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Medical cannabis cultivation requires substantial energy for heating, lighting, and climate control. This study evaluates the economic feasibility of an innovative biomass-fired micro-CHP system in a greenhouse facility for medicinal cannabis cultivation. The system comprises an 80 kW_th boiler retrofitted for biomass and a 7 kW_el ORC engine and is assessed against a diesel-boiler Business-As-Usual (BAU) benchmark. Thermal load simulations for two growing periods (1 March–30 June and 1 September–30 December) estimate an annual heating demand of 91,065.20 kWh_th. The micro-CHP system delivers 8195.87 kWh_el per year, exceeding the greenhouse’s 7839.90 kWh_el consumption. Over a 30-year lifespan at a 7% discount rate, Life Cycle Costing yields EUR 196,421.33 for micro-CHP versus EUR 229,468.46 for BAU, a 14.4% reduction. Under all-equity financing, the project achieves an NPV of EUR 59,591.88, IRR of 27.32%, and a DPBP of 12.1 years; with 70% debt financing, NPV rises to EUR 61,211.39 and DPBP shortens to 10.5 years. Levelized Cost of Energy (LCOE) and Heat (LCOH) are EUR 0.122 per kWh_el and EUR 0.062 per kWh_th, respectively. While the LCOE is below the Greek and EU non-household averages (EUR 0.1578 and EUR 0.1515 per kWh_el), the LCOH exceeds the corresponding heat price benchmarks (EUR 0.0401 and EUR 0.0535 per kWh_th). These results indicate that, in the modeled context, biomass-ORC cogeneration can be a financially attractive and lower-carbon option for medicinal cannabis greenhouse operations. Full article

(This article belongs to the Special Issue Energy Storage and Electric Power Systems: Theory, Methods, and Applications)

23 pages, 4220 KB

Open AccessArticle

Exploration for Gas Generation Potential and Geochemical Signatures of Neogene Clastic Deposits from Gavdos Island, Greece, Eastern Mediterranean

by Dimosthenis Telemenis, Spyridon Bellas, Nikolaos Kallithrakas-Kontos, Nikos Pasadakis and Emmanouil Manoutsoglou

Geosciences 2025, 15(11), 432; https://doi.org/10.3390/geosciences15110432 (registering DOI) - 13 Nov 2025

Abstract

The latest exploration developments and discoveries from the eastern Mediterranean documented that Neogene formations can act as source-rocks for hydrocarbon generation and their exploitation delivered large amounts of mostly biogenic gas to the market. Examples of such offshore gas-fields include the Zohr-Egypt, Leviathan/Tamar-Israel, and Aphrodite-Cyprus. Having attracted the oil majors’ attention for hydrocarbons exploration in southern Greece (e.g., Exxon-Mobil, Chevron), by using onshore geologic analogs, we suggest relevant perspectives in the country’s offshore sector. Our study focuses on Miocene marine deposits exploration, from Gavdos Island, southern Greece, evaluating their characteristics as potential source-rocks affected by a paleodepositional framework. By integrating fieldwork, organic (Rock-Eval VI-pyrolysis, CHNS) and inorganic geochemical data (XRF), the current results indicate gas-prone organic matter with variable preservation status, reflecting a few oxidation episodes during deposition under generally dysoxic-to-suboxic conditions. Paleoclimatic weathering indices (CIA, C.I., Sr/Cu, Rb/Sr) suggest predominantly arid to semi-arid regimes punctuated by short-lived humid phases that locally enhance organic accumulation and nutrient supply. Variations in paleosalinity and stratification, particularly within the Messinian section, are interpreted as precursors to the Messinian Salinity Crisis. Our findings highlight the potential for hydrocarbon-prone intervals in the deeper-offshore Eastern Mediterranean basins, where most favorable conditions for organic-carbon preservation and maturation are documented by the discoveries. Full article

(This article belongs to the Section Geochemistry)

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18 pages, 4811 KB

Open AccessArticle

Alternative Diagnostic Approaches for Various Single-Fault Conditions in Direct-Drive Low-Speed Coreless Permanent Magnet Generators

by Alexandros Sergakis, Nikolaos Gkiolekas, Marios Salinas, Markus Mueller and Konstantinos N. Gyftakis

Energies 2025, 18(22), 5973; https://doi.org/10.3390/en18225973 (registering DOI) - 13 Nov 2025

Abstract

A finite-element model of the direct-drive coreless permanent-magnet generator is used to simulate faults individually. Each fault case—rotor magnet demagnetization, a stator inter-turn short circuit, static eccentricity, and dynamic eccentricity—is introduced into the finite-element analysis (FEA) model separately, rather than in combination. For each isolated fault scenario, the stator current signals are processed using the Extended Park’s Vector Approach (EPVA) and the electromagnetic torque is examined in the frequency domain. The EPVA spectra and torque harmonics exhibit unique features for each fault type, allowing for clear discrimination among faults. These results demonstrate that modeling and analyzing faults one at a time yields distinct diagnostic signatures. Full article

(This article belongs to the Special Issue Condition Monitoring of Electrical Machines Based on Models)

26 pages, 1711 KB

Open AccessArticle

Nobody’s Listening: Evaluating the Impact of Immersive VR for Engaging with Difficult Heritage and Human Rights

by Rozhen K. Mohammed-Amin, Maria Economou, Akrivi Katifori, Karo K. Rasool, Tabin L. Raouf, Niyan H. Ibrahim, Roza A. Radha and Kavi O. Ali

Heritage 2025, 8(11), 474; https://doi.org/10.3390/heritage8110474 (registering DOI) - 13 Nov 2025

Abstract

Immersive virtual reality (VR) offers promising approaches for engaging with difficult heritage and human rights issues, potentially fostering deeper emotional connections than traditional media. This paper presents a mixed-methods evaluation of Nobody’s Listening, a VR experience documenting the Yazidi genocide in Iraq (2014–2017). Employing a historical empathy framework, the study analyses pre- and post-experience surveys, interviews, and observational data from 127 non-Yazidi participants across five Iraqi cities. It contributes a replicable framework for evaluating immersive heritage experiences, assessing how VR can foster emotional engagement, raise human rights awareness, and inspire positive action. Findings reveal substantial impact across cognitive, emotional, and behavioral domains: 85% reported increased awareness of the genocide, 71% gained new knowledge of Yazidi culture, and over 80% experienced intense emotional reactions, including empathy, grief, and shock. When describing what impressed them most, 57% demonstrated historical empathy (including contextualization, perspective taking, and affective connection). Notably, 92% believed justice had not been served, with many expressing intentions to support advocacy. Our findings suggest that VR’s impact in post-conflict contexts stems not solely from immersion, but from resonance with participants’ own trauma histories—activating empathy through analogical recognition and collective memory. The study offers key design and ethical principles, including cultural specificity, survivor testimony, community consultation, and trauma-informed evaluation. These insights contribute to inclusive heritage interpretation, reconciliation, and human rights education. Full article

(This article belongs to the Special Issue Digital Museology and Emerging Technologies in Cultural Heritage)

40 pages, 1225 KB

Open AccessArticle

F-DeNETS: A Hybrid Methodology for Complex Multi-Criteria Decision-Making Under Uncertainty

by Konstantinos A. Chrysafis

Systems 2025, 13(11), 1019; https://doi.org/10.3390/systems13111019 (registering DOI) - 13 Nov 2025

Abstract

In the modern business environment, where uncertainty and complexity make decision-making difficult, the need for robust, transparent and adaptable support tools is highlighted. The proposed method, named Flexible Decision Navigator for Evaluating Trends and Strategies (F-DeNETS), offers a complementary perspective to classic Artificial Intelligence (AI), Big Data and Multi-Criteria Decision-Making (MCDM) tools. Despite their broad use, these methods frequently suffer from critical sensitivities In the weighting of criteria and the handling of uncertainty, leading to compromised reliability and limited practical utility in environments with limited data availability. To bridge this gap, F-DeNETS integrates intuition and uncertainty into a transparent and statistically grounded process. It introduces a balanced approach that combines statistical evidence with human judgment, extending the boundaries of classic AI, Big Data and MCDM methods. Classic MCDM methods, although useful, are sometimes limited by subjectivity, staticity and dependence on large volumes of data. To fill this gap, F-DeNETS, a hybrid framework combining Fuzzy Decision-Making Trial and Evaluation Laboratory (DEMATEL), Non-Asymptotic Fuzzy Estimators (NAFEs) and Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), transforms expert judgments into statistically sound fuzzy quantifications, incorporates dynamic adaptation to new data, reduces bias and enhances reliability. A numerical application from the shipping industry demonstrates that F-DeNETS offers a flexible and interpretable methodology for optimal decisions in environments of high uncertainty. Full article

(This article belongs to the Special Issue Decision Making in Uncertain Environments via Advanced Analytical Methods: Second Edition)

18 pages, 883 KB

Open AccessArticle

The Prevalence and Predictors of Hypertension and Albuminuria in People with HIV (PWHIV)—Real-World Greek Data

by Vasileios Petrakis, Andreas G. Tsantes, Petros Rafailidis, Konstantia Kantartzi, Maria Panopoulou, Theocharis Konstantinidis, Nikoleta Babaka, Pelagia Kriki, Stylianos Panagoutsos, Dimitrios Papazoglou and Periklis Panagopoulos

Life 2025, 15(11), 1747; https://doi.org/10.3390/life15111747 - 13 Nov 2025

Abstract

Background: After the implementations of Highly Active Antiretroviral Therapy (HAART) HIV infection became a chronic condition and the clinical focus on non-AIDS-related comorbidities such as hypertension and chronic kidney disease has increased. This study aims to investigate the prevalence and independent predictors of hypertension and albuminuria in a cohort of people with HIV (PWHIV) with high rates of viral suppression. Methods: This is a cross-sectional study of 183 HAART-experienced PWHIV. Hypertension, defined as office systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg and albuminuria, was defined as a sex-based albumin–creatinine ratio (ACR) of >355 mg/g for females and >250 mg/g for males. Univariable and multivariable logistic regression was conducted to identify the association of hypertension and albuminuria with demographic, clinical, and HIV-specific factors. Results: The prevalence of hypertension was 43.9% (n = 74) and albuminuria was 22.4% (n = 41). In the multivariable analysis, factors independently associated with prevalence of HTN were older age, overweight/obesity, and diabetes mellitus. TDF-based ART was explored as a potential factor but did not reach statistical significance (aRR = 1.85, p = 0.065). For albuminuria, older age, diabetes mellitus, and duration of HAART (aRR = 1.03 per year) were revealed as independent predictors. Conclusions: The results of this study demonstrate that the development of hypertension is primarily driven by traditional metabolic risk factors. However, the progression to albuminuria appears to be influenced not only by these comorbidities but also by long-term HIV disease and HAART exposure. These findings underline the critical need for the screening and management of hypertension and other comorbidities to mitigate the risk of long-term cardiovascular and renal complications in this aging population of PWHIV. Full article

(This article belongs to the Special Issue Emerging Knowledge on Human Immunodeficiency Virus)

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41 pages, 3504 KB

Open AccessArticle

Redefining Development Through Logistics Performance and ESG Metrics

by Panagiotis Karountzos, Damianos P. Sakas, Dimitrios K. Nasiopoulos and Kanellos Toudas

Account. Audit. 2025, 1(3), 11; https://doi.org/10.3390/accountaudit1030011 - 13 Nov 2025

Abstract

This study investigates the systemic interrelations between logistics performance, environmental performance, sustainable development progress, and institutional governance. While the existing literature often examines these dimensions separately, this research conceptualizes them as co-determined drivers of national development. Using data from 123 countries, the analysis integrates four composite indices—Logistics Performance Index (LPI), Environmental Performance Index (EPI), Sustainable Development Goals Index (SDG), and Worldwide Governance Indicators (WGI)—alongside GDP per capita. Methodologically, this study applies multiple linear regressions and correlation analyses to assess the associations among these variables and employs Fuzzy Cognitive Mapping (FCM) to simulate scenario-based systemic interactions. Results show that all ESG indicators are positively and significantly associated with LPI, with WGI exerting the strongest effect. In turn, LPI, EPI, SDG, and WGI jointly explain 81.7% of the variance in GDP per capita, confirming their integrated role in shaping economic performance. FCM simulations further reveal that both environmental and institutional improvements generate reinforcing effects on logistics capacity and GDP outcomes. This study’s originality lies in its multiple-method approach and its synthesis of ESG and logistics performance metrics into a unified explanatory framework. It contributes to development studies by highlighting the structural embeddedness of logistics within broader institutional and sustainability ecosystems. Its policy implication lies in suggesting that integrated reforms—combining infrastructure, regulatory quality, and environmental stewardship—are essential for enhancing long-term national competitiveness and resilience. Full article

(This article belongs to the Special Issue Rethinking ESG and CSR: Advancing Transparency and Integrity in Corporate Governance)

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17 pages, 224 KB

Open AccessEntry

Technocracy

by Cameron Elliott Gordon

Encyclopedia 2025, 5(4), 194; https://doi.org/10.3390/encyclopedia5040194 - 13 Nov 2025

Definition

Technocracy refers to any political–social–economic system that is governed and managed using purportedly objective scientific and technical principles, and in which ultimate power and authority rests with technical and scientific experts. The concept had its initial origins in the early decades of the Industrial Revolution (with antecedents stretching back to the rationalism of ancient Greece and, later, the Enlightenment in the West). Henri Saint-Simon in early 19th century France was the earliest exponent of a technocratic system which involved overall political and economic government by industrialists. Technocracy was formally coined as a term in the early 20th century in the United States in the context of a specific intellectual movement under the same name which laid out a more detailed system of economic and social management by industrialists and scientists that supposedly would guarantee maximum efficiency in production, consumption and distribution without the self-defeating tendencies of political systems of the time, either democratic or authoritarian. Technocracy is currently used to refer to any policy or governmental arrangement that purportedly emphasizes technical criteria above non-technical values in policy, planning and public decision-making, and which gives significant authority to experts. Singapore is often referred to as a leading example of such an approach. Various controversies have arisen around technocracy, especially its potential incompatibility with democracy and social values that are not easily translated into technical terms. There is also debate about how feasible a genuine technocracy actually is in practice. Full article

(This article belongs to the Collection Encyclopedia of Social Sciences)

24 pages, 1396 KB

Open AccessArticle

Drivers of Efficient Destination Management in Times of Transition: Key Findings for Destination Development Management and Marketing Organisations (DDMMOs)

by Iordanis Katemliadis, Andreas Papatheodorou, Maria Doumi and Nicholas Karachalis

Tour. Hosp. 2025, 6(5), 244; https://doi.org/10.3390/tourhosp6050244 - 13 Nov 2025

Abstract

This paper reflects on the results of a survey and aims to illuminate the operations of Destination Development, Management and Marketing Organisations (DDMMOs) by identifying different Key Performance Areas (KPAs), the indicators connected to them, and examining how they influence each other. Various linkages were explored between Enablers and Results performance areas, both within and across these categories. The use of multivariate statistical techniques such as Structural Equation Modelling (SEM), along with Analysis of Variance (ANOVA), chi-square tests, Pearson correlation, and other descriptive statistical methods yielded several insightful findings. The authors developed a research model which operated at an observation level and measured all the latent variables and tested all the hypothetical dependencies. The model investigates causal relationships among variables and understands how each contributes to overall performance. Researchers created a questionnaire using the EFQM framework, which consisted of seven constructs and 72 indicators rated on a Likert scale (1–5). Out of the 141 questionnaires distributed, 128 were considered valid and formed the sample for this research. All respondents were experienced employees/managers of DDMMOs in various roles. The results revealed that Leadership is one of the most valuable functions that DDMMOs can provide, and that when stakeholders trust the DDMMO, they become more efficient. The optimal size and ownership structure should be tailored to the specific needs of the destination, which can also influence how it manages its response. Furthermore, this paper revealed the link between sustainability and performance. The effectiveness of DDMMOs will largely determine the impact on the local economy and society. The research model developed together with the insights revealed is a testament of the practical relevance of this paper. Full article

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17 pages, 303 KB

Open AccessReview

Linguistic Markers in Spontaneous Speech: Insights into Subjective Cognitive Decline (Review)

by Sofia Segkouli, Mara Gkioka, Stylianos Kokkas, Konstantinos Votis, Sergi Valero, Andrea Miguel, Athos Antoniades, Emily Charalambous and George Manias

Healthcare 2025, 13(22), 2888; https://doi.org/10.3390/healthcare13222888 - 13 Nov 2025

Abstract

Background and Objectives: Population rapid growth and demographic shift is leading to a rise in neurodegenerative disorders such as dementia and mild cognitive impairment (MCI). Evidence indicates that MCI is not the earliest phase of prodromal AD. Subjective Memory Decline (SMD) refers to a self-perceived decline in cognitive abilities compared to previous functioning levels in individuals with normal cognition. Language impairment represents a critical marker of neurodegenerative disorders and early memory decline in healthy older adults. Methods: This review was conducted in accordance with PRISMA Statement guidelines. The inclusion criteria of the selection process were set as follows: (1) All studies analyzed spontaneous speech samples in individuals with SMD or individuals with +αβ amyloid. (2) Studies reported language performance indicators (e.g., lexical, syntactic, semantic, phonetic, or fluency measures) derived from spontaneous speech. (3) The study population included participants with SMD based on recognized diagnostic criteria or self-reported cognitive complaints without objective cognitive impairment. (4) Studies were written in English. (5) The time frame of studies was 5 years. Results: The present work is a review of speech features—particularly from spontaneous and narrative speech—and methods that can serve as sensitive indicators of early cognitive changes due to AD pathology. Conclusions: Spontaneous speech analysis, through acoustic and temporal parameters such as silence duration, phrasal segment length, and speech segment frequency, offers a rich window into the subtle cognitive and linguistic changes that reflect early memory decline in healthy older adults. Spontaneous speech performance could be a scalable, low-cost, and non-invasive diagnostic tool in proactive cognitive health. Full article

(This article belongs to the Section Digital Health Technologies)

31 pages, 1106 KB

Open AccessReview

AΙ-Driven Drug Repurposing: Applications and Challenges

by Paraskevi Keramida, Nikolaos K. Syrigos, Marousa Kouvela, Garyfallia Poulakou, Andriani Charpidou and Oraianthi Fiste

Medicines 2025, 12(4), 28; https://doi.org/10.3390/medicines12040028 - 13 Nov 2025

Abstract

Drug repurposing is the process of discovering new therapeutic indications for already existing drugs. By using already approved molecules with known safety profiles, this approach reduces the time, costs, and failure rates associated with traditional drug development, accelerating the availability of new treatments to patients. Artificial Intelligence (AI) plays a crucial role in drug repurposing by exploiting various computational techniques to analyze and process big datasets of biological and medical information, predict similarities between biomolecules, and identify disease mechanisms. The purpose of this review is to explore the role of AI tools in drug repurposing and underline their applications across various medical domains, mainly in oncology, neurodegenerative disorders, and rare diseases. However, several challenges remain to be addressed. These include the need for a deeper understanding of molecular mechanisms, ethical concerns, regulatory requirements, and issues related to data quality and interpretability. Overall, AI-driven drug repurposing is an innovative and promising field that can transform medical research and drug development, covering unmet medical needs efficiently and cost-effectively. Full article

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17 pages, 1018 KB

Open AccessArticle

Methane Production Using Olive Tree Pruning Biomass Under H₂O₂ Pretreatment Enhanced with UV and Alkali

by Fotini Antoniou, Ilias Apostolopoulos, Athanasia G. Tekerlekopoulou and Georgia Antonopoulou

Molecules 2025, 30(22), 4379; https://doi.org/10.3390/molecules30224379 - 13 Nov 2025

Abstract

Olive tree pruning (OTP), a widely available agricultural residue in Mediterranean countries, represents a promising lignocellulosic feedstock for anaerobic digestion. However, its recalcitrant structure limits its biodegradability and methane yields, necessitating effective pretreatment approaches. In this context, hydrogen peroxide in combination with ultraviolet (UV) radiation (UV/H₂O₂) at ambient temperature was used as a pretreatment method for enhancing methane production from OTP. Three concentrations of H₂O₂ (0, 1, and 3% w/w) alone or in combination with UV radiation, at different retention times (8, 14, and 20 h), were evaluated to enhance OTP depolymerization and methane generation. In addition, the combination of UV/H₂O₂ with alkali (UV/H₂O₂/NaOH) was compared with the typical alkaline pretreatment (NaOH) in terms of lignocellulosic biomass fractionation and biochemical methane potential (BMP). Results showed that increasing H₂O₂ concentration during UV/H₂O₂ pretreatment enhanced hemicellulose solubilization. Both NaOH and UV/H₂O₂/NaOH pretreatment promoted lignin reduction (37.3% and 37.8%), resulting in enhanced BMP values of 330.5 and 337.9 L CH₄/kg TS, respectively. Considering operational energy requirements (heating at 80 °C and irradiance for 20 h) and methane energy recovery, net energy balances of 45.52 kJ and 66.65 kJ were obtained for NaOH and UV/H₂O₂/NaOH, respectively. Full article

(This article belongs to the Special Issue Novel Biochemical Processes for Treatment and Valorization of Wastes and Biomass)

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32 pages, 2795 KB

Open AccessReview

How Will Environmental Conditions Affect Species Distribution and Survival in the Coming Decades—A Review

by Pavel Kindlmann, Spyros Tsiftsis, Lucie Buchbauerová, Iva Traxmandlová and Zuzana Štípková

Diversity 2025, 17(11), 793; https://doi.org/10.3390/d17110793 (registering DOI) - 13 Nov 2025

Abstract

Species are disappearing worldwide and the expectation is that this will increase in the future. This review summarizes information on the reasons for the global reduction in biodiversity and what might happen in the future. The literature indicates that the most important factors responsible for this are changes in climate and land use. As changes in land use result in the destruction of natural habitats, they are thought to be the prime driver in the future. Climate change is, however, also often cited as a major driving force. To reduce the effect of climate change on the decline in biodiversity, it is important to know, how climate change affects the abundance and distribution of species. A particular emphasis should be placed not only on conserving specific species but also the environment and communities they live in. In addition, there are many other factors that might play a role, e.g., overexploitation, eutrophication and the introduction and spread of invasive non-native species. Full article

(This article belongs to the Section Biodiversity Conservation)

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32 pages, 9488 KB

Open AccessArticle

A CAD-Integrated Framework for Dynamic Structural Topology Optimisation via Visual Programming

by Laura Sardone, Stefanos Sotiropoulos and Alessandra Fiore

Computation 2025, 13(11), 267; https://doi.org/10.3390/computation13110267 - 13 Nov 2025

Abstract

Structural Topology Optimisation (STO) plays a critical role in computational engineering, enabling the creation of material-efficient, performance-driven structures. However, dynamic STO workflows, particularly those involving time-varying or seismic excitations, are often inaccessible to architects and engineers due to their reliance on standalone solvers, large-scale data handling, and advanced programming skills. This paper introduces a Computer-Aided Design (CAD)-embedded, time-dependent STO framework built upon a modular, adjoint-based optimisation core integrated into a Visual Programming Language (VPL) interface. Implemented within a parametric CAD environment through a custom C# component, the framework embeds a MATLAB-based solver to support geometry definition, boundary condition control, and dynamic finite element analysis under harmonic and seismic loading. The resulting Graphical User Interface (GUI) lowers technical barriers by enabling users to iteratively configure STO parameters, manage meshing, and visualise real-time results. Case studies on tall building façades under earthquake excitation validate the framework’s ability to minimise displacement at targeted Degrees of Freedom (DOFs), dynamically adapt material distributions, and enhance structural resilience. By bridging high-fidelity computational methods with accessible visual workflows, the proposed system advances the integration of dynamic STO into both architectural and engineering practice. Full article

(This article belongs to the Special Issue Advanced Topology Optimization: Methods and Applications)

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23 pages, 502 KB

Open AccessReview

Brainstem Stroke and Dysphagia Treatment: A Narrative Review on the Role of Neuromodulation, Skill-Based Swallowing Training and Transient Receptor Potential Agonists

by Ivy Cheng, Wan-Qi Li, Shaheen Hamdy, Emilia Michou, Maggie-Lee Huckabee, Noemí Tomsen, Pere Clavé and Rainer Dziewas

Audiol. Res. 2025, 15(6), 156; https://doi.org/10.3390/audiolres15060156 - 12 Nov 2025

Abstract

Swallowing is mediated by the central nervous system, including cortical and subcortical structures, the cerebellum, and the brainstem. The brainstem contains the swallowing centre that is crucial for initiating and coordinating swallowing. Consequently, brainstem damage due to stroke often leads to severe and persistent dysphagia. The aim of the present narrative review is to provide an overview of dysphagia following brainstem stroke and its management. It summarizes the physiology and pathophysiology of dysphagia following brainstem stroke and the available therapeutic options, and evaluate their effectiveness for dysphagia following brainstem stroke, which would promote the development of therapeutic protocols. Neuromodulatory techniques, including pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), modulate the excitability of corticobulbar circuits. These techniques promote neuroplasticity through peripheral or cortical electrical or electromagnetic inputs. Skill-based swallowing training emphasizes cortical involvement in enhancing swallowing skill, offering a targeted approach to behavioural rehabilitation. Finally, transient receptor potential (TRP) agonists increase sensory inputs to the swallowing system by stimulating the sensory receptors in the oropharynx, potentially activating the swallowing network. While these options have shown promise in dysphagia rehabilitation following stroke, most the available data comes from patients with mixed stroke lesions, with limited data focused specifically on brainstem lesions. Therefore, the evidence for their efficacy in patients with brainstem stroke remains underexplored. Therefore, treatment decisions should rely on the understanding of swallowing physiology, neuroplasticity, and clinical evidence from related stroke populations. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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