Search Results (4,970)

The increasing diffusion of Renewable Energy Communities offers new opportunities to support vulnerable households through locally generated renewable energy. However, current Home Energy Management Systems mainly optimize energy efficiency and cost reduction, while providing limited support for protecting critical household loads under constrained energy availability. This paper proposes an AI-based Energy Guardianship framework that combines a commissioning phase, in which a Local Appliance Atlas is created from the electrical signatures of the appliances actually installed in a specific dwelling, with an online phase that identifies operating appliances from aggregated measurements and dynamically allocates available energy according to appliance priority. Appliance identification is performed using rich electrical signatures including transient behavior, dynamic V-I trajectories, harmonic information, power profiles, and conventional electrical features extracted from aggregate voltage and current measurements. Unlike conventional home energy management systems, where appliance identification is mainly used to optimize energy consumption, the proposed framework exploits NILM information to support socially aware decisions that preserve critical services while delaying or limiting non-essential loads. A low-cost monitoring architecture is developed to recognize household appliances through electrical signatures and classify loads according to their criticality. When power thresholds are approached, the system recommends demand-side actions, postpones non-essential consumption, and protects critical devices. Preliminary simulation scenarios demonstrate the feasibility of the proposed framework in protecting vulnerable users under limited energy availability while simultaneously improving photovoltaic self-consumption and reducing dependence on grid energy. Although optimization is not the primary objective, the framework naturally supports renewable-aware energy scheduling and future interaction with energy service providers. Full article

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and emerging dual incretin therapies have demonstrated substantial effects on weight reduction and metabolic improvement, with growing evidence supporting favorable cardiovascular outcomes. This narrative review provides a focused overview of key cardiovascular outcomes trials (CVOTs) and HFpEF-oriented clinical studies evaluating GLP-1 RA and dual incretin therapies in patients living with obesity, including completed and ongoing investigations. We summarize trial characteristics, critically appraise their outcomes, and briefly discuss mechanistic pathways potentially linking incretin-based therapies to cardiovascular and HFpEF-related benefits. Because available data derive from heterogeneous study designs, we explicitly distinguish evidence from type 2 diabetes cardiovascular outcomes trials, obesity-without-diabetes cardiovascular outcomes trials, HFpEF-specific randomized trials, mechanistic substudies, ongoing trials, and real-world observational analyses. We also situate incretin-based therapies within contemporary obesity, diabetes, cardiovascular, and HFpEF guideline-directed care. Finally, we identify current knowledge gaps, future research priorities, and innovative approaches needed to refine personalized therapeutic strategies and optimize patient-centered outcomes in obesity-associated HFpEF. Full article

The discovery of activating epidermal growth factor receptor (EGFR) mutations transformed the management of non-small cell lung cancer and has driven two decades of therapeutic advances in precision oncology across metastatic, resectable, and unresectable locally advanced disease, including central nervous system (CNS) control. Consequently, treatment outcomes for patients with tumors harboring classical EGFR mutations have markedly improved. Despite these advances, many questions remain unanswered, and the expanding number of treatment options has created new challenges in treatment selection and sequencing. This narrative review summarizes contemporary data on the management of classical EGFR-mutant NSCLC, encompassing novel therapeutic approaches across disease stages, biomarker-informed resistance strategies, multimodality treatment integrating radiotherapy, CNS-directed management, and challenging scenarios such as small-cell transformation. We also discuss emerging fourth-generation inhibitors, nucleic-acid delivery platforms, and data-enabled personalized treatment. We highlight evolving standards of care, unresolved knowledge gaps, and research priorities for the next decade. Full article

Fiscal transfers and special autonomy are intended to improve public-service outcomes, yet their effectiveness depends on how local governments govern, allocate, and politically support public resources. This study aims to examine how budget capacity, budget regulatory compliance, budget management, budget quality, and budget politics shape local government performance in Aceh, Indonesia. It hypothesizes that these governance mechanisms enhance budget quality and performance, that budget quality mediates the effects of budget capacity, regulatory compliance, and budget management on performance, and that budget politics strengthens the effects of budget management on both budget quality and performance. Survey data from 192 local government agencies responsible for priority public services were analyzed using partial least squares structural equation modeling. The findings show that budget capacity, budget regulatory compliance, budget management, and budget politics improve both budget quality and local government performance. Budget quality is the strongest predictor of performance and significantly mediates the effects of the three technical governance mechanisms. Budget politics further strengthens the effects of budget management on budget quality and performance. These findings indicate that fiscal transfers generate greater public value when supported by credible budgeting, disciplined management, and politically accountable coordination. Full article

To address the severe coverage blind spots and concurrent collision bottlenecks faced by LoRa networks in dense deployments and complex three-dimensional (3D) occlusion environments, this paper proposes a distributed cross-layer protocol framework for LoRa ad hoc networks supporting heterogeneous traffic. To break through the limitations of a single star architecture, this framework constructs a 3D penetration loss model at the physical layer and designs a distributed relay deployment algorithm based on hybrid simulated annealing, achieving blind-spot-free connectivity in complex spaces. At the MAC layer, a non-preemptive priority access mechanism based on symbol energy detection is introduced. Through differentiated backoff windows with time-domain isolation, it precisely guarantees the quality of service (QoS) requirements of heterogeneous traffic and significantly suppresses concurrent collisions. At the network layer, the CAM-AODV routing algorithm is proposed, which integrates hop count, link quality, MAC queue congestion, and nodal residual energy to achieve dynamic traffic diversion and network-wide energy balancing under bursty high loads. Simulation results demonstrate that this cross-layer framework effectively breaks the traditional network capacity bottlenecks. In a large-scale, high-density scenario with 300 nodes, CAM-AODV reduces the average end-to-end delay by 19.46% compared to the traditional AODV. Under high-concurrent loads, the packet delivery ratio (PDR) of the proposed framework improves by 16.32% over the traditional protocol, while the system delay is reduced by 13.66%. Furthermore, under the two aforementioned evaluation scenarios, the Energy Balancing Index (EBI) is significantly improved by 11.13% and 10.57%, respectively, compared to the traditional protocol. This study provides an efficient joint optimization scheme for building high-capacity, wide-coverage, and long-lifespan complex Internet of Things (IoT) networks. Full article

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by progressive insulin resistance, impaired glucose regulation, and elevated cardiometabolic risk. Despite the availability of pharmacological therapies, long-term glycemic control remains suboptimal in many patients, highlighting the need for effective adjunctive nutritional strategies. Probiotic yogurt containing well-characterized bacterial consortia has been proposed as one such approach, given its potential to modulate gut microbiota composition, increase short-chain fatty acid (SCFA) production, improve intestinal barrier integrity, and attenuate low-grade systemic inflammation. A narrative review was conducted by searching PubMed, Scopus, and Google Scholar databases using terms related to probiotic yogurt, synbiotic yogurt, insulin sensitivity, T2DM, gut microbiota, Lactobacillus, and Bifidobacterium. Priority was given to randomized controlled trials (RCTs), meta-analyses, and systematic reviews, supplemented by mechanistically relevant preclinical studies. The reviewed evidence indicates that probiotic yogurt generally produces more consistent improvements in long-term metabolic markers, particularly glycated hemoglobin (HbA1c) and lipid profile, than in acute fasting glucose responses. Several trials also report reductions in fasting insulin and the homeostatic model assessment of insulin resistance (HOMA-IR), combined with improvement in the quantitative insulin sensitivity check index (QUICKI), particularly when yogurt is enriched with prebiotic substrates such as inulin and konjac glucomannan. Probiotic yogurt formulated with well-selected microbial consortia may serve as a safe complementary intervention for improving insulin sensitivity and overall metabolic control in T2DM patients. Full article

Peritoneal carcinomatosis (PC) is a common, prognostically unfavorable manifestation of advanced gastrointestinal and gynecological malignancies whose treatment is constrained by the blood-peritoneal barrier, which limits drug penetration even when cytoreductive surgery is combined with systemic chemotherapy. This review evaluates current intraperitoneal treatment modalities and emerging technologies for overcoming this limitation, based on recent clinical trials and meta-analyses identified through Scopus and PubMed. We sequentially examine conventional intraperitoneal chemotherapy (IPC); hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian, gastric, and colorectal cancers, with attention to patient selection and the peritoneal cancer index as determinants of survival benefit; pressurized intraperitoneal aerosol chemotherapy (PIPAC) and its electrostatic precipitation variant (ePIPAC); and photodynamic and photothermal therapy for tumor treatment. Novel strategies are also discussed, including IPC combined with immune checkpoint inhibitors, optical dosimetry, and nanomedicine-based drug delivery as tools for improving treatment precision. Overall, management of PC is transitioning toward a personalized, multimodal approach: HIPEC and PIPAC provide standardized platforms for regional therapy, but future progress depends on integrating advanced drug delivery systems, immunotherapy, and real-time intraoperative monitoring, with standardization of protocols through large multicenter trials remaining a priority for translating these modalities into clinical practice. Full article

Perovskite solar cells (PSCs) have reached certified efficiencies exceeding 26%, yet the gap to the Shockley–Queisser limit and insufficient operational stability remain key obstacles to commercialization. Quantum dots (QDs) offer a versatile platform to address both challenges through their size-tunable bandgaps, high photoluminescence yields, and solution processability. This review systematically examines four QD integration strategies in PSCs: transport layer modification, active layer doping, UV conversion layers, and tandem sub-cells. The underlying mechanisms—including defect passivation, energy-level engineering, crystallization control, and ion migration suppression—are critically compared across these approaches. Despite significant advances, challenges persist, including the ligand–charge transport trade-off, the environmental toxicity of Pb/Cd-containing QDs, poor reproducibility, and the absence of standardized stability testing protocols. By providing a mechanism-oriented assessment across all device components, this review offers a clear framework for selecting appropriate QD strategies and identifies priority research directions. The perspective of QD strategies in this review provides a useful and significant reference for approaching the theoretical PCE limits of single-junction PSCs by reducing non-radiative recombination and improving light utilization, while QD-based tandem architectures offer a viable route toward surpassing the single-junction Shockley–Queisser limit. Full article

Objectives: To estimate the added value of dostarlimab compared to durvalumab and pembrolizumab as first-line treatment for adult patients with primary advanced or recurrent endometrial cancer (EC) in Spain using a Multi-Criteria Decision Analysis (MCDA) framework. Methods: Following the Evidence and Value: Impact on Decision Making (EVIDEM) framework and International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations, 25 Spanish experts (12 medical oncologists and 13 hospital pharmacists) weighted and scored 11 quantitative and 5 qualitative criteria based on an evidence matrix from a literature review. Results: Efficacy and safety were weighted as the most important criteria. Dostarlimab showed positive added value in both comparisons with scores of 0.58 versus durvalumab/durvalumab + olaparib and 0.50 versus pembrolizumab. Dostarlimab and pembrolizumab are the only therapies reimbursed in the Spanish public health system; therefore, their comparative assessment is of clinical and strategic relevance. While pembrolizumab may show longer progression-free survival (PFS) and response duration in specific subgroups, the evidence for dostarlimab—including a statistically significant improvement in overall survival (OS) in the overall population as a primary endpoint, more robust data, and favorable long-term quality-of-life outcomes—was considered by the expert panel to support a more favorable assessment. Conclusions: Within the MCDA framework, experts consider dostarlimab an option with a higher value contribution for adult patients with primary advanced or recurrent EC. Its clinical benefits, improved quality-of-life outcomes, and alignment with healthcare priorities promote treatment continuity and adherence in clinical practice. MCDA provided a transparent approach for multidimensional evaluation of these therapies. Full article

Per- and polyfluoroalkyl substances (PFAS) have emerged as a major global environmental challenge because of their widespread use, exceptional persistence, environmental mobility, bioaccumulation potential, and associated risks to human and ecosystem health. Their continued release threatens water security, environmental quality, and sustainable development, highlighting the need for effective governance and sustainable chemical management. This review critically evaluates PFAS governance by synthesising recent advances in regulatory frameworks, environmental monitoring, and environmental risk management across major international jurisdictions. The analysis demonstrates that effective PFAS governance extends beyond establishing regulatory limits and depends on integrated approaches combining class-based regulation, harmonised environmental monitoring, adaptive governance, robust enforcement, and stakeholder collaboration. Despite significant regulatory progress, persistent challenges, including fragmented governance, inconsistent monitoring capacity, limited toxicological data for emerging PFAS, and disparities in institutional resources, continue to hinder effective management. The review identifies international regulatory harmonisation, expanded monitoring of emerging PFAS, advanced analytical technologies, improved data sharing, and integration of One Health and circular economy principles as priorities for strengthening future governance. Collectively, these findings provide a comprehensive framework to support evidence-based policymaking, sustainable PFAS management, and long-term protection of human health and the environment while contributing to the achievement of the United Nations Sustainable Development Goals. Full article

While multi-phase short circuits are reliably cleared by conventional overcurrent relays, single-phase-to-ground faults (SPGFs) in isolated, compensated, or resistance-grounded 6–10 kV distribution networks produce extremely low, highly distorted currents that frequently cause traditional zero-sequence protections to misoperate. Because SPGFs constitute the vast majority of network disturbances, resolving this specific low-current detection challenge remains a critical priority for grid resilience. This paper presents a preselective protection approach based on Vector Analysis of Reactive Asymmetry Current (VARAC), designed for implementation in digital relay protection and automation terminals. Instead of relying primarily on vulnerable zero-sequence quantities, the method derives diagnostic features from the reactive asymmetry structure of three-phase current phasors. A reactive asymmetry matrix is formed from pairwise imaginary cross-products, symmetrized to preserve real eigenvalues and stable modal interpretation. The dominant eigenvalue and eigenvector are then used to quantify fault intensity and directional skew through two decision features: a magnitude-based index and a normalized asymmetry ratio. This enables robust discrimination between normal and faulted operation, including low-current and compensated-fault conditions where conventional criteria lose sensitivity. Simulation and oscillographic evaluations show a clear separation between pre-fault and SPGF regimes, fast onset detection, and improved structural selectivity versus traditional zero-sequence indicators. The proposed algorithm is computationally lightweight and compatible with hierarchical distributed SCADA architectures, supporting coordinated monitoring, diagnostics, and adaptive protection functions in modern medium-voltage networks. Full article

Tomato (Solanum lycopersicum L.) is the world’s second-most cultivated vegetable. Production reached 192 million tonnes in 2023; approximately 23% is industrially processed, leaving 4.3 to 10.2 million tonnes of pomace each year. Despite its high content of lycopene, tocopherols, polyphenols, dietary fibre, and seed oil, most of this residue is composted, landfilled, or fed without prior processing. This narrative review examines how the chemistry of tomato by-products maps onto their effects in farm animals, and how green-extraction biorefinery fits within the European Green Deal. Reported pomace lycopene runs from 36.7 to 50.2 mg/100 g DM, with phenolics near 161.8 mg GAE/g. Lycopene is an efficient singlet-oxygen quencher; it activates Keap1–Nrf2–ARE signaling while dampening NF-κB. Supercritical CO₂, ultrasound, microwave, pressurized-liquid, and NADES extractions can now recover up to 91% of peel lycopene using green, food-grade solvents. In broilers, 5 to 10% pomace or 30 to 400 mg/kg purified lycopene improves antioxidant status and lessens heat stress; in dairy ruminants, ensiled pomace at 10 to 40% maintains milk yield while improving milk PUFA. In finishing pigs and rabbits, dietary pomace or lycopene improves tissue oxidative stability, with growth benefits reported in heat-stressed rabbits. Standardized bioactive reporting and clearer inclusion limits remain the main research priorities. Full article

Long-endurance unmanned aerial vehicle (UAV) missions beyond 72 consecutive flight hours face a reliability boundary at which thermal gyroscope drift drives the inertial navigation system (INS) position error into rapid nonlinear divergence at a predictable threshold t_c. This paper presents BAZ II, a simulation-validated multi-agent navigation system that extends the analytical BAZ (bifurcation-aware zonal navigation) framework. Its central idea is to treat communication quality as a planning resource and combine it with multi-agent collaboration, making the navigation cliff a manageable degradation event rather than a hard operating limit. Four contributions support this idea: a thermalhysteresis MEMS gyroscope drift model reproduces the analytical cliff in simulation and supplies its physical mechanism; a distributed collaborative simultaneous localization and mapping (SLAM) filter coupled to a stochastic continuous-time Markov chain (CTMC) interagent channel sustains GPS-denied localization within the operational accuracy budget; a 3D Gaussian process RF-aware model predictive controller (MPC) with cognitive radio frequency-hopping restores link availability under jamming, while an analytic hierarchy process (AHP)-weighted multi-objective communication cost improves latency and jitter at negligible signal-to-noise ratio cost; finally, the integrated controller executes within the onboard real-time budget of an NVIDIA Jetson Xavier NX. All results are obtained in simulation, with hardware-in-the-loop and field testing remaining as priority future work. Full article

Background: Tuberculosis remains a major public health challenge in Latin America, where social inequalities, fragmented health systems, and barriers to care continue to undermine disease control. Although effective treatment is available, treatment abandonment and loss to follow-up remain persistent obstacles to successful outcomes. Methods: A structured critical analysis of the contemporary literature on tuberculosis treatment abandonment and retention in care was conducted using a narrative evidence synthesis approach. Forty scientific documents published between 2018 and 2026 were included. Of these, 23 Latin American studies informed the results synthesis, while 13 international studies supported the comparative critical reflection. Results: Findings were organised into five domains: social vulnerability, clinical complexity, health system barriers, priority populations, and protective factors and innovation. The evidence indicates that treatment abandonment is not an isolated individual behaviour, but a phenomenon associated with the convergence of social, clinical, and institutional determinants across the care trajectory. Poverty, migration, drug resistance, incarceration, weak follow-up systems, and fragmented care were repeatedly associated with discontinuity, whereas social support, active follow-up, digital tools, and economic measures were linked to improved adherence and retention in care. Conclusions: From a biopsychosocial perspective, treatment abandonment should be understood as a systemic and preventable failure across the tuberculosis care continuum. The proposed Latin American Integrated Model for Retention in Tuberculosis Care (MILERTB) offers an anticipatory, equity-oriented, and person-centred framework to strengthen retention in care and guide future implementation research. Full article

Ischemic stroke remains a leading cause of death and long-term disability worldwide. Although acute reperfusion therapies have improved outcomes in selected patients, effective strategies that directly promote neurovascular repair during the subacute and chronic phases remain limited. Vascular network remodeling in the peri-infarct region is increasingly recognized as a key process supporting tissue repair, blood–brain barrier restoration, and functional recovery after stroke. Microglia, as resident immune cells of the central nervous system, undergo dynamic morphological, metabolic, and functional changes after ischemic injury and participate in inflammation, phagocytic clearance, blood–brain barrier regulation, and tissue repair. Among repair-associated microglial states, microglia with M2d-like features have attracted increasing attention because of their potential association with immunoregulation and pro-vascular repair. However, whether repair-associated microglia with M2d-like features represent a distinct and stable microglial subtype after stroke remains unresolved. In this review, we summarize current evidence linking repair-associated microglial responses to vascular network remodeling after ischemic stroke, with particular emphasis on the conceptual value of the M2d-like state. We discuss putative mechanisms involving paracrine signaling, perivascular localization, metabolic reprogramming, and extracellular vesicle-mediated communication. We also evaluate therapeutic implications, including traditional Chinese medicine, extracellular vesicle-based strategies, and nanodelivery systems. However, current therapeutic evidence does not establish that these interventions specifically induce M2d-like microglial states. We highlight the need for rigorous validation of cellular identity, spatial localization, and functional vascular outcomes. Overall, the M2d-like framework provides a candidate perspective for understanding immune–vascular coupling after stroke, but further studies integrating single-cell omics, spatial mapping, lineage tracing, and functional vascular assessment are required to define the identity and functional contribution of repair-associated microglia with M2d-like features. Method: This article is a narrative review. The relevant literature was searched in PubMed from database inception to June 2026 using combinations of the terms “ischemic stroke,” “microglia,” “macrophage,” “vascular remodeling,” “angiogenesis,” “M2d,” “extracellular vesicles,” “traditional Chinese medicine,” and “nanomedicine.” Priority was given to original studies directly examining microglial or myeloid responses and vascular repair after ischemic stroke. Relevant review articles were included to provide conceptual background. Because direct evidence for M2d-like microglial responses after stroke remains limited, selected studies involving peripheral macrophages, tumor-associated macrophages, traditional Chinese medicine, extracellular vesicles, and nanomedicine were included as indirect or hypothesis-generating evidence. Evidence was interpreted according to the disease model, cellular source, and vascular outcomes examined, with stroke-specific microglial studies regarded as more directly relevant than evidence extrapolated from non-stroke or non-microglial models. Full article