of such data. Methods A comprehensive literature search will be conducted across multiple databases (PubMed, IEEE Xplore, ACM Digital Library, and Web of Science) for peer‐reviewed primary studies from 2014 to 2024. Gray literature and conference proceedings are excluded. Eligible studies empirically evaluate a framework, architecture or tool that enables technical, semantic, organizational, and regulatory interoperability for person‐generated health data outside clinical settings. Two reviewers will conduct title and abstract screening and full‐text screening in Covidence using predefined criteria, with blinding of authors, journal, and year. Disagreements will be resolved by consensus or a third reviewer. Data will be extracted in Microsoft Excel, and methodological quality will be assessed with the Mixed Methods Appraisal Tool (2018). Interoperability methodology synthesis will be primarily narrative with evidence tables. Where comparable quantitative outcomes exist, we will compute effect sizes and consider robust statistically significant findings ( p  < 0.05). Anticipated Implications This systematic review protocol will sufficiently assemble a comprehensive and reproducible evidence base to conduct the review. The completed review will synthesize and critically appraise peer‐reviewed approaches to interoperability for ubiquitous device‐generated personal health data outside of traditional health systems; identify recurrent barriers and current solutions; and outline good practices to enable cross‐sector data usage, thereby increasing the volume of interoperable data available for predictive modeling of personalized health outcomes.