We have developed a hypersonic high-order, high-performance code ((HPC)-P-3) utilizing the "Trixi.jl" framework in order to simulate both non-reactive and chemically reactive compressible Euler and Navier-Stokes equations for complex three-dimensional geometries. (HPC)-P-3 is parallel on CPU platforms and can perform parallel computations of hypersonic turbulent flows. The numerical approach is based on the discontinuous Galerkin spectral element method, satisfying the entropy and energy stability conditions for the Euler equations. (HPC)-P-3 can perform simulations of high-speed flows from subsonic to hypersonic speeds based on frozen, equilibrium, and non-equilibrium chemistry modeling of the gas mixture, using the Mutation.jl, which is a Julia package developed to wrap the C++-based Mutation++ library. (HPC)-P-3 can also perform parallel adaptive mesh refinement for two-and three-dimensional Euler and Navier-Stokes discretizations with non-conforming elements. In this study, we first demonstrate the successful integration of Mutation++ into the (HPC)-P-3 solver, and then verify its accuracy through simulations of Taylor-Green vortex flow, supersonic flow past a square and circular cylinder, and hypersonic P8-inlet.
Inverse problems governed by partial differential equations (PDEs) are central to computational mechanics and are commonly solved by adjoint-based optimization, while physics-informed neural networks (PINNs) have emerged as a flexible alternative. Their relative performance remains difficult to assess because the two approaches are often compared under different formulations, parameterizations, optimizers, and regularization choices. We present a controlled comparison of adjoint optimization and PINNs for PDE-constrained inverse problems. From a common abstract formulation, we instantiate both methods on identical domains, governing equations, observation models, and regularization terms, while matching the optimizer, unknown parameterization, and arithmetic precision wherever applicable. The benchmarks include unsteady Burgers, noisy Darcy permeability inversion, three-dimensional Allen–Cahn reaction identification, and unsteady Navier–Stokes viscosity identification. The results show that the representation of the unknown largely determines the preferred method: grid-based fields favor the discrete adjoint, whereas neural representations are native to PINNs and relevant for closure and constitutive modeling. For time-dependent problems, adjoint inversion can be dominated by trajectory storage and differentiation, while PINNs provide satisfactory reconstructions at lower cost. A PINN-warm-started adjoint strategy then recovers adjoint-level accuracy at about half the cost.
The experiences of care-partners of people with epilepsy are complex and dynamic throughout the lifespan, yet their wellbeing remains insufficiently recognized within care systems. There is a public health need to examine and address the wellbeing of epilepsy care-partners. Utilizing the National Institute of Health (NIH) Whole Person Health framework, we present a narrative synthesis of often-overlooked challenges faced by epilepsy care-partners, along with potential strategies for improving their identification, measurement, support and advocacy. These considerations are essential to advancing a whole-person health approach that addresses the needs of both individuals with epilepsy and their care-partners as an interconnected dyad. We present a call to action for clinicians and systems of epilepsy care to invest in research and resources to improve health outcomes and wellbeing for care-partners of people with epilepsy; and to innovate epilepsy center care pathways that are inclusive of whole person health values and logic for epilepsy dyads.
Purpose Patients with end-stage renal disease (ESRD) have high rates of pathologies, which may necessitate finger amputation, such as infection or vascular insufficiency. Still, little work has examined its significance in upper-extremity amputation. This study aimed to explore ESRD as a predictor of postoperative sequelae in the setting of finger amputation. Methods A retrospective cohort study was performed using the TriNetX database to identify patients with finger amputation through the phalanx, metacarpal, or distal to the carpometacarpal with or without preexisting ESRD or dependence on dialysis. Propensity score matching was used to control for risk factors such as diabetes, atherosclerosis, peripheral vascular disease hypertension, among others. Outcomes included return to operating room or death within 1-year, subsequent ray amputation, proximal upper-extremity amputation, and other common sequelae of finger amputation. Results After propensity score matching, 1,619 patients without and 1,619 patients with ESRD or dialysis dependence before index finger amputation were in each cohort. More patients with ESRD returned to the operating room within 1 year for debridement or secondary closure of dehisced wound (334 [20.63%] vs 217 [13.40%]). Furthermore, 338 (20.88%) non-ESRD amputees and 536 (33.11%) ESRD amputees underwent repeat or subsequent ray amputation. Similarly, patients with ESRD demonstrated higher rates of proximal upper extremity amputation (ie, at the hand, wrist, or forearm) following index surgery: 296 (18.28%) patients without ESRD versus 481 (29.71%) patients with ESRD. ESRD amputees also developed significantly higher rates of chronic osteomyelitis (290 [17.91%] vs 219 [13.53%], P < .001) as well as death within 1 year (375 [23.16%] vs 121 [7.47%], P < .001). Conclusions Patients with ESRD experience higher rates of subsequent proximal upper extremity amputation, subsequent ray amputation, chronic osteomyelitis, return to the operating room, and death. Further work expositing the pathophysiological mechanism of these associations may assist hand surgeons in preoperative optimization of these patients. Type of study/level of evidence Prognostic IIb.
Purpose Employment provides psychological and financial benefits. In this secondary analysis of the Eastern Cooperative Oncology Group- American College of Radiology Imaging Network (ECOG-ACRIN) EAQ162CD study results, we assessed longitudinal changes in employment and work productivity among individuals with stage I–III colorectal cancer and their association with financial hardship.Methods Adults with newly diagnosed stage I–III colorectal cancer treated with curative intent (2018–2020) were surveyed at enrollment, 3, 6, and 12 months. Employment, productivity, and work impairment were measured. Financial hardship was measured using the Comprehensive Score for Financial Toxicity (COST). Longitudinal associations were analyzed using multivariable models.Results Among 280 participants (mean age 55.5; 56.1% [157/280] male) 16.4% (46/280) reported decreased employment at enrollment vs. 4.2% (4/96) at 12 months; employment increases rose from 1.4% (4/280) at enrollment vs. 9.4% (9/96) at 12 months. Higher COST scores (lower hardship) were associated with lower odds of employment change. Among 202 participants employed at enrollment, median work missed declined from 21.9% at enrollment to 0% at follow-up. Physical work ability improved, while mental work ability transiently declined. Employment disruption occurred early, but improved over time.Conclusions These findings highlight the importance of early identification and support for individuals experiencing employment disruption and financial hardship during cancer treatment.
