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Operating reserve demand curves (ORDCs) have become part of the electricity market design in several power systems. They improve the security of supply through enhanced peak prices that occur already when the system is running low on operating reserves, before an actual shortfall occurs. Previous research, however, suggests that the ORDC’s impact on resource adequacy would be thwarted by the merit order effect. Hence, we propose a methodology to model the investment in markets with ORDC, which specifically captures the interaction with renewable deployment. A stylized power system setting is used to determine the market equilibrium at different stages of decarbonization, and compared to a conventional energy-only market. Classical ORDCs consistently increase reliability by attracting additional investments. This effect can be amplified by “shifting” the ORDC, increasing the willingness to pay for balancing reserves. Our results suggest that perfect reliability can be achieved with only moderate cost increases.

BackgroundThe optimal surgical approach for adenocarcinoma directly at the esophagogastric junction (AEG II) is still under debate. This study aims to evaluate the differences between right thoracoabdominal esophagectomy (TAE) (Ivor–Lewis operation) and transhiatal extended gastrectomy (THG) for AEG II.MethodsFrom a prospective database, 242 patients with AEG II (TAE, n = 56; THG, n = 186) were included and analyzed according to characteristics and perioperative morbidity and mortality and overall survival (chi-square, Mann–Whitney U, log-rank, Cox regression).ResultsGroups were comparable at baseline with exception of age. Patients older than 70 years were more frequently resected by THG (p = 0.003). No differences in perioperative morbidity (p = 0.197) and mortality (p = 0.711) were observed, including anastomotic leakages (p = 0.625) and pulmonary complications (p = 0.494). There was no significant difference in R0 resection (p = 0.719) and number of resected lymph nodes (p = 0.202). Overall median survival was 38.4 months. Survival after TAE was significantly longer than after THG (median OS not reached versus 33.6 months, p = 0.02). Multivariate analysis revealed pN-category (p < 0.001) and type of surgery (p = 0.017) as independent prognostic factors. The type of surgery was confirmed as prognostic factor in locally advanced AEG II (cT 3/4 or cN1), but not in cT1/2 and cN0 patients.ConclusionsOur single-center experience suggests that patients with (locally advanced) AEG II tumors may benefit from TAE compared to THG. For further evaluation, a randomized trial would be necessary.

Without decarbonizing cities energy and climate objectives cannot be achieved as cities account for approximately two thirds of energy consumption and emissions. This goal of decarbonizing cities has to be facilitated by promoting net-zero/positive energy buildings and districts and replicating them, driving cities towards sustainability goals. Many projects in smart cities demonstrate novel and groundbreaking low-carbon solutions in demonstration and lighthouse projects. However, as the historical, geographic, political, social and economic context of urban areas vary greatly, it is not always easy to repeat the solution in another city or even district. It is therefore important to look for the opportunities to scale up or repeat successful pilots. The purpose of this paper is to explore common trends in technologies and replication strategies for positive energy buildings or districts in smart city projects, based on the practical experience from a case study in Leipzig—one of the lighthouse cities in the project SPARCS. One of the key findings the paper has proven is the necessity of a profound replication modelling to deepen the understanding of upscaling processes. Three models analyzed in this article are able to provide a multidimensional representation of the solution to be replicated.

Adoption of dynamic energy tariffs by households is crucial for the transition to carbon-neutral energy systems. Influencing the adoption patterns of these tariffs necessitates an examination of the drivers, decision components, and contextual factors influencing household decisions. Few computational models address this comprehensively, often omitting non-financial decision variables. Moreover, methodologically robust integrative reviews on this topic are scarce. To address this gap, this paper develops a concept-centered integrative review methodology aimed at deriving computer models for socio-techno-economic simulations of household adoption of sustainable technologies. The methodology encompasses five sequential phases: Setup, Literature Search, Analysis, Synthesis and Conceptual Model, and Discussion. To illustrate the methodology, it is applied to the case of household adoption of dynamic energy tariffs, resulting in an abstract conceptual model adaptable to local contexts. The review reveals a lack of consensus on modeled tariffs but highlights the significance of tariff complexity, relative advantage, household heterogeneity, and various agent properties. It also identifies potential improvements in model fundamentals, particularly spatial modeling. The developed process model focuses on the stages ‘knowledge’, ‘decision’, and ‘reevaluation’. The article contributes by presenting a comprehensive review scheme and delivering a concept-centered integrative review along with an explicit conceptual model derived from it.

Despite the intensive research on residential photovoltaic adoption, there is a lack of understanding regarding the social dynamics that drive adoption decisions. Innovation diffusion is a social process, whereby communication structures and the relations between sender and receiver influence what information is perceived and how it is interpreted. This paper addresses this research gap by investigating stakeholder influences in household decision-making from a procedural perspective, so-called stakeholder dynamics. A literature review derives major influence dynamics which are then synthesized based on egocentric network maps for distinct process stages. The findings show a multitude of stakeholders that can be relevant in influencing photovoltaic adoption decisions of owner-occupied households. Household decision-makers are mainly influenced by stakeholders of their social network like family, neighbors, and friends as well as PV-related services like providers and civil society groups. The perceived closeness and likeability of a stakeholder indicate a higher level of influence because of greater trust involved. Furthermore, the findings indicate that social influence shifts gradually from many different stakeholders to a few core stakeholders later on in the decision-making process. These insights suggest that photovoltaic (PV) adoption may be more reliably predicted if a process perspective is taken into account that not only distinguishes between different stakeholders but considers their dynamic importance along the process stages. In addition, especially time- and location-bound factors affect the influence strength. This clearly shows the importance of local and targeted interventions to accelerate the uptake.

The transition toward decentralized energy systems has amplified interest in peer-to-peer electricity trading. However, research on prosumer behavior in such markets remains fragmented, hindered by a lack of benchmarkable experimental infrastructure. Addressing this gap, the LabChain system was developed—a modular, interactive prototype designed to study human behavior in synthetic P2P electricity markets under controlled laboratory conditions. This system integrates real-world technologies, such as blockchain-based transaction backends, flexibility market interfaces, and asset control tools, allowing fine-grained observation of strategic and perceptual dimensions of prosumer activity. The research followed an iterative design approach to develop the infrastructure for experimental energy economics research, and to assess its effectiveness in aligning participant experience with design intentions. Based on the meta-requirements generality, affordance-centric design, and technological grounding, 13 detailed peer-to-peer market, software, and system requirements that allow for system evaluation were developed. As a proof of concept, seven participants simulated prosumer behavior over a week through interaction with the system. Their interaction with the system was analyzed through simulation data and focus group interviews, using a modified thematic content analysis with a hybrid inductive–deductive coding approach. The main achievements are (i) the design and implementation of the LabChain system as a modular infrastructure for P2P electricity market experiments, (ii) the development of an associated experimental workflow and research design, and (iii) its demonstration through an illustrative, proof-of-concept evaluation based on thematic content analysis of a single focus group session focusing on interaction and perceptions. The behavioral results from an initial session are limited, exploratory, and demonstrative in nature and should be interpreted as illustrative only. They nevertheless revealed tension between system flexibility and cognitive usability: while the system supports diverse strategies and market roles, limitations in interface clarity and information feedback constrain strategic engagement.

Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The aim of the study is to determine the mid−/long-term functional outcome, failure rates and predictors of failure after primary arthroscopic Bankart repair for traumatic anterior shoulder instability. Methods A total of 100 patients were primarily operated using arthroscopic Bankart repair after traumatic anterior shoulder instability. Medical records were retrospectively reviewed, and patients were assessed using postal questionnaire after a mean follow-up of 8.3 years [3–14]. Clinical assessment was performed using Constant score, Rowe score, and American Shoulder and Elbow Surgeons score. Results The overall recurrence rate was 22%. The Kaplan-Meier failure-free survival estimates. were 80% at 5 years and 70% at 10 years. Nearly half (54.5%) of recurrences occurred at 2 years postoperative. Compared with normal shoulder, there were statistical differences in all 3 scores. Failure rate was significantly affected by age at the time of surgery with 86% of recurrence cases observed in patients aged 30 years or younger. Nevertheless, Younger age at the time of surgery ( P  = 0.007) as well age at the time of initial instability ( P  = 0.03) was found to correlate negatively with early recurrence within 2 years of surgery. Among those with recurrent instability, recurrence rate was found to be higher if there had been more than 5 instability episodes preoperatively ( P  = 0.01). Return to the preinjury sport and occupational level was possible in 41 and 78%, respectively. Conclusion Failure-free survival rates dropped dramatically over time. Alternative reconstruction techniques should be considered in those aged ≤30 years due to the high recurrence rate.

Background Excessive early migration of cemented stems and cups after THA has been associated with poor long-term survival and allows predictable evaluation of implant performance. However, there are few data regarding the relationship between early migration and aseptic loosening of cementless femoral components, and whether early migration might predict late failure has not been evaluated, to our knowledge. Einzel-Bild-Röntgen-Analyse-femoral component analysis (EBRA-FCA) is a validated technique to accurately measure axial femoral stem migration without the need for tantalum markers, can be performed retrospectively, and may be a suitable tool to identify poor performing implants before their widespread use. Questions/purposes We asked: (1) Is axial migration within the first 24 months as assessed by EBRA-FCA greater among cementless stems that develop aseptic loosening than those that remain well fixed through the second decade; (2) what is the diagnostic performance of implant migration at 24 months postoperatively to predict later aseptic loosening of these components; and (3) how does long-term stem survivorship compare between groups with high and low early migration? Methods We evaluated early axial stem migration in 158 cementless THAs using EBRA-FCA. The EBRA-FCA measurements were performed during the first week postoperatively (baseline measurement) and at regular followups of 3, 6, and 12 months postoperatively and annually thereafter. The mean duration of followup was 21 years (range, 18–24 years). The stems studied represented 45% (158 of 354) of the cementless THAs performed during that time, and cementless THAs represented 34% (354 of 1038) of the THA practice during that period. No patient enrolled in this study was lost to followup. Multivariate survivorship analysis using Cox’s regression model was performed with an endpoint of aseptic loosening of the femoral component. Loosening was defined according to the criteria described by Engh et al. and assessed by two independent observers. Patients with a diagnosis of prosthetic joint infection were excluded. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance of axial stem migration 1, 2, 3, and 4 years postoperatively as a predictor of aseptic loosening. Survivorship of hips with high (≥ 2.7 mm) and low (< 2.7 mm) migration was compared using a competing-events analysis. Results Femoral components that had aseptic loosening develop showed greater mean distal migration at 24 months postoperatively than did components that remained well fixed throughout the surveillance period (4.2 mm ± 3.1 mm vs 0.8 mm ± 0.9 mm; mean difference, 3.4 mm, 95% CI, 2.5–4.4; p ≤ 0.001). Distal migration at 24 months postoperatively was a strong risk factor for aseptic loosening (hazard ratio, 1.98; 95% CI, 1.51–2.57; p < 0.001). The associated overall diagnostic performance of 2-year distal migration for predicting aseptic loosening was good (area under the ROC curve, 0.86; 95% CI, 0.72–1.00; p < 0.001). Sensitivity of early migration measurement was high for the prediction of aseptic loosening during the first decade after surgery but decreased markedly thereafter. Stems with large amounts of early migration (≥ 2.7 mm) had lower 18-year survivorship than did stems with little early migration (29% [95% CI, 0%–62%] versus 95% [95% CI, 90%–100%] p < 0.001). Conclusions Early migration, as measured by EBRA-FCA at 2 years postoperatively, has good diagnostic capabilities for detection of uncemented femoral components at risk for aseptic loosening during the first and early second decades after surgery. However, there was no relationship between early migration patterns and aseptic loosening during the late second and third decades. EBRA-FCA can be used as a research tool to evaluate new cementless stems or in clinical practice to evaluate migration patterns in patients with painful femoral components. Level of Evidence Level III, diagnostic study.

Clinical photon-counting CT (PCCT) offers a spatial resolution of about 200 µm and might allow for acquisitions close to conventional dental CBCTs. In this study, the capabilities of this new system in comparison to dental CBCTs shall be evaluated. All 8 apical osteolysis identified in CBCT were identified by both readers in all three PCCT scan protocols. Mean visibility scores showed statistical significant differences for root canals(p = 0.0001), periodontal space(p = 0.0090), cortical(p = 0.0003) and spongious bone(p = 0.0293) in favor of high and medium dose PCCT acquisitions. Overall, both devices showed excellent image quality of all structures assessed. Interrater-agreement showed high values for all protocols in all structures. Bland–Altman plots revealed a high concordance of both modalities with the reference measurements. In vitro, ultra-high resolution PCCT can reliably identify different diagnostic entities and structures relevant for dental diagnostics similar to conventional dental CBCT with similar radiation dose. Acquisitions of five cadaveric heads were performed in an experimental CT-system containing an ultra-high resolution PC detector (0.25 mm pixel size in isocenter) as well as in a dental CBCT scanner. Acquisitions were performed using dose levels of 8.5 mGy, 38.0 mGy and 66.5 mGy (CTDI16cm) in case of PCCT and of 8.94 mGy (CTDI16cm) in case of CBCT. The quality of delineation of hard tissues, root-canals, periodontal-space as well as apical osteolysis was assessed by two readers. Mean visibility scores and interrater-agreement (overall agreement (%)) were calculated. Vertical bone loss (bl) and thickness (bt) of the buccal bone lamina of 15 lower incisors were measured and compared to reference measurements by ore microscopy and clinical probing.

Loss of body weight is often seen in pancreatic cancer and also predicts poor prognosis. Thus, maintaining muscle mass is an essential treatment goal. The primary aim was to investigate whether progressive resistance training impacts muscle and adipose tissue compartments. Furthermore, the effect of body composition on overall survival (OS) was investigated. In the randomized SUPPORT-study, 65 patients were assigned to 6-month resistance training (2x/week) or a usual care control group. As secondary endpoint, muscle strength of the upper and lower extremities was assessed before and after the intervention period. Routine CT scans were assessed on lumbar L3/4 level for quantification of total-fat-area, visceral-fat-area, subcutaneous-fat-area, intramuscular-fat-area, visceral-to-subcutaneous fat ratio (VFR), muscle-area (MA), muscle-density and skeletal-muscle-index (SMI). OS data were retrieved. Of 65 patients, 53 had suitable CT scans at baseline and 28 completed the intervention period with suitable CT scans. There were no significant effects observed of resistance training on body composition (p>0.05; effect sizes ω2p <0.02). Significant moderate to high correlations were found between MA and muscle strength parameters (r = 0.57-0.85; p<0.001). High VFR at baseline was a predictor of poor OS (VFR≥1.3 vs. <1.3; median OS 14.6 vs. 45.3 months; p = 0.012). Loss of muscle mass was also a predictor of poor OS (loss vs. gain of SMI; median OS 24.6 vs. 50.8 months; p = 0.049). There is anabolic potential in patients with resectable pancreatic cancer. A progressive resistance training may help patients to maintain their muscle mass and avoid muscle depletion. CT-quantified muscle mass at the level of L3/4 showed a good correlation to muscle strength. Therefore, maintaining muscle mass and muscle strength through structured resistance training could help patients to maintain their physical functioning. A high VFR at baseline and a high loss of muscle mass are predictors of poor OS. Registered on ClinicalTrials.gov (NCT01977066).