Search Results (3,639)

The fastest growth in electricity demand in the industrialized world will likely come from the broad adoption of artificial intelligence (AI)—accelerated by the rise of generative AI models such as OpenAI’s ChatGPT. The global “data center arms race” is driving up power demand and grid stress, which creates local and regional challenges because people in the area understand that the additional data center-related electricity demand is coming from faraway places, and they will have to support the additional infrastructure while not directly benefiting from it. So, there is an incentive for the data center operators to manage the fast and unpredictable power surges internally so that their loads appear like a constant baseload to the electricity grid. Such high-intensity and short-duration loads can be served by hybrid energy storage systems (HESSs) that combine multiple storage technologies operating across different timescales. This review presents an overview of energy storage technologies, their classifications, and recent performance data, with a focus on their applicability to AI-driven computing. Technical requirements of storage systems, such as fast response, long cycle life, low degradation under frequent micro-cycling, and high ramping capability—which are critical for sustainable and reliable data center operations—are discussed. Based on these requirements, this review identifies lithium titanate oxide (LTO) and lithium iron phosphate (LFP) batteries paired with supercapacitors, flywheels, or superconducting magnetic energy storage (SMES) as the most suitable HESS configurations for AI data centers. This review also proposes AI-specific evaluation criteria, defines key performance metrics, and provides semi-quantitative guidance on power–energy partitioning for HESSs in AI data centers. This review concludes by identifying key challenges, AI-specific research gaps, and future directions for integrating HESSs with on-site generation to optimally manage the high variability in the data center load and build sustainable, low-carbon, and intelligent AI data centers. Full article

Children with rare tumours and malformations may benefit from innovative imaging, including patient-specific 3D models that can enhance communication and surgical planning. The primary aim was to evaluate the impact of patient-specific 3D models on communication with families. The secondary aims were to assess their influence on medical management and to establish an efficient post-processing workflow. From 2021 to 2024, we prospectively included patients aged 3 months to 18 years with rare tumours or malformations. Families completed questionnaires before and after the presentation of a 3D model generated from MRI sequences, including peripheral nerve tractography. Treating physicians completed a separate questionnaire before surgical planning. Analyses were performed in R. Among 21 patients, diagnoses included 11 tumours, 8 malformations, 1 trauma, and 1 pancreatic pseudo-cyst. Likert scale responses showed improved family understanding after viewing the 3D model (mean score 3.94 to 4.67) and a high overall evaluation (mean 4.61). Physicians also rated the models positively. An efficient image post-processing workflow was defined. Although manual 3D reconstruction remains time-consuming, these preliminary results show that colourful, patient-specific 3D models substantially improve family communication and support clinical decision-making. They also highlight the need for supporting the development of MRI-based automated segmentation softwares using deep neural networks, which are clinically approved and usable in routine practice. Full article

This study investigates the crucial role energy leaders play in driving strategic energy management (SEM) and accelerating cost savings within a manufacturing organization and consequently, the industrial sector. Whereas energy efficiency can be seen as an innovative business practice with irrefutable cost benefits, its effective implementation requires strategic leadership and a structured approach. This research analyzes data collected from 120 participants representing 71 companies attending the Energy Bootcamp events organized by the U.S. Department of Energy’s (DOE) Better Plants program. The collected data focused on the state of SEM implementation, the presence and responsibilities of energy leaders, and the formation and function of energy teams. The findings reveal a significant gap between the perceived importance of SEM and its actual adoption, highlighting the need for strong leadership to drive behavioral changes by championing energy efficiency initiatives. Results indicate that effective energy leaders possess a diverse skill set, including the ability to secure top management buy-in, foster a culture of energy consciousness, and collaborate across departments. This study emphasizes the importance of empowering energy leaders with clearly defined roles and responsibilities as well as the authority to build and lead cross-functional energy teams. Furthermore, integrating energy management into existing organizational structures and leveraging readily available resources are identified as key factors for successful implementation. This research underscores how dedicated leadership and effective SEM practices help achieve industrial energy efficiency goals, providing practical insights for organizations seeking to improve performance and contribute to a resilient future. Full article

Background: Comprehensive genomic profiling (CGP) is a tool used in precision oncology to identify genomic alterations and match them with targeted therapies across several tumor types. However, real-world data on its clinical utility and impact remains limited. The FRONTAL study (Foundation Medicine Real wOrld evideNce in porTugAL) is a multicenter academic initiative that established a national registry of Portuguese patients with solid tumors who underwent CGP with FoundationOne CDx, Liquid CDx or FoundationOne Heme assays. Methods: Eligible patients had advanced solid tumors not suitable for curative treatment at the time of recruitment. Prior CGP testing was permitted if taken within 12 months before study initiation. Genomic profiling data were extracted from FoundationOne Medicine reports, and clinical information was extracted from medical records. Actionable alterations were defined as those associated with approved treatments or with clinical evidence of benefit in other cancers, per NCCN guidelines. Variant interpretation was also reviewed according to ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT) guidelines. The primary outcome was disease control at 16 weeks, defined by the absence of progression. Results: The study included 205 patients between 2020 and 2025 across 10 sites, with colorectal (40, 19.5%), sarcomas (28, 13.7%), and other gastrointestinal tumors (22, 10.7%) being the most common pathologies. Actionable alterations were identified in 104 cases (50.7%). Genomic findings guided therapy decisions in 50 patients (24.4%), of whom 30 achieved disease control at 16 weeks (14.6%). Conclusions: The FRONTAL study highlighted the clinical relevance of CGP in advanced solid tumors. Over half of the patients had actionable alterations, a quarter had therapy changes based on CGP results, and improved disease outcome was observed in approximately 15% of the cohort. Full article

Belatacept, a selective costimulation blocker targeting the CD28–CD80/86 pathway, represents a major innovation in solid organ transplantation immunosuppression. By providing upstream inhibition of T-cell activation without calcineurin inhibition, belatacept offers the potential for improved long-term graft and patient outcomes with reduced nephrotoxicity and metabolic adverse effects. This review summarizes the mechanistic rationale, pivotal evidence, and clinical experience supporting the use of belatacept as first-line or conversion therapy in solid organ transplantation, while addressing safety, pharmacoeconomic impact, and future research directions. A comprehensive analysis of pivotal phase II–III trials (BENEFIT, BENEFIT-EXT), recent prospective conversion studies, and ongoing trials in liver, heart, and lung transplantation was performed. Safety data and health–economic evaluations were critically appraised. In kidney transplantation, belatacept-based immunosuppression provides superior renal function and improved metabolic profiles compared with calcineurin inhibitors (CNIs), though with higher early acute rejection rates. In liver, heart, and lung transplantation, evidence remains limited, with de novo use contraindicated in liver grafts due to excess mortality and rejection. Conversion from CNI to belatacept in selected patients improves renal outcomes without compromising graft survival. Safety considerations include a higher risk of post-transplant lymphoproliferative disorder (PTLD) in Epstein–Barr virus-negative recipients. Belatacept represents a paradigm shift in transplant immunology by targeting upstream T-cell activation. While currently approved only for kidney transplantation, ongoing studies in thoracic and hepatic grafts may expand its therapeutic role. Personalized patient selection, combination regimens mitigating rejection risk, and real-world cost-effectiveness analyses will define its place in future precision immunosuppression strategies. Full article

This paper presents an experimental investigation of hydrogen enrichment effects on combustion behavior and exhaust emissions in a self-developed micro gas turbine fueled with a propane–butane mixture. Hydrogen was blended with the base fuel in volume fractions of 0–30%, and combustion was examined under unloaded operating conditions at three global equivalence ratios (ϕ = 0.7, 1.1, and 1.3). The global equivalence ratio (ϕ) is defined as the ratio of the actual fuel–air ratio to the corresponding stoichiometric fuel–air ratio, with ϕ < 1 representing lean, ϕ = 1 stoichiometric, and ϕ > 1 fuel-rich operating conditions. The micro gas turbine is based on an automotive turbocharger coupled with a custom-designed counterflow combustion chamber developed specifically for alternative gaseous fuel research. Exhaust gas emissions of CO, CO₂, and NO_x were measured using a laboratory-grade FTIR analyzer (Horiba Mexa FTIR Horiba Ltd., Kyoto, Japan), while combustion chamber temperature was monitored with thermocouples. The results show that hydrogen addition significantly influences flame stability, combustion temperature, and emission characteristics. Increasing the hydrogen fraction led to a pronounced reduction in CO emissions across all equivalence ratios, indicating enhanced oxidation kinetics and improved combustion completeness. CO₂ concentrations decreased monotonically with hydrogen enrichment due to the reduced carbon content of the blended fuel and the shift of combustion products toward higher H₂O fractions. In contrast, NO_x emissions increased with increasing hydrogen content for all tested equivalence ratios, which is attributed to elevated local flame temperatures, enhanced reaction rates, and the formation of locally near-stoichiometric zones in the compact combustor. A slight reduction in NO_x at low hydrogen fractions was observed under near-stoichiometric conditions, suggesting a temporary shift toward a more distributed combustion regime. Overall, the findings demonstrate that hydrogen–propane–butane blends can be stably combusted in a micro gas turbine without major operational issues under unloaded conditions. While hydrogen addition offers clear benefits in terms of CO reduction and carbon-related emissions, effective NO_x mitigation strategies will be essential for future high-hydrogen microturbine applications. Full article

Background: Stroke and subclinical cerebral ischemia remain important neurological complications of transcatheter aortic valve replacement (TAVR). The Sentinel cerebral embolic protection (CEP) device is designed to capture embolic debris during TAVR, but its impact on clinical and imaging outcomes remains incompletely characterized. Methods: PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) comparing Sentinel CEP versus no protection when TAVR was performed. Outcomes of interest included all stroke, disabling stroke, infarct volume by diffusion-weighted MRI in protected and unprotected areas, all-cause mortality, acute kidney injury, and major vascular complications. Risk ratios (RRs) and median differences with 95% confidence intervals (CIs) were calculated using random-effects models and trial sequential analysis (TSA) assessed evidence robustness. Results: Four RCTs including 10,986 patients were analyzed. Sentinel CEP did not significantly reduce clinical stroke (RR 0.88, 95% CI 0.69–1.12) or disabling stroke (RR 0.68, 95% CI 0.41–1.14). Pooled DW-MRI data showed a significant reduction in new ischemic lesion volume within Sentinel CEP-protected territories (difference in medians −75.7 mm³; 95% CI −130.4 to −21.0). Subgroup analyses in elderly, female, and high-surgical-risk patients revealed no benefit with Sentinel CEP. Additionally, TSA indicated that current data are underpowered for definitive conclusions. Conclusions: The Sentinel CEP device during TAVR did not significantly reduce clinical stroke but was associated with lower MRI-detected ischemic lesion volumes compared with no protection. Further adequately powered RCTs integrating clinical and imaging endpoints are needed to define its role in neuroprotection during TAVR. Full article

This study aims to develop and apply a novel methodology to assess the scope, benefits and challenges of distributed photovoltaic generation (DG-PV). The research provides a replicable framework applicable to any country, as long as official energy consumption data are available and the nation is seeking to modify its energy matrix as part of a sustainable transition through the design of renewable-energy-based policies. To support the viability of the proposal, data from the Ecuadorian electrical system for the period between 2014 and 2024 were analyzed using technical, operational and socio-economic indicators defined in the methodology. These include renewable participation, energy diversification, DG-PV, technical efficiency, regulatory index, operational resilience and electrical coverage. The investigation concludes with the definition of a Distributed Photovoltaic Integration Index (DPII), which can be used to measure a country’s progress toward the proper implementation of renewable energy. The DPII supports informed decision-making by allowing utilities and policymakers to prioritize distributed photovoltaic integration and compare alternative energy transition scenarios. In the case of Ecuador, a DPII of 0.170 is obtained for 2024 compared to a value of 0 for 2014. This result is mainly due to an increase in renewable energy participation (P1), which rose from 0.49 to 0.76 during this period, largely supported by hydropower expansion. This value was obtained because over the last ten years, Ecuador has committed to implementing active policies that incorporate renewable energies, as well as other aspects such as technical efficiency and the expansion of electrical coverage. This approach offers a replicable quantitative tool for evaluating the integration of DG-PV, providing key information for energy planning and for the formulation of policies that promote the decarbonization, decentralization and digitalization of the national electrical system. Full article

Developing low-carbon building materials is essential for achieving sustainability in the construction sector. This study proposes a carbon-negative concrete (CNC) system that combines low-carbon binders derived from industrial by-products with carbonated recycled aggregates capable of CO₂ absorption. To enhance particle packing and mechanical performance, the Modified Andreasen–Andersen (MAA) model was adopted for mix design optimization and experimentally validated. The optimized CNC mixture containing 22% coarse aggregate achieved the minimum residual sum of squares between the graded particle distribution and the theoretical MAA curve, as well as the highest strength performance. Compared with a 14% coarse aggregate mixture, the 22% mix exhibited 13.5% and 19.8% increases in compressive strength at 7 and 28 days, confirming the applicability of the MAA model for CNC proportioning. Carbon emission assessment, limited to raw material production, demonstrated significant environmental benefits. CNC incorporating both low-carbon binders and carbonated recycled aggregates reduced total emissions and CO₂ intensity by 87.1% and 86.2%, respectively, compared with ordinary concrete of the same strength grade. Economic evaluation further showed that CNC reduced material cost by 48.1% relative to ordinary concrete. It should be emphasized that the reported CO₂ reduction and negative emission effects are limited to the defined raw material production boundary and do not represent a fully net-negative life cycle. Overall, these results confirm the technical, environmental, and economic feasibility of CNC as a sustainable alternative to traditional concrete. Full article

Background: International policy increasingly recognises the importance of inclusive, community-based support for people living with dementia. Football, as a culturally significant sport, has the potential to reach older adults and communities disproportionately affected by health inequalities. The objectives of this review were to collate evidence on football-based dementia initiatives, including intervention format, delivery approaches, and reported outcomes. Methods: Seven databases (Sportdiscus, MEDLINE, Embase, Scopus, PsycINFO, CINAHL, and Web of Science) were searched for relevant peer-reviewed and grey literature from their inception to June 2025. The PICO framework was used to define eligibility criteria. Eligible studies described community-based football-themed or football-based programmes involving people living with dementia. Data were extracted on participant sample, intervention characteristics, and reported outcomes, and iteratively charted. Results: In total, 11 of the 1059 identified articles were included within this review. Initiatives were often delivered through professional football clubs and charitable foundations, with formats ranging from reminiscence therapy sessions to walking football. Common outcomes for participants included increased sociability, improved mood, enhanced communication, and a strengthened sense of identity and belonging. Some interventions also reported physical benefits, such as improved mobility. Carers highlighted respite opportunities, peer support, and enjoyment from seeing relatives more engaged. Despite positive reports, outcome measurement was inconsistent, and most studies were small-scale or descriptive pilot projects. Conclusions: Football-based dementia initiatives provide meaningful, culturally grounded opportunities for social inclusion and support. Their delivery through community clubs/organisations positions them well to address inequities in dementia care, particularly in areas of disadvantage. However, stronger evaluation methods are required to build a robust evidence base and guide sustainable implementation at scale. Full article

In this paper, the authors survey and summarize the widely researched morbidities and their life expectancy results. A constant impaired mortality adjustment for each morbidity is defined so that life expectancy is consistent with current medical research. Impaired mortality factors are derived and used to evaluate morbidity’s impact on retirement benefits. A morbidity-based pension benefit evaluation algorithm is proposed. Popular pension payment options, such as single life payment and joint life, are evaluated. The authors found that the optimal decision is highly sensitive to health status: lump sums are preferred when health is impaired, whereas annuities dominate for healthier individuals. Full article

Background/Objectives: Insulin resistance and ambulatory blood pressure monitoring (ABPM) abnormalities represent distinct but interrelated pathways contributing to cardiovascular risk. The triglyceride–glucose (TyG) index reflects metabolic burden, whereas arterial load—captured through arterial stiffness, blood pressure variability, and morning surge—reflects hemodynamic instability. Whether the coexistence of these domains identifies a particularly high-risk ambulatory phenotype remains unclear. To evaluate the independent and combined effects of metabolic burden (TyG) and arterial load on circadian blood pressure pattern and short-term systolic blood pressure variability. Methods: This retrospective cross-sectional study included 294 adults who underwent 24 h ABPM. Arterial load was defined using three ABPM-derived indices (high AASI, high SBP-ARV, high morning surge). High metabolic burden was defined as TyG in the upper quartile. The “double-high” phenotype was classified as high TyG plus high arterial load. Primary and secondary outcomes were non-dipping pattern and high SBP variability. Multivariable logistic regression and Firth penalized models were used to assess independent associations. Predictive performance was evaluated using ROC analysis. Results: The double-high phenotype (n = 15) demonstrated significantly higher nighttime SBP, reduced nocturnal dipping, and markedly elevated BP variability. It was the strongest independent predictor of non-dipping (adjusted OR = 42.0; Firth OR = 11.73; both p < 0.001) and high SBP variability (adjusted OR = 41.7; Firth OR = 26.29; both p < 0.001). Arterial load substantially improved model discrimination (AUC = 0.819 for non-dipping; 0.979 for SBP variability), whereas adding TyG to arterial load produced minimal incremental benefit. Conclusions: The coexistence of elevated TyG and increased arterial load defines a distinct hemodynamic endotype characterized by severe circadian blood pressure disruption and exaggerated short-term variability. While arterial load emerged as the principal determinant of adverse ambulatory blood pressure phenotypes, TyG alone demonstrated limited discriminative capacity. These findings suggest that TyG primarily acts as a metabolic modifier, amplifying adverse ambulatory blood pressure phenotypes predominantly in the presence of underlying arterial instability rather than serving as an independent discriminator. Integrating metabolic and hemodynamic domains may therefore improve risk stratification and help identify a small but clinically meaningful subgroup of patients with extreme ambulatory blood pressure dysregulation. Full article

Extreme wildfires are becoming increasingly frequent and severe across many regions worldwide, driven by climate change, land-use transitions, and long-standing fire-suppression legacies. In this context, Nature-based Solutions (NbS)—defined as actions that work with ecological processes to address societal challenges while providing biodiversity and socio-economic benefits—offer a promising yet underdeveloped pathway for enhancing wildfire resilience. This Special Issue brings together eleven contributions spanning empirical ecology, landscape configuration, simulation modelling, spatial optimisation, ecosystem service analysis, governance assessment, and community-based innovation. Collectively, these studies demonstrate that restoring ecological fire regimes, promoting multifunctional landscapes, and integrating advanced decision support tools can substantially reduce wildfire hazard while sustaining ecosystem functions. They also reveal significant governance barriers, including fragmented policies, limited investment in prevention, and challenges in incorporating social demands into territorial planning. By synthesising these insights, this editorial identifies several strategic priorities for advancing NbS in fire-prone landscapes: mainstreaming prevention within governance frameworks, strengthening the science–practice interface, investing in long-term socio-ecological monitoring, managing trade-offs transparently, and empowering local communities. Together, the findings highlight that effective NbS emerge from the alignment of ecological, technological, institutional, and social dimensions, offering a coherent pathway toward more resilient, biodiverse, and fire-adaptive landscapes. Full article

The article explores the current challenges and prospects for the electrification of the bus fleet in urban passenger transport, with a particular focus on the municipal operator Municipal Transport Ruse EAD. The study is motivated by the growing importance of sustainable mobility and the European Union’s policy framework aimed at decarbonization of urban transport systems. A mixed-integer linear programming (MILP) model is developed to optimize the investment and operational strategies for the gradual replacement of diesel buses with electric ones, taking into account capital expenditures, operational costs, charging infrastructure, and environmental benefits. Scenario analysis is employed to compare six different pathways of fleet electrification, ranging from partial to full transition within a defined planning horizon. The results highlight significant trade-offs between financial feasibility and ecological impact, illustrating that an accelerated electrification strategy yields the largest emission reductions but requires substantial upfront investment. Conversely, gradual transition scenarios demonstrate better budget alignment but achieve lower environmental benefits. The discussion emphasizes the practical applicability of the model for municipal decision-makers, offering a tool for strategic planning under economic and ecological constraints. The paper concludes that sustainable electrification of municipal bus fleets requires a balanced approach that aligns environmental objectives with financial and operational capacities. Full article

The transformative potential of Artificial Intelligence (AI) in urban management is severely constrained by pervasive systemic fragmentation. While AI applications demonstrate high efficacy within isolated domains, they rarely achieve the cross-domain integration necessary for realizing systemic benefits. Our prior research identified this fragmentation paradox, revealing that 91.5% of urban AI implementations operate at the lowest levels of integration. While the Urban Systems Artificial Intelligence Framework (UAIF) offers a technical blueprint for integration, realizing this vision is contingent upon organizational readiness. This paper addresses this critical gap by introducing the Urban AI Governance Maturity Model (UAIG), developed using a Design Science Research methodology. Distinguished from generic maturity models, the UAIG operationalizes Socio-Technical Systems theory by establishing a direct Governance-Technology Interlock that specifically links organizational maturity levels to the engineering requirements of cross-domain AI. The model defines five maturity levels across five critical dimensions: Strategy and Investment; Organizational Structure and Culture; Data Governance and Policy; Technical Capacity and Interoperability; and Trust, Ethics, and Security. Through illustrative applications, we demonstrate how the UAIG serves as a diagnostic tool and a strategic roadmap, enabling policymakers to bridge the gap between technical possibility and organizational reality. Full article