Management Activities Research Articles

Future climate-driven escalation of Southeastern Siberia wildfires revealed by deep learning

The Southeastern Siberia (SES) region has recently experienced increasingly extensive wildfires in spring, which have threatened its large carbon sequestration capacity from vast forests and peatlands. However, the underlying mechanisms propelling the increased fires and their potential responses to future climate change remain unclear. Here, by using reanalysis data and climate model output together with a deep learning model, we explore the relationship between positive-phase North Atlantic Tripole (NAT) sea-surface temperature anomalies and SES wildfire increases and project the future trend in SES wildfire intensities under climate change. We found that the positive-phase April NAT enhances the Siberian anticyclone, causing increased temperatures and snowmelt via strengthened transport of warm-air advection into the SES region. The latter process heightens the exposure of local high-density peatlands to favorable conditions for fire ignition and leads to more intensive wildfire incidents. We further demonstrate that the projected NAT variations can drive interdecadal changes in future April SES wildfires. With future phase shifting of NAT modes under global warming, the regionally averaged burned area in SES could be increased by 47–62% under different warming scenarios from 1982–2014 to 2015–2100. Our findings reveal the climate-driven escalation of future wildfires in SES in the context of global warming and call for active and urgent fire management strategies to mitigate the fire risk.

Long-term facial nerve outcome in surgically treated petrous bone cholesteatoma patients.

The term petrous bone cholesteatoma (PBC) represents a slow-growing epidermal lesion arising from the petrous part of the temporal bone. It is a rare incidence accounting for only 4-9% of all petrous bone lesions. PBC represents a real surgical challenge due to its complex relationship with critical neurovascular structures. To demonstrate our experience in using various options of facial nerve (FN) management during surgical treatment of PBC and analyze the long-term facial function outcomes. Retrospective medical record review in a quaternary skull-base center. Medical records of 298 PBC cases operated between the years 1983 and 2024 were thoroughly evaluated. Sanna's classification scheme was used to classify cases into the appropriate class and the House-Brackmann (HB) grading system of the FN was used to assess the facial function pre- and postoperatively. A total of 298 PBC cases were surgically treated at our center. Males constitute 68% (n = 203) of total operated PBC patients while the rest 32% (95) were females, making the male-to-female ratio 2.2:1. The age in this series ranged from 9 to 85. According to updated Sanna's PBC classification, 44% were supralabyrinthine, 33% were massive, 9% were infralabyrinthine-apical, 8% were infralabyrinthine, and 5% were apical. On preoperative FN function examination, 45% (n = 133) of patients had various degrees of paresis and complete paralysis whereas 55% (n = 165) had normal FN function. The commonest degree of paresis observed was HB-III (18.5%) followed by HB-IV (5.7%). A total of 40(13.4%) patients, however, had complete facial paralysis at the initial presentation. The facial function was compromised more frequently in supralabyrinthine and massive PBCs. Among the total patients who had an abnormal facial function at presentation, 52% had paresis/paralysis for less than a year whereas 48% had FN paresis/paralysis for greater than one year. The most commonly used surgical approaches at our center were transotic (TO), modified transcochlear type A (MTCA) with rerouting of the FN, and translabyrinthine (TLAB) with external auditory canal (EAC) closure. Intraoperatively an intact fallopian canal was found only in 33% (n = 99) cases whereas the rest 67% (n = 199) had erosion of the fallopian canal either with intact (n = 24) or infiltrated FN (n = 175). The FN was maintained in the bony fallopian canal in 35% (n = 104) cases. An active form of FN management, however, was required in 65% (n = 194) of cases either intraoperatively or as a second-stage procedure. Factors affecting postoperative FN function include age, preoperative FN function (HB), duration of paralysis, class of PBC, surgical approach, and method of active FN management. PBCs represent diagnostically and surgically challenging lesions of temporal bone which are usually frustrating to the treating surgeon. Preoperative anatomic classification of the lesion enables the physician to choose the appropriate surgical approach. Sanna's classification is the most widely accepted system used to classify PBC. This classification is based on the relation of the lesion to the labyrinthine block. Active FN management, including rerouting, end-to-end anastomosis, cable nerve grafting, and masseteric-to-FN anastomosis routinely come into play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.

Real-Time Monitoring of Visitor Carrying Capacity in Crowded Historic Streets Through Digital Technologies

This paper addresses methodological issues related to the identification and monitoring of visitor overcrowding and congestion situations in historic centres. Once the visitor carrying capacity was estimated for public spaces, taking into consideration the standards of quality and comfort for visitor experience and those related to the desired conditions for heritage assets’ conservation, digital real-time monitoring tools were implemented in an experimental urban area in Valencia, Spain, in order to know, through the establishment of proxemic triggers, when the standards were violated (or may soon be violated); then, the carrying capacity was exceeded, and management actions may be required. The results show that these digital monitoring tools are very efficient and accurate in micro-scale public spaces, user-friendly and affordably priced.

Water quality–fisheries tradeoffs in a changing climate underscore the need for adaptive ecosystem–based management

Changes driven by both unanticipated human activities and management actions are creating wicked management landscapes in freshwater and marine ecosystems that require new approaches to support decision-making. By linking a predictive model of nutrient- and temperature-driven bottom hypoxia with observed commercial fishery harvest data from Lake Erie (United States-Canada) over the past century (1928-2022) and climate projections (2030-2099), we show how simple, yet robust models and routine monitoring data can be used to identify tradeoffs associated with nutrient management and guide decision-making in even the largest of aquatic ecosystems now and in the future. Our approach enabled us to assess planned nutrient load reduction targets designed to mitigate nutrient-driven hypoxia and show why they appear overly restrictive based on current fishery needs, indicating tradeoffs between water quality and fisheries management goals. At the same time, our temperature results show that projected climate change impacts on hypoxic extent will require more stringent nutrient regulations in the future. Beyond providing a rare example of bottom hypoxia driving changes in fishery harvests at an ecosystem scale, our study illustrates the need for adaptive ecosystem-based management, which can be informed by simple predictive models that can be readily applied over long time periods, account for tradeoffs across multiple management sectors (e.g., water quality, fisheries), and address ecosystem nonstationarity (e.g., climate change impacts on management targets). Such approaches will be critical for maintaining valued ecosystem services in the many aquatic systems worldwide that are vulnerable to multiple drivers of environmental change.

Preparedness for and collaboration during regional outbreaks with multidrug-resistant organisms

Abstract Background Outbreaks with multidrug-resistant organisms (MDROs) are a significant burden on the healthcare system and the wellbeing of affected patients and carriers. Cross-institutional MDRO outbreaks require a concerted multidisciplinary effort for effective outbreak management. This presents challenges regarding cooperation, coordination and communication between stakeholders. In this study, we investigate collaborative structures and coordination roles in Dutch outbreak response networks and how Dutch healthcare professionals engage in preparedness activities relating to MDRO outbreaks. These findings form the basis for the development of a stress test exercise for improving professional and organizational collaboration and coordination during MDRO outbreaks. Methods Using a mixed-methods design, an online survey and qualitative interviews are conducted among healthcare professionals in two healthcare regions in the Netherlands. Social network analysis is used to gain insight in collaborative structures and brokerage roles. To investigate preparedness activities, the survey is combined with qualitative interviews to explore respondents’ experiences, preferences and needs regarding preparedness activities for MDRO outbreak management. Results During the workshop we will show the cross-organizational network structures, the strengths and weakness of the mutual connections and provide insight in positions in networks, roles and responsibilities. Also, we provide insight in how the use of and experience with training and exercise activities, such as stress tests, contribute to preparedness for MDRO outbreaks in vulnerable patient populations. Conclusions This study shows how healthcare professionals from different organizations collaborate during MDRO outbreaks, and how they engage with preparedness activities. This provides valuable input for development of a stress test specific to MDRO outbreak management, and other interventions to improve outbreak preparedness.

Risk communication with asylum-seekers: Insights from the COVID-19 Pandemic experience in Munich

Abstract Background The COVID-19 pandemic has created a ‘double crisis’ for asylum-seekers, whose lives were already in crisis. Many reports indicated the syndemic consequences on asylum seekers’ health, underscoring the need for their inclusion in risk communication (RC) and community engagement (CE) and infodemic management (IM) actions. This study aims to describe RCCE experience with asylum seekers in Munich during the COVID-19 pandemic from an expert perspective and thus gain a thorough understanding of the requirements for inclusive RCCE. Methods Our qualitative study involved people who conducted COVID-19-related RCCE for asylum-seekers. Volunteers/workers of civil society organizations and health professionals were interviewed using purposeful sampling. After reviewing international guidelines, an interview form was created. The content analysis resulted in themes and categories. Results Four of the interviewees were health managers, while 8 were working in civil society organizations. The first category of the results describes the context in which RCCE occurs; syndemic factors (uncertainty; social exclusion and stigma; precarious housing; limited access to healthcare and unmet mental health needs) and pandemic management. The second category includes determinants of RCCE from both the asylum-seeker (trust; risk perception; health literacy; language; culture and gender) and RCCE member (competences; overburden; continuity) standpoint. The third category focuses on various RCCE-IM measures, including their effectiveness and consequences. Conclusions Syndemic factors hampered the effective implementation of RCCE for asylum seekers in Munich. RCCE determinants show that pre-crisis actions are necessary for an effective response and individual interactions should accompany community-level activities, particularly for female and marginalised migrants. This study’s scope will be expanded by incorporating the IM component.

Ethics in social listening in infodemic management in health emergencies

Abstract Issue During the COVID-19 pandemic and subsequent outbreaks, health organizations have increased the use of social listening to inform infodemic management and outbreak response activities. This demonstrated the need to provide ethical guidance to organizations, and individuals engaging in social listening practices before, during and after public health emergencies, whilst protecting human rights. Description of the problem Social listening as a public health activity draws on analysis of conversations in social media, internet platforms, and feedback from geographically localized communities. Infodemic insights are generated rapidly, to support agile action by health organizations that improves outbreak response, health information delivery, community engagement, or reduction of unintended harm experiences by communities. Social listening involves use of social media and internet trace data, which were traditionally not used in public health for understanding community expressions, WHO convened a panel of experts to develop a framework on ethical considerations for social listening in infodemic management to provide recommendations for health authorities and researchers on practical tools that support setting up new data analysis and use of insights hereto not used in routine. Results The guidance framework has been structured into segments that vary from ethical principles and challenges in social listening and generation of infodemic insights, alignment with human rights, substantive principles, procedural principles, and practical guidance for translating these principles into real-world practice. Lessons This guidance aims to illuminate the intricate ethical dimensions of social listening and stress the urgent need for ethical guidance in this realm. The framework is a comprehensive inquiry of the ethical scope in social listening, providing valuable insights, practical guidance, and case studies to enhance understanding of this critical global health issue. Key messages • While essential, social listening and infodemic insights come with ethical risks, including potential harm to populations in vulnerable situations, erosion of trust, and misuse of data. • This ethical framework will govern social listening practices and ensure responsible and ethical social listening.

An ovine septic shock model of live bacterial infusion

BackgroundEscherichia coli is the most common cause of human bloodstream infections and bacterial sepsis/septic shock. However, translation of preclinical septic shock resuscitative therapies remains limited mainly due to low-fidelity of available models in mimicking clinical illness. To overcome the translational barrier, we sought to replicate sepsis complexity by creating an acutely critically-ill preclinical bacterial septic shock model undergoing active 48-h intensive care management.AimTo develop a clinically relevant large-animal (ovine) live-bacterial infusion model for septic shock.MethodsSeptic shock was induced by intravenous infusion of the live antibiotic resistant extra-intestinal pathogenic E. coli sequence type 131 strain EC958 in eight anesthetised and mechanically ventilated sheep. A bacterial dose range of 2 × 105–2 × 109 cfu/mL was used for the dose optimisation phase (n = 4) and upon dose confirmation the model was developed (n = 5). Post-shock the animals underwent an early-vasopressor and volume-restriction resuscitation strategy with active haemodynamic management and monitoring over 48 h. Serial blood samples were collected for testing of pro-inflammatory (IL-6, IL-8, VEGFA) and anti-inflammatory (IL-10) cytokines and hyaluronan assay to assess endothelial integrity. Tissue samples were collected for histopathology and transmission electron microscopy.ResultsThe 2 × 107 cfu/mL bacterial dose led to a reproducible distributive shock within a pre-determined 12-h period. Five sheep were used to demonstrate consistency of the model. Bacterial infusion led to development of septic shock in all animals. The baseline mean arterial blood pressure reduced from a median of 91 mmHg (71, 102) to 50 mmHg (48, 57) (p = 0.004) and lactate levels increased from a median of 0.5 mM (0.3, 0.8) to 2.1 mM (2.0, 2.3) (p = 0.02) post-shock. The baseline median hyaluronan levels increased significantly from 25 ng/mL (18, 86) to 168 ng/mL (86, 569), p = 0.05 but not the median vasopressor dependency index which increased within 1 h of resuscitation from zero to 0.39 mmHg−1 (0.06, 5.13), p = 0.065, and. Over the 48 h, there was a significant decrease in the systemic vascular resistance index (F = 7.46, p = 0.01) and increase in the pro-inflammatory cytokines [IL-6 (F = 8.90, p = 0.02), IL-8 (F = 5.28, p = 0.03), and VEGFA (F = 6.47, p = 0.02)].ConclusionsThis critically ill large-animal model was consistent in reproducing septic shock and will be applied in investigating advanced resuscitation and therapeutic interventions.

LDL-C target attainment and statin use in patients with ASCVD, familial hypercholesterolaemia, and those otherwise at moderate/high-risk of ASCVD in australian general practice (SCOPE-GP)

Abstract Background The proportion of Australian general practice patients not attaining low-density lipoprotein cholesterol (LDL-C) goals is not well described. The SCOPE-GP study evaluated duration of LDL-C exceeding treatment goals, statin use and discontinuation rates in patients with atherosclerotic cardiovascular disease (ASCVD), without ASCVD events but at moderate/high-risk, and familial hypercholesterolemia (FH). Methods This population-based retrospective cohort study used de-identified medical records of adult patients captured in the IQVIA GP-EMR database. Patients were indexed at the earliest date of ASCVD, FH, or hyperlipidemia diagnosis from January 1, 2010 to June 30, 2022, with a variable follow-up period from index to June 30, 2022. Ascertainment of study cohort was based on the 2021 ESC/EAS guidelines and Framingham Risk Equation. LDL-C test result levels were extracted per patient, summarised and analysed. Patients were stratified based on their test results at latest results/closest to censor date. Average time above target levels is the proportion of number of days above LDL-C target levels over total number of follow-up days for each patient. A Poisson distribution was fitted to estimate 95% confidence interval. Lipid lowering therapies (LLT) were stratified by (ASCVD, FH and moderate/high risk of CVD) at last visit/censor date. Combination of LLT were defined as prescriptions for fixed dose combinations or ≥2 separate scripts of LLT from different classes within 180 days from last visit/censor date (look back period). Discontinuation is defined as no statins were prescribed again after the last script for 270 days or more, limited to the first occurrence. Results The average time with LDL-C levels above target was 1077.5 days in ASCVD patients (n=2,688), 938.6 days in moderate-risk ASCVD (n=37,003), 980.9 days in high-risk ASCVD (n=85,199), and 900.8 days in FH (n=279). The proportion of days above target level for all four cohorts is described in Figure 1. Among 107,552 patients with recorded LDL-C levels ≥1.8mmol/L at their last visit/censor date, 30.9% were on statin monotherapy and 1.0% were on statin+ezetimibe. Statin use was highest in ASCVD patients (65.4%), followed by FH (49.5%), high risk (40.0%) and moderate risk subjects (29.5%) (Table 1). Statin discontinuation rates were 60.3%, 76.3, 66.1%, and 65.8% in these groups, respectively. The predominant reason for statin discontinuation was non-specific adverse drug reactions (12.2% ASCVD, 11.7% moderate-risk, 13.2% high-risk and 17.9% FH). The proportion of subjects contraindicated to statins was highest in moderate risk subjects (0.05%). Conclusions Prolonged periods of elevated LDL-C and high statin discontinuation rates were prevalent among at-risk individuals in Australian primary care. This underscores a significant ASCVD burden that could be prevented with more active lipid management.

Youth Health Trends in Northern Portugal: Analyzing Diet, Physical Activity, and Body Image

(1) Background: In the face of global concerns regarding unhealthy lifestyles among youths, understanding dietary habits, physical activity, and weight management strategies among third-cycle students in Portugal becomes essential. This study aims to evaluate the extent to which middle school students adhere to the Mediterranean diet and assess their physical activity habits and overall weight perceptions. (2) Methods: This study is a cross-sectional observational study. Using self-reported data from a sample of 232 students aged between 12 and 18, this study delved into their dietary patterns, engagement in physical activities, perceptions of weight, and weight management approaches, measured by the KIDMED and YRB questionnaires. (3) The results demonstrated that adolescents engaged in a varied diet, and 65.5% had recently engaged in physical activity. However, 25% reported exercise-related injuries, suggesting potential safety gaps. Extreme weight management practices were minimal, but a disparity in weight perception and weight loss desire emerged, hinting at underlying societal and media influences. Gender differences in certain habits were minimal. (4) Conclusions: While students were generally inclined towards healthy habits, there are evident areas of concern, particularly regarding safety in physical activities and weight perceptions. In the future, interventions should be implemented to increase students’ literacy and raise awareness of the Mediterranean diet and physical well-being.

Patient referral pathways to leisure providers: impacts on physical activity and falls risk

Abstract Background Physical activity aids prevention and management of noncommunicable diseases. Yet many UK adults, particularly those with long-term health conditions, do not meet recommended activity levels. In 2021, West Suffolk Foundation Trust commissioned local leisure provider Abbeycroft to offer 24 week tailored physical activity programs as part of respiratory and frailty patient pathways. Objectives Evaluation of activity and outcome data for all 1670 individuals referred between January - December 2023 to determine future commissioning decisions. Results 256 participants had completed a 24 week pathway by the time of analysis. Compared to baseline, they demonstrated statistically significant (p < 0.05) self-reported improvements on the Short Warwick Edinburgh Mental Well-being Scale (median 25 to 27) amongst 68.9% of participants; and on the self-reported International Physical Activity Questionnaire 62.1% reduced time spent sitting (average 436 to 300 minutes/ week), 75% increased metabolically active minutes (average 955 to 2632 minutes/week) and the proportion of participants with a low (inactive) score decreased by 61%. Of 40 frailty patients, 87.5% lowered their self-reported Short Falls Efficacy Scale Score (14.6 to 10.4) and observed Timed Get up and Go (13.55 to 9.53 seconds), indicative of moving from a higher risk to lower falls risk (p < 0.05). 24 week retention exceeded 80% for all ages except 16-20 years. 17.8% of participants were >75 years. Lessons Both pathways have been recommissioned and new tailored pathways for Parkinson’s disease, COPD and cancer are planned. This partnership working is a sustainable, integrated way to embed prevention in the community but needs time to build relationships and streamline data sharing. Key messages • Hospital and community referral pathways to leisure providers significantly improve patient well-being, physical activity and falls risk. • These pathways are affordable, adaptable across conditions and show high retention.

Climate-related risk to maize crops in China from Fall Armyworm, Spodoptera frugiperda

AbstractThe Fall Armyworm, Spodoptera frugiperda, invaded China late in 2018 and was responsible for substantial crop losses, especially to maize. This work focuses on the suitability of climate across China for Fall Armyworm survival and spread. It uses climate metrics derived with guidance from experts to enable assessment of the risks posed by Fall Armyworm on maize production in different regions of China. The locations and time of year when temperature conditions are within a viable range for Fall Armyworm survival (minimum temperature higher than 9.7$$^\circ$$ ∘ C and maximum temperature lower than 39.2$$^\circ$$ ∘ C) are used to estimate the spatial distribution of winter breeding and overwintering zones, which helps understand the regions and timing of Fall Armyworm migration risk into northern maize production regions. In addition, meridional wind conditions across the Yangtze River basin area are assessed, and a metric of migration potential from the winter breeding and overwintering regions in the south towards northern regions with maize production is established. Results show that temperature during the winter months currently limits Fall Armyworm winter breeding populations to the very southern regions of China (and bordering countries to the south). However, due to the consistent timing and direction of the East Asian Summer Monsoon winds, the Fall Armyworm could easily be directed northwards to the Yangtze River basin during summer months with a peak in July. For this reason, pest management actions against the Fall Armyworm on summer maize should be taken.

Assessing microplastic abundances in freshwater fishes in a subtropical African reservoir

Microplastics are emerging pollutants of global concern, and their presence in the aquatic environment poses a serious risk for aquatic biota. While many studies have been conducted on the presence of microplastics in marine habitats, little research has been done in freshwater African reservoirs on microplastic pollution and their impacts on fish within the subtropical regions. To bridge this gap, the current study investigated microplastic abundances and distribution in freshwater fish within Nandoni reservoir, South Africa, across two seasons (i.e., hot–wet, cool–dry). Fish were randomly sampled using seine and gill nets from seven sites within the reservoir. In the laboratory, fish were then sorted according to taxa before dissecting them to remove the gills and the gastrointestinal tract (GIT). The organs were digested using hot hydrochloric acid and hydrogen peroxide, and the microplastics were classified according to their colours and shapes. Among the 94 fishes (i.e., 8 species) examined, microplastics were detected in 86.6% of the eight species caught. Microplastics were dominant in the gills and GIT during the cool–dry and hot–wet seasons, respectively. High microplastic abundances were found in the gills of Micropterus salmoides and the GIT of Coptodon rendalli, where fibres and the transparent colour were the most dominant. The results further showed high microplastic abundances in benthopelagic feeders highlighting that habitat influences fish consumption of microplastics whether directly or indirectly. Significant differences were observed in the feeding zone and season for all microplastic types. Microplastic sources in the reservoirs could be due to anthropogenic activities such as illegal dumping, fishing, and agriculture. Thus, there is a need for further investigation into the relation of fish weight, fish sex and body in relation to microplastic pollution. The highlighted ecological factors should be taken into consideration for future research and management actions aimed at mitigating and protecting the negative impacts of microplastic pollution on environmental and human health.

Editorial

Dear Readers, It gives me great pleasure to announce the tenth regular issue of 2024. I would like to thank all the authors for their sound research papers and the editorial board and our guest reviewers for their extremely valuable reviews and suggestions for improvement. These contributions and the generous support of the consortium members enable us to run our journal and maintain its quality. I would also like to thank our broader community for reading and incorporating sound J.UCS papers into their research. Still, I would like to expand our editorial board: If you are a tenured associate professor or above with a good publication record, please apply to join our editorial board. We are also interested in receiving high-quality proposals for special issues on new topics and emerging trends. In this regular issue, I am very pleased to introduce six accepted papers involving 17 authors from six different countries (Argentina, Brazil, Ecuador, Hong Kong, India, Saudi Arabia). Álex dos Santos Moura, Fábio Gomes Rocha, and Michel S. Soares from Brazil propose in their research a recommendation tool based on information retrieval to assist developers in choosing the suitable microservices pattern to solve a given problem. In a collaborative research effort between Ecuador and Argentina, Gonzalo P. Espinel-Mena, José L. Carrillo-Medina, Eddie E. Galarza, and Mario Matias Urbieta discuss a systematic mapping of configuration management activities in software product line. Edward Kai Fung Dang, Robert Wing Pong Luk, and Qing Li from Hong Kong contribute to the forum for negative results with their study on word bigrams for pseudo-relevance feedback in information retrieval. Prateek Thakral and Yugal Kumar from India present in their work an improved water flow optimizer (IWFO) algorithm for cluster analysis that can address the issues of traditional and heuristic algorithms. Samit Bhanja, Banani Ghose, and Abhishek Das from India highlight their findings on multi-step-ahead time series forecasting using a deep learning and fuzzy time series-based error correction method. And last but not least, Abdullilah A. Alotaibi and Salman A. AlQahtani from Saudi Arabia present in their research an intelligent distributed channel selection framework with hybrid mode selection for interference mitigation in D2D based 5G networks.  Enjoy Reading! Best regards,  Christian Gütl, Managing Editor Graz University of Technology, Graz, Austria

A Systematic Mapping of Configuration Management Activities in Software Product Line

In the software product line (SPL), configuration management (CM) is a multidimensional problem that is taking great attention in software development.  Although much research has been developed on this topic, there is no clear view of the current state of it. In this study, we used a systematic method to develop a map of configuration management across product lines to classify relevant literature. The resulting map provides an overview of this research through the identification of the main activities of the CM, the types and trends of research as well as the maturity of existing contributions. Because the CM in SPL is still in its formative stage, we believe that this work will contribute to the process of providing a more common and coherent conceptual basis for its understanding. In addition, it can help to detect important research problems and gaps.

Lessons learned and new approaches to stockpiling for public health emergencies

Abstract Background The COVID-19 pandemic highlighted the need to improve preparedness for emerging health threats. This includes reserving assets for use in health emergencies, such as, shelters, energy supply items, and a stockpile of medical countermeasures (MCMs). Learnings from the recent pandemic are key to improving future strategies for preparedness in Ireland and across Europe. Methods Semi-structured interviews were conducted with key representatives in France, Latvia, Lithuania, the Netherlands, and Norway. These countries were chosen as they have a similar threat profile to Ireland. The interviews aimed to understand the national approach taken in each country to stockpiling of MCMs for public health emergencies. Interview summaries were developed and reviewed by key representatives for clarity. Thematic analysis was conducted. Results All of the key representatives interviewed were working within their associated Department of Health, or a government affiliated public health agency. Themes and key findings identified included scope and current stockpiling approaches; cost considerations and efficiency, and an understanding of how stockpiling approaches have evolved overtime. While some countries stockpiled items such as facemasks, gloves and ventilators during the COVID-19 pandemic, this is being reviewed, due to the high costs involved. Additionally, all countries reported that waste due to unused stock was a challenge, however, the use of stock rotation can reduce stock waste. Choice of supplier is also key for security of supply. Using indigenous suppliers can facilitate a scale up of supply in times of crises. Conclusions National MCMs stockpiles are a key resource that may be deployed as part of a response to health emergencies and disasters. Reducing waste was a key priority and challenge for all countries. Measures identified to reduce waste in future included active management of stockpiles, stock rotation and the use of indigenous suppliers. Key messages • As a result of the COVID-19 pandemic, many countries are reviewing their current approach to stockpiling. • Key issues for countries included preventing waste and ensuring security of MCM supply.

Future of Earthquake-Based Disaster Logistics and Futuristic Approaches

Disasters that occur in the world can be caused by natural as well as human-induced factors. These disasters cause damage to cities, villages, and inhabited areas, and also result in loss of life and property. Accurately and effectively planned disaster logistics management activities are crucial during these moments when life comes to a halt. Today, it is evident that cities suffer damage or even face extinction due to deficiencies in planning, coordination, and opportunities within these practices. To mitigate the consequences of disasters and minimize damage, it is essential to always be prepared for such events and manage them well before, during, and after they occur. Disaster logistics practices should be dynamic and tailored to the specific event, suitable for addressing the situation at hand. Each disaster requires a unique set of solutions that depend on the area and geography affected. Therefore, disaster logistics must adopt and develop new approaches with a sustainable perspective. Given that earthquakes are among the disasters that occur frequently in our country, there is a critical need to create earthquake-based disaster management and action plans. Looking at disaster logistics from a futuristic perspective, it is clear that digital transformation technologies can have a significant and beneficial impact, making disaster logistics services more efficient, innovative, and solution oriented. The study conducted a literature review within the framework of qualitative research methodology, providing a detailed analysis of the role of digital transformation technologies in earthquake logistics processes. The literature review was conducted by reviewing relevant academic articles, reports, books, and scientific research. Special emphasis was placed on studies published in the last 10 years, focusing on the intersection of disaster logistics and digital transformation technologies.

Influence of stream temperature and human disturbance on prespawn mortality of Chinook Salmon in the Willamette River basin

AbstractObjectivePremature mortality of adult female Chinook Salmon Oncorhynchus tshawytscha is a major barrier to population recovery. The Willamette River basin, Oregon, typifies the problems that are faced by fishery managers in the Pacific Northwest (USA). Adult salmon are trapped and transported upstream of dams to access historical spawning grounds, but annual rates of prespawn mortality (PSM) are high (often >40%) and may limit the recovery of natural populations. The purpose of this study was to identify potential factors related to PSM of female Chinook Salmon that are outplanted above dams and incorporate them into a modeling framework to facilitate adaptive management of outplanting operations.MethodsWe evaluated PSM in Fall Creek of the Willamette River basin prior to transport facility improvements in summer and fall of 2010–2017 and postimprovement during 2020–2021. We estimated PSM and conducted exploratory analyses to identify possible nontransport sources of stress that may contribute to the observed high PSM rates. Candidate factors included long‐term elevated temperature exposure, elevated temperature exposure below the trap, total number of outplanted fish, and monthly human disturbance of outplanted fish. We then developed and fit three models, each representing a hypothesis of a factor influencing PSM, incorporated them into a single alternative decision model, and conducted sensitivity analyses.ResultPrespawn mortality averaged 0.66 (ranging from 0.37 to 0.94) over the study period. According to the simulation results, the top two management actions were to exclude human activities—swimming and fishing—from Fall Creek in July and August.ConclusionExpected PSM rates were predicted to be 0.38 when human activity was excluded in July and 0.37 for August. Sensitivity analyses indicated that the most influential decision model component was the choice of the alternative model.

Exploring Collaboration and Social Dynamics in the Paediatric Morbidity and Mortality Meeting, A Qualitative Case Study.

To explore collaboration and social dynamics within paediatric Morbidity and Mortality meetings. Qualitative Exploratory Case Study Methodology incorporating semi-structured interviews and qualitative observations. Data were collected in a large quaternary paediatric hospital in Melbourne, Australia. Semi-structured interviews with meeting attendees were conducted after observing and documenting meeting conduct. Reflexive thematic analysis was used to interpret data and generate a thematic map of findings. Forty-four interviews and 32 meeting observations were conducted between July 2019 and January 2020. Participants valued collaboration between attendees in Morbidity and Mortality meetings, however there were barriers to this. They included differing views about roles and negative impacts of hierarchies and authority. Senior doctors dominated discussion, and participants described this occasionally signalling reverence and respect, but sometimes signified intimidation and feeling unsure about how to contribute. Because of this complexity, successfully achieving positive social dynamics in a meeting required active promotion and management. Morbidity and Mortality meetings mirror the complexity and richness of the clinical environment. Descriptions of how meeting conduct can shape positive workplace culture and address hierarchical obstructions to safe clinical care highlight their far-reaching potential. Effective collaboration is an intrinsic part of realising this value. This paper addresses a paucity in the literature in understanding how social dynamics and collaboration in Morbidity and Mortality meetings are interpreted and experienced. These findings illuminate challenges and obstacles to achieving a productive and equitable social dynamic in meetings. They also illustrate positive discrimination strategies that may improve participation and widespread engagement of nurses, junior doctors, and allied health professionals. Importantly, fostering constructive social dynamics in the Morbidity and Mortality meeting could positively impact patient safety culture and therefore patient care. No patient or public contribution.

Synergistic effect of periodontitis and C-reactive protein levels on mortality: NHANES 2001-2004.

Periodontitis is associated with elevated C-reactive protein (CRP) levels. Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying potential interventions to reduce mortality risk in individuals with periodontitis. This study aimed to assess the synergistic effects of periodontitis and elevated CRP levels on mortality in 7,938 adult individuals who participated in the National Health and Nutrition Examination Study 2001-2004. The association of periodontitis status and CRP levels with mortality was assessed using a survey-weighted Cox model. The interactive effect was estimated; the synergistic effect of CRP levels and periodontitis status on mortality was assessed using the relative excess risk due to interaction (RERI). Periodontitis was diagnosed in 1,065 (13.4%) participants. Compared with the participants without periodontitis and possessing CRP levels of ≤ 0.5 mg/dL, those with periodontitis (hazard ratio [HR], 1.38) or CRP levels of > 0.5 mg/dL (HR 1.23) had higher HRs. The participants with both periodontitis and CRP levels of > 0.5 mg/dL had the highest HR of 2.01. The additive scale interactive effect of the periodontal status and CRP levels, measured using RERI 0.41 (-0.07, 0.95), was positive and nearly significant in the total population. The synergy between the periodontal status and CRP levels was more prominent in the participants aged ≥60 years than that in younger individuals. Periodontitis with high CRP levels may indicate a high mortality rate, indicating the importance of active monitoring and intensive management of periodontitis and inflammatory markers.