Search Results (996)

Electric vehicles are now a completely familiar part of the street scene. Their number is determined by many factors, one of the most significant of which is price. With the ever-increasing supply, it is becoming increasingly difficult for buyers to decide between different vehicles, as in many cases, there is a minimal difference between the two vehicles. A parameter influencing such a purchase is the vehicle’s range. Experience shows that in many cases the range given in the catalogue and the real, available range differ significantly. The available range changes dynamically while driving, typically showing a decreasing value. This research describes a range estimation model that takes into account driving habits and temperature conditions. Full article

Novel antidiabetic drugs introduced in the last decade have not only revolutionized the treatment of type 2 diabetes mellitus but have also changed our cardiovascular risk reduction strategy. Glucagon-like peptide-1 (GLP-1) receptor agonists reduce the risk of atherosclerotic diseases primarily through their complex anti-atherosclerotic effect due to their endothelial function-improving, anti-inflammatory, anti-thrombotic, and plaque-stabilizing effects. Sodium–glucose cotransporter 2 (SGLT2) inhibitors, on the other hand, have a favorable cardiovascular effect, mainly by increasing sodium excretion, reducing plasma volume, enhancing the use of ketone bodies as metabolic substrates in heart and kidney tissues, and reducing oxidative stress and uric acid serum levels. However, when using these two groups of drugs, important questions arise. What criteria should be used to decide on the administration of one or the other class of drugs? Which group of agents can be used more effectively to reduce our patients’ cardiovascular risk? What are the possible adverse effects? What can be gained by combining the two drugs? Our objective was to provide a current literature-based and comparative summary on the mechanisms of action, cardiovascular-risk-reducing efficacy, and safety profiles of these two drug classes, with an emphasis on identifying key factors influencing everyday clinical decision-making. Full article

Objectives: To our knowledge, no previous study has specifically investigated the impact of COVID-19 on the management of recurrent squamous cell carcinoma (HNSCC) of the upper aerodigestive tract. The aim was to investigate the impact of the COVID-19 pandemic on the adequacy of treatments decided upon in multidisciplinary team meetings (MTMs) and those actually administered to patients with recurrent tumors. Secondary objectives were to study the characteristics of this population and tumors, factors that may influence the mismatch between treatments decided upon and those administered, and treatment delays. Methods: A retrospective study conducted at a tertiary referral center included 80 patients with recurrent HNSCC diagnosed between 2019 and 2021. Results: Of the 80 patients, 19 (24%) received treatment that differed from the recommended treatment. In case of mismatching, treatments were mostly less invasive or palliative (32% of palliative treatments decides (n = 6) versus 64% of palliative treatments realized (n = 12)). No factors were identified that could explain the discrepancy between treatment decided and treatment administered. The study population was homogeneous over the 3 years, with the only difference being lower lymph node staging in 2020 (p = 0.002). The time to recurrence was longer (p < 0.001), and the time to treatment initiation was shorter during the pandemic and post-pandemic periods (p = 0.002). Conclusions: The COVID-19 pandemic did not appear to affect the consistency between treatment decisions made in MTM and the treatments ultimately delivered. The COVID-19 pandemic has enabled earlier treatment with less advanced staging in patients with recurrence. Full article

Traditions in connection with foods do not just refer to the kinds of food consumed, but also to the place and society they originated from and the ways the items to be consumed were obtained and prepared. There is a tendency to believe that what people ate in former times was more natural, nutritionally superior and generally healthier than what we include in our diets nowadays. Although this is true for some foods, it is not correct for all foods and one needs to be critical and accept that even in the past some, dangerously unhealthy and nutritionally deficient food items and diets existed and that in our modern society we avoid various foods for a variety of reasons. On the other hand, in addition to age-old methods to preserve foods and make them palatable, we developed new ways to increase the shelf life of our food products and learned to improve taste and quality of some of our foods. Some dishes and ingredients are used to highlight important occasions and commemorative events. This paper critically evaluates the nutritional and cultural significance of traditional foods and explores the factors influencing their acceptance or rejection among contemporary consumers. By re-evaluating the cultural and nutritional roles of traditional foods, this paper contributes to ongoing discussions on health, identity, and sustainability in the global food landscape. Moreover, it functions as a conceptual lens to help decide which of the traditional foods and beverages to keep, modify, or discard. Full article

The present study investigated how visual characteristics of a fire influence extinguisher use. Safety guidance indicates that occupants should consider situational aspects when deciding whether to use an extinguisher, such as fire characteristics. The visual fire cues of intensity, growth rate, and smoke thickness were systematically manipulated to examine the impact on judgments to intervene with an extinguisher. Participants (N = 135) viewed simulated fire scenes as part of an experiment and judged whether they could safely attempt to use an extinguisher. The results indicated that the participants were significantly less likely to attempt extinguisher use with greater fire intensity and thicker smoke. In contrast, variations in fire growth rate did not significantly affect participant decisions. These findings indicate that perceived fire intensity and smoke density are strong factors in extinguisher use decisions, while growth rate may not meaningfully influence occupant behavior. Understanding these perceptual factors can inform fire safety education and improve guidance on when extinguisher use is appropriate, potentially enhancing residential fire response outcomes. Full article

Autoimmune pulmonary alveolar proteinosis (aPAP) is characterized by the accumulation of phospholipids and surfactant proteins in the peripheral air spaces due to alveolar macrophage dysfunction caused by anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies (GMAb). Hypersensitivity pneumonitis (HP) is a granulomatous lung disease associated with GM-CSF. In this report, we evaluated serial changes in serum GMAb levels in a 67-year-old male current smoker with HP and aPAP and examined their correlation with HP disease activity. GMAb levels increased at HP onset and decreased after HP remission with oral prednisolone therapy. After the first remission, the patient experienced three relapses and remissions. Although GMAb levels were not evaluated for all HP relapses and remissions, GMAb levels increased at one relapse but decreased at two remissions induced by the oral prednisolone therapy. Pulmonary fibrosis progressed, and the patient died of pneumonia. GMAb was at its almost normal levels at 8 months before the onset of pneumonia. We hypothesized that GMAbs may have been induced to improve HP through neutralizing GM-CSF. Although the hypothesis needs to be confirmed in additional patients, serial measurement of GMAb may be useful for a better understanding of the pathophysiology and deciding the appropriate treatment for HP with aPAP. Full article

This research considers the production of Potassium Nitrate product, a water-soluble nitrogen–potassium (NK) fertilizer containing 13.7% nitrogen and 46% potassium oxide. Potassium Nitrate (NOP) is produced as a fertilizer grade. The current system incurred high energy consumption, elevated emissions of greenhouse gases, resource degradation, and excessive production costs. Consequently, this research aims to implement the four steps of Cleaner Production (CP) to assess the environmental impacts of Potassium Nitrate products and their main manufacturing processes, and identify the best solution that achieves environmental goals. Environmental assessment was then used to calculate the unit indicators for raw materials, energy, waste generation, product, and packaging. The results showed that the integrated indicator was 5.18, with the energy profile being the most influential factor. Solar thermal and photovoltaic (PV) cell systems were suggested to reduce the high consumption of heavy fuel oil (HFO), including a solar thermal system to support the steam boilers and photovoltaic cells to support the electrical generator. The two alternatives were assessed based on multiple criteria using feasibility analysis and the Analytical Hierarchical Process (AHP). The solar thermal system, comprising 250 evacuated tube collectors, was preferable and resulted in savings of HFO by 121 tons/year, which led to a reduction in gaseous emissions by 375.6 metric tons of CO₂ and 21.685 kg of N₂O per year. Such improvements can also result in significant cost reductions. In conclusion, applying the CP methodology supported decision-makers in deciding the best system to enhance energy efficiency and reduce environmental nuisance at NOP plants. Full article

Collagen hydrogels serve as biomimetic scaffolds that closely resemble the natural extracellular matrix, thus providing an ideal 3D biocompatible environment for cells. However, based on our previous experience, not all collagen isolates are capable of gelling, which appears to depend on the type, origin, species, age and sex of the source animal and the collagen isolation method applied. We therefore decided to evaluate porcine collagen-rich materials isolated from two different porcine genotypes applying two different specific isolation methods, and to analyse other main components, i.e., lipids and glycosaminoglycans, as well as amino acid composition and structural and morphological properties. While all the collagen isolates obtained were subjected to the gelling process, only one of them successfully gelled. In addition, the gelling ability of this isolate was confirmed repeatedly on collagens that were isolated from other pigs of the same porcine genotype. The results revealed that the gelling process proceeds via cooperation between the composition and the structure of the collagen isolate. With respect to the composition, one of the most important factors in terms of the success of the gelation process of collagen isolates concerns elevated glycosaminoglycan contents. The structural factors that characterise collagen isolates, i.e., cross-links (immature and mature) and their mutual ratio, as well as the presence of telopeptides, strongly impact the progress of the gelling process and the resulting character of the hydrogel structure. All these factors are influenced by the isolation procedure. Full article

We present some numerical results on piston and tilt detection by using the Young experiment with Genetic Algorithms (GAs). We have simulated the cophasing of a flat surface by following the experimental setup and the mathematical model for Optical Path Difference (OPD) in the Young experiment to characterize piston and tip–tilt misalignment images in the order of a few nanometers, considering diffraction effects and random noise of 5%. Thus, the best fitness obtained by the genetic algorithm is considered as a determining factor to decide a complete error measurement because the proposed algorithm is capable of extracting the values of piston and tilt separately, regardless of which error is present or both. As a result, we have developed a study on piston detection from (0.001, 10) mm with a tilt present in the same pattern from (0, $\lambda /2$) by using GAs embedded in a computational application. Full article

Background and Objectives: Complicated left-sided colonic diverticulitis is one of the important causes of hospital admissions and emergency surgery in industrialized societies and requires serious clinical decision-making processes for patient management. This study aims to evaluate the predictive role of albumin-based nutritional indices in deciding on surgical strategy (primary anastomosis vs. Hartmann procedure) in patients treated operatively for complicated left-sided colonic diverticulitis. Materials and Methods: This retrospective single-center study included 57 patients who were operatively treated for Hinchey stage III–IV diverticulitis between 2021 and 2024. Patients were divided into two groups according to surgical method: Hartmann procedure (n = 40) and primary anastomosis (n = 17). Prognostic Nutritional Index (PNI), Hemoglobin–Albumin–Lymphocyte–Platelet Score (HALP), CRP–Albumin–Lymphocyte (CALLY) Index, and Modified Glasgow Prognostic Score (mGPS) were evaluated as albumin-based nutritional indices in the preoperative period. Predictive parameters were determined using ROC analysis and multivariate logistic regression. Results: Albumin level, PNI, HALP, and CALLY scores were found to be significantly lower in the Hartmann procedure group. Additionally, the proportion of patients with mGPS score 2 was significantly higher in the Hartmann procedure group (57.5% vs. 5.9%; p < 0.001). In the ROC analysis, the cut-off value for the CALLY index was determined as 0.45 (AUC: 0.826). In multivariate analysis, albumin < 38.5 g/L (OR: 16.53), CALLY index < 0.45 (OR: 6.40), and systemic inflammatory response syndrome (SIRS) detection (OR: 12.98) were determined as independent factors predicting the Hartmann procedure. Conclusions: A low CALLY index was found to be independent predictors for the Hartmann procedure. The CALLY index, which reflects the inflammatory response, immune capacity and nutritional status, can assist surgeons in making objective, and individualized decisions by holistically evaluating the patient’s physiological status. Multicenter prospective studies are required to confirm the clinical validity of the findings. Full article

Neuromuscular hip dysplasia (NHD) is a common deformity in children with cerebral palsy (CP). Although some predictive factors of NHD are known, the prediction of NHD is in its infancy. We present a Clinical Decision Support System (CDSS) designed to calculate the probability of developing NHD in children with CP. The system utilizes an ensemble of three machine learning (ML) algorithms: Neural Network (NN), Support Vector Machine (SVM), and Logistic Regression (LR). The development and evaluation of the CDSS followed the DECIDE-AI guidelines for AI-driven clinical decision support tools. The ensemble was trained on a data series from 182 subjects. Inclusion criteria were age between 12 and 18 years and diagnosis of CP from two specialized units. Clinical and functional data were collected prospectively between 2005 and 2023, and then analyzed in a cross-sectional study. Accuracy and area under the receiver operating characteristic (AUROC) were calculated for each method. Best logistic regression scores highlighted history of previous orthopedic surgery (p = 0.001), poor motor function (p = 0.004), truncal tone disorder (p = 0.008), scoliosis (p = 0.031), number of affected limbs (p = 0.05), and epilepsy (p = 0.05) as predictors of NHD. Both accuracy and AUROC were highest for NN, 83.7% and 0.92, respectively. The novelty of this study lies in the development of an efficient Clinical Decision Support System (CDSS) prototype, specifically designed to predict future outcomes of neuromuscular hip dysplasia (NHD) in patients with cerebral palsy (CP) using clinical data. The proposed system, PredictMed-CDSS, demonstrated strong predictive performance for estimating the probability of NHD development in children with CP, with the highest accuracy achieved using neural networks (NN). PredictMed-CDSS has the potential to assist clinicians in anticipating the need for early interventions and preventive strategies in the management of NHD among CP patients. Full article

Operations management personnel emphasize the maintenance of workforce empowerment on the shop floor. This is made possible by implementing effective operations and human resource management practices. However, organizations are adept at controlling the workforce empowerment domain within operational scenarios. In the current industry revolution scenario, industry personnel often face failure due to a laggard mindset in the face of industry revolutions. There are higher possibilities of failure because of standardized operations controlling the shop floor. Organizations utilize well-established human resource concepts, including McClelland’s acquired needs theory, Herzberg’s two-factor theory, and Maslow’s hierarchy of needs, in order to enhance the workforce’s performance on the shop floor. Current SME individuals require fast-paced approaches for tracking the performance and idleness of a workforce in order to control them more efficiently in both flexible and transformational stages. The present study focuses on investigating the parameters and factors that contribute to workforce empowerment in an industrial revolution scenario. The present research is used to develop a framework utilizing operations and human resource management approaches in order to identify and address the issues responsible for deteriorating workforce contributions. The framework includes HRM and operations management practices, including Herzberg’s two-factor theory, Maslow’s theory, and lean and smart approaches. The developed framework contains four phases for achieving desired outcomes on the shop floor. The developed framework is validated by implementing it in a real-life electric vehicle manufacturing organization, where the human resources and operations team were exhausted and looking to resolve employee-related issues instantly and establish a sustainable work environment. The current industry is transforming from Industry 3.0 to Industry 4.0, and seeks future-ready innovations in operations, control, and monitoring of shop floor setups. The operations management and human resource management practices teams reviewed the results over the next three months after the implementation of the developed framework. The results revealed an improvement in workforce empowerment within the existing work environment, as evidenced by reductions in the number of absentees, resignations, transfer requests, and medical issues, by 30.35%, 94.44%, 95.65%, and 93.33%, respectively. A few studies have been conducted on workforce empowerment by controlling shop floor scenarios through modifications in operations and human resource management strategies. The results of this study can be used to fulfil manufacturers’ needs within confined constraints and provide guidelines for efficiently controlling workforce performance on the shop floor. Constraints refer to barriers that have been decided, including production time, working time, asset availability, resource availability, and organizational policy. The study proposes a decision-making plan for enhancing shop floor performance by providing suitable guidelines and an action plan, taking into account both workforce and operational performance. Full article

Anaerobic digestion (AD) has long been valued for producing a biogas–digestate pair, yet its profitability is tightening. Next-generation AD biorefineries now position syngas both as a supplementary feedstock and as a springboard to capture high-value intermediates, hydrogen (H₂) and volatile fatty acids (VFA). This review dissects how complex natural consortia “decide” between hydrogenogenesis and acetogenesis when CO, H₂, and CO₂ co-exist in the feedstocks, bridging molecular mechanisms with process-scale levers. The map of the bioenergetic contest between the biological water–gas shift reaction and Wood–Ljungdahl pathways is discussed, revealing how electron flow, thermodynamic thresholds, and enzyme inhibition dictate microbial “decision”. Kinetic evidence from pure and mixed cultures is integrated with practical operating factors (gas composition and pressure, pH–temperature spectrum, culture media composition, hydraulic retention time, and cell density), which can bias consortia toward the desired product. Full article

Discourses on breastfeeding extend beyond simple scientific evidence, framed within a dialogue between diverse sociocultural perspectives throughout history. Building on this premise, this article aims to explore, from the perspective of the sociology of deviance, the maternal experiences of women who choose not to breastfeed or cease breastfeeding within the hospital setting. To this end, this qualitative and phenomenological study was conducted, using semi-structured interviews with mothers in the municipality of Lorca who had decided not to breastfeed or had discontinued breastfeeding as a data collection tool. The results indicate that breastfeeding is influenced by the repercussions of delivery room routines and a challenging learning process where complications often arise, contradicting the prevailing innatist discourse of maternal instinct. Within this framework, mothers feel pressured by professionals to breastfeed, and their identities are undermined by symbolic stigma when they express their decision not to breastfeed. We conclude that it is essential to propose clinical approaches and support models that genuinely consider the sociocultural, historical, and experiential factors influencing breastfeeding, moving beyond an exclusive focus on its biological or nutritional aspects. Full article

When non-functioning pituitary adenomas (NFPAs) behave aggressively or recur after first-line surgical treatment, it can be challenging to decide whether and how to escalate therapy. Up to 47% of patients with residual tumor after transsphenoidal surgery will show disease recurrence or progression and may require an intervention. Repeat surgical resection can be attempted in select cases if the tumor is accessible; for the remainder of patients, non-surgical treatment options may need to be considered. Radiotherapy can control tumor growth in 75% of NFPAs, but confers increased risk of hypopituitarism and other disorders. Currently, there are no medical therapies approved for patients with recurrent or aggressive NFPA. However, several have been investigated, including temozolomide, somatostatin receptor ligands, dopamine agonists, immune checkpoint inhibitors, vascular endothelial growth factor inhibitors, and peptide receptor radionuclide therapy. We present a review of the available evidence to provide guidance for pituitary endocrinologists and neuro-oncologists when treating patients with recurrent or aggressive NFPA. Full article