Search Results (1,051)

The sustainability of a port is directly related to the time spent by ships in terminals and depends on the terminal, the technologies used in it, and external conditions. Currently used sustainable port terminal technologies allow a significant increase in the intensity of ship loading operations and, at the same time, shorten the time spent by ships at the quays. Since port construction processes take a lot of time, many ports have many quays every day that are not moored by ships. Ports try to attract passenger and cargo flows, but they are also not infinite. In individual port terminals, for example, container and Ro–Ro terminals, most of the time is spent on cargo processing inside the terminal, and only part of the time is spent on ship loading operations. Probabilistic assessment of ship mooring at quays allows an understanding of not only the optimal need for quays and modernization of their equipment, but at the same time for a more purposeful assessment of the possibilities of using quays, accepting diversification options and, therefore, optimizing the ports themselves as a sustainable port entity. The article presents a methodology for assessing berth occupancy focused on the development of a sustainable port based on probabilistic methods that would allow calculating potential berth occupancy. The developed methodology, compared to existing methodologies and models, allows for a more realistic assessment of the expected berth occupancy, using actual port and ship data. The presented theoretical and experimental research results confirm the suitability of the developed methodology for the development of a sustainable port and the possibilities of applying the developed methodology in any port, adapting it to specific port conditions. Full article

Carob pulp flour (Ceratonia siliqua) is gaining attention as a sustainable ingredient with nutritional and functional potential. This study evaluated the partial replacement of soft wheat flour with 10% carob pulp flour in breadmaking, focusing on the role of different leavening strategies: commercial baker’s yeast (LB), a selected starter culture, Lactiplantibacillus plantarum SL31 and Saccharomyces cerevisiae SY17 (LI), and a type I sourdough (LS). Dough rheology, microbial dynamics, bread quality, acceptability, and shelf-life were assessed. Results showed that the inclusion of carob pulp flour enhances the nutritional profile while maintaining satisfactory technological performance. The leavening strategy strongly influenced the final products: breads made with commercial yeast displayed high volume and softness but were less stable during storage; LS breads achieved greater microbial stability but were limited by excessive acidity and reduced sensory acceptance; breads obtained with the selected starter culture offered the most balanced outcome, combining moderate structure with enhanced flavor and consumer preference. Overall, the findings demonstrate the feasibility of incorporating carob pulp flour into bakery products and highlight the potential of tailored starter cultures as a promising compromise between technological performance, sensory quality, and shelf-life. Future work should optimize fermentation approaches to further enhance consumer appeal and support industrial application. Full article

Type 1 Diabetes Mellitus (T1D) is an autoimmune disease characterized by the destruction of pancreatic β-cells, predominantly manifesting in childhood or adolescence. The lack of clearly interpretable biological markers in the early stages, combined with the insidious onset of the disease, poses significant challenges to early diagnosis and the implementation of preventive strategies. The applicability of classic T1D biomarkers for understanding the mechanisms of the autoimmune process, preclinical diagnostics and treatment efficiency is limited. Despite advances in next-generation sequencing (NGS) technologies, which have enabled large-scale genome-wide association studies (GWASs) and the identification of polygenic risk scores (PRSs) associated with T1D predisposition, as well as progress in bioinformatics approaches for assessing dysregulated gene expression, no universally accepted risk assessment model or definitive predictive biomarker has been established. Until now, the use of new promising biomarkers for T1D diagnostics is limited by insufficient evidence base. However, they have great potential for the development of diagnostic methods on their basis, which has been shown in single or serial large-scale studies. This critical review covers both well-known biomarkers widely used in clinical practice, such as HLA-haplotype, non-HLA SNPs, islet antigen autoantibodies, C-peptide, and the promising ones, such as cytokines, cfDNA, microRNA, T1D-specific immune cells, islet-TCR, and T1D-specific vibrational bands. Additionally, we highlight new approaches that have been gaining popularity and have already demonstrated their potential: GWAS, single-cell transcriptomics, identification of antigen-specific T cells using scRNA-seq, and FTIR spectroscopy. Although some of the biomarkers, in our opinion, are still limited to a research context or are far from being implemented in clinical diagnostics of T1D, they have the greatest potential of being applied in clinical practice. When integrated with the monitoring of the classical autoimmune diabetes markers, they would increase the sensitivity and specificity during diagnostics of early and preclinical stages of the disease. This critical review aims to evaluate the current landscape of classical and emerging biomarkers in autoimmune diabetes, with a focus on those enabling early detection—prior to extensive destruction of pancreatic islets. Another goal of the review is to focus the attention of the scientific community on the gaps in early T1D diagnostics, and to help in the selection of markers, targets, and methods for scientific studies on creating novel diagnostic panels. Full article

Background: Acute appendicitis is the most common surgical emergency in children, yet timely and accurate diagnosis remains challenging due to nonspecific clinical presentations and limitations of imaging and blood tests. Saliva has emerged as a promising diagnostic medium because it is non-invasive, painless, inexpensive, and highly acceptable for pediatric patients. Salivary biomarkers may provide rapid and child-friendly adjuncts to existing diagnostic pathways. Methods: A systematic literature search was performed in Ovid/MEDLINE, Scopus, Web of Science, and the Cochrane Library to identify studies assessing salivary biomarkers in pediatric appendicitis. Eligible studies included children with suspected or confirmed appendicitis and evaluated the diagnostic accuracy of salivary markers compared to clinical, laboratory, or imaging standards. Results: To date, only three salivary biomarkers have been investigated. Leucine-rich α-2-glycoprotein 1 (LRG1) demonstrated high specificity of 100% but low sensitivity of 35–36%, with diagnostic accuracy ranging from AUC 0.77 to 0.85. C-reactive protein (CRP) showed excellent diagnostic performance with sensitivity of 91.3% and specificity of 95.4% (AUC 0.97), and strong correlation with serum CRP (ρ = 0.96). Irisin showed sensitivity of 90% and specificity of 60% with estimated AUC around 0.75, suggesting potential as an adjunct marker but limited as a standalone test. Conclusions: Salivary biomarkers in pediatric appendicitis are promising but remain underexplored, with evidence limited to small, single-center studies totalling fewer than 300 patients. Their advantages include feasibility, tolerability, and suitability for integration into point-of-care testing. Future research should focus on multicenter validation, development of multi-marker salivary panels, and application of biosensor technologies. With further evidence, salivary diagnostics could complement existing strategies and improve the accuracy and child-friendliness of appendicitis care. Full article

Background: Mild cognitive impairment (MCI) affects up to 40% of patients with Parkinson’s disease (PD), yet conventional rehabilitation often lacks engagement. The OPERA project developed a novel Bio-cooperative Robotic Platform (PRoBio), integrating a service robot and a virtual reality-based rehabilitation for personalized cognitive training. This work presents two preliminary user-centred studies aimed to assess PRoBio usability and acceptability. Methods: to gather qualitative feedback on robotic and virtual reality technologies, through ad hoc questionnaires, developed according to participatory design principles and user-centered evaluation literature, Study 1 (Focus group) involved 23 participants: 10 PD patients (F = 6; mean age = 68.9 ± 8.2 years), 5 caregivers (F = 3; mean age = 49.0 ± 15.5), 8 healthcare professionals (F = 6; mean age = 40.0 ± 12.0). Study 2 (Living Lab) tested the final version of PRoBio platform with 6 healthy volunteers (F = 3; mean age = 50.3 ± 11.0) and 8 rehabilitation professionals (F = 3; mean age = 32.8 ± 9.9), assessing usability and acceptability through validated questionnaires. Results: The focus group revealed common priorities across the three groups, including ease of use, emotional engagement, and personalization of exercises. Living Lab unveiled PRoBio as user-friendly, with high usability, hedonic quality, technology acceptance and low workload. No significant differences were found between groups, except for minor concerns on system responsiveness. Discussion: These preliminary findings support the feasibility, usability, and emotional appeal of PRoBio as a cognitive rehabilitation tool. The positive convergence among the groups suggests its potential for clinical integration. Conclusions: These preliminary results support the feasibility and user-centred design of the PRoBio platform for cognitive rehabilitation in PD. The upcoming usability evaluation in a pilot study with patients will provide critical insights into its suitability for clinical implementation and guide further development. Full article

Emergency medical services confront significant challenges in delivering timely patient assessments within geographically isolated or disaster-impacted regions. While drones (unmanned aircraft systems, UAS) show transformative potential in healthcare, standardized protocols for drone-assisted patient evaluations remain underdeveloped. This study introduces the ABCD-IN-BARS protocol, a 9-step telemedicine checklist integrating patient-assisted maneuvers and drone technology to systematize remote emergency assessments. A wait-list randomized controlled trial with 68 first-aid-trained volunteers evaluated the protocol’s feasibility. Participants underwent web-based modules and in-person simulations and were randomized into immediate training or waitlist control groups. The ABCD-IN-BARS protocol was developed via a content validity approach, incorporating expert-rated items from the telemedicine literature. Outcomes included time-to-assessment, provider confidence (Modified Cooper–Harper Scale), measured at baseline, post-training, and 3-month follow-up. Ethical approval and informed consent were obtained. Most of the participants can complete the assessment with a cue card within 4 min. A mixed-design repeated measures ANOVA assessed the effects of Time (baseline, post-test, 3-month follow-up within subject) on assessment durations. Assessment times improved significantly over three time points (p = 0.008), improving with standardized protocols, while patterns were similar across groups (p = 0.101), reflecting skill retention at 3 months and not affected by injury or not. Protocol adherence in simulated injury identification increased from 63.3% pre-training to 100% post-training. Provider confidence remained high (MCH scores: 2.4–2.7/10), and Technology Acceptance Model (TAM) ratings emphasized strong Perceived Usefulness (PU2: M = 4.48) despite moderate ease-of-use challenges (EU2: M = 4.03). Qualitative feedback highlighted workflow benefits but noted challenges in drone maneuvering. The ABCD-IN-BARS protocol effectively standardizes drone-assisted emergency assessments, demonstrating retained proficiency and high usability. While sensory limitations persist, its modular design and alignment with ABCDE principles offer a scalable solution for prehospital care in underserved regions. Further multicenter validation is needed to generalize findings. Full article

Background: Patient satisfaction with diabetes technology is increasingly recognized as a key factor in therapeutic success. Patient-reported outcomes (PROs) are gaining importance in diabetes care and in the evaluation of advanced insulin delivery systems. Objectives: This study aimed to design and validate a new questionnaire, the Insulin Pump Infusion Sets Satisfaction Scale (IPISS), to assess satisfaction with insulin infusion sets among individuals with type 1 diabetes. Methods: The questionnaire was developed by our Diabetology Unit in two versions: one for patient self-reporting and one for caregivers when the patient is too young to complete it autonomously. Content validity was assessed by six healthcare professionals (three diabetologists and three nurses) based on Polit and Beck’s methodology. The Item Content Validity Index (I-CVI) was calculated for both relevance and comprehensibility and was considered satisfactory if expert agreement reached ≥83%. The Scale Content Validity Index (S-CVI) was computed as the average of I-CVIs, with a cut-off value > 90% deemed acceptable. Results: Almost all items achieved 100% positive agreement for both relevance and comprehensibility, except one item in the caregiver version, for which one rater did not provide a rating for comprehensibility (I-CVI = 83.3%). The S-CVI was 100% for relevance in both versions, 99.24% for comprehensibility in the caregiver version, and 100% in the patient version. Conclusions: The IPISS is a content-validated, self-reported tool, suitable for evaluating satisfaction with infusion sets in individuals using insulin pumps, with versions adapted for both patients and caregivers. Full article

All over the world, the problem of ensuring the safety of pedestrians, who are the most vulnerable road users, is becoming more acute due to urbanization and the growth of micromobility. In 2013, according to WHO data, more than 270 thousand pedestrians were dying each year worldwide (accounting for 22% of all traffic accidents). Currently, experts report that around 1.3 million people die every year globally from road crashes. The roads in developing countries are particularly hazardous, according to experts, because the increase in the number of vehicles far exceeds the development of road infrastructure and safety systems. Since the risk of hitting a pedestrian depends on many factors that can have different natures, and the severity of the consequences can be determined by a set of other factors, the risk of an accident can only be reduced by influencing all these factors in a comprehensive manner. The novelty of our approach is to create an intelligent system that will gradually accumulate all the best practices into a single complex aimed at reducing the risk of an accident with pedestrians and the severity of the consequences if an accident does occur. The distinction lies in offering an integrated system where each module addresses a particular task, so by mitigating risks at every stage, one achieves a synergistic outcome. From the analysis of existing and applied developments, it is known that many specialists mainly solve a narrowly focused problem aimed at ensuring the one subsystems sustainability in the “vehicle-infrastructure-driver-pedestrian” system. Some of these ideas are given as practical examples. The relevance of the designated problem increases with the emergence of autonomous vehicles and smart cities, the sustainability of which depends on the sustainable interaction between all road users. As experience shows, only the implementation of comprehensive solutions allows us to solve strategic problems, including improving road safety. Here, by complex solutions we mean solutions that combine technical issues, as well as environmental, social, and managerial aspects. To account for different kinds of effects, indicator systems are developed and composite indices are computed to choose the most rational solution. The novelty of our approach consists in combining within a unified DSS algorithms for assessing the efficiency of the proposed solution with respect to technological soundness, environmental sustainability, economic viability, social acceptability, as well as administrative rationality and computation of interrelated effects resulting from implementing any given project. In our opinion, the proposed system will lead to a synergistic effect due to the integrated application of various developments, which will ensure increased sustainability and safety of the transport system of smart cities. Our paper proposes a conceptual approach to addressing pedestrian safety, and the examples provided illustrate how the same model or algorithm can lead to positive changes from different perspectives. Full article

Background/Objectives: Coupling mobile health (mHealth) technology with community-based nutrition programs may enhance diet quality in adolescents. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of integrating PortionSize Ed (PSEd), an image-assisted dietary assessment and education app, into the six-week Hawaii Food and Lifeskills for Youth (HI-FLY) curriculum delivered via Supplemental Nutrition Assistance Program Education (SNAP-Ed). Methods: Adolescents (grades 6–8) from two classrooms were cluster-randomized into HI-FLY or HI-FLY + PSEd. Both groups received HI-FLY and completed Youth Questionnaires (YQ) and food records (written or app-based) at Weeks 0 and 7. Feasibility and acceptability were assessed via enrollment, attrition, and User Satisfaction Surveys (USS). Diet quality was measured using Healthy Eating Index-2020 (HEI-2020) scores and analyzed via mixed-effects models. Results: Of 50 students, 42 (84%) enrolled and attrition was minimal (2.4%). The sample was 49% female and 85% at least part Native Hawaiian or Pacific Islander (NHPI). PSEd was acceptable, with average USS scores above the scale midpoint. No significant HEI-2020 changes were observed, though YQ responses indicated improvements in sugary drink intake (p = 0.03) and use of nutrition labels in HI-FLY + PSEd (p = 0.0007). Conclusions: Integrating PSEd into SNAP-Ed was feasible, acceptable, and demonstrated potential healthy behavior change among predominantly NHPI youth in Hawaii. Full article

Background/Objectives: A high-performing blood biomarker (BBM) test for Alzheimer’s disease (AD) represents an accurate, accessible, and scalable tool to aid healthcare professionals (HCPs) evaluating patients presenting with signs or symptoms of mild cognitive impairment (MCI) or dementia. However, implementation of AD blood tests into clinical practice has not been extensively evaluated. The objective of this study was to assess the implementation of the multi-analyte PrecivityAD2™ blood test (C2N Diagnostics, LLC, St. Louis, MO, USA) into the clinical workflow of memory care clinics. Methods: A total of 8 HCPs (neurologists, geriatricians, geriatric psychiatrists) who served as site directors from 8 outpatient sites that evaluated 203 cognitively symptomatic patients were included in this sub-study of the real-world QUIP II Study (NCT06025877). Implementation of this blood test was assessed through surveying these HCPs using published frameworks including the Technology Acceptance Model, net promoter score, and forced choice preference questions. These assessments were analyzed using Wilcoxon signed-rank test, Fisher’s Exact test, and Wilcoxon signed-rank test, respectively. Results: HCPs reported acceptance scores that averaged 9.6 out of 10 (p < 0.0001, effect size 0.840): the test’s contribution to clinical decision-making as well as the ease of understanding test results received the highest ratings. The net promoter score was 75 (p < 0.0001), exceeding the typical benchmark of 30 reported as good levels of satisfaction in healthcare settings. The APS2 results and individual blood analyte results were rated with similar preference around their roles in HCP clinical decision-making. Conclusions: The results indicate early evidence of user acceptance and recognition by HCPs that this AD blood test can personalize the clinical care pathway for evaluating cognitively symptomatic patients. Full article

The building sector plays a key role in the transition toward climate neutrality, with national regulations across the EU requiring the construction of nearly zero-energy buildings (nZEBs). However, while energy performance has been extensively studied, less attention has been given to the problem of ensuring user comfort—both indoors and in the surrounding outdoor areas—under nZEB design constraints. This gap raises two key research objectives: (1) to evaluate whether a well-designed nZEB with extensive glazing maintains acceptable indoor thermal comfort and (2) to assess whether residents experience greater outdoor thermal comfort and satisfaction in small, sun-exposed private gardens or in larger, shaded communal green spaces. To address these objectives, a newly built residential estate near Kraków (Poland) was analyzed. The investigation included simulation-based assessments during the design phase and in situ measurements during building operation, complemented by a user survey on spatial preferences. Indoor comfort was evaluated for rooms with large glazed façades, as well as rooms with standard-sized windows, while outdoor comfort was assessed in both private gardens and a shared green courtyard. Results show that shading the southwest-oriented glazed façade with an overhanging terrace provided slightly lower temperatures in ground-floor rooms compared to rooms with standard unshaded windows. Outdoors, users experienced lower thermal comfort in small, unshaded gardens than in the larger, vegetated communal area (pocket park), which demonstrated greater capacity for temperature moderation and thermal stress reduction. Survey responses further indicate that potential future residents prefer the inclusion of a shared green–blue infrastructure area, even at the expense of building some housing units in semi-detached form, instead of maximizing the number of detached units with unshaded individual gardens. These findings emphasize the importance of addressing both indoor and outdoor comfort in residential nZEB design, showing that technological efficiency must be complemented by user-centered design strategies. This integrated approach can improve the well-being of residents while supporting climate change adaptation in the built environment. Full article

Brewer’s spent grain enhances nutritional quality by increasing fiber and plant-based proteins and reducing the need for synthetic additives. Technologies such as extrusion and fermentation transform BSG into functional ingredients that improve texture and stability. A significant increase in antioxidant capacity was observed in enriched foods; for example, in burgers, BSG improved fiber and protein levels, while decreasing fat and calories without negatively affecting sensory acceptance. In sausages, substituting 5% of pork with BSG achieved acceptance similar to traditional formulations, and hybrid formulations with BSG maintained improved protein content while preserving texture. However, concentrations above 20% may negatively impact sensory and technological properties, by introducing undesirable flavors or altering texture. Thus, BSG is a promising source of high-value functional ingredients that contribute to the circular economy and healthier, sustainable foods. Nonetheless, more in vivo studies are needed to validate the health benefits, understand the interactions in complex matrices, assess the shelf life, and evaluate the long-term sensory perception. The “Silent Revolution” of BSG requires a multidisciplinary approach that integrates science, technology, sustainability, and effective communication with consumers. Full article

Background/Objectives: Integrating 3D visualization technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), into dental education may enhance students’ understanding of facial anatomy and clinical procedures. This study aimed to assess dental students’ perceptions of using MR for three-dimensional visualizations of impacted teeth. Methods: Cone-beam computed tomography (CBCT) scans of patients with impacted teeth were retrospectively selected from a university clinic database. The CBCT images were processed to adjust contrast for optimal visualization before being uploaded to MR goggles (HoloLens 2). A total of 114 final-year dental students participated, each manipulating the 3D images in space using the goggles. Following this, they completed a seven-question survey on a five-point Likert scale (1 = strongly agree, 5 = strongly disagree), evaluating image quality and the usefulness of 3D visualization. Results: The study group consisted of 29 males and 85 females (mean age = 24.11 years, SD = 1.48). The most favorable responses were for enhanced visualization of the impacted tooth’s position relative to adjacent structures and the inclusion of 3D image visualization as a teaching aid, which benefited students while learning and allowed them to better understand the course of the procedure for exposure/extraction of the impacted tooth, with median scores of 1, indicating a highly favorable opinion. A statistically significant relationship was found between the responses of females and males regarding the quality of the presented image using HoloLens 2 goggles. No significant correlation was found between participants with and without prior experience using VR/MR/AR. No significant correlation was found between age and responses. Conclusions: Students reported an improved understanding of the relationships between impacted teeth and adjacent structures, as well as potential benefits for clinical training. These findings demonstrate a high level of acceptance of MR technology among students; however, further research is required to objectively assess its effectiveness in enhancing learning outcomes. Full article

Fresh pasta was enriched with olive pomace (OP) and artichoke by-products (AB), respectively, at three concentrations: 13.5%, 14.5%, and 15% for OP, and 15%, 17%, and 19% for AB. Both control and fortified samples were assessed for technological properties, nutritional content and sensory quality. A Life Cycle Assessment was also performed to estimate the carbon footprint associated with pasta production. Results demonstrated a worsening of pasta quality, above all the resistance to break for row pasta and sandiness and taste for cooked samples, even though the pasta remained in an acceptable range. Fibers, polyphenol content, flavonoids, and antioxidant activity were found to be better in fortified samples than in the control pasta. With AB as new ingredient, the antioxidant activity increased substantially. The environmental impact revealed two different scenarios: compared to the control (1.08 kgCO₂eq), lower carbon footprint values were found for pasta fortified with OP (from 0.96 to 0.98 kgCO₂eq) and higher values for pasta fortified with AB (from 1.53 to 1.62 kgCO₂eq), due to the energy consumption associated with by-product processing (dehydration at 50 °C and grinding). Thus, combining sensory quality, nutritional improvements and environmental impact, a Global Quality Index (GQI) was also calculated for each sample. The GQI values, according to the weighting scheme of this index, revealed that the benefits of AB superimposed the drawbacks and suggested that 15% AB fortification is the best solution to balance pros and cons of by-product recycling. Full article

Enriching bread with functional ingredients is a promising strategy to enhance the nutritional and bioactive profile of widely consumed foods. This study evaluated partial substitution of wheat flour (WF) with chestnut flour (CF) and rosehip powder (RP) on bread nutritional quality, functionality, and rheology. Five bread formulations were developed by replacing WF with CF at 0%, 5%, 10%, 15%, and 20%. Four other formulations were prepared by replacing WF in the 15% CF sample with RP at 0.5%, 1%, 2%, and 3%. Proximate composition, total phenolic content (TPC), total flavonoid content (TFC), antioxidant activity (DPPH and FRAP), and key physical characteristics were assessed, alongside the retention rates of functional attributes after baking. Rheological behavior of composite flours was analyzed using the MIXOLAB system to evaluate dough performance. Results showed that moderate WF substitution with CF (5–15%) increased dietary fiber and antioxidant activity while maintaining acceptable dough rheology and bread quality. At 20% CF substitution, TPC, TFC, FRAP, and DPPH increased 1.62-, 1.63-, 2.93-, and 3.03-fold versus control, with 59–66% retention. Addition of RP up to 3% to the 15% CF-substituted sample further enhanced bioactive properties, with TPC, TFC, FRAP, and DPPH reaching 2.13-, 2.03-, 4.49-, and 3.99-fold vs. BCF15, while retaining 61–67% of their functionality. Further inclusion of RP up to 2% in the 15% CF formulation maintains acceptable dough and bread performance, while 3% RP maximizes phytochemical enrichment but slightly affects technological properties. The combination of 15% CF and 2% RP provided a balanced enhancement in bioactive content and technological performance, offering a practical approach for producing functional bread with improved nutritional and technological attributes. Full article