Search Results (17,450)

Background/Objectives: Evidence-based nursing practice (EBNP) is essential in high-acuity settings such as intensive care units (ICUs) and emergency departments (EDs), where nurses are frequently required to make time-critical, high-stakes clinical decisions that directly influence patient safety and outcomes. Despite its recognized importance, the implementation of EBNP remains inconsistent, with frontline nurses often facing barriers to accessing and applying current evidence. Methods: This descriptive, cross-sectional study systematically mapped and prioritized clinical questions generated by ICU and ED nurses at a tertiary hospital in South Korea. Using open-ended questionnaires, 204 clinical questions were collected from 112 nurses. Each question was coded and classified according to the Nursing Interventions Classification (NIC) taxonomy (8th edition) through a structured cross-mapping methodology. Inter-rater reliability was assessed using Cohen’s kappa coefficient. Results: The majority of clinical questions (56.9%) were mapped to the Physiological: Complex domain, with infection control, ventilator management, and tissue perfusion management identified as the most frequent areas of inquiry. Patient safety was the second most common domain (21.6%). Notably, no clinical questions were mapped to the Family or Community domains, highlighting a gap in holistic and transitional care considerations. The mapping process demonstrated high inter-rater reliability (κ = 0.85, 95% CI: 0.80–0.89). Conclusions: Frontline nurses in high-acuity environments predominantly seek evidence related to complex physiological interventions and patient safety, while holistic and community-oriented care remain underrepresented in clinical inquiry. Utilizing the NIC taxonomy for systematic mapping establishes a reliable framework to identify evidence gaps and support targeted interventions in nursing practice. Regular protocol evaluation, alignment of continuing education with empirically identified priorities, and the integration of concise evidence summaries into clinical workflows are recommended to enhance EBNP implementation. Future research should expand to multicenter and interdisciplinary settings, incorporate advanced technologies such as artificial intelligence for automated mapping, and assess the long-term impact of evidence-based interventions on patient outcomes. Full article

Background/Objectives: Pneumatic dilation (PD) is a widely used treatment modality in the management of achalasia. It is particularly relevant in regions where many centers lack access to advanced therapeutic modalities. Therefore, we aimed to assess the effectiveness and safety of PD in our local region. Methods: This study retrospectively analyzed patients with achalasia that underwent PD from 1/2013 to 12/2019. The diagnosis of achalasia was established on the grounds of clinical symptoms, radiological and endoscopic findings, and esophageal manometry. Data on patient’s clinical characteristics, dilation technique and postprocedural follow-up were collected and statistically analyzed. Procedure effectiveness was defined as the postprocedural Eckardt score ≤ 3. Results: PD significantly reduced frequency of dysphagia, regurgitation, and retrosternal pain (p < 0.001). Body-weight increased significantly one month and one year after the procedure (p < 0.001). The procedural success rate was 100%. No severe complications were reported. Conclusions: PD is an effective and safe treatment modality in the management of achalasia. The study limitations include a single center design with the small number of participants, not all of whom underwent manometry, gender disproportion, absence of non-responders, and a short follow-up. Full article

Introduction/Objective: Post-bariatric surgery patients require long-term, coordinated care to address complex nutritional, physiological, and behavioral challenges. Personalized smart nutrition, combining individualized dietary strategies with targeted monitoring, has emerged as a valuable direction for optimizing recovery and long-term outcomes. This article examines how traditional medical protocols can be enhanced by digital solutions in a multidisciplinary framework. Methods: The study analyzes current clinical practices, including personalized meal planning, physical rehabilitation, biochemical marker monitoring, and psychological counseling, as applied in post-bariatric care. These established approaches are then analyzed in relation to the NutriMonitCare system, a digital health system developed and tested in a laboratory environment. Used here as an illustrative example, the NutriMonitCare system demonstrates the potential of digital tools to support clinicians through real-time monitoring of dietary intake, activity levels, and physiological parameters. Results: Findings emphasize that medical protocols remain the cornerstone of post-surgical management, while digital tools may provide added value by enhancing data availability, supporting individualized decision making, and reinforcing patient adherence. Systems like the NutriMonitCare system could be integrated into interdisciplinary care models to refine nutrition-focused interventions and improve communication across care teams. However, their clinical utility remains theoretical at this stage and requires further validation. Conclusions: In conclusion, the integration of digital health tools with conventional post-operative care has the potential to advance personalized smart nutrition. Future research should focus on clinical evaluation, real-world testing, and ethical implementation of such technologies into established medical workflows to ensure both efficacy and patient safety. Full article

Demand Side Management (DSM) plays a crucial role in modern energy systems, enabling more efficient use of energy resources and contributing to the sustainability of the power grid. This study examines DSM strategies within a multi-environment context encompassing residential, commercial, and industrial sectors, with a focus on diverse appliance types that exhibit distinct operational characteristics and user preferences. Initially, a single-objective optimization approach using Genetic Algorithms (GAs) is employed to minimize the total energy cost under a real Time-of-Use (ToU) pricing scheme. This heuristic method allows for the effective scheduling of appliance operations while factoring in their unique characteristics such as power consumption, usage duration, and user-defined operational flexibility. This study extends the optimization problem to a multi-objective framework that incorporates the minimization of CO₂ emissions under a real annual energy mix while also accounting for user discomfort. The Non-dominated Sorting Genetic Algorithm II (NSGA-II) is utilized for this purpose, providing a Pareto-optimal set of solutions that balances these competing objectives. The inclusion of multiple objectives ensures a comprehensive assessment of DSM strategies, aiming to reduce environmental impact and enhance user satisfaction. Additionally, this study monitors the Peak-to-Average Ratio (PAR) to evaluate the impact of DSM strategies on load balancing and grid stability. It also analyzes the impact of considering different periods of the year with the associated ToU hourly schedule and CO₂ emissions hourly profile. A key innovation of this research is the integration of detailed, category-specific metrics that enable the disaggregation of costs, emissions, and user discomfort across residential, commercial, and industrial appliances. This granularity enables stakeholders to implement tailored strategies that align with specific operational goals and regulatory compliance. Also, the emphasis on a user discomfort indicator allows us to explore the flexibility available in such DSM mechanisms. The results demonstrate the effectiveness of the proposed multi-objective optimization approach in achieving significant cost savings that may reach 20% for industrial applications, while the order of magnitude of the trade-offs involved in terms of emissions reduction, improvement in discomfort, and PAR reduction is quantified for different frameworks. The outcomes not only underscore the efficacy of applying advanced optimization frameworks to real-world problems but also point to pathways for future research in smart energy management. This comprehensive analysis highlights the potential of advanced DSM techniques to enhance the sustainability and resilience of energy systems while also offering valuable policy implications. Full article

Integrated hydrological modeling plays a crucial role in advancing sustainable water resource management, particularly in regions facing seasonal and extreme precipitation events. However, comprehensive studies that assess hydrological variability in temperate river basins remain limited. This study addresses this gap by evaluating the performance of the Soil and Water Assessment Tool (SWAT) in simulating streamflow, water balance, and seasonal hydrological dynamics in the Chikugo River Basin, Kyushu Island, Japan. The basin, originating from Mount Aso and draining into the Ariake Sea, is subject to frequent typhoons and intense rainfall, making it a critical case for sustainable water governance. Using the Sequential Uncertainty Fitting Version 2 (SUFI-2) approach, we calibrated the SWAT model over the period 20072–2021. Water balance analysis revealed that baseflow plays dominant roles in basin hydrology which is essential for agricultural and domestic water needs by providing a stable groundwater contribution despite increasing precipitation and varying water demand. These findings contribute to a deeper understanding of hydrological behavior in temperate catchments and offer a scientific foundation for sustainable water allocation, planning, and climate resilience strategies. Full article

The growing need for secure and privacy-preserving identity management in industrial environments has exposed the limitations of traditional, centralized authentication systems. In this context, SIBERIA was developed as a modular solution that empowers users to control their own digital identities, while ensuring robust protection of critical services. The system is designed in alignment with European standards and regulations, including EBSI, eIDAS 2.0, and the GDPR. SIBERIA integrates a Self-Sovereign Identity (SSI) framework with a decentralized blockchain-based infrastructure for the issuance and verification of Verifiable Credentials (VCs). It incorporates multi-factor authentication by combining a voice biometric module, enhanced with spoofing-aware techniques to detect synthetic or replayed audio, and a behavioral biometrics module that provides continuous authentication by monitoring user interaction patterns. The system enables secure and user-centric identity management in industrial contexts, ensuring high resistance to impersonation and credential theft while maintaining regulatory compliance. SIBERIA demonstrates that it is possible to achieve both strong security and user autonomy in digital identity systems by leveraging decentralized technologies and advanced biometric verification methods. Full article

Smart cities are technologically advanced urban environments where interconnected systems and data-driven technologies enhance public service delivery and quality of life. These cities rely on information and communication technologies, the Internet of Things, big data, cloud computing, and other Industry 4.0 tools to support efficient city management and foster citizen engagement. Often referred to as digital cities, they integrate intelligent infrastructures and real-time data analytics to improve mobility, security, and sustainability. Ubiquitous sensors, paired with Artificial Intelligence, enable cities to monitor infrastructure, respond to residents’ needs, and optimize urban conditions dynamically. Given the increasing significance of Industry 4.0 in urban development, this study adopts a bibliometric approach to systematically review the application of these technologies within smart cities. Utilizing major academic databases such as Scopus and Web of Science the research aims to identify the primary Industry 4.0 technologies implemented in smart cities, assess their impact on infrastructure, economic systems, and urban communities, and explore the challenges and benefits associated with their integration. The bibliometric analysis included publications from 2016 to 2023, since the emergence of urban researchers’ interest in the technologies of the new industrial revolution. The task is to contribute to a deeper understanding of how smart cities evolve through the adoption of advanced technological frameworks. Research indicates that IoT and AI are the most commonly used tools in urban spaces, particularly in smart mobility and smart environments. Full article

Prognostic and Health Management (PHM) strategies are gaining increasingly more traction in almost every field of engineering, offering stakeholders advanced capabilities in system monitoring, anomaly detection, and predictive maintenance. Primary flight control actuators are safety-critical elements within aircraft flight control systems (FCSs), and currently, they are mainly based on Electro-Hydraulic Actuators (EHAs) or Electro-Hydrostatic Actuators (EHSAs). Despite the widespread diffusion of PHM methodologies, the application of these technologies for EHAs is still somewhat limited, and the available information is often restricted to the industrial sector. To fill this gap, this paper provides an in-depth analysis of state-of-the-art EHA PHM strategies for aerospace applications, as well as their limitations and further developments through a Systematic Literature Review (SLR). An objective and clear methodology, combined with the use of attractive and informative graphics, guides the reader towards a thorough investigation of the state of the art, as well as the challenges in the field that limit a wider implementation. It is deemed that the information presented in this review will be useful for new researchers and industry engineers as it provides indications for conducting research in this specific and still not very investigated sector. Full article

Effective building operation requires a careful balance between energy conservation and indoor environmental comfort. Although numerous methods have been developed to reduce energy consumption during the operational phase, their objectives and applications vary widely. However, the complexity of building energy management makes it challenging to identify the most suitable methods that simultaneously achieve both comfort and efficiency goals. Existing studies often lack a systematic framework that supports integrated decision-making under comfort constraints. This research aims to address this gap by proposing a decision-making tree for selecting energy conservation methods during building operation with an explicit consideration of indoor environmental comfort. A comprehensive literature review is conducted to identify four main energy-consuming components during building operation: the building envelope, HVAC systems, lighting systems, and plug loads and appliances. Three key comfort indicators—thermal comfort, lighting comfort, and air quality comfort—are defined, and energy conservation methods are categorized into three strategic groups: passive strategies, control optimization strategies, and behavioural intervention strategies. Each method is assessed using a defined set of evaluation criteria. Subsequently, a questionnaire survey is administered for the calibration of the decision tree, incorporating stakeholder preferences and expert judgement. The findings contribute to the advancement of understanding regarding the co-optimization of energy conservation and occupant comfort in building operations. Full article

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, with hypercholesterolemia identified as a major, but modifiable risk factor. This review serves as the second part of a comprehensive analysis of dyslipidemia management. The first installment laid the groundwork by detailing the key pathophysiological mechanisms of lipid metabolism, the development of atherosclerosis, major complications of hyperlipidemia, and the importance of cardiovascular risk assessment in therapeutic decision-making. It also examined non-pharmacological interventions and conventional therapies, with a detailed focus on statins and ezetimibe. Building upon that foundation, the present article focuses exclusively on emerging pharmacological therapies designed to overcome limitations of standard treatment. It explores the mechanisms, clinical applications, safety profiles, and pharmacogenetic aspects of novel agents such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (alirocumab, evolocumab), small interfering RNA (siRNA) therapy (inclisiran), adenosine triphosphate–citrate lyase (ACL) inhibitor (bempedoic acid), microsomal triglyceride transfer protein (MTP) inhibitor (lomitapide), and angiopoietin-like protein 3 (ANGPTL3) inhibitor (evinacumab). These agents offer targeted strategies for patients with high residual cardiovascular risk, familial hypercholesterolemia (FH), or statin intolerance. By integrating the latest advances in precision medicine, this review underscores the expanding therapeutic landscape in dyslipidemia management and the evolving potential for individualized care. Full article

Biofilms are structured microbial communities that pose significant challenges to food safety and quality within the food-processing industry. Their formation on equipment and surfaces enables persistent contamination, microbial resistance, and recurring outbreaks of foodborne illness. This review provides a comprehensive synthesis of current knowledge on biofilm formation mechanisms, genetic regulation, and the unique behavior of multi-species biofilms. The review evaluates modern detection and monitoring technologies, including PCR, biosensors, and advanced microscopy, and compares their effectiveness in industrial contexts. Real-world outbreak data and a global economic impact analysis underscore the urgency for more effective regulatory frameworks and sanitation innovations. The findings highlight the critical need for integrated, proactive biofilm management approaches to safeguard food safety, reduce public health risks, and minimize economic losses across global food sectors. Full article

Background/Objectives: Papillary thyroid microcarcinoma (MPTC), a subset of papillary thyroid carcinoma (PTC), is increasingly detected with advanced imaging. While most MPTCs are indolent, some exhibit aggressive behavior, complicating clinical management. The BRAF V600E mutation, common in PTC, is linked to aggressive features, and its allele frequency (AF) may serve as a biomarker for tumor aggressiveness. This study explored the association between BRAF V600E AF and aggressive histopathological features in MPTC. Methods: Data from 1 January 2016 to 23 December 2023 were retrieved from two McGill University teaching hospitals. Inclusion criteria comprised patients aged ≥ 18 years with thyroid nodules ≤ 1 cm, documented BRAF V600E mutation and AF results, and available surgical pathology reports. Tumor aggressiveness was defined as the presence of lymph node metastasis, aggressive histological subtype (tall cell, hobnail, columnar, solid/trabecular or diffuse sclerosing), extra thyroidal extension, or extensive lymphovascular extension. Associations were explored using t-tests. Results: Among 1564 records, 34 met the inclusion criteria and were included in analyses. The mean BRAF V600E AF was significantly higher in aggressive tumors (23.58) compared to non-aggressive tumors (13.73) (95% CI: −18.53 to −1.16, p = 0.03). Although not statistically significant, trends were observed for higher BRAF V600E AF in tumors with lymph node metastasis (mean AF: 25.4) compared to those without (mean AF: 16.67, p = 0.08). No significant difference was noted in BRAF V600E AF by histological subtype (mean AF for aggressive: 19.57; non-aggressive: 19.15, p = 0.94). Conclusions: Elevated BRAF V600E AF is associated with aggressive behavior in MPTC, highlighting its potential as a biomarker to inform treatment strategies. Larger studies are warranted to validate these findings and enhance clinical management of MPTC patients. Full article

This paper presents a comprehensive review of the environmentally friendly management and reutilization of electronic waste (e-waste) plastics in flexible pavement construction. The discussion begins with an overview of e-waste management challenges and outlines key recycling approaches for converting plastic waste into asphalt-compatible materials. This review then discusses the types of e-waste plastics used for asphalt modification, their incorporation methods, and compatibility challenges. Physical and chemical treatment techniques, including the use of free radical initiators, are then explored for improving dispersion and performance. Additionally, in situations where advanced pretreatment methods are not applicable due to cost, safety, or technical constraints, the application of alternative approaches, such as the use of low-cost complementary additives, is discussed as a practical solution to enhance compatibility and performance. Finally, the influence of e-waste plastics on the conventional and rheological properties of asphalt binders, as well as the performance of asphalt mixtures, is also evaluated. Findings indicate that e-waste plastics, when combined with appropriate pretreatment methods and complementary additives, can enhance workability, cold-weather cracking resistance, high-temperature anti-rutting performance, and resistance against moisture-induced damage while also offering environmental and economic benefits. This review highlights the potential of e-waste plastics as sustainable asphalt modifiers and provides insights across the full utilization pathway, from recovery to in-field performance. Full article

Marine biomass, particularly from waste streams, by-products, underutilized, invasive, or potential cultivable marine species, offers a sustainable source of high-value biopolymers such as collagen and chitin. These macromolecules have gained significant attention due to their biocompatibility, biodegradability, functional versatility, and broad applicability across health, food, wellness, and environmental fields. This review highlights recent advances in the uses of marine-derived collagen and chitin/chitosan. In alignment with the United Nations Sustainable Development Goals (SDGs), we analyze how these applications contribute to sustainability, particularly in SDGs related to responsible consumption and production, good health and well-being, and life below water. Furthermore, we contextualize the advancement of product development using marine collagen and chitin/chitosan within the European Union’s Blue bioeconomy strategies, highlighting trends in scientific research and technological innovation through bibliometric and patent data. Finally, the review addresses challenges facing the development of robust value chains for these marine biopolymers, including collaboration, regulatory hurdles, supply-chain constraints, policy and financial support, education and training, and the need for integrated marine resource management. The paper concludes with recommendations for fostering innovation and sustainability in the valorization of these marine resources. Full article

Lung cancer is one of the most common cancers and the leading cause of cancer-related death worldwide. Despite advancements, the overall survival rate for lung cancer remains between 10% and 20% in most countries. However, recent progress in diagnostic tools and therapeutic strategies has led to meaningful improvements in survival outcomes, highlighting the growing importance of personalized management based on accurate disease assessment. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has become essential in the management of lung cancer, serving as a key imaging modality for initial diagnosis, staging, treatment response assessment, and follow-up evaluation. Recent developments in radiomics and artificial intelligence (AI), including machine learning and deep learning, have revolutionized the analysis of complex imaging data, enhancing the diagnostic and predictive capabilities of FDG PET/CT in lung cancer. However, the limitations of FDG, including its low specificity for malignancy, have driven the development of novel oncologic radiotracers. One such target is fibroblast activation protein (FAP), a type II transmembrane glycoprotein that is overexpressed in activated cancer-associated fibroblasts within the tumor microenvironment of various epithelial cancers. As a result, FAP-targeted radiopharmaceuticals represent a novel theranostic approach, offering the potential to integrate PET imaging with radioligand therapy (RLT). In this review, we provide a comprehensive overview of FDG PET/CT in lung cancer, along with recent advances in AI. Additionally, we discuss FAP-targeted radiopharmaceuticals for PET imaging and their potential application in RLT for the personalized management of lung cancer. Full article