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With carbon neutrality as a target and the increased penetration of renewable energy, the operational flexibility of power systems has begun to face challenges. In order to explicitly represent the operational flexibility of power systems, two types of flexibility indexes and corresponding models for their evaluation are established in this paper. One of the indexes is the supply–demand balance, which evaluates the adequacy of operational flexibility at the system level. The other is the availability of flexible resources, which comprehensively quantifies the flexibility of the power system from the perspectives of power generation, load, and energy storage. In the case study presented here, the proposed evaluation method is illustrated and validated based on a provincial power system in China. Next, the role of energy storage in enhancing flexibility is quantitatively analyzed using the proposed indexes. Then, the economic model reveals the nonlinear decline in the marginal benefit of investment in energy storage. Energy storage alone cannot fully meet the requirements for supply–demand balance in the power system, necessitating a comprehensive consideration of the available capacity for flexibility from the perspectives of generation, load, and energy storage. Analysis of a typical scenario shows that the provincial power system has 5000 MW of upward and downward flexibility in capacity. The numerical results highlight the critical importance of integrating flexibility across all components.

Clinical trials have confirmed that chimeric antigen receptor (CAR) T cell therapies are revolutionizing approaches for treating several relapsed or refractory hematological tumors. Cytokine release syndrome (CRS) is an adverse event with high incidence during CAR-T treatment. A further understanding of the characteristics and related risk factors of CRS is important for effective management. A total of 142 patients with relapsed or refractory acute lymphocyte leukemia (ALL), lymphoma, or multiple myeloma (MM) received lymphodepletion chemotherapy followed by infusion of CAR-T cells. The characteristics of CRS at different time points after treatment were monitored and risk factors were analyzed. The incidence of CRS for ALL, lymphoma, and multiple myeloma were 82%, 90%, and 90% respectively. Fever was observed on a median of day 3 for ALL, day 1 for lymphoma, and day 8.5 for MM after CAR-T cell infusion, and the duration was different between grade 1–2 CRS and grade 3–5 CRS. Disease types, peak concentration of IL-6, and CRP were associated with CRS. For patients with ALL, numbers of lymphoblast in bone marrow before lymphodepletion, peak concentration of IL-6, and CRP were independent risk factors of CRS. Clinical stage of lymphoma patients and high tumor burden in marrow of MM patients were independent risk factors of CRS. In conclusion, the characteristics and risk factors of CRS in different B-cell hematological tumors are different and should be managed individually during CAR-T cell therapy.

Effects of metachronous primary malignant solid tumor (MPMST) on survival risk and prognosis of multiple myeloma (MM) and differences between MPMST occurring before and after MM remains unclear. Use of well-characterized clinical information of individual patient, we found that older patients with MM (≥ 65 years) had a higher risk of developing MPMST. Patients with MM and MPMST including male patients, aged ≥ 65 years and those with ISS stage III had a worse prognosis. The top three solid cancers occurred before and after MM were the lung, thyroid, and breast cancer. These findings provide detailed information for the precise treatment of patients with MM and MPMST. To analyze the effects of MPMST on MM and the risk difference of MPMSTs occurring before and after MM. Retrospective data from patients with MM and MPMST, including sex, age, immunoglobulin isotype, ISS stage, and therapy, were collected from 2015 to 2023. Differences in variables, risk, and survival were compared using the test, logistic regression analysis and the Cox model, respectively. The 34 (1.57%) patients with MM and MPMST identified from a total of 2167 MM patients had a shorter overall survival. The survival risk was higher in male patients with MM and MPMST (HR: 3.96, 95% CI: 1.05 -14.96), in those aged ≥ 65 years (HR: 3.30, 95% CI: 1.41 -7.71), and with ISS stage III (HR: 4.08, 95% CI: 0.81-20.65). Patients with MM subsequent to CAR-T cell therapy had neither enhanced incidence rates of second solid cancers nor had longer overall survival time. Furthermore, the top three solid cancers occurred before or after MM were lung, thyroid, and breast cancer. Male patients, aged ≥ 65 years and MM patients with ISS stage III and MPMST had a worse prognosis.

The study focuses on the T-shaped tunnel scenario with protective doors, performs explosion tests using aluminized explosives, and investigates the propagation patterns and loading characteristics of explosion shock waves in the straight tunnel, at the T-shaped junction, and within the semi-enclosed space in front of the protective door. It was observed that, in comparison to TNT explosives, the overpressure curve of aluminized explosives in the near-explosion zone exhibited a two- batch characteristic. The second batch presented the maximum overpressure peak. In contrast, in the far zone, the curve displayed a stable triangular waveform. In the main tunnel of the T-shaped opening with protective doors, it was found that the back blast surface located in front of the entrance to the main tunnel experienced the maximum momentum, which could be as high as 12 times greater than that of the reflection area on the blast-facing surface at the entrance of the main tunnel and the shock-wave pressure wave pattern can be divided into four batch. The regularities of each measurement point in multiple tests show consistency, highlighting the influence laws of the geometric structure on the wave pattern and load distribution. In addition, this paper integrates LS-DYNA numerical simulation with aerodynamics theory to reveal that shock waves generate expansion waves and oblique shock waves as they pass through the T-shaped opening. After two reflections off the main tunnel wall and the door, a stable propagation waveform is established. In addition, through dimensional analysis and in combination with the experimental results, the momentum at key positions was analyzed and predicted. This study offers a reference for the design of relevant engineering protection measures.

Although chimeric antigen receptor T (CAR-T) cell therapy has been indicated to be effective in treating relapsed or refractory multiple myeloma (R/R MM), severe hematological toxicity (HT) remains an intractable issue. This study enrolled 54 patients with R/R MM following combined infusion of anti-CD19 and anti-BCMA CAR-T cells. The results showed that the rates of severe cytopenia were high, including severe neutropenia (28/54, 52%), severe anemia (15/54, 28%), and severe thrombocytopenia (18/54, 33%). Moreover, the incidence of prolonged HT (PHT) on Day 28 post-infusion was 52% (28/54), including 46% for severe neutropenia, 30% for severe anemia, and 31% for severe thrombocytopenia. Patients with PHT had a poorer median progression-free survival (PFS) and overall survival (OS) than patients without PHT ( P =0.011; P =0.007). Furthermore, Cox regression analyses showed that PHT was an independent risk factor for PFS and OS. Univariate analyses showed that IFNγ (OR: 1.046; 95% CI: 1.002-1.093, P =0.042) and severe HT after lymphodepletion chemotherapy (OR: 0.082; 95% CI: 0.017-0.404; P =0.002) were independent risk factors for PHT. In conclusion, these results indicated that PHT was associated with poor outcomes following CAR-T-cell therapy in MM patients. Early detection and management of PHT would be beneficial for the prevention of life-threatening complications and improvement in the survival of patients after CAR-T-cell therapy.

Promoting safe behaviors among construction workers and mitigating unsafe behaviors is an effective approach to enhancing safety performance in the construction industry. Although progress has been made, the research themes concerning construction workers’ safety-related behaviors (CWSRB) and the detailed progress of each theme remain unclear due to differences in review perspectives and conceptual scopes. This study utilized CiteSpace software (V6.2R3 version) to conduct an analysis of co-authorship networks, co-word networks, and co-citations on 563 published articles in this field from 2013 to 2023. This study’s outcomes highlight several key insights: (1) journals such as Safety Science play a pivotal role in the domain; (2) institutions such as the City University of Hong Kong and Hong Kong Polytechnic University, along with prolific authors like Li, are major contributors to the field; (3) the focus of research has evolved from early organizational factors towards a more diverse range of topics, with deep learning emerging as a significant current research hotspot; (4) this study has identified high-cited literature and 11 primary clusters within the field. Current research focuses on five areas: safety-related behavior concepts, influencing factors and consequences, formation mechanisms, interventions, and applications of new technologies. Establishing clear classification criteria for unsafe behaviors, comprehensively understanding the formation mechanisms of safety-related behaviors, evaluating the effectiveness of intervention strategies, and exploring the practical applications of new technologies are future research directions. This study provides researchers with a holistic view of the present state of research and potential avenues for future exploration, thereby deepening the knowledge and comprehension of stakeholders within this domain.

The sustainable development of China’s economy and society has been restricted by energy and environmental issues. With the implementation of the Rise of Central China strategy, Henan, a populous province in China, is facing the threat of an energy shortage as its economy grows steadily and the urbanization process accelerates. Using panel data of 18 cities in Henan Province for the period of 2006–2018, this study investigates the relationship between energy consumption and economic and social development variables based on the extended Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model and threshold regression method. The empirical results indicate that economic and social development are significantly positively correlated with total electricity consumption, although there is regional heterogeneity in this relationship. Moreover, there is evidence for a nonlinear relationship between economic and social development and urban energy consumption. These conclusions not only promote the healthy and sustainable economic development of Henan Province but also provide a reference for other provinces and cities that are experiencing rapid development in China.

BackgroundGlucocorticoids (GCs) are often used to treat cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The effects of GCs on the efficacy of CAR-T cell treatment in relapsed/refractory multiple myeloma (RRMM) have not been fully established. We evaluated the impact of GCs on clinical outcomes of RRMM patients treated with CAR-T cells.MethodsThis study involved RRMM patients treated with CAR-T cells at our center between June 2017 and December 2020. Patients were stratified into GC-used group (GC-group) and non-GC-used group (NGC-group). CRS or ICANS was graded on the basis of the American Society of Transplantation and Cellular Therapy consensus grading system. Response status was evaluated by the IMWG Uniform Response Criteria. The duration of response (DOR), progression-free survival (PFS), and overall survival (OS) were calculated.ResultA total of 71 patients were included in this study. In the NGC group (40 patients), 34 (85%) had responses to CAR-T cell therapy, including 16 (40%) stringent complete response (sCR), seven (17.5%) complete response (CR), five (12.5%) very good partial response (VGPR), and six (15%) partial response (PR). The overall response rate (ORR) and complete response rate (CRR) in the NGC group were 85% and 57.5%. In the GC group (31 patients), 29 (93.5%) had responses, including 11 (35.5%) sCR, nine (29%) CR, two (6.4%) VGPR, and seven (22.6%) PR. Differences in ORR and CRR between the two groups were insignificant. The dose, duration, and timing of GCs did not affect ORR and CRR. At a median follow-up of 28.2 months, the median PFS was 20.4 months (95% CI, 7.9 to 32.9) while the median OS was 36.6 months (95% CI, 25.9 to 47.2) for the GC group. The median PFS and OS for the NGC group were 13.7 months (95% CI, 8.8 to 18.6) and 27.5 months (95% CI, 14.1 to 41.0). There were no significant differences in either PFS or OS between the GC group and the NGC group. Differences in median DOR for the patients with CR or better in the GC group and NGC group were not significant ( p = 0.17). Earlier, prolonged use and high dose of GCs were not associated with any effects on either PFS or OS. Additionally, GCs had no effects on CAR-T cell proliferation.ConclusionAdministration of GCs, dose, timing, and duration does not influence the clinical efficacy of CAR-T cells in RRMM in this study.

Traffic engineering such as tunnels in various altitudinal gradient zone are at risk of accidental explosion, which can damage personnel and equipment. Accurate prediction of the distribution pattern of explosive loads and shock wave propagation process in semi-enclosed structures at various altitude environment is key research focus in the fields of explosion shock and fluid dynamics. The effect of altitude on the propagation of shock waves in tunnels was investigated by conducting explosion test and numerical simulation. Based on the experimental and numerical simulation results, a prediction model for the attenuation of the peak overpressure of tunnel shock waves at different altitudes was established. The results showed that the peak overpressure decreased at the same measurement points in the tunnel entrance under the high altitude condition. In contrast, an increase in altitude accelerated the propagation speed of the shock wave in the tunnel. The average error between the peak shock wave overpressure obtained using the overpressure prediction formula and the measured test data was less than 15%, the average error between the propagation velocity of shock waves predicted values and the test data is less than 10%. The method can effectively predict the overpressure attenuation of blast wave in tunnel at various altitudes. •Conducted tunnel explosion tests under low-temperature and low-pressure conditions.•The effect of plateau effect on the shock wave propagation process in tunnels was analyzed.•Calculation method of peak shock wave overpressure in tunnels at different altitudes is established.•Calculation method of shock wave propagation velocity in tunnels was established.

The construction industry is replete with significant safety risks, underscoring the necessity to comprehend the factors that shape workers’ safety behaviors for efficacious accident prevention. This study aims to investigate the impact of managers’ safety perception (MSP) on construction workers’ safety behaviors (WSBs), while also exploring the mediating roles of workers’ safety awareness (WSA) and workers’ safety competency (WSC). Utilizing a structural equation model (SEM), data were collected from 248 construction workers through a validated questionnaire. The findings indicate that MSP has a direct influence on WSBs (mean effect size = 0.065, p < 0.01) and an indirect effect on WSBs through enhanced WSA (effect size = 0.386, p < 0.01) and WSC (effect size = 0.392, p < 0.01). This research makes a contribution to the existing literature in several ways. First, it introduces a new measurement scale for MSP. Second, it highlights the direct and indirect effects on WSBs. Third, it emphasizes the importance of fostering safety awareness and competency among workers. In addition, the study offers practical implications for construction managers seeking to improve safety outcomes on-site.