Search Results (1,881)

Using waste biomass as a raw material for the combined production of electricity and heat offers corresponding energy, economic, environmental and resource efficiency benefits. The study examines both the performance of a system for combined energy production based on the Organic Rankine Cycle (ORC) utilizing wood biomass and the market interest in its deployment within Bulgaria. Its objective is to propose a technically and economically viable solution for the recovery of waste biomass through the combined production of electricity and heat while simultaneously assessing the readiness of industrial and municipal sectors to adopt such systems. The cogeneration plant incorporates an ORC module enhanced with three additional economizers that capture residual heat from flue gases. Operating on 2 t/h of biomass, the system delivers 1156 kW of electric power and 3660 kW of thermal energy, recovering an additional 2664 kW of heat. The overall energy efficiency reaches 85%, with projected annual revenues exceeding EUR 600,000 and a reduction in carbon dioxide emissions of over 5800 t/yr. These indicators can be achieved through optimal installation and operation. When operating at a reduced load, however, the specific fuel consumption increases and the overall efficiency of the installation decreases. The marketing survey results indicate that 75% of respondents express interest in adopting such technologies, contingent upon the availability of financial incentives. The strongest demand is observed for systems with capacities up to 1000 kW. However, significant barriers remain, including high initial investment costs and uneven access to raw materials. The findings confirm that the developed system offers a technologically robust, environmentally efficient and market-relevant solution, aligned with the goals of energy independence, sustainability and the transition to a low-carbon economy. Full article

Background/Objectives: Inflammation-based markers have emerged as potential prognostic tools in hepatocellular carcinoma (HCC), but comparative data with classical prognostic factors in untreated HCC are limited. This study aimed to evaluate and compare the prognostic performance of inflammatory and conventional markers using Harrell’s concordance index (C-index). Methods: This retrospective study included 250 patients with untreated HCC. Prognostic variables included age, BCLC stage, Child–Pugh classification, Milan criteria, MELD score, AFP, albumin, Charlson comorbidity index, and the inflammation-based markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), Systemic Inflammation Response Index (SIRI), and Systemic Immune-inflammation Index (SIII). Survival was analyzed using Cox regression. Predictive performance was assessed using the C-index, Akaike Information Criterion (AIC), and likelihood ratio tests. Results: Among the classical markers, BCLC showed the highest predictive performance (C-index: 0.717), while NLR ranked highest among the inflammatory markers (C-index: 0.640), above the MELD score and Milan criteria. In multivariate analysis, NLR ≥ 2.3 remained an independent predictor of overall survival (HR: 1.787; 95% CI: 1.264–2.527; p < 0.001), along with BCLC stage, albumin, Charlson index, and Milan criteria. Including NLR in the model modestly improved the C-index (from 0.781 to 0.794) but significantly improved model fit (Δ–2LL = 10.75; p = 0.001; lower AIC). Conclusions: NLR is an accessible, cost-effective, and independent prognostic marker for overall survival in untreated HCC. It shows discriminative power comparable to or greater than most conventional predictors and may complement classical stratification tools for HCC. Full article

Background: Point-of-care ultrasound (POCUS) is gaining recognition as a valuable diagnostic tool in various fields of medicine, including pediatrics. Its application at the point of care enables real-time clinical decision-making, which is particularly advantageous in pediatric settings. Although global interest in POCUS is growing, many European countries—including Poland—still lack formal training programs for POCUS at both the undergraduate and postgraduate levels. Nevertheless, the number of pediatricians incorporating POCUS into their daily clinical practice in Poland is increasing. However, the extent of its use and perceived value among pediatricians remains largely unknown. This study aimed to evaluate the current level of POCUS utilization in pediatric care in Poland, focusing on pediatricians’ self-assessed competencies, perceptions of its clinical utility, and key barriers to its implementation in daily practice. Methods: This cross-sectional study was conducted between July and August 2024 using an anonymous online survey distributed to pediatricians throughout Poland via national professional networks, with a response rate of 7.3%. Categorical variables were analyzed using the chi-square test of independence to assess the associations between key variables. Quantitative data were analyzed using descriptive statistics, and qualitative data from open-ended responses were subjected to a thematic analysis. Results: A total of 210 pediatricians responded. Among them, 149 (71%) reported access to ultrasound equipment at their workplace, and 89 (42.4%) reported having participated in some form of POCUS training. Only 46 respondents (21.9%) reported frequently using POCUS in their clinical routine. The self-assessed POCUS competence was rated as low or very low by 136 respondents (64.8%). While POCUS was generally perceived as a helpful tool in facilitating and accelerating clinical decisions, the main barriers to implementation were a lack of formal training and limited institutional support. Conclusions: Although POCUS is perceived as clinically valuable by the surveyed pediatricians in Poland, its routine use remains limited due to training and systemic barriers. Future efforts should prioritize the development of a validated, competency-based training framework and the implementation of a larger, representative national study to guide the structured integration of POCUS into pediatric care. Full article

Museums serve as essential cultural centers, yet their mostly visual exhibits restrict access for blind and partially sighted (BPS) individuals. While recent technological advances have started to bridge this gap, many accessibility solutions focus mainly on basic inclusion rather than promoting independent exploration. This research addresses this limitation by creating features that enable visitors’ independence through customizable interaction patterns and self-paced exploration. It improved upon existing interactive tangible user interfaces (ITUIs) by enhancing their audio content and adding more flexible user control options. A mixed-methods approach evaluated the ITUI’s usability, ability to be used independently, and user satisfaction. Quantitative data were gathered using ITUI-specific satisfaction, usability, comparison, and general preference scales, while insights were obtained through notes taken during a think-aloud protocol as participants interacted with the ITUIs, direct observation, and analysis of video recordings of the experiment. The results showed a strong preference for a Pushbutton-based ITUI, which scored highest in usability (M = 87.5), perceived independence (72%), and user control (76%). Participants stressed the importance of tactile interaction, clear feedback, and customizable audio features like volume and playback speed. These findings underscore the vital role of user control and precise feedback in designing accessible museum experiences. Full article

Conventional immunotherapy, including immune checkpoint blockade and chimeric antigen receptor (CAR)-T cells, has revolutionized cancer therapy over the past decade. Yet, the efficacy of these therapies is limited by tumor resistance, antigen escape mechanisms, poor persistence, and T-cell exhaustion, particularly in the treatment of solid tumors. The emergence of unconventional immunotherapies offers novel opportunities by leveraging diverse immune cell subsets and synthetic biologics. This review explores various immunotherapy platforms, including gamma delta T cells, invariant natural killer T cells, mucosal-associated invariant T cells, engineered regulatory T cells, and universal CAR platforms. Additionally, it expands on biologics, including bispecific and multispecific antibodies, cytokine fusions, agonists, and oncolytic viruses, showcasing their potential for modular engineering and off-the-shelf applicability. Distinct features of unconventional platforms include independence from the major histocompatibility complex (MHC), tissue-homing capabilities, stress ligand sensing, and the ability to bridge adaptive and innate immunity. Their compatibility with engineering approaches highlights their potential as scalable, efficient, and cost-effective therapies. To overcome translational challenges such as functional heterogeneity, immune exhaustion, tumor microenvironment-mediated suppression, and limited persistence, novel strategies will be discussed, including metabolic and epigenetic reprogramming, immune cloaking, gene editing, and the utilization of artificial intelligence for patient stratification. Ultimately, unconventional immunotherapies extend the therapeutic horizon of cancer immunotherapy by breaking barriers in solid tumor treatment and increasing accessibility. Continued investments in research for mechanistic insights and scalable manufacturing are key to unlocking their full clinical potential. Full article

In the context of achieving low-carbon goals, building low-carbon energy systems is a crucial development direction and implementation pathway. Renewable energy is favored because of its clean characteristics, but the access may have an impact on the power grid. Microgrid technology provides an effective solution to this problem. Uncertainty exists in single microgrids, so multiple microgrids are introduced to improve system stability and robustness. Electric carbon trading and profit redistribution among multiple microgrids have been challenges. To promote energy commensurability among microgrids, expand the types of energy interactions, and improve the utilization rate of renewable energy, this paper proposes a cooperative operation optimization model of multi-microgrids based on the green certificate and carbon trading mechanism to promote local energy consumption and a low carbon economy. First, this paper introduces a carbon capture system (CCS) and power-to-gas (P2G) device in the microgrid and constructs a cogeneration operation model coupled with a power-to-gas carbon capture system. On this basis, a low-carbon operation model for multi-energy microgrids is proposed by combining the local carbon trading market, the stepped carbon trading mechanism, and the green certificate trading mechanism. Secondly, this paper establishes a cooperative game model for multiple microgrid electricity carbon trading based on the Nash negotiation theory after constructing the single microgrid model. Finally, the ADMM method and the asymmetric energy mapping contribution function are used for the solution. The case study uses a typical 24 h period as an example for the calculation. Case study analysis shows that, compared with the independent operation mode of microgrids, the total benefits of the entire system increased by 38,296.1 yuan and carbon emissions were reduced by 30,535 kg through the coordinated operation of electricity–carbon coupling. The arithmetic example verifies that the method proposed in this paper can effectively improve the economic benefits of each microgrid and reduce carbon emissions. Full article

Rural regions face significant barriers to adopting IoT technologies, due to limited connectivity, energy constraints, and poor technical infrastructure. While urban environments benefit from advanced digital systems and cloud services, rural areas often lack the necessary conditions to deploy and evaluate secure and autonomous IoT solutions. To help overcome this gap, this paper presents the Smart Rural IoT Lab, a modular and reproducible testbed designed to replicate the deployment conditions in rural areas using open-source tools and affordable hardware. The laboratory integrates long-range and short-range communication technologies in six experimental scenarios, implementing protocols such as MQTT, HTTP, UDP, and CoAP. These scenarios simulate realistic rural use cases, including environmental monitoring, livestock tracking, infrastructure access control, and heritage site protection. Local data processing is achieved through containerized services like Node-RED, InfluxDB, MongoDB, and Grafana, ensuring complete autonomy, without dependence on cloud services. A key contribution of the laboratory is the generation of structured datasets from real network traffic captured with Tcpdump and preprocessed using Zeek. Unlike simulated datasets, the collected data reflect communication patterns generated from real devices. Although the current dataset only includes benign traffic, the platform is prepared for future incorporation of adversarial scenarios (spoofing, DoS) to support AI-based cybersecurity research. While experiments were conducted in an indoor controlled environment, the testbed architecture is portable and suitable for future outdoor deployment. The Smart Rural IoT Lab addresses a critical gap in current research infrastructure, providing a realistic and flexible foundation for developing secure, cloud-independent IoT solutions, contributing to the digital transformation of rural regions. Full article

The rapidly changing dynamics of the digital age reshape the addiction relationship that high school students establish with technology. While smartphones remove boundaries in terms of communication and access to information, their usage triggers a source of anxiety and nomophobia. The increase in students’ anxiety levels because of their over-reliance on mobile phone use leads to significant behavioral changes in their mental health, academic performance, social interactions and financial dependency. This study examined the nomophobia levels of high school students according to selected socio-demographic indicators. Using the relational screening model, the multistage sampling technique was used to select a sample of 884 participants: 388 from Science High School and 496 from Anatolian High School (459 female, 425 male, Mage = 16.45 ± 1.14 year). Independent sample test and One-way ANOVA were applied. Depending on the homogeneity assumption of the data, Welch values were considered, and Tukey tests were applied as a second-level test from post hoc analyses. Comprehensive analyses of nomophobia levels revealed that young individuals’ attitudes towards digital technology differ significantly according to their demographic and behavioral characteristics. Variables such as gender, physical activity participation, grade level and duration of smartphone use are among the main factors affecting nomophobia levels. Female individuals and students who do not participate in physical activity exhibit higher nomophobia scores. Full article

Background/Objectives: Agricultural workers in Spain with a migratory background face challenging working and living conditions that significantly affect their health. This study aimed to explore how professionals in healthcare, social services, civil society organisations, and labour institutions perceive that the working conditions affect the physical health of this population. Methods: A qualitative descriptive study was conducted through 92 semi-structured interviews with professionals from six provinces in Spain. Data were analysed using thematic analysis following Braun and Clarke’s six-phase framework. Rigour was ensured through triangulation, independent coding, and interdisciplinary consensus. Results: Two overarching themes were identified: (1) the health consequences of workplace demands and environmental hazards, and (2) navigating health services such as sick leave and disability permits. These findings highlight how the impact of precarious working conditions and limited access to healthcare affect the physical health of migrant agricultural workers. Conclusions: The professionals interviewed described and relate precarious working conditions with adverse health outcomes among migrant agricultural workers. Their insights reveal the need for systemic reforms to enforce labour rights, ensure access to health services, and address the structural factors that contribute to exclusion and vulnerability. Full article

Background: Chemotherapy-induced peripheral neuropathy is a common and debilitating side effect of cancer treatment. While exercise has shown promise in alleviating this burden, it remains underutilised in clinical practice due to the lack of accessible, clinician-friendly guidance. Aim: This review aimed to synthesise current evidence on exercise interventions for managing chemotherapy-induced peripheral neuropathy and provide practical insights to support clinicians in integrating these approaches into patient care. Methods: A search was conducted across MEDLINE, CINAHL, and SPORTDiscus using keywords related to exercise and CIPN. Studies were included if they involved adults receiving neurotoxic chemotherapy and exercise-based interventions. Two authors independently screened studies and resolved conflicts with a third author. Study quality was assessed using the JBI Critical Appraisal Tools, and only studies meeting a minimum quality standard were included. A balanced sampling approach was employed. Data on study design, participant characteristics, interventions, and outcomes were extracted. Results: Eleven studies were included, covering various exercise modalities: multimodal (n = 5), yoga (n = 2), aerobic (n = 1), resistance (n = 1), balance (n = 1), and sensorimotor (n = 1). Exercise interventions, particularly multimodal exercise, significantly improved symptom severity, functionality, and quality of life (p < 0.05). The studies had high methodological quality, with randomised controlled trials scoring between 9/13 and 11/13, and quasi-experimental studies scoring 8/9 on JBI tools. Conclusions: This review highlights the significant benefits of exercise, especially multimodal exercise, for managing CIPN and provides guidance for integrating these strategies into clinical practice. Future research is needed to refine exercise prescriptions and develop standardised guidelines. Full article

Introduction and Aim: Sarcopenia has emerged as a key prognostic factor in patients with chronic limb-threatening ischemia (CLTI), with potential implications for clinical decision-making. This study aimed to assess the association between sarcopenia and clinical outcomes, mortality, and amputation, using simple, accessible screening tools in a CLTI population. Methods: In this prospective, single-center study conducted between December 2023 and December 2024, 170 patients with CTLI were enrolled. Sarcopenia screening was performed using the SARC-F (strength, assistance in walking, rising from a chair, climbing stairs, falls) questionnaires, handgrip strength measurement, and calf circumference, adjusted for body mass index and sex. The primary outcome was 6-month all-cause mortality and/or major amputation. Results: Sarcopenia was identified in 77 patients (45.3%). Compared to non-sarcopenic individuals, sarcopenic patients were significantly older. They exhibited greater functional impairment, as well as poorer nutritional and muscle status. They also had significantly higher in-hospital mortality (16.9% vs. 3.2%, p = 0.002), 30-day mortality (24.7% vs. 4.3%, p = 0.001), and 6-month mortality (50.6% vs. 15.1%, p = 0.001). Sarcopenia was significantly associated with the primary outcome in univariate analysis (HR: 2.05; 95% CI: 1.31–3.20; p = 0.002) and remained an independent predictor after multivariate adjustment (HR: 1.95; 95% CI: 1.01–3.79; p = 0.048). Conclusions: Sarcopenia is a strong, independent predictor of poor outcome in patients with CLTI. Its detection through simple tools offers an easy and cost-effective strategy to improve risk stratification and guide early intervention through exercise-based therapy. Full article

Secure autonomous secret key distillation (SKD) systems traditionally depend on external common randomness (CR) sources, which often suffer from instability and limited reliability over long-term operation. In this work, we propose a novel SKD architecture that synthesizes CR by combining a keystream of a shared-key keystream generator $KSG\left(K_G\right)$ with locally generated binary Bernoulli noise. This construction emulates the statistical properties of the classical Maurer satellite scenario while enabling deterministic control over key parameters such as bit error rate, entropy, and leakage rate (LR). We derive a closed-form lower bound on the equivocation of the shared-secret key $K_G$ from the viewpoint of an adversary with access to public reconciliation data. This allows us to define an admissible operational region in which the system guarantees long-term secrecy through periodic key refreshes, without relying on advantage distillation. We integrate the Winnow protocol as the information reconciliation mechanism, optimized for short block lengths ($N=8$), and analyze its performance in terms of efficiency, LR, and final key disagreement rate (KDR). The proposed system operates in two modes: ideal secrecy, achieving secret key rates up to 22% under stringent constraints (KDR < 10⁻⁵, LR < 10⁻¹⁰), and perfect secrecy mode, which approximately halves the key rate. Notably, these security guarantees are achieved autonomously, without reliance on advantage distillation or external CR sources. Theoretical findings are further supported by experimental verification demonstrating the practical viability of the proposed system under realistic conditions. This study introduces, for the first time, an autonomous CR-based SKD system with provable security performance independent of communication channels or external randomness, thus enhancing the practical viability of secure key distribution schemes. Full article

Background/Objectives: Frailty is a multifactorial clinical syndrome characterized by diminished physiological reserves and increased vulnerability to stressors. It is increasingly recognized as a predictor of poor outcomes in cardiac rehabilitation (CR). However, how frailty is defined, assessed, and addressed across outpatient CR programmes remains unclear. This scoping review aimed to map the extent, range, and nature of research examining frailty in the context of outpatient CR, including how frailty is measured, its impact on CR participation and outcomes, and whether sex and gender considerations or participation barriers are reported. Methods: Following the PRISMA-ScR guidelines, we conducted a comprehensive search across six electronic databases (from inception to 15 May 2025). Eligible peer-reviewed studies included adult participants assessed for frailty using validated tools and enrolled in outpatient CR programmes. Two reviewers independently screened citations and extracted data. Results were synthesized descriptively and narratively across three domains: frailty assessment, sex and gender considerations, and barriers to CR participation. The protocol was registered with the Open Science Framework. Results: Thirty-nine studies met inclusion criteria, all conducted in the Americas, Western Pacific, or Europe. Frailty was assessed using 26 distinct tools, most commonly the Kihon Checklist, Fried’s Frailty Criteria, and Frailty Index. The median pre-CR frailty prevalence was 33.5%. Few studies (n = 15; 38.5%) re-assessed frailty post-CR. Sixteen studies reported sex or gender data, but none applied sex- or gender-based analysis (SGBA) frameworks. Only eight studies examined barriers to CR participation, identifying physical limitations, emotional distress, cognitive concerns, healthcare system-related factors, personal and social factors, and transportation as key barriers. Conclusions: The literature on frailty in CR remains fragmented, with heterogeneous assessment methods, limited global representation, and inconsistent attention to sex, gender, and participation barriers. Standardized frailty assessments and individualized CR programme adaptations are urgently needed to improve accessibility, adherence, and outcomes for frail individuals. Full article

Objective: To explore the relationship between type of grocery store used (chain vs. independent), transportation access, food insecurity, and fruit and vegetable intake in Detroit, Michigan, USA, during the COVID-19 pandemic. Design: A cross-sectional online survey was conducted from December 2021 to May 2022. Setting: Detroit, Michigan. Participants: 656 Detroit residents aged 18 and older. Results: Bivariate analyses showed that chain grocery store shoppers reported significantly greater fruit and vegetable intake (2.42 vs. 2.14 times/day for independent grocery store shoppers, p < 0.001) and lower rates of food insecurity compared to independent store shoppers (45.9% vs. 65.3% for independent grocery store shoppers, p < 0.001). Fewer independent store shoppers used their own vehicle (52.9% vs. 76.2% for chain store shoppers, p < 0.001). After adjusting for socioeconomic and demographic variables transportation access was strongly associated with increased odds of shopping at chain stores (OR = 1.89, 95% CI [1.21,2.95], p = 0.005) but food insecurity was no longer associated with grocery store type. Shopping at chain grocery stores was associated with higher fruit and vegetable intake after adjusting for covariates (1.18 times more per day, p = 0.042). Qualitative responses highlighted systemic barriers, including poor food quality, high costs, and limited transportation options, exacerbating food access inequities. Conclusions: These disparities underscore the need for targeted interventions to improve transportation options and support food security in vulnerable populations, particularly in urban areas like Detroit. Addressing these structural challenges is essential for reducing food insecurity and promoting equitable access to nutritious foods. Full article

Background: Parents of children with type 1 diabetes play a key role in managing their child’s self-management, which can be stressful and burdensome. High involvement can lead to reactions such as emotional, cognitive, and physical exhaustion in parents. Understanding parents’ psychosocial impact due to their child’s disease is crucial for the family’s overall well-being. The purpose of this study was to describe stress and burden experienced by parents in families with children living with type 1 diabetes. Methods: This study utilized a qualitative approach, analyzing interviews with 16 parents of children aged 10 to 17 years living with T1D through qualitative content analysis. The data collection occurred between January and February 2025. Results: Managing a child’s Type 1 diabetes can be tough on family relationships, affecting how partners interact, intimacy, and sibling relationships. The constant stress and worry might leave parents feeling exhausted, unable to sleep, and struggling to think clearly, on top of the pain of losing a normal everyday life. The delicate balance between allowing a child with type 1 diabetes to be independent and maintaining control over their self-management renders these challenges even more demanding for the parents. Conclusions: Parents’ experiences highlight the need for robust support systems, including dependable school environments, trustworthy technical devices, reliable family and friends, and accessible healthcare guidance. These elements are essential not only for the child’s health and well-being but also for alleviating the emotional and practical burdens parents face. Full article