Search Results (1,114)

The energy and resource efficient operation of continuously operated large-scale chemical plants is an important factor in the transition towards a sustainable and green process industry. In this work, the operation of the heat exchangers in the diphenylmethane diisocyanate (MDI) process is optimized to reduce fouling and thereby increase their energy efficiency. Real-time optimization (RTO) using Modifier Adaptation With Quadratic Approximation (MAWQA) is applied to cope with plant–model mismatch. It is combined with distributed estimation of the modifiers while retaining a centralized optimization to ensure rapid convergence. It reduces the data points needed for their computation and enables application to large-scale processes. The plant model that is used in the optimization is a surrogate of an available detailed flow-sheet simulator model. The algorithm is demonstrated first for a small problem and then applied to the operator training simulator (OTS) of the MDI process in several operation scenarios. Compared to previous work, the algorithm converges to the optimal operating conditions in fewer iterations. Full article

This case report describes four pediatric patients with severe, therapy-refractory ulcerative colitis (UC) and one pediatric patient with severe, therapy-refractory Crohn’s disease (CD), all of whom failed widely used biologic therapies, including the approved treatments infliximab and adalimumab, as well as off-label use of vedolizumab and ustekinumab. Despite these first- and second-line interventions, patients’ diseases remained active. Following the initiation of upadacitinib, an off-label Janus kinase (JAK) inhibitor with positive results in adult UC and CD patients, four children experienced rapid symptom improvement and achieved clinical remission. The rising incidence of pediatric inflammatory bowel disease (IBD) and the limited number of approved therapies underscore the need for additional treatment options in pediatric gastroenterology. Infliximab remains one of the only biologic therapies approved for pediatric UC and CD, forcing clinicians to rely on off-label medications, such as vedolizumab, ustekinumab, and upadacitinib, when standard treatments fail. To address this gap, it is crucial to include pediatric patients in clinical trials of new therapies, expanding the range of approved medications and improving outcomes for children with IBD. Full article

Latvia faces one of the lowest nurse-to-population ratios in the EU, resulting in critical staff shortages in intensive care units (ICUs). Nurses frequently care for more patients than recommended, which not only compromises patient safety but also places heavy psycho-emotional burdens on staff. The aim of this study was to examine organizational-level relationships between objectively measured ICU nursing workload and subjectively reported psycho-emotional outcomes, including moral distress, burnout, and intention to leave one’s job. A secondary analysis combined data from two cross-sectional studies conducted in 2025. Workload was measured using 3420 Nursing Activities Score (NAS) protocols from three hospitals, while 155 ICU nurses from 16 units completed validated instruments assessing moral distress, burnout, and turnover intentions. The findings revealed persistent nurse shortages, with one ICU showing deficits exceeding 70% and mean NASs above 100 points per nurse per shift. Nurses reported moderate moral distress, particularly in situations of unsafe patient ratios and aggressive treatment, while burnout levels were moderate to high, especially in personal and work-related dimensions. About one-quarter of respondents were actively considering leaving their jobs. Moral distress significantly correlated with burnout (r = 0.357, p < 0.001), and organizational-level comparison indicated that higher workload was associated with greater emotional strain. These results not only highlight urgent national challenges but also resonate with international evidence on the link between unsafe staffing, moral distress, and workforce sustainability. Implementing systematic workload monitoring, safe staffing ratios, and structured support mechanisms is essential to safeguard ICU nurses’ well-being, reduce turnover, and protect patient safety in both Latvian and global contexts. Full article

Bioregions are examples of true sustainable development. The desire for sustainability within local communities leads to agreements and the formation of bioregions in which sustainable development is based on practical action. This paper analyzes the concept of bioregions, emphasizing holistic approaches applied to, and relationships with, economic, environmental and social factors in pathways and the pace of specialization for the development of territories, thereby complementing the agricultural dimension and paying special attention to the application of organic farming techniques. The formation of bioregions is based on the desires of local communities, but at the same time, we believe that there are objective factors that influence the development of bioregions. Thirteen factors that could affect the creation of bioregions were selected using factors referred to in research papers, as well as by adding original ones. These factors can be divided into the sustainable agriculture and tourism groups, in which high values indicate a high potential for the formation of bioregions, as well as the intensive agriculture factor group, where high values indicate the benefits of large-scale economies that hinder the formation of bioregions. Cluster analysis identified six potential bioregions in Latvia, each with distinct socio-economic, environmental, and agricultural characteristics: the metropolitan region (dominant indicator-PIT per capita, value 890 EUR), the tourism cluster (dominant indicator—tourists served as a % of the total population, value 28%), the extensive agriculture cluster (dominant indicator—organically certified UAA, value 14,645 ha), the nature and education cluster (dominant indicator—protected areas, value 7587 ha), the intensive agriculture cluster (dominant indicator—profit from productive land, value 278 EUR ha⁻¹), as well as a non-specialized cluster (no strongly dominant indicators). This paper describes each cluster and discusses its potential for bioregion development. Full article

This study aims to answer the research question what are the characteristics of existing institutional governance factors within Lithuanian coastal municipalities that lead to the establishment of a common aim of sustainable development across different coastal municipalities. The method employed includes a systematic academic literature review and document analysis. The data collected were coded according to predefined themes and sub-themes, facilitating the determination of extent to which institutional factors influencing the public governance of sustainable development are integrated into the structures and credentials of municipalities. The findings reveal that while some municipalities incorporate sustainability into their vision and strategic plans, there is a general lack of dedicated policies and accountability for sustainable development. The absence of a dedicated unit or responsible employee for sustainable development implementation further fragments the approach to addressing these issues. Communication methods and public engagement vary, impacting the effectiveness of sustainable development initiatives. This study concludes that meta-governance serves as a unifying factor in public governance coordination among municipalities. To foster sustainable development in Lithuanian coastal cities, recommendations for policymakers are provided to increase transparency and civic trust, lead initiatives, and enhance dialogue through regional stakeholder forums or digital platforms for the co-creation of solutions across coastal municipalities. Full article

In December 2023, the World Health Organization reported an Australian nosocomial Ralstonia pickettii outbreak caused by contaminated saline solutions, causing bloodstream infections. The Antibiotic Resistance Surveillance, a Germany-wide laboratory network, has identified five R. pickettii-bacteraemia cases since August 2023 (0–1 annually 2019–2022), prompting an outbreak investigation to identify the source. We defined a case as a person with R. pickettii in any material (possible) or in blood culture (probable), confirmed if in the genetic outbreak cluster. We implemented nationwide R. pickettii surveillance, subjected isolates to core genome multilocus sequence typing, and compared cases by exposure, including medical products. From August 2023 to June 2024, we detected 25 cases. For eighteen cases, isolates were available, and sequences from six cases clustered within 6 allelic differences but showed >43 allelic differences from Australian outbreak-associated sequences. These confirmed cases occurred in three hospitals across three federal states between October 2023 and March 2024, linked only by saline solution exposure. Four products and 11 lots matched across two of three hospitals. Retain sample testing remained negative. The R. pickettii outbreak in Germany was likely linked to saline solutions, although no product/lot was confirmed. Tracing products/lots was particularly challenging. Patient-level documentation of medical products/lots and official mandates for the testing of retained samples could improve product traceback in future outbreaks. Full article

Studies spanning decades provide important information about the epidemiology and occurrence of a broad range of diseases that affect the central nervous system (CNS) of dogs. This study analyzed records and formalin-fixed paraffin-embedded (FFPE) CNS tissue samples from necropsied dogs with neuropathologic changes between 1962 and 2022. A total of 134,854 animals, including 20,117 dogs, were submitted for necropsy during this time span. Of these dogs, 2646 displayed alterations of the CNS. Degenerative and non-suppurative inflammatory lesions were the most common changes, accounting for 35.6% and 28.6%, respectively. Vascular diseases, neoplasms, congenital malformations, and suppurative inflammation represented 13.8%, 8.6%, 7.2%, and 5.4% of cases, respectively. Morbillivirus canis, the agent of canine distemper, was the most commonly diagnosed. The second most commonly detected virus, varicellovirus suidalpha1, the agent of pseudorabies, occurred almost exclusively between the mid-1970s and 1990s. Other pathogens, including Lyssavirus rabies, canine herpes virus, tick-borne encephalitis virus, apicomplexan parasites, such as Neospora caninum and Toxoplasma gondii, as well as fungal and other parasitic infections, were less frequently diagnosed. Interestingly, 47.6% of cases with non-suppurative inflammation remained etiologically undetermined. This study provides insights into the epidemiology of canine neurotropic infections and shows the value of FFPE material for investigations of past disease outbreaks. Full article

Background/Objectives: Neuropathic pain, resulting from damage or pathology affecting the somatosensory nervous system, is a prevalent form of chronic pain that significantly impacts quality of life. Combined therapies are often utilised to manage this condition. Three-dimensional printing (3DP) offers a promising approach for personalising medication doses and dosage forms to meet individual patient needs. Methods: In this study, a formulation suitable for 3D printing was developed using magnesium citrate, uridine monophosphate, vitamins B₃ (niacin), B₆ (pyridoxine), B₁₂ (cobalamin), B₉ (folic acid), and spermidine to create a novel gel-based oral tablet for the targeted treatment of neurological pain. The antioxidant potential of the active pharmaceutical ingredients (APIs) was assessed using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) methods. The physical properties of the tablets were evaluated using a texture analyser, while the in vitro release profiles were determined by high-performance liquid chromatography (HPLC). Results: Results demonstrated that pectin–gelatin tablets hardened over time, with higher citric acid concentrations further enhancing this effect. Formulation AVII exhibited good hardness and low stickiness. Formulation AV, however, showed poor performance across all physical parameters and lacked sufficient structural integrity for practical application. While uridine monophosphate, B₁₂, and B₉ showed no significant differences in the release profiles of the tablets, spermidine, B₆, and B₃ displayed statistically significant variations. Specifically, AVII outperformed AV in terms of spermidine and B₆ release, and AV showed a higher release of B₃ compared to AV. Conclusions: The AVII tablet demonstrates potential for use in combined therapy targeting neurological pain disorders. Full article

Energy policies and economies of scale have promoted the expansion of renewable energy sources, leading to the displacement of conventional generation units and a consequent reduction in system inertia. Low inertia amplifies frequency deviations in response to generation–load imbalances, increasing the risk of load shedding and service interruptions. To address this issue, this paper proposes a coordinated control strategy based on neuro-fuzzy networks, applied to a hybrid energy storage system (HESS) composed of batteries and supercapacitors. The controller is designed to simultaneously emulate virtual inertia and implement virtual droop control, thereby improving frequency stability and reducing reliance on spinning reserve. Additionally, a state-of-charge (SOC) management layer is integrated to prevent battery operation in critical zones, mitigating degradation and extending battery lifespan. The neuro-fuzzy controller dynamically coordinates the power exchange both among the energy storage technologies (batteries and supercapacitors) and between the HESS and the conventional generation unit, enabling a smooth and efficient transition in response to power imbalances. The proposed strategy was validated through simulations in MATLAB R2022b using a two-area power system model with parameters sourced from the literature and validated references. System performance was evaluated using standard frequency response metrics, including performance indicators (ITSE, ISE, ITAE and IAE) and the frequency nadir, demonstrating the effectiveness of the approach in enhancing frequency regulation and ensuring the operational safety of the energy storage system. Full article

Background and Objectives: This systematic review and meta-analysis aimed to evaluate the efficacy of xenogeneic collagen matrix (XCM) in combination with a coronally advanced flap (CAF) in the management of multiple gingival recessions and to compare its outcomes with those achieved using the conventional connective tissue graft (CTG) + CAF approach. Materials and Methods: After searching and reviewing the literature in the electronic databases PubMed/PMC, Google Scholar, ScienceDirect, Cochrane Library, and LILACS, 601 publications were found. The titles and abstracts of 543 publications were screened. After evaluating the full text of 290 publications, based on the inclusion criteria, four randomized controlled clinical trials were included in the systematic review and meta-analysis. In all the studies, the test group was treated with XCM + CAF, whereas in the control group, CTG + CAF was used. Results: Clinical attachment level (CAL), gingival recession depth (GR), keratinized tissue width (KTW), and complete root coverage (CRC) statistically significantly (p < 0.05) improved in both groups in all of the studies. Inter-group comparison showed better results in the control group in individual studies. All clinical trials reported a statistically significant (p < 0.05) decrease in surgery time and less postoperative pain in the test group. The meta-analysis of KTW (−0.438 [95% CI, −0.714 to −0.163], p < 0.002) and GR (0.35 [95% CI, 0.098 to 0.602], p < 0.001) showed a significant difference between the test and the control groups in all of the studies. CAL (0.78 [95% CI, −0.305 to 0.461], p > 0.05) showed no statistically significant difference between test and control groups. Conclusions: CTG + CAF remains the gold standard in root coverage procedures. However, XCM offers a less invasive alternative with improved patient comfort, less postoperative pain, shorter surgical time, and acceptable clinical outcomes. Full article

Healthcare systems worldwide face growing challenges related to staff shortages, excessive workload, and deteriorating working conditions, which compromise both staff well-being and care quality. Despite these issues, there is a lack of validated tools that capture healthcare professionals’ subjective perceptions of resource adequacy. This study presents the development and initial validation of the Staff Resource Adequacy Questionnaire for Healthcare Professionals (SRAQ-HP), a multidimensional tool designed to assess staffing adequacy and workload, quality of care, and working conditions and support. The development process followed a mixed-methods design, incorporating theoretical foundations from Kanter’s empowerment theory, role enactment models, and professional competence frameworks. The initial item pool of 32 statements was reduced to 26 through expert reviews, focus groups, and pilot testing (n = 35). Content validity index (CVI = 0.931) and face validity index (FVI = 0.976) demonstrated high content relevance and clarity. Cronbach’s alpha for the full scale was 0.841, confirming internal consistency. Expert re-review confirmed strong content (S-CVI/Ave = 0.931) and face validity (FVI = 0.976) for the final 26-item version. Three core dimensions were retained: Staffing Adequacy and Workload, Quality of Care, and Working Conditions and Support. The SRAQ-HP provides a novel, evidence-based approach to systematically assess workforce sufficiency and support structures in clinical settings. It can guide decision-making in healthcare institutions and inform national workforce policies. Further research with larger and more diverse samples is needed to confirm its factorial validity and practical applicability. Full article

Hybrid organic–inorganic materials incorporating high-Z nanocompounds represent an emerging area of research with high, cost-effective potential for radiation detection applications, owing to their ability to enable unprecedented architectures and functional devices. Herein, we introduce a new hybrid system composed of tungstate nanoparticles (SrWO₄ or CdWO₄) blended with P3HT:PCBM, engineered for direct X-ray detection without the need for external bias. The nanocrystalline tungstates were synthesized through a hydrothermal route. X-ray diffraction and scanning electron microscopy were employed to characterize the nanoparticle structure and morphology, respectively. Incorporation of high-Z tungstate nanoparticles was found to substantially enhance detector sensitivity within specific energy ranges, with performance tunable by varying the tungstate composition. The use of the fabricated detectors was demonstrated for both spectroscopic and imaging applications. Full article

This study examines the transformative effects of gamification and active learning strategies in inclusive education, with a specific focus on students with disabilities. The objective was to explore how these methodologies can improve participation, motivation, and accessibility in post-pandemic educational contexts, where virtuality has become more relevant. A descriptive methodological approach was employed, consisting of three phases: data collection through surveys, analysis of results using descriptive statistics, and comparison with previous studies. The population consisted of 111 Ecuadorian teachers from different educational levels. The findings indicate that teachers between the ages of 31 and 35 are most likely to implement gamification, particularly in virtual environments. Barriers such as poor training and technological limitations were identified. It was concluded that gamification is an effective pedagogical tool for promoting inclusion, provided it receives institutional support and is tailored to individual needs. These results support the need to promote educational policies that strengthen teaching innovation in favor of a more equitable education. The findings should be interpreted with caution, as the study relied on a single-country sample of Ecuadorian teachers, which restricts the generalizability of results. Nevertheless, the outcomes suggest promising directions for future research, particularly through the application of multivariate analyses and longitudinal intervention studies to assess the sustained effects of gamification on inclusive education. Full article

Background: Persistent fatigue is among the most commonly reported symptoms in patients suffering from post-acute sequelae of SARS-CoV-2 infection (long COVID). Autonomic dysfunction, measurable via heart rate variability, has been implicated as a contributing factor. Osteopathic manipulative treatment is a manual therapeutic approach that targets autonomic balance and may offer a novel intervention for long COVID-related fatigue. Methods: In this single-blind, randomized controlled trial, 42 participants (mean age 51 ± 11 years; fatigue severity score: 31 ± 5 points) with long COVID and persistent fatigue ≥12 weeks post-infection were allocated to either a 45 min standardized osteopathic treatment (n = 21) or a sham-treatment group (n = 21). Heart rate variability was assessed using a 10 min resting electrocardiogram before intervention, immediately after, and again 48 h later. The analysis of heart rate variability encompassed time-domain indices, including the root mean square of successive differences, the standard deviation of normal-to-normal intervals, mean heart rate, and mean RR interval. Additionally, frequency-domain measures such as low-frequency, high-frequency, total power, and the LF/HF ratio were considered. Results: The osteopathy group showed a statistically significant increase in root mean square of successive differences post-treatment (p < 0.01), accompanied by a decrease in the stress index (p < 0.05) and an increase in the mean of the standard deviations of RR intervals (p < 0.05). Significant between-group differences were observed for mean heart rate and mean of RR intervals (p < 0.05). Frequency-domain measures also improved significantly from baseline in the intervention group. Outlier patterns suggest potential subgroup effects, possibly due to underlying dysautonomia. Conclusions: A single session of osteopathic treatment significantly enhanced short-term heart rate variability in long COVID patients with fatigue. These findings highlight the potential role of manual autonomic modulation as a supportive therapy in long COVID management. Further research is needed to assess the long-term effects and optimal treatment frequency of osteopathic manipulative treatment in this population. Full article

Erythrina edulis, commonly known as pajuro, is a large leguminous plant native to the Amazon region of Peru. Its seeds are valued for their high protein content and their potential to enhance food security in rural communities. However, the current methods of harvesting and sorting are entirely manual, making the process labor-intensive, time-consuming, and subject to high variability, particularly in industrial contexts. A custom lightweight convolutional neural network (CNN) was developed from scratch and optimized specifically for real-time execution on embedded hardware. The model employs ReLU activation, Adam optimization, and a SoftMax output layer to enable efficient and accurate classification. The system employs a fixed-region segmentation strategy to prevent overcounting and utilizes GPIO-based control on a Raspberry Pi 5 to synchronize seed classification with physical sorting in real time. Seeds identified as defective are automatically removed via a servo-controlled ejection mechanism. The integrated system combines object detection, image processing, and real-time actuation, achieving a classification accuracy exceeding 99.6% and an average processing time of 12.4 milliseconds per seed. The proposed solution contributes to the industrial automation of pajuro sorting and provides a scalable framework for color-based grain classification applicable to a wide range of agricultural products. Full article