Search Results (1,004)

Background/Objectives: Nutritional medicine remains underrepresented in medical education despite its relevance across specialties. Online learning offers a resource-efficient option to address this gap, yet evidence on the effectiveness and acceptability of online learning modules (OLMs) is limited. Methods: In this exploratory randomized controlled single post-test trial, medical students were assigned to either an OLM or an in-person lecture (IPL) on nutritional medicine (n = 91, no a priori sample size calculation performed). After course completion, students took a knowledge test and completed a questionnaire on their learning experience. Group differences were analyzed using permutation Welch t-tests, Wilcoxon–Mann–Whitney tests, or Fisher’s exact tests, depending on variable characteristics, with α = 0.05. Results: OLM students achieved significantly higher test scores than IPL students (mean difference: 2.4 points on a 0–40 scale), resulting in differences in grade classification (p < 0.05). OLM was further rated more favorably regarding content delivery, overall course evaluation, and exam preparation (all p < 0.05), while self-reported attention, concentration, and involvement did not differ between groups. Flexibility, time savings, and convenience were the most frequently reported advantages of OLM over IPL. Conclusions: This study suggests that OLM in nutritional medicine may be associated with higher test performance and more favorable student evaluations compared to IPL. These findings highlight the potential of online learning as a scalable, resource-efficient approach that may help address persistent gaps in nutritional medicine education. Building on this evidence, future work should examine how such modules can be optimally integrated into medical curricula to complement existing teaching structures. Full article

Nowadays, the urban population is steadily increasing worldwide and, as a result, global construction output is expected to grow to more than 16 trillion EUR by 2030. This rapid urbanization has created a strong need for the successful selection and delivery of urban development projects to meet the challenges related to the provision of sustainable and resilient infrastructure, together with affordable residence solutions. Meanwhile, the dominance of the traditional capital budgeting discounted cash flow (DCF) technique has long been questioned for its inability to be effectively applied to the complex, uncertain, and turbulent current environment. The main cause of this stems from its deficiencies in recognizing and incorporating the value of managerial interventions through strategic decisions to delay, expand, or even abandon an investment. A real options analysis (ROA) is proposed in this paper as a dynamic “wait and see” alternative to the static “now or never” DCF methodology, which is based entirely on a positive net present value (NPV) output. Thus, the aim of the research is to explore whether the practical application of ROA for the assessment of the financial viability of urban development capital investment projects can be improved from the obtained managerial flexibility in the decision-making process. Spreadsheet-based mathematical models are developed for the analysis and implementation of both the Black–Scholes formula and the binomial lattice method. The results are discussed and compared with a classic DCF analysis. The main advantages of using ROA, i.e., determining alternative paths of urban development and providing a practical and flexible means to adapt to changing external conditions, are highlighted through the application of a common type of real option to an actual new multistorey office building project. Based on the DCF model and its negative NPV, the investment under study is not viable. However, when simply considering the delay strategic option, the project turns out to be highly valuable. For comparison reasons, future work is recommended on alternative types of real options, like the compound staging option, and towards the use of alternative ROA tools, like the Monte Carlo Simulation technique, non-recombining binomial lattices, and the dividend-based version of the Black–Scholes model. Full article

This study investigates the integration of a molten salt thermal energy storage (TES) system into a 330 MW coal-fired power unit to enhance its operational flexibility and exergy-based performance. Using EBSILON Professional (version 13) software, several heat storage and heat release schemes were modeled and analyzed to assess their effects on turbine performance, coal consumption rate, heat rate, and exergy losses under various load conditions. The results reveal that coupling TES with conventional thermal units can effectively decouple heat and power generation, enabling deep peak-shaving operation while maintaining system efficiency. The six heat storage schemes and seven heat release schemes considered in this study were selected based on the physical characteristics of the 330 MW reheat-steam cycle and the practical constraints of integrating a molten salt TES system into an existing coal-fired unit. Specifically, the schemes were designed to represent all feasible pathways for redirecting thermal energy within the boiler–turbine system, including steam extraction from different turbine stages, reheater-side interventions, and electric-heating-assisted charging options. These schemes also reflect the operational boundaries of the unit, such as allowable extraction fractions, steam temperature limits, and turbine safety margins. The findings demonstrate that molten salt TES can serve as a feasible and efficient pathway for retrofitting existing coal-fired power units to improve load-following capability, reduce fuel consumption, and support grid flexibility under renewable-dominated energy scenarios. Full article

Local energy markets (LEMs) are increasingly promoted as coordinated market frameworks for distributed electricity resources in low-carbon-level energy systems. In parallel, green hydrogen is emerging as an energy carrier used for long-duration storage and sector coupling. Yet hydrogen is typically treated as a technological extension of the existing flexibility options rather than as a separate market participant. This paper argues that such a perspective is conceptually insufficient for future LEM design. It is proposed that hydrogen should be understood as a hybrid market participant in LEMs, rather than as a special case for load, storage or generation. Hydrogen can simultaneously be used to meet a flexible electricity demand, be stored for a long duration, and act as a dispatchable electricity supply. These combined roles violate the core assumptions embedded in electricity-only LEMs, including one-direction energy flow, short-term time prospects, symmetric storage behavior and there being an electricity-only supply option. Particular attention is given to small-to-medium-scale electrolyzers, which are likely to dominate hydrogen participation in local contexts. Rather than proposing a specific market mechanism or numerical model, this paper suggests market design considerations for future local energy markets and highlights open challenges for electricity–hydrogen market coordination. Full article

This paper presents the design and implementation of a low-cost microcontroller-based dual-channel fan controller optimized for high-power audio amplifiers, yet adaptable to power supplies, electronic loads, and other thermally intensive systems. Unlike conventional designs that drive all fans uniformly, the proposed solution provides fully independent cooling via dual I²C temperature sensors, predictive trend analysis, and multi-stage hysteresis. The controller incorporates advanced features including an anti-dust startup sequence, predictive boost with latching, active cross-cooling, anti-heat-soak protection, and stall detection via tachometer monitoring, complemented by LED-based fault signaling and automatic channel muting during overheating or fan failure. Hardware support for 12 V and 24 V fans, dual power-input options, and a compact PCB layout enhance integration flexibility. The firmware employs temperature-driven PWM mapping with EMA filtering and multi-level hysteresis. The experimental results confirm that all implemented features operate as intended, with each function demonstrating clear practical relevance, whether in improving responsiveness, preventing heat accumulation, or enhancing system reliability under a wide range of operating conditions. Full article

The European Union’s energy transition framework presents significant challenges for the maritime sector, requiring technical, organizational, and market-based compliance measures. The FuelEU Maritime Regulation (FuelEU) introduces flexible mechanisms such as banking, borrowing, and pooling that broaden compliance options for shipowners. This study examines the role of pooling in European shipping, focusing on its operational models, enabling conditions, and economic implications. Pool formation demands extensive information exchange and effective coordination, creating a need for specialized intermediaries and supporting the emergence of a market in which pooling prices are shaped by supply and demand. The research employs a qualitative methodology combining stakeholder and exploratory market analysis, assessment of regulatory and market drivers, case studies, and comparative analysis, complemented by expert interviews and a targeted survey. The findings highlight pooling as a pivotal compliance instrument, particularly as a fallback option during the reporting period, and show that it currently represents the most cost-efficient means of achieving FuelEU compliance. Intermediary service providers, especially digital platforms, play a central role by facilitating coordination, improving transparency, and reducing compliance costs. The study further identifies key factors influencing shipowners’ costs and revenues in pools, emphasizing the critical importance of alternative fuel availability and prices. Full article

Background: The role of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) management has evolved over recent years. Although it appears that the overall number of procedures is declining, international guidelines now endorse TACE beyond the Barcelona Clinic Liver Cancer (BCLC) intermediate stage, and multiple TACE platforms allow patient-tailored treatments. In this context, degradable starch microspheres TACE (DSM-TACE) may be valuable when the goal is to preserve liver function and spare healthy parenchyma. This study reports multicenter retrospective Italian data to assess the efficacy and safety of DSM-TACE with EmboCept^® in patients with early-to advanced-stage HCC, and to evaluate whether procedural selectivity (superselective vs. lobar) influences outcomes. Methods: This retrospective multicenter study included 201 patients initially; after applying exclusion criteria, 187 patients (334 HCC nodules) treated across eight centers (2014–2024) were analyzed. Treatment indications were discussed in multidisciplinary tumor boards in all centers. Superselective DSM-TACE was performed in 48 patients (66 nodules, 19.8%), while 139 patients (268 nodules, 80.2%) underwent a lobar approach. Repeated sessions were performed on demand and recorded for lobar treatments. Tumor response was assessed using mRECIST criteria at 1, 3–6, 6–9, and 9–12 months; adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). efficacy and safety outcomes were compared according to the DSM-TACE approach. Results: In terms of safety, analysis confirmed the overall good tolerability of DSM-TACE, with no grade ≥ 3 adverse events and no major complications or procedure-related deaths. No significant differences were observed in post-embolization syndrome (PES) rates between groups. With regard to efficacy, for the entire cohort, the overall response rate (ORR) was 70% at 1 month, 31.6% at 3–6 months, 20.5% at 6–9 months, and 13.5% at 9–12 months, while the disease control rate (DCR) was 91.4% at 1 month, 69% at 3–6 months, 38.6% at 6–9 months, and 27% at 9–12 months. At intermediate follow-up, superselective DSM-TACE achieved higher ORR than lobar treatment at 3–6 months (53.8% vs. 26.4%; p = 0.009) and 6–9 months (43.8% vs. 15.3%; p = 0.009). Per-nodule analysis confirmed this advantage at 3–6 months (ORR = 66.7% vs. 31.3%; p = 0.0008). Conclusions: DSM-TACE with EmboCept^® provides favorable tumor control and a good safety profile in routine clinical practice. A superselective approach is associated with improved response at intermediate follow-up compared with lobar strategy, supporting DSM-TACE as a flexible therapeutic option for localized HCC. Full article

Under high renewable energy penetration, nuclear power units face significant challenges in peak regulation and market clearing due to constraints on minimum technical output and ramping capability. To address this issue, a long-term power system of Guangdong Province in 2035 is taken as the study case, and an energy–reserve co-clearing simulation framework based on Security-Constrained Unit Commitment (SCUC) and Security-Constrained Economic Dispatch (SCED) is established to systematically evaluate the clearing performance of nuclear power and the formation mechanism of residual electricity under multiple market scenarios. On this basis, a nuclear power-coupled Alkaline Electrolysis (AEL) hydrogen production pathway is proposed as a peak-shaving utilization option, and an economic assessment model for nuclear-based hydrogen production is developed to quantify the investment performance under different hydrogen production capacities and operating modes. The results indicate that the integration of an AEL hydrogen production system can effectively alleviate the rigidity of nuclear power output. Under the “12-3-48-3” flexible peak-shaving mode, the residual electricity available for hydrogen production increases by approximately 30% compared with a typical peak-shaving strategy. Under scenarios with low electricity prices and green hydrogen prices, when the hydrogen production capacity is configured at 50–100 MW, the investment payback period is approximately six years, and the project exhibits strong economic robustness against variations in the discount rate. These findings demonstrate that nuclear-based hydrogen production is economically feasible in future power systems with high renewable penetration, providing quantitative support for nuclear flexibility enhancement and the coordinated development of low-carbon energy systems. Full article

Electrophysiology, mechanobiology, and the study of soft matter within cells demonstrate increasing amounts of evidence that neuronal signaling arises from interactions between membrane potential, force, and phase. Herein, we have attempted to collect and organize the evidence for each of these areas of study into an approximate structure called the electromechanical connectome: a three-way state–space (membrane potentials, nanoscale mechanical forces, and cytoplasmic rheology, including phase-separated liquid–liquid droplets) where membrane potentials, nanoscale mechanical forces, and cytoplasmic rheology, and phase-separated liquid–liquid droplets are likely to influence one another, influencing synaptic processing, plasticity and network stability. We will also attempt to illustrate the following: how changes in electrostatic fields can be used to alter the arrangement of lipids, hydration, and dielectric microdomains, and the contact geometry between organelles and activity dependent transcription; how mechanical dynamics associated with spines, axons, and the active zone of synapses may be used to modify the energy landscape of channels, the docking and priming of vesicles, and the transport of cytoskeletons; and how viscosity corridors, along with phase-separated micro-reactors, can be used to regulate the kinetics of signaling, molecular trafficking and metabolic processes in local environments. With these connections in mind, we will propose a multiphysical attractor model in which cognition is the result of navigating through metastable manifolds, while neurodegenerative disease may be a result of the progressive loss of electromechanical coherence, phase boundary control and energetic flexibility. Finally, we will present testable hypotheses and use AI-enabled digital twin methods to potentially quantify the early deformation of manifolds and provide precision biomarkers and therapeutic options. Full article

Camera-based wildlife monitoring is often overwhelmed by non-target triggers and slowed by manual review or cloud-dependent inference, which can prevent timely intervention for high stakes human–wildlife conflicts. Our key contribution is a deployable, fully offline edge vision sensor that achieves near-real-time, highly accurate wildlife event classification by combining detector-based empty-image suppression with a lightweight classifier trained with a staged transfer-learning curriculum. Specifically, Stage 1 uses a pretrained You Only Look Once (YOLO)-family detector for permissive animal localization and empty-trigger suppression, and Stage 2 uses a lightweight EfficientNet-based binary classifier to confirm puma on detector crops and gate downstream actions. Our design is robust to low-quality nighttime monochrome imagery (motion blur, low contrast, illumination artifacts, and partial-body captures) and operates using commercially available components in connectivity-limited settings. In field deployments running since May 2025, end-to-end latency from camera trigger to action command is approximately 4 s. Ablation studies using a dataset of labeled wildlife images (pumas, not pumas) show that the two-stage approach substantially reduces false alarms in identifying pumas relative to a full-image classifier while maintaining high recall. On the held-out test set ($N=1434$ events), the proposed two-stage cascade achieves precision $0.983$, recall $0.975$, F1 $0.979$, accuracy $0.986$, and balanced accuracy $0.983$, with only 8 false positives and 12 false negatives. The system can be easily adapted for other species, as demonstrated by rapid retraining of the second stage to classify ringtails. Downstream responses (e.g., notifications and optional audio/light outputs) provide flexible actuation capabilities that can be configured to support intervention. Full article

This study examines risky decision-making in a free-ranging population of Balinese long-tailed macaques (Macaca fascicularis fascicularis), addressing gaps in research that have largely focused on captive primates and have rarely considered individual differences by age and sex. Thirty-three macaques of different age–sex classes were tested using a choice task contrasting a guaranteed small reward with a probabilistic larger reward. At the group level, macaques showed no preference for safe or risky options. However, substantial individual variation emerged: some individuals were risk-prone, others risk-averse, and many indifferent. Notably, age and sex interacted in shaping risk preferences. Among males, adults and juveniles were more risk-prone than younger adults, whereas among females, adults were more risk-prone than juveniles. Juveniles also displayed outcome-dependent flexibility, choosing the risky option more often after a previous successful risky choice, consistent with a win–stay strategy. Like in rodents, this pattern may reflect adaptive learning during developmental transitions. Importantly, the observed behavioral differences were not due to misunderstanding of the task, as macaques reliably chose the larger option when outcomes were visible. This pronounced individual variability in primate risk preferences underscore the importance of considering demographic factors when characterizing species-typical risk preferences. Full article

This study examines the political dilemma in tourism governance in Mandalika, Indonesia, focusing on three key components: accountability, transparency, and resource allocation. This research aims to reframe the role of political activity to align with the principles of community benefit and justice. Data collection was conducted through a survey from August to September 2025, with 465 questionnaires distributed. A total of 444 questionnaires (95.48%) were deemed valid, while 21 (4.52%) did not meet the criteria and were excluded from the analysis. Data were analyzed through Microsoft Excel and SmartPLS version 4.1.1. The results show that a serious political problem leads to less freedom in how things are managed, making it harder to trust the systems for accountability, transparency, and resources in tourism governance. This condition is closely related to the dominance of the central authority, which holds significant control over the tourism industry and positions it as a national strategic sector. Consequently, the limited policy flexibility and strict restrictions of the tourism management framework leave local authorities and communities with limited maneuvering options. Statistical testing supports significant relationships, both direct and indirect. This study recommends more genuine and balanced integration between national and local authorities to create mutually beneficial opportunities, strengthen sustainability, and enhance international competitiveness through multi-stakeholder engagement in more inclusive governance. This research employs a quantitative, exploratory approach to elucidate the political dynamics and constraints that limit the involvement of local tourism authorities and communities in tourism management in Mandalika, Indonesia. Full article

This research evaluates the technical and financial feasibility of green hydrogen production in Colombia using Small Hydropower Plants (SHPs), positioning them as a strategic complement to intermittent sources such as solar and wind. To address an underexplored niche in the national hydrogen roadmap, the study applies a Real Options framework, specifically using a binomial tree model, and incorporates the Weibull distribution to estimate risk-adjusted discount rates. This methodological combination allows for the modeling of operational flexibility under uncertainty, particularly through the analysis of an American-style abandonment option. The results indicate that SHPs provide continuous power generation, enhance electrolyzer efficiency, lower the Levelized Cost of Hydrogen (LCOH), and improve cash flow. However, fiscal incentives and high initial capital costs remain limiting factors. The study proposes extending the evaluation horizon to 15 years and implementing mechanisms such as Capital Expenditures (CAPEX) subsidies to improve project viability. Overall, the research contributes to the diversification of Colombia’s energy matrix, encourages regional development, and supports the positioning of green hydrogen as a viable financial asset within the country’s energy transition framework. Full article

Local renewable energy microgrids in remote regions are typically characterized by high renewable energy penetration and weak grid-interconnection channels. These features lead to insufficient inertia and poor stability in both the microgrid and the AC main grid, with a failure to meet the power supply demands of microgrid loads. Conventional grid-forming converters or flexible interconnection devices have limited optional capabilities, making it challenging to comprehensively address these issues. This paper proposes a grid-forming energy-storage-based flexible interconnection system (GFM-ESFIS) which integrates the flexible interconnection converters with energy-storage units to fully meet the stability and power supply reliability requirements of the microgrid–main grid interconnection system in remote regions. Key steady-state and transient control strategies are analyzed and designed for the GFM-ESFIS. Simulations based on MATLAB/Simulink 2024a and hardware-in-the-loop experiments based on RT-LAB verify the effectiveness of the proposed system and control strategies. Compared with conventional schemes, the proposed system can operate flexibly in series or parallel modes, realizing multiple capabilities including dual-terminal grid-forming support, fault ride-through control, power flow regulation, operation mode transition, and black start. It holds significant application value in reducing grid investment costs and improving the power supply reliability of microgrids in remote regions. Full article

Per-oral flexible endoscopy has expanded minimally invasive options for the management of gastric subepithelial tumors (G-SETs). This narrative review appraises conventional and advanced endoscopic resections alongside hybrid laparoscopic–endoscopic procedures, within a size- and layer-based clinical framework. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) achieve high en bloc resection rates for small, intraluminal tumors arising from mucosa or submucosa. Traction strategies and dedicated traction devices may improve submucosal exposure, shorten procedure time, and reduce adverse events. Submucosal tunneling endoscopic resection (STER) has been developed to enucleate tumors originating from the muscularis propria while preserving mucosal integrity. However, tunnel creation and specimen retrieval become challenging for large tumors or for those located in the cardia or fundus. Endoscopic full-thickness resection (EFTR) enables controlled transmural excision of G-SETs arising from deeper wall layers. Exposed EFTR, combined with secure endoscopic closure, provides high en bloc and complete (R0) resection rates. Closure options range from through-the-scope clips—for small defects—to over-the-scope clips, endoloop-clip purse-string methods, reopenable-clip over-the-line techniques and endoscopic suturing systems—for larger defects. Non-exposed EFTR and device-assisted systems reduce the risk of peritoneal contamination, although complete resection rates are more variable. Hybrid approaches, including classical laparoscopic–endoscopic cooperative surgery (LECS) and non-exposure variants, combine endoscopic precision with the safety and closure capabilities of laparoscopic surgery, minimizing the amount of resected gastric wall. They are particularly suited to larger, awkwardly located or ulcerated G-SETs. Emerging traction platforms, flexible robotic systems, and AI-based tools may further broaden the role of per-oral flexible endoscopy for the treatment of G-SETs. However, evidence remains preliminary, and surgery continues to play a key role for large, extraluminal or anatomically prohibitive G-SETs. Full article