Search Results (54,604)

Although technological innovations are often intended to improve quality and efficiency, they can exacerbate systemic challenges when not aligned with the principles of value-based care. As a result, healthcare systems in many countries face persistent inefficiencies stemming from the overuse, underuse, misuse, and waste associated with the adoption of health technology. This narrative review examines the dual impact of healthcare technology and evaluates how contract mechanisms can serve as strategic tools for promoting cost-effective, outcome-oriented integration. Drawing from healthcare management, and supply chain literature, this paper analyzes various payment and contract models, including performance-based, bundled, cost-sharing, and revenue-sharing agreements, through the lens of stakeholder alignment. It explores how these mechanisms influence provider behavior, patient access, and system sustainability. The study contends that well-designed contract mechanisms can align stakeholder incentives, reduce inefficiencies, and support the delivery of high-value care across diverse healthcare settings. We provide concrete examples to illustrate how various contract mechanisms impact the integration of health technologies in practice. Full article

The objectives of this study were to prepare whey protein–quercetin–gellan gum conjugates using the pH-shift method and to evaluate the impacts of varying pH values and quercetin concentrations on the interaction mechanisms and functional characteristics of the complexes. Spectroscopic analyses (fluorescence, UV-vis, and FT-IR) revealed that new complexes formed under alkaline conditions. Notably, an increasing quercetin concentration led to a reduction in complex particle size and an increase in the zeta potential value, with these effects being more pronounced under alkaline conditions. The particle size was 425.7 nm, and the zeta potential value was −30.00 mV at a quercetin addition concentration of 15 umol/g protein. Additionally, the complexes formed under alkaline conditions exhibited superior foaming capacity, emulsification properties, and significantly enhanced free radical scavenging activity. The complex’s DPPH and ABTS radical scavenging rates rose by 41.57% and 57.69%, respectively. This study provides theoretical foundations and practical insights for developing protein—polyphenol systems, offering significant implications for the application of quercetin functional foods and supplements in the food science and pharmaceutical industries. Full article

Traditional Pavement Condition Index (PCI) assessments are highly resource-intensive, demanding substantial time and labor while generating significant carbon emissions through extensive field operations. To address these sustainability challenges, this research presents an innovative methodology utilizing Gene Expression Programming (GEP) to determine PCI values based on International Roughness Index (IRI) measurements from Iraqi road networks, offering an environmentally conscious and resource-efficient approach to pavement management. The study incorporated 401 samples of IRI and PCI data through comprehensive visual inspection procedures. The developed GEP model exhibited exceptional predictive performance, with coefficient of determination (R²) values achieving 0.821 for training, 0.858 for validation, and 0.8233 overall, successfully accounting for approximately 82–85% of PCI variance. Prediction accuracy remained robust with Mean Absolute Error (MAE) values of 12–13 units and Root Mean Square Error (RMSE) values of 11.209 and 11.00 for training and validation sets, respectively. The lower validation RMSE suggests effective generalization without overfitting. Strong correlations between predicted and measured values exceeded 0.90, with acceptable relative absolute error values ranging from 0.403 to 0.387, confirming model effectiveness. Comparative analysis reveals GEP outperforms alternative regression methods in generalization capacity, particularly in real-world applications. This sustainable methodology represents a cost-effective alternative to conventional PCI evaluation, significantly reducing environmental impact through decreased field operations, lower fuel consumption, and minimized traffic disruption. By streamlining pavement management while maintaining assessment reliability and accuracy, this approach supports environmentally responsible transportation systems and aligns contemporary sustainability goals in infrastructure management. Full article

Background and Objectives: Lower limb defects often present significant reconstructive challenges due to limited soft tissue availability and exposure of critical structures. Perforator-based flaps offer reliable solutions, with minimal donor site morbidity. This study aimed to evaluate the efficacy of infrared thermography (IRT) in preoperative planning and postoperative monitoring of perforator-based flaps, assessing its accuracy in identifying perforators, predicting complications, and optimizing outcomes. Materials and Methods: A prospective observational study was conducted on 76 patients undergoing lower limb reconstruction with fascio-cutaneous perforator flaps between 2022 and 2024. Perforator mapping was performed concurrently with IRT and Doppler ultrasonography (D-US), with intraoperative confirmation. Flap design variables and systemic parameters were recorded. Postoperative monitoring employed thermal imaging on days 1 and 7. Outcomes were correlated with thermal, anatomical, and systemic factors using statistical analyses, including t-tests and Pearson correlation. Results: IRT showed high sensitivity (97.4%) and positive predictive value (96.8%) for perforator detection. A total of nine minor complications occurred, predominantly in patients with diabetes mellitus and/or elevated glycemia (p = 0.05). Larger flap-to-defect ratios (A/C and B/C) correlated with increased complications in propeller flaps, while smaller ratios posed risks for V-Y and Keystone flaps. Thermal analysis indicated significantly lower flap temperatures and greater temperature gradients in flaps with complications by postoperative day 7 (p < 0.05). CRP levels correlated with glycemia and white blood cell counts, highlighting systemic inflammation’s impact on outcomes. Conclusions: IRT proves to be a reliable, non-invasive method for perforator localization and flap monitoring, enhancing surgical planning and early complication detection. Combined with D-US, it improves perforator selection and perfusion assessment. Thermographic parameters, systemic factors, and flap design metrics collectively predict flap viability. Integration of IRT into surgical workflows offers a cost-effective tool for optimizing reconstructive outcomes in lower limb surgery. Full article

Optical fringe projection is an outstanding technology that significantly enhances three-dimensional (3D) metrology in numerous applications in science and engineering. Although the complexity of fringe projection systems may be overwhelming, current scientific advances bring improved models and methods that simplify the design and calibration of these systems, making 3D metrology less complicated. This paper provides an overview of the fundamentals of fringe projection profilometry, including imaging, stereo systems, phase demodulation, triangulation, and calibration. Some applications are described to highlight the usefulness and accuracy of modern optical fringe projection profilometers, impacting 3D metrology in different fields of science and engineering. Full article

With the large-scale integration of high-penetration distributed photovoltaic (DPV) into distribution networks, its output volatility and reverse power flow characteristics are prone to causing voltage violations, necessitating the accurate identification of weak nodes to enhance operational reliability. This paper investigates the definition, quantification criteria, and multi-indicator comprehensive determination methods for weak nodes in distribution networks. A multi-criteria assessment method integrating voltage deviation rate, sensitivity analysis, and power margin has been proposed. This method quantifies the node disturbance resistance and comprehensively evaluates the vulnerability of voltage stability. Simulation validation based on the IEEE 33-node system demonstrates that the proposed method can effectively identify the distribution patterns of weak nodes under different penetration levels (20~80%) and varying numbers of DPV access points (single-point to multi-point distributed access scenarios). The study reveals the impact of increased penetration and dispersed access locations on the migration characteristics of weak nodes. The research findings provide a theoretical basis for the planning of distribution networks with high-penetration DPV, offering valuable insights for optimizing the siting of volatile loads such as electric vehicle (EV) charging stations while considering both grid safety and the demand for distributed energy accommodation. Full article

Cucumbers (Cucumis sativus L.) are highly sensitive to cold, but grafting onto cold-tolerant rootstocks can enhance their low-temperature resilience. This study investigates the physiological and molecular mechanisms by which exogenous vitamin C (Vc) mitigates cold stress in grafted cucumber seedlings. Using cucumber ‘Chiyu 505’ as the scion and pumpkin ‘Chuangfan No.1’ as the rootstock, seedlings were grafted using the whip grafting method. In the third true leaf expansion stage, seedlings were foliar sprayed with Vc at concentrations of 50, 100, 150, and 200 mg L⁻¹. Three days after initial spraying, seedlings were subjected to cold stress (8 °C) for 3 days, with continued spraying. After that, morphological and physiological parameters were assessed. Results showed that 150 mg L⁻¹ Vc treatment was most impactive, significantly reducing the cold damage index while increasing the root-to-shoot ratio, root vitality, chlorophyll content, and activities of antioxidant enzymes (SOD, POD, CAT). Moreover, this treatment enhanced levels of soluble sugars, soluble proteins, and proline compared to control. However, 200 mg L⁻¹ treatment elevated malondialdehyde (MDA) content, indicating potential oxidative stress. For transcriptomic analysis, leaves from the 150 mg L⁻¹ Vc and CK treatments were sampled at 0, 1, 2, and 3 days of cold stress. Differential gene expression revealed that genes associated with photosynthesis (LHCA1), stress signal transduction (MYC2-1, MYC2-2, WRKY22, WRKY2), and antioxidant defense (SOD-1, SOD-2) were initially up-regulated and subsequently down-regulated, as validated by qRT-PCR. Overall, we found that the application of 150 mg L⁻¹ Vc enhanced cold tolerance in grafted cucumber seedlings by modulating gene expression networks related to photosynthesis, stress response, and the antioxidant defense system. This study provides a way for developing Vc biostimulants to enhance cold tolerance in grafted cucumbers, improving sustainable cultivation in low-temperature regions. Full article

Background and aim: Advanced Therapy Medicinal Products (ATMPs) are innovative drugs based on genes, tissues, or cells that target rare and severe diseases. ATMPs have shown promising clinical outcomes but are associated with high costs, raising questions about cost-effectiveness. Hence, this systematic review aims to analyze the cost-effectiveness and cost-utility profiles of the European Medicines Agency-authorized ATMPs for treating rare diseases. Methods: A systematic review was conducted following PRISMA guidelines. Studies were identified by searching PubMed, Embase, Web of Science, and ProQuest scientific databases. Economic evaluations reporting incremental cost-effectiveness/utility ratios (ICERs/ICURs) for ATMPs were included. Costs were standardized to 2023 Euros, and a cost-effectiveness plane was constructed to evaluate the results against willingness-to-pay (WTP) thresholds of EUR 50,000, EUR 100,000, and EUR 150,000 per QALY, as part of a sensitivity analysis. Results: A total of 61 studies met the inclusion criteria. ATMPs for rare blood diseases, such as tisagenlecleucel and axicabtagene ciloleucel, were found to be cost-effective in a majority of studies, with incremental QALYs ranging from 1.5 to 10 per patient over lifetime horizon. Tisagenlecleucel demonstrated a positive cost-effectiveness profile in the treatment of acute lymphoblastic leukemia (58%), while axicabtagene ciloleucel showed a positive profile in the treatment of diffuse large B-cell lymphoma (85%). Onasemnogene abeparvovec for spinal muscular atrophy (SMA) showed uncertain cost-effectiveness results, and voretigene neparvovec for retinal diseases was not cost-effective in 40% of studies, with incremental QALYs around 1.3 and high costs exceeding the WTP threshold set. Conclusions: ATMPs in treating rare diseases show promising economic potential, but cost-effectiveness varies across indications. Policymakers must balance innovation with system sustainability, using refined models and the long-term impact on patient outcomes. Full article

Proper joint function has a significant impact on people’s quality of life. Joints are the point of connection between two or more bones and consist of at least three elements: joint surfaces, the joint capsule, and the joint cavity. Joint diseases are a serious social problem. Risk factors for the development of these diseases include overweight and obesity, gender, and intestinal microbiome disorders. Another factor that is considered to influence joint diseases is trace elements. Under normal conditions, elements such as iron (Fe), copper (Cu), cobalt (Co), iodine (I), manganese (Mn), zinc (Zn), silver (Ag), cadmium (Cd), mercury (Hg), lead (Pb), nickel (Ni) selenium (Se), boron (B), and silicon (Si) are part of enzymes involved in reactions that determine the proper functioning of cells, regulate redox metabolism, and determine the maturation of cells that build joint components. However, when the normal concentration of the above-mentioned elements is disturbed and toxic elements are present, dangerous joint diseases can develop. In this article, we focus on the role of trace elements in joint function. We describe the molecular mechanisms that explain their interaction with chondrocytes, osteocytes, osteoblasts, osteoclasts, and synoviocytes, as well as their proliferation, apoptosis, and extracellular matrix synthesis. We also focus on the role of these trace elements in the pathogenesis of joint diseases: rheumatoid arthritis (RA), osteoarthritis (OA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and systemic lupus erythematosus (SLE). We describe the roles of increased or decreased concentrations of individual elements in the pathogenesis and development of joint diseases and their impact on inflammation and disease progression, referring to molecular mechanisms. We also discuss their potential application in the treatment of joint diseases. Full article

According to the United Nations Environment Programme reports, buildings are responsible for nearly 40% of energy-related emissions; therefore, energy-optimized building design is crucial to reduce the reliance on non-renewable energy sources as well as greenhouse gas emissions. The OECD reports indicate the use of Building Information Modelling (BIM) as one of the effective strategies for decarbonization of buildings, since a 3D digital representation of both physical and functional characteristics of a building can help to design a more efficient infrastructure. An efficient integration of solar energy in building design can be vital for the enhancement of energy performance in terms of heating, cooling, and lighting demand. This paper presents results of an analysis of how factors related to the use of daylight, such as automatic control of artificial lighting, external shading, or the visual absorptance of internal surfaces, influence the energy efficiency within an example room in two different climatic zones. The simulation was conducted using Design Builder software, with predefined occupancy schedules and internal heat gains, and standard EPW weather files for Warsaw and Genua climate zones. The study indicates that for the examined room, when no automatic sunshades or a lighting control system is utilized, most of the final energy demand is for cooling purposes (45–54%), followed by lighting (42–43%), with only 3–12% for heating purposes. The introduction of sunshades and/or the use of daylight allowed for a reduction of the total demand by up to half. Moreover, it was pointed out that often neglected factors, like the colour of the internal surfaces, can have a significant effect on the final energy consumption. In variants with light interior, the total energy consumption was lower by about 3–4% of the baseline demand, compared to their corresponding ones with dark surfaces. These results are consistent with previous studies on daylighting strategies and highlight the importance of considering both visual and thermal impacts when evaluating energy performance. Similarly, possible side effects of certain actions were highlighted, such as an increase in heat demand resulting from a reduced need for artificial lighting. The results of the analysis highlight the potential of a simulation-based design approach in optimizing daylight use, contributing to the broader goals of building decarbonization. Full article

Leptospirosis is a globally significant zoonosis affecting animal health, productivity, and the environment. While typically associated with tropical climates, its persistence in semi-arid regions such as La Laguna, Mexico—characterized by low humidity, high temperatures, and limited water sources—remains poorly understood. Although these adverse environmental conditions theoretically limit the survival of Leptospira, high livestock density and synanthropic reservoirs (e.g., rodents) may compensate, facilitating transmission. In this cross-sectional study, blood sera from 445 dairy cows (28 herds: 12 intensive [MI], 16 semi-intensive [MSI] systems) were analyzed via microscopic agglutination testing (MAT) against 10 pathogenic serovars. Urine samples were cultured for active Leptospira detection. Risk factors were assessed through epidemiological surveys and multivariable analysis. This study revealed an overall apparent seroprevalence of 27.0% (95% CI: 22.8–31.1), with significantly higher rates in MSI (54.1%) versus MI (12.2%) herds (p < 0.001) and an estimated true seroprevalence of 56.3% (95% CI: 50.2–62.1) in MSI and 13.1% (95% CI: 8.5–18.7) in MI herds (p < 0.001). The Sejroe serogroup was isolated from urine in both systems, confirming active circulation. In MI herds, rodent presence (OR: 3.6; 95% CI: 1.6–7.9) was identified as a risk factor for Leptospira seropositivity, while first-trimester abortions (OR:10.1; 95% CI: 4.2–24.2) were significantly associated with infection. In MSI herds, risk factors associated with Leptospira seropositivity included co-occurrence with hens (OR: 2.8; 95% CI: 1.5–5.3) and natural breeding (OR: 2.0; 95% CI: 1.1–3.9), whereas mastitis/agalactiae (OR: 2.8; 95% CI: 1.5–5.2) represented a clinical outcome associated with seropositivity. Despite semi-arid conditions, Leptospira maintains transmission in La Laguna, particularly in semi-intensive systems. The coexistence of adapted (Sejroe) and incidental serogroups underscores the need for targeted interventions, such as rodent control in MI systems and poultry management in MSI systems, to mitigate both zoonotic and economic impacts. Full article

Nanofluids are an innovative working medium in solar hot water installations (DHWs), thanks to their increased thermal conductivity and heat transfer coefficient. The aim of this work was to assess the effect of Al₂O₃ nanofluids in a water–ethylene glycol base (40:60%) and with the addition of Tween 80 surfactant (0.2 wt%) on thermal efficiency (ε) and exergy (η_ex) in a plate heat exchanger at DHW flows of 3 and 12 L/min. The numerical NTU–ε model was used with dynamic updating of thermophysical properties of nanofluids and the solution of the ODE system using the ode45 method, and the validation was carried out against the literature data. The results showed that the nanofluids achieved ε ≈ 0.85 (vs. ε ≈ 0.87 for the base fluid) and η_ex ≈ 0.72 (vs. η_ex ≈ 0.74), with higher entropy generation. The addition of Tween 80 reduced the viscosity by about 10–15%, resulting in a slight increase of Re and h-factor; however, the impact on ε and η_ex was marginal. The environmental analysis with an annual demand of Q = 3000 kWh/year and an emission factor of 0.2 kg CO₂/kWh showed that for ε < 0.87 the nanofluids increased the emissions by ≈16 kg CO₂/year, while at ε ≈ 0.92, a reduction of ≈5% was possible. This paper highlights the need to optimize nanofluid viscosity and exchanger geometry to maximize energy and environmental benefits. Nowadays, due to the growing problems of global warming, the analysis of energy efficiency and carbon footprint related to the functioning of a building seems to be crucial. Full article

Mushrooms are eukaryotic organisms with absorptive heterotrophic nutrition, capable of feeding on organic matter rich in cellulose and lignocellulose. Since ancient times, they have been considered allies and, in certain cultures, they were seen as magical beings or food of the gods. Of the great variety of edible mushrooms identified worldwide, less than 2% are traded on the market. Although mushrooms have been valued for their multiple nutritional and healing benefits, some cultures perceive them as toxic and do not accept them in their culinary practices. Despite the existing skepticism, several researchers are promoting the potential of edible mushrooms. There are two main methods of mushroom cultivation: solid-state fermentation and submerged fermentation. The former is the most widely used and simplest, since the fungus grows in its natural environment; in the latter, the fungus grows suspended without developing a fruiting body. In addition, submerged fermentation is easily monitored and scalable. Both systems are important and have their limitations. This article discusses the main methods used to increase the performance of submerged fermentation with emphasis on the modes of operation used, types of bioreactors and application of morphological bioengineering of filamentous fungi, and especially the use of intelligent automatic control technologies and the use of non-invasive monitoring in fermentation systems thanks to the development of machine learning (ML), neural networks, and the use of big data, which will allow more accurate decisions to be made in the fermentation of filamentous fungi in submerged environments with improvements in production yields. Full article

Effective flood management in agricultural fields has become increasingly important due to the rising frequency and intensity of rainfall events driven by climate change. This study investigates the applicability of urban flood analysis models—SWMM (1D) and K-Flood (2D)—to irrigated agricultural fields with artificial drainage systems. A case study was conducted in a rural area near the Sindae drainage station in Cheongju, South Korea, using rainfall data from an extreme weather event in 2017. The models simulated inland flooding and were validated against flood trace maps provided by the Ministry of the Interior and Safety (MOIS). Receiver Operating Characteristic (ROC) analysis showed a true positive rate of 0.565, a false positive rate of 0.21, and an overall accuracy of 0.731, indicating reasonable agreement with observed inundation. Scenario analyses were also conducted to assess the effectiveness of three improvement strategies: reducing the Manning coefficient, increasing pump station capacity, and widening drainage channels. Among them, increasing pump capacity most effectively reduced flood volume, while channel widening had the greatest impact on reducing flood extent. These findings demonstrate the potential of urban flood models for application in agricultural contexts and support data-driven planning for rural flood mitigation. Full article

Floating solar technology has gained significant attention as part of the global expansion of renewable energy due to its potential for installation in underutilized water bodies. Several countries, including the Netherlands, have initiated efforts to extend this technology from inland freshwater applications to open offshore environments, particularly within offshore wind farm areas. This development is motivated by the synergistic benefits of increasing site energy density and leveraging the existing offshore grid infrastructure. The deployment of offshore floating photovoltaic (OFPV) systems involves assembling multiple modular units in a marine environment, introducing operational risks that may give rise to safety concerns. To mitigate these risks, weather windows must be considered prior to the task execution to ensure continuity between weather-sensitive activities, which can also lead to additional time delays and increased costs. Consequently, optimizing marine logistics becomes crucial to achieving the cost reductions necessary for making OFPV technology economically viable. This study employs a simulation-based approach to estimate the installation duration of a 5 MWp OFPV plant at a Dutch offshore wind farm site, started in different months and under three distinct risk management scenarios. Based on 20 years of hindcast wave data, the results reveal the impacts of campaign start months and risk management policies on installation duration. Across all the scenarios, the installation duration during the autumn and winter period is 160% longer than the one in the spring and summer period. The average installation durations, based on results from 12 campaign start months, are 70, 80, and 130 days for the three risk management policies analyzed. The result variation highlights the additional time required to mitigate operational risks arising from potential discontinuity between highly interdependent tasks (e.g., offshore platform assembly and mooring). Additionally, it is found that the weather-induced delays are mainly associated with the campaigns of pre-laying anchors and platform and mooring line installation compared with the other campaigns. In conclusion, this study presents a logistics modeling methodology for OFPV systems, demonstrated through a representative case study based on a state-of-the-art truss-type design. The primary contribution lies in providing a framework to quantify the performance of OFPV installation strategies at an early design stage. The findings of this case study further highlight that marine installation logistics are highly sensitive to local marine conditions and the chosen installation strategy, and should be integrated early in the OFPV design process to help reduce the levelized cost of electricity. Full article