Flexible Program Research Articles

Static- vs. Dynamic-Stretching in Development of the Dynamic Balance; Chronic Effects of Specific Training Interventions in Female Football Players

Flexibility is an important determinant of dynamic balance, but studies rarely examined the chronic effects of flexibility training on changes in balance capacity. This study aimed to determine the influence of different forms of flexibility exercises on dynamic balance in female professional football players. Participants were 30 female professional football players (age =19.0±4.1 years), divided into three groups dynamic stretching group (DSG; N=10, age =18.9±3.3 years), static stretching group (SSG; N=10, age =19.5±4.3 years) and control group (N=10, age =18.5±3.3 years). All groups participated in equal football training, while DSG and SSG performed additional flexibility training 3-times a week (10-15 min of duration) throughout the study course (16 weeks). Dynamic balance was measured by the Y-balance test (YBT), and ANOVA for repeated measurement was applied to identify the effects. Results evidenced the significant influence of both flexibility programs on dynamic balance. Both DSG and SSG were equally effective in the first part of the study (until the 8th week), but between the 8th and 16th study week, only DSG improved their balance capacity significantly. Static stretching should be applied in the first phases of flexibility training aiming at the improvement of dynamic balance, but in later phases, usage of dynamic stretching is suggested.

METHODOLOGY OF TRAINING MASTERS: EXPERIENCE OF FOREIGN COUNTRIES

The training of masters in the 21st century is in demand due to the progressive development of society and the national economy of a particular country. On the other hand, the rapid adaptive development of society, caused by the pandemic and military conflicts in Ukraine, requires a review of the preparation of applicants for the second (master's) level of higher education, the flexibility of educational programs, the high level of professionalism of teachers and the understanding by students of their own needs and demands for education. Appeal to foreign experience in the preparation of masters contributes to the above challenges. The purpose of the article is to generalize the methodology for preparing masters of various specialties in the advanced countries of the world. To achieve the goal of the study, the following scientific and pedagogical methods were used: system-analytical (study, analysis and systematization of the obtained data, ideas and facts), contextual (representation of the components of the methodology for preparing masters in the leading countries of the world), comparative (detection and comparison of the main characteristics of the methodology preparation of masters, taking into account the specifics of Ukraine and global trends). The article notes that the personality of the teacher is important in working with masters in higher education institutions of foreign countries. The teaching process at the university covers three areas of activity: scientific, professional and complex, which leads to the use by teachers of optimally effective methods (case methods, clusters, performance tests, keeping educational diaries, organizing group projects, etc.) and forms (co-creation and interviews) learning. The development of educational programs for the preparation of masters ensures the preparation of masters in individual academic disciplines, the introduction of intensive courses, probation or internships, integrative interdisciplinary courses, and compulsory academic mobility. Valuable when entering a master's program is the applicant's own practical experience, the skills of generating and putting into practice advanced ideas, and carrying out research work. The methodology for preparing masters consists of systemic, competence-based, personality-oriented, practice-oriented methodological approaches. The methods of analyzing experience and innovations in the preparation of masters, the stratification of the accumulated factual material are given a special place, which makes the educational systems of the studied countries unique and inimitable, transparent and relevant, open to cooperation and competition in the market of educational services in the international market.

Addressing loneliness among people living with dementia: The key features of personal contact interventions

AbstractBackgroundInterventions to address loneliness among older adults have been developed which target modifiable influencing factors of social contact, social participation, and social support. However, few interventions have been designed specifically to address loneliness for use with people living with dementia. The purpose of this mixed methods study was to identify key features of personal contact interventions for use with people living with dementia.MethodThis was a mixed methods (concurrent triangulation) design using a convenience sample of family, friends, and health care providers of people living with dementia (n = 25). In face‐to‐face sessions, participants were read a short description of two personal contact interventions: an animal contact and a human contact intervention. They completed questionnaires to rate acceptability (adapted Treatment Perception and Preference measure), followed by semi‐structured interviews to explore their perspectives in‐depth. Descriptive statistics and conventional content analysis were completed, and themes from the qualitative analysis were emphasized in the interpretation of results.ResultA majority (>80%) of participants rated personal contact interventions, with either a human or animal visitor, as being low risk, effective, logical and suitable to address loneliness among people living with dementia. While some form of human contact was viewed as essential for every person living with dementia, appropriateness of animal contact was seen as dependent on the individual characteristics of the person living with dementia. In addition to preventing loneliness, participants highlighted that the benefits of personal contact could include promoting happiness and comfort, offering something to do, and preventing responsive behaviors. For all personal contact interventions with a human or animal, it was important to prepare the contact, focus on meaningful relationships, consider flexible program delivery options, and ensure high quality facilitation of visits.ConclusionPersonal contact with a human or animal shows promise to address loneliness experienced by people living with dementia when it is facilitated, flexible, and carefully designed to promote meaningful interactions. Future feasibility studies are needed to assess how people living with dementia experience and perceive personal contact interventions.

Trade-offs in telemetry tag programming for deep-diving cetaceans: data longevity, resolution, and continuity

BackgroundAnimal-borne telemetry instruments (tags) have greatly advanced our understanding of species that are challenging to observe. Recently, non-recoverable instruments attached to cetaceans have increased in use, but these devices have limitations in data transmission bandwidth. We analyze trade-offs in the longevity, resolution, and continuity of data records from non-recoverable satellite-linked tags on deep-diving Ziphius cavirostris in the context of a behavioral response study of acute noise exposure. We present one data collection programming scheme that balances resolution and continuity against longevity to address specific questions about the behavioral responses of animals to noise exposure in experimental contexts. We compare outputs between two programming regimes on a commercially available satellite-linked tag: (1) dive behavior summary defined by conductivity thresholds and (2) depth time-series at various temporal resolutions.ResultsWe found that time-series data vary from the more precisely defined dives from a dive summary record data stream by an acceptable error range for our application. We determined a 5-min time-series data stream collected for 14 days balanced resolution with longevity, achieving complete or nearly complete diving records in 6 out of 8 deployments. We increased our data message reception rate several fold by employing a boat based data capture system. Finally, a tag deployed in a group concurrently with a high-resolution depth recorder showed high depth concordance.ConclusionsWe present the conceptual framework and iterative process for matching telemetry tag programming to research questions that we used and which should be applicable to a wide range of studies. Although designing new hardware for our specific questions was not feasible at the time, we were able to optimize the sampling regime of a commercially available instrument to meet the needs of our research questions and proposed analyses. Nevertheless, for other study species or designs, the complicated intersection between animal behavior and bandwidth of telemetry systems can often create a severe mismatch among research questions, data collection, and analysis tools. More flexible programming and purpose-built instruments will increase the efficacy of these studies and increase the scientific yield relative to the inherently higher risk of invasive studies.

Developing a logic model to support creative education and wellbeing in higher education

University students are at higher risk than the general population of becoming mentally unwell. Dominant risk factors are to do with relationships, work load, the university environment and approaches to learning and teaching. Over recent decades higher education has been increasingly influenced by rules of commodification, however less commercially driven foci relating to wellbeing and mental health are increasingly being prioritised in higher education. This paper describes the development of a multifaceted logic model that can be adapted to university contexts to support wellbeing and creative approaches to learning. A socioecological approach refers to considering the group as a microsystem representative of larger systems and integrating emotionally focused and creative learning experiences that enhance subject relevant content. We implemented and evaluated a series of workshops to improve psychological safety and learning experience. We used a logic model design as an evaluation framework to map the inputs, activities, outputs, and outcomes. The pre and post outcome measure of psychological safety demonstrated significant change, where students could be more open and explorative in their learning experience. We also used a survey evaluation that demonstrated students found the project acceptable, delivered to a high standard, and that the content was relevant to their subject area. Given that the changing culture and ethos of a University can have a major influence on the wellbeing of the students, a flexible programme design as mapped through a logic model, provided us with a framework for introducing and evaluating a complex model for improving learning and wellbeing.

Development of a Joint Penalty Signal for Building Energy Flexibility in Operation with Power Grids: Analysis and Case Study

Electricity generation from renewable energy reduces greenhouse gas emissions and, in the long term, the cost of electricity in power grids. However, there is currently no strong positive correlation between greenhouse gas intensity and electricity spot prices in Germany, despite increasing renewable energy penetration. Therefore, energy flexibility programs that rely on demand response may not be fully effective in reducing carbon emissions unless the energy market aligns consistently with carbon emission factors. To address this issue, we propose a model for joint signals consisting of power grid climate gas intensity and price signals that can achieve both environmental and economic benefits for building energy flexibility applications. Next, to assess the maximum possible flexibility hours from the grid side, we explore penalty signal threshold limits with daily and biweekly aggregation. Using a case study, we analyze energy flexibility with joint signals to explore their effect on greenhouse gas emissions and building operation cost. Our results suggest that joint signals can be more effective than a single type of signal in promoting energy flexibility.

An integrated sustainable bio-fuel and bio-energy supply chain: A novel approach based on DEMATEL and fuzzy-random robust flexible programming with [formula omitted] measure

The viability of the Indian government’s green initiative to blend 20% fuel grade ethanol with gasoline is investigated by modelling a sustainable integrated bio-fuel and bio-energy supply chain with multiple echelons in order to address the dual crisis of fossil fuels, i.e., environmental as well as gradually diminishing reserves. In order to find the best strategic and planning decisions, a multi-objective mixed integer programming model is developed that analyses the supply chain from a technological, economic, environmental, and social standpoints while handling various feedstocks, supply zones, products, and multiple periods. The drawbacks in addressing the uncertainty in the parameter as well as risk in decision making are overcome by introducing a novel fuzzy-random robust flexible programming approach based on Me measure and probabilistic programming. The presented model incorporates hybrid uncertainty, flexible constraints and a convex mixture of optimistic-pessimistic perspective of decision maker. A hybrid strategy combining the fuzzy Decision Making Trial and Evaluation Laboratory (DEMATEL) method and the multi-choice reference point goal programming with S-shaped utility function is presented to solve the generated multi-objective model. A case study in West Bengal, India is then performed that envisages the economic, environmental and social aspects of a bio-fuel and bio-energy supply chain.

The absolute nodal coordinate formulation in the analysis of offshore floating operations Part I: Theory and modeling

The analysis of flexible structures is essential to the design and safety in various offshore floating operations. It is challenging to take full considerations of the flexibility and large motion generated by the coupled floating systems under dynamic loads. In this paper series, the absolute nodal coordinate formulation (ANCF) is introduced to model and study the flexible cable in various types of floating operations. ANCF employs coordinate slope instead of angle to enable arbitrary large deformation in flexible cable without considering centrifugal and Coriolis effects. Linear expression of inertial force is derived and the hydrodynamic-structure and soil–structure interactions are also fully considered in dynamic analysis. The theory and modeling of dynamic flexible cable, multibody hydrodynamics and dynamics of floating systems, as well as the numerical calculation process in time domain are derived. The in-house code MiNos dedicated for flexible cable dynamics and program KraKen for multibody floating operation analysis were developed. Dynamic analysis of flexible cable in several floating operation scenarios by ANCF is performed and the in-house code MiNos is validated. The results show the advantage of ANCF for solving flexible structures with fewer elements and good accuracy as well as the robustness, which makes this method feasible and suitable for dynamic cable problems in most situations of floating offshore operations. Part I of this paper series contains the detailed theory and modeling of ANCF and a short review on methodology of hydrodynamics and dynamics of floating systems. Part II focus on the in-house code validation and analysis of flexible cable and mooring line in actual floating operation scenarios.

Activating Auditing Procedures Over Government Financial Reports Through the Mediating Role of a Proposed Audit Program

Purpose: The aim of this study is to preparation of a proposed audit program that includes effective audit procedures in which financial irregularities are identified. Theoretical Framework: The shed light on the conceptual aspect of the procedures for controlling government financial reports .and definitional The objective of the government financial reporting process is for the purpose of translating economic events in government institutions into numbers so that they can be understood when presented to users of accounting information in order to assist them in making current and future decisions. Thus, this information may face some obstacles and limitations that prevent the accounting measurement from being provided in an appropriate manner, as well as make the credibility far from the goal that the accounting measurement. Design/Methodology/Approach :The inductive method was relied upon in defining the research problem by observing that activating auditing procedures through a proposed auditing program on government financial reports ensures the accuracy and fairness of the financial statements for the transition from the general to the private, as well as relying on the deductive method for the transition from the private To the public by presenting the audit procedures according to the proposed program and disseminating the results that can be reached from the audit of government financial reports in the Iraqi environment . Findings: The results Ascertaining the risks of material errors in auditing government financial reports, as the higher the risks, the greater the amount of evidence that the auditor must obtain. As well as the process of making sure that the trial balance is prepared according to the government accounting system applied in the government economic entity and correcting errors in the financial reports in a timely manner that helps its users to make economic decisions. Research Practical & Social implication: The study With the possibility of the oversight and audit plan being exposed to any changes during the process of ensuring the accuracy and fairness of government financial reports, the auditor should carry out a flexible audit program that responds to any changes that may occur during the audit process according to the limits of the scope of the if it is complete auditing. The program must include the necessary steps for its implementation, and if it is partial auditing, the program must be prepared within the limit of that. Implications/Originality/Value: The value of the study Government financial reports provide useful information for the parties involved in managing the state's financial resources, whether in the present or future, in order to guide them in making their decisions at the state level and at the level of other government institutions.

Balancing the water-energy dilemma in nexus system planning with bi-level and multi-uncertainty

The complicated interrelationship between water and energy makes the water-energy dilemma a complex challenge to be tackled, especially considering the tradeoffs among decision-makers at different hierarchical levels and multiple uncertainties derived from climate change, socio-economic development, technical improvement and decision-making preferences. Thus, a water-energy nexus planning framework would be established in this paper to assist optimal decision-making with bi-level programming and multi-uncertainty. By integrating the regional climate model, multiple linear regression, and bi-level interval flexible programming, an integrated prediction optimization model would be developed as the core of the water-energy nexus planning framework. Then it is applied to planning Zhengzhou City over fifteen years. Multiple scenarios based on electricity demand-supply and carbon dioxide emission satisfaction degrees are analyzed leading to the results of (1) compared to the conventional single-level optimization method, the developed model can achieve the hierarchical goals of water saving and economic suitability; (2) renewable energy will be largely developed and its ratio to electricity generation will reach [26.30, 27.51] % under the limited water availability. Overall, the proposed water-energy nexus planning framework can achieve a balanced water-energy dilemma considering bi-level decision-making preferences and multi-uncertainties, which can be applied to planning water-energy nexus systems at a similar scale.

코로나 시대, 장애인의 삶과 장애인 복지 실천의 변화에 대한 고찰

Background/Objectives: This study aims to derive innovative action plans tailored to the changed environment by identifying changes in the welfare practice field for the disabled in the COVID-19 situation.
 Methods: First, various pieces of literature related to the situation at the welfare practice site for the disabled and their families after the COVID-19 outbreak were analyzed. Second, life changes and difficulties in the COVID-19 situation and modifications in service provision were evaluated through interviews with persons with disabilities, guardians, and facility workers.
 Results: The disabled and their families experienced difficulties in various areas of their lives and encountered several issues for each type of disability due to the COVID-19 outbreak. As COVID-19 persisted, welfare facilities prepared new alternatives. However, services still lacked in quantity and quality. In addition, the labor intensity of facility workers was substantially high , which resulted in high burnout and turnover rates for employees. With the COVID-19 outbreak, welfare facilities for the disabled struggled to cope with the changed situations, such as variations in service delivery methods, flexible program operation, reorganization, and installation of new equipment.
 Conclusion/Implications: First, changing the perception of administrative agencies that support services provided by welfare facilities for the disabled is necessary. Second, additional financial and workforce support should be provided to facilitate the operation of open facilities in the event of an infectious disease situation. Third, a systematic support system should be prepared in accordance with the development of detailed manuals for responding to infectious diseases by facility type and the occurrence of confirmed cases.

Mighty Macros and Powerful Parameters: Maximizing Efficiency and Flexibility in HDL Programming

This paper explores the use of macros and parameters in Hardware Description Language (HDL) programming. Macros and parameters are powerful tools that allow for efficient and reusable code, yet their full potential is often underutilized. By examining the advantages of macros and parameters, this paper aims to demonstrate how these features can enhance the flexibility, readability, and maintainability of HDL code. Additionally, the paper discusses the use cases of mixing macros and parameters in HDL programming, highlighting their applicability in a range of scenarios. Furthermore, the paper addresses the challenges that arise from the mix use of macros and parameters and provides best practices to overcome these challenges. Overall, this paper aims to encourage HDL programmers to fully explore the capabilities of macros and parameters in their code, leading to more efficient and effective hardware designs and verification.

Transect-based trapping for area-wide delimitation of insects.

Typical delimitation trapping survey designs for area-wide (nonlocalized) insect populations are regularly spaced grids, and alternative shapes have not been evaluated. We hypothesized that transect-based designs could give similar detection rates with significantly shorter servicing distances. We used the TrapGrid model to investigate novel "trap-sect" designs incorporating crossed, spoked, and parallel lines of traps, comparing them to a regular grid, in single survey and multiple-site scenarios. We calculated minimum servicing distances and simulated mean probabilities of detecting a pest population, judging overall performance of trap network designs using both metrics. For single sites, trap-sect designs reduced service distances by 65-89%, and most had similar detection probabilities as the regular grid. Kernel-smoothed intensity plots indicated that the best performing trap-sect designs distributed traps more fully across the area. With multiple sites (3 side by side), results depended on insect dispersal ability. All designs performed similarly in terms of detection for highly mobile insects, suggesting that designs minimizing service distances would be best for such pests. For less mobile pests the best trap-sect designs had 4-6 parallel lines, or 8 spokes, which reduced servicing distances by 33-50%. Comparisons of hypothetical trap-sect arrays to real program trap locations for 2 pests demonstrated that the novel designs reduced both trap numbers and service distances, with little differences in mean nearest trap distance to random pest locations. Trap-sect designs in delimitation surveys could reduce costs and increase program flexibility without harming the ability to detect populations.

A Project Monitoring Study on the Improvement of Elementary Science Teacher's Science Teaching Efficacy through a Flexible Online Training Course

The curricular revamp in the Philippine's Basic Education aimed to improve the learning outcomes of Filipino Students. In science education, this revision in the curriculum posed a mismatch in the past teacher preparation and current basic education science education curriculum. As a response, a flexible training program was conducted to address this curriculum gap. This study investigated the improvement of science teaching efficacy utilizing rapid project monitoring through a pre-experimental research design. Standardized adopted questionnaires were utilized before and after the training program. At the end of the training program, teachers were found to have improved in all aspects of science teaching efficacy except in the personal science teaching efficacy, which indicates success in achieving the training objectives. In addition, all targeted concepts for science teaching efficacy were improved after the training. The results of this present work support the notion that professional development programs are potential ways to address curricular gaps in teacher and curriculum mismatch. It is recommended that further studies be conducted to examine science teachers' experiences during the training program to understand how it contributes to the development of their science teaching efficacy.

Analysis and Application of Chinese Language and Literature Teaching Program Based on Computer Multimedia Technology

With the rapid development of 5G network and information technology, the means of modern multimedia are becoming more and more perfect. Many enterprises and industry organizations have entered the information age, and the field of higher education cannot lag behind because of its practical importance of training talents. The major of Chinese language and literature has a great influence on the development of the country’s soft power. The current teaching mode is backward and old-fashioned, paying more attention to the examination-oriented education of theoretical knowledge, and the practical training of comprehensive quality is still insufficient. This paper plans to design an intelligent classroom teaching system. Under the intelligent control of multimedia, the system can assist teachers to formulate flexible and rich teaching programs of Chinese language and literature. Finally, the weight distribution of the teaching evaluation system designed in this paper is reasonable, and the material library of the system is set up scientifically and comprehensively. After several groups of simulation verification, the improved teaching scheme helped the students who participated in the experiment to improve their academic performance by nearly 30 points. While maintaining the interest in Chinese language, the accuracy of spam article recognition algorithm is more than 85%, and the highest result can reach 94.5%.

Improvement in Quality of Life and Motor Function during Daily Clinical Practice using Directional DBS Systems (P4-11.010)

<h3>Objective:</h3> To understand the benefits of Deep Brain Stimulation (DBS) systems with Multiple Independent Current Control (MICC) in daily clinical practice in patients with Parkinson’s disease (PD). <h3>Background:</h3> The main goal of DBS therapy is to achieve optimal outcomes while avoiding side effects. The challenging anatomy surrounding DBS targets requires precise control of neurostimulation. Directional DBS systems can deliver specific amounts of current to each contact using MICC, and this capability has been shown to increase therapeutic window under controlled study conditions (Dembek 2017; Schnitzler 2022). In so doing, vertical and horizontal steering of cathodic and/or anodic current can be achieved, thereby providing flexible programming options to deliver stimulation while minimizing side effects (Steigerwald 2016) (Kirsch 2018). <h3>Design/Methods:</h3> This is a prospective, multicenter (International), registry of up to 1500-patients implanted with directional MICC-based DBS systems (Vercise, Boston Scientific), per standard-of-care. Participants are being followed up to 3-years post-implantation whereby quality-of-life, motor symptoms improvement, overall satisfaction, and other disease aspects are measured. Adverse events and device-related complications are collected. <h3>Results:</h3> A total of 815-patients have been evaluated. Quality-of-life as assessed by PDQ-39 out to 2-years demonstrated sustained clinically significant improvement (minimal clinically important difference [MCID] &gt;4.7-points) despite an expected 5-point worsening due to disease progression (p&lt;0.001) (Horvath 2017; Reuther 2007). Improvement in motor function (MDS-UPDRS III Meds-OFF ) versus baseline were also noted (35% reduction at 2-year; p&lt;0.0001). To date, with &gt;1500 directional leads implanted, no lead breakages have been reported. <h3>Conclusions:</h3> This on-going registry represents the first large-scale collection of real-world, long-term outcomes using MICC-based directional DBS systems. Use of directional DBS systems in clinical practice has been demonstrated to be beneficial per increases in therapeutic window and associated positive outcomes. Results from this on-going evaluation demonstrate sustained improvement in overall outcomes with the use of directional DBS systems. <b>Disclosure:</b> Dr. Deuschl has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific Cavion Functional Neuromodulation. The institution of Dr. Deuschl has received research support from Medtronic. Dr. Deuschl has received publishing royalties from a publication relating to health care. Roshini Jain has received personal compensation for serving as an employee of Boston Scientific. Roshini Jain has received stock or an ownership interest from Boston Scientific. Heleen Scholtes has received personal compensation for serving as an employee of Boston Scientific. Lilly Chen has received personal compensation for serving as an employee of Boston Scientific . Michael Barbe, MD has nothing to disclose. Steffen Paschen has nothing to disclose. Andrea Kuehn has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Andrea Kuehn has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Lee has nothing to disclose. Jan Vesper has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific . Jan Vesper has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic . Jan Vesper has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbott . Jan Vesper has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbott . Jan Vesper has received research support from German Research Council.

Supporting Critical Access Hospital operational and financial improvement through the Medicare Rural Hospital Flexibility Program.

Supporting Critical Access Hospital operational and financial improvement through the Medicare Rural Hospital Flexibility Program.

PERSPECTIVEs on supervised exercise programs in people with metastatic breast cancer- a qualitative study in four European countries

PurposeSupervised exercise is a potentially promising supportive care intervention for people with metastatic breast cancer (MBC), but research on the patients’ perspective is limited. The aim of the current focus group study was to gain an in-depth understanding of MBC patients’ perceived barriers, facilitators, and preferences for supervised exercise programs.MethodsEleven online focus groups with, in total, 44 MBC patients were conducted in four European countries (Germany, Poland, Spain, Sweden). Main topics of the semi-structured discussions covered attitudes towards participation in supervised exercise programs, perceived facilitators, experienced barriers, and exercise preferences. Interviews were transcribed verbatim, translated into English, and coded based on a preliminary coding framework, supplemented by themes emerging during the sessions. The codes were subsequently examined for interrelations and re-organized into overarching clusters.ResultsParticipants had positive attitudes towards exercise, but experienced physical limitations and insecurities that inhibited their participation. They expressed a strong desire for exercise tailored to their needs, and supervision by an exercise professional. Participants also highlighted the social nature of group training as an important facilitator. They had no clear preference for exercise type, but rather favored a mixture of different activities. Flexible training modules were considered helpful to increase exercise program adherence.ConclusionsMBC patients were generally interested in supervised exercise programs. They preferred group exercise that facilitates social interaction, but also expressed a need for individualized exercise programs. This suggests the relevance to develop flexible exercise programs that are adjusted to the individual’s needs, abilities, and preferences.

Optimizing the Performance of Commercial Demand Response Aggregator Using the Risk-Averse Function of Information-Gap Decision Theory

Power systems face challenges with regard to handling the high penetration of renewable energies, including energy intermittency and fluctuations, which are not present in conventional electricity systems. Various flexibility models have been developed to address these fluctuations, including demand-side flexibility, which offers a practical solution with which to overcome these challenges in all demand sectors, including the commercial sector. This paper proposes a new structure for the participation of the commercial sector in the electricity market to integrate and coordinate the consumption of the commercial sector. Unlike previous studies that had commercial consumers participate in the electricity market individually and sometimes fail to meet the requirements for flexibility programs, this study adopts a commercial aggregator to enhance the responsiveness of commercial systems. The proposed structure includes a mathematical model for commercial systems, e.g., shopping centers, with responsive ventilation systems to achieve demand flexibility. The study also uses the information-gap decision theory to address time-based commercial demand response planning from 24 h ahead to near real time. Moreover, a multi-layered structure is proposed to integrate the flexibility of shopping centers from the demand side to the supply side through a newly invented commercial demand response aggregator. The proposed approach was implemented in the New York electricity market, and the results show that it provides demand flexibility for up to 18% of the nominal level of electricity consumption compared to the traditional system. The paper aims to present a responsive structure for commercial systems, addressing the challenges of integrating renewable energies with the electricity system.

Precision Medical Education.

Medical schools and residency programs are increasingly incorporating personalization of content, pathways, and assessments to align with a competency-based model. Yet, such efforts face challenges involving large amounts of data, sometimes struggling to deliver insights in a timely fashion for trainees, coaches, and programs. In this article, the authors argue that the emerging paradigm of precision medical education (PME) may ameliorate some of these challenges. However, PME lacks a widely accepted definition and a shared model of guiding principles and capacities, limiting widespread adoption. The authors propose defining PME as a systematic approach that integrates longitudinal data and analytics to drive precise educational interventions that address each individual learner's needs and goals in a continuous, timely, and cyclical fashion, ultimately improving meaningful educational, clinical, or system outcomes. Borrowing from precision medicine, they offer an adapted shared framework. In the P4 medical education framework, PME should (1) take a proactive approach to acquiring and using trainee data; (2) generate timely personalized insights through precision analytics (including artificial intelligence and decision-support tools); (3) design precision educational interventions (learning, assessment, coaching, pathways) in a participatory fashion, with trainees at the center as co-producers; and (4) ensure interventions are predictive of meaningful educational, professional, or clinical outcomes. Implementing PME will require new foundational capacities: flexible educational pathways and programs responsive to PME-guided dynamic and competency-based progression; comprehensive longitudinal data on trainees linked to educational and clinical outcomes; shared development of requisite technologies and analytics to effect educational decision-making; and a culture that embraces a precision approach, with research to gather validity evidence for this approach and development efforts targeting new skills needed by learners, coaches, and educational leaders. Anticipating pitfalls in the use of this approach will be important, as will ensuring it deepens, rather than replaces, the interaction of trainees and their coaches.