Aggressive Goals Research Articles

Green Initiatives for Climate Change Mitigation in Palakkad District of Kerala, India

Trees and forested ecosystems play a significant role in in meeting global commitments on sustainable development as well as adaptation to climate change and mitigation of its impacts. Aggressive tree planting goals to achieve canopy cover growth targets are a common manifestation to overcome the climate change challenges. Miyawaki forest creation, a method developed by Japanese botanist Akira Miyawaki, involves planting trees per square meter which is intended for intensification of green cover to support local biodiversity. A food forest is essentially a planned and planted forest of food plants that provides a variety of food throughout the year. While both Miyawaki forest and food forest aim to restore ecosystems and enhance biodiversity, they differ in their design, purpose, and management practices. Hence a study on comparative analysis of food forests and Miyawaki forests was envisaged to highlight their respective benefits, challenges, and implementation strategies. The present investigation was undertaken on selected institutions of Palakkad district of Kerala namely Krishi Vigyan Kendra Palakkad where Miyawaki forest patch is created at its premises and V T Bhattathiripad College, Sreekrishnapuram where food forest is established. From this study it is understood that Miyawaki forest is reconnecting with the nature by harboring an array of native flora and fauna promoting biodiversity conservation and habitat restoration while food forest is reconnecting with nature by providing food source for pollinated server, as a habitat for many animals and it is very ecofriendly because don’t require any chemical pesticides. These techniques are highly effective in the establishment of urban forests as well as converting unproductive waste lands into ecological and socially beneficial productive lands.

Managing High Debt Levels: Strategies, Causes, and Impacts on Economic Stability

In recent years, the exponential growth of debt in many economic sectors, including people, enterprises, and governments, has emerged as a major worldwide issue, jeopardising economic stability. The high debt levels may be attributed to many factors, including stagnant earnings, increasing living expenditures, aggressive business development goals, and fiscal deficits. The ramifications of this buildup of debt are extensive, including serious financial hardship, reduced competitiveness, and decelerated economic development. This study analyses the causes and consequences of high levels of debt, highlighting the need for implementing efficient debt management techniques. Central strategies include improving financial literacy, advocating for responsible borrowing, adopting cautious financial management practices in firms, and attaining fiscal consolidation and structural changes at the governmental level. Furthermore, the study emphasizes the need for cutting-edge debt management strategies, such as the use of technology, to guarantee sustained economic strength and stability in the long run. This research emphasizes the crucial need to tackle excessive debt to avoid financial crises and maintain economic development in the presence of global economic difficulties. Keywords: Debt Accumulation, Economic Stability, High Debt Levels, Financial Hardship, Competitiveness.

Concentrating Solar Power (CSP) Plant Optimization Study for the California Power Market (CalCSP)

In the United States, many states are implementing goals to achieve 100% carbon free power generation by 2050 or sooner. California has one of the more aggressive goals to achieve 100% carbon free generation of its retail power sales by 2045. California has excellent solar resources, but to accomplish this goal, California’s power utilities will need new zero carbon resources that can replace the natural gas units that they currently rely on for suppling power at night. Appropriately configured concentrating solar power plants with thermal energy storage are an option to serve this nighttime load. These plants would be designed to take advantage of CSP’s low-cost thermal energy storage and collect and store energy during the day and then be dispatched to produce power at night. The U.S. Department of Energy has funded a study to identify the design of a CSP plant that optimally meets the evolving CA grid needs. This will be done by taking a fresh look at how CSP technologies can best be designed to meet the emerging nighttime market for carbon free power generation or zero-carbon firm resources. The paper provides an overview of the study and present preliminary findings on the California power market requirements, CSP configurations, technoeconomic analysis, siting opportunities, and key issues for CSP deployment in this market.

The future of ship engines: Renewable fuels and enabling technologies for decarbonization

Shipping is one of the most efficient transportation modes for moving freight globally. International regulations concerning decarbonization and emission reduction goals drive rapid innovations to meet the 2030 and 2050 greenhouse gas reduction targets. The internal combustion engines used for marine vessels are among the most efficient energy conversion systems. Internal combustion engines dominate the propulsion system architectures for marine shipping, and current marine engines will continue to serve for several decades. However, to meet the aggressive goals of low-carbon-intensity shipping, there is an impetus for further efficiency improvement and achieving net zero greenhouse gas emissions. These factors drive the advancements in engine technologies, low-carbon fuels and fueling infrastructure, and emissions control systems. This editorial presents a perspective on the future of ship engines and the role of low-life cycle-carbon-fuels in decarbonizing the marine shipping sector. A selection of zero-carbon, net-zero carbon, and low-lifecycle-carbon-fuels are reviewed. This work focuses on the opportunities and challenges of displacing distillate fossil fuels for decarbonizing marine shipping. Enabling technologies such as next-generation air handling, fuel injection systems, and advanced combustion modes are discussed in the context of their role in the future of low-CO2 intensity shipping.

Fleet Operator Perspectives on Heavy-duty Vehicle Alternative Fueling Infrastructure

Despite the aggressive policy goals aiming to transition heavy-duty vehicles (HDVs) toward zero-emission technologies, the penetration rates of zero-emission or even alternative fuel technologies (including zero-emission and other fuels cleaner than petroleum) are still very low. Given that the majority of HDVs are used as fleet vehicles, a better understanding of fleet operator behavior and perspectives on clean fuel technologies is crucial to develop effective demand-side strategies to achieve such policy goals. Of many adoption barriers, a well-known major obstacle is the lack of fueling/charging infrastructure. However, there is limited understanding on how HDV fleet operators have navigated the issues involving the insufficient infrastructure. This study explores how HDV fleets have used alternative fueling infrastructure, how dis/satisfied fleet operators are with the infrastructure, and for what reasons they have decided to construct their own on-site fueling facilities, or to use off-site stations. Based on a case study of compressed natural gas, the most prevalent alternative fuel option so far in the HDV sector, 17 in-depth qualitative interviews were conducted with HDV fleet operators in California. Content and thematic analyses of the data yielded detailed qualitative inferences on use behavior, satisfaction, and fleet decisions between on-site versus off-site fueling. The study findings are the first step toward enhancing our understanding of HDV fleet behavior regarding alternative fueling infrastructure, which can contribute to filling the knowledge gap in this field and to developing further research questions to elicit policy recommendations that can support the adoption of clean fuel technologies in HDV fleets.

Intensity at the end of life in pediatric neuro-oncology patients: The case for pediatric palliative care.

10021 Background: Although pediatric cancer is rare, it is the leading cause of death by disease after infancy for children and adolescents in the United States. Children exist in the context of a family; hence, excellent care for a child must also include attention to the needs of the family. Palliative care aims to enhance quality-of-life for these children living with life threatening illnesses and their families. Among pediatric cancers, brain tumors have high disease-related mortality rates; therefore, early introduction of palliative care to these patients is critical. This study aims to evaluate the association of palliative care during the terminal admissions of pediatric neuro-oncology patients and intensity of care provided at the end of life. Methods: Pediatric patients with brain tumors were identified using the Pediatric Health Information System (PHIS). Inclusion criteria were age <18, diagnosis of brain tumor as defined by ICD-10 codes, discharged as deceased, and hospital admission between 1/1/2017 and 12/31/2021. Intensity of care measures included: pediatric intensive care unit (PICU) admission, mechanical ventilation, total parenteral nutrition (TPN), and extracorporeal membrane oxygenation (ECMO). Results: 567 patients met the inclusion criteria. 359/567 (63%) patients had an inpatient palliative care consultation during their terminal hospital stay. Patients receiving a palliative care consultation had a lower percentage of PICU admission (64.9 vs 83.2, p=<0.001), mechanical ventilation use (51.0 vs 76.0, p=<0.001), and TPN use (18.1 vs 25.5, p=0.027). There were no significant differences in length of stay (22.07 vs 22.25 days, p=0.181) and ECMO use (0.28% vs 1.92%, p=0.450). Conclusions: Pediatric patients receiving palliative care consultations during their terminal admission received less intense care while having comparable lengths of stay. Palliative care should be offered to all families, even with aggressive goals, to help incorporate quality of life and comfort in the treatment plan and to ensure bereavement support is available if needed. Similar to data in the adult palliative care literature, this data demonstrates reduced resource utilization among pediatric patients receiving palliative care. Palliative care has been shown to be a supportive service that has the potential to improve the quality of life of patients. The first step toward equitable healthcare is to ensure that all children with a potentially terminal cancer diagnosis have access to full supportive services, including palliative care.

Assessing progress and equity in the distribution of electric vehicle rebates using appropriate comparisons

To meet aggressive transportation-electrification goals, electric-vehicle (EV) sales must expand deeper into mainstream markets. To address equity concerns, EV sales must go beyond the mainstream to increase access to EV benefits. To support needed expansion in sales and equity, this research examined the characteristics of California consumers that claimed the statewide rebate for EVs purchased/leased in 2017–2020. It weighted n = 32,524 survey responses to represent N = 193,167 rebate recipients and focused on 2020 adoption, trends over time, and differences between consumers of battery and plug-in hybrid EVs. Importantly, incentive-recipient characteristics were compared using Market-Majority Metrics to those of California new-vehicle buyers as a more appropriate baseline. Results raise the possibility that findings about the equity of EV-rebate-recipient incomes based upon comparisons to Census data could largely and more simply be findings about new-car buying, rather than particular to EV-incentive recipients. Rebate-recipient incomes continued to progress toward the mainstream despite the dominance of Tesla consumers and COVID. The distribution of rebate funding by income is now roughly comparable to new-vehicle buyers. Indeed, fewer rebated PHEV consumers (52%) had household incomes greater than $100,000 than even new-vehicle buyers (56%). Except for age, PHEV consumers are more similar to typical vehicle buyers than BEV consumers are. The characteristics most distinguishing of EV consumers are now home ownership and male sex/gender identification. Market-Majority Metric “heat map tables” are developed as an intuitive but quantitative tool to highlight the length of the road ahead that EV markets must travel toward the mainstream and beyond to priority populations.

Antithrombotic therapy and bleeding risk in the era of aggressive lipid-lowering: current evidence, clinical implications, and future perspectives.

The clinical efficacy of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in reducing major cardiovascular adverse events related to atherosclerotic cardiovascular disease (ASCVD) has been well established in recent large randomized outcome trials. Although the cardiovascular and all-cause mortality benefit of PCSK9i remains inconclusive, current cholesterol management guidelines have been modified toward more aggressive goals for lowering low-density lipoprotein cholesterol (LDL-C). Consequently, the emerging concept of "the lower the better" has become the paradigm of ASCVD prevention. However, there is evidence from observational studies of a U-shaped association between baseline LDL-C levels and all-cause mortality in population-based cohorts. Among East Asian populations, low LDL-C was associated with an increased risk for hemorrhagic stroke in patients not on antithrombotic therapy. Accumulating evidence showed that low LDL-C was associated with an enhanced bleeding risk in patients on dual antiplatelet therapy following percutaneous coronary intervention. Additionally, low LDL-C was associated with a higher risk for incident atrial fibrillation and thereby, a possible increase in the risk for intracranial hemorrhage after initiation of anticoagulation therapy. The mechanism of low-LDL-C-related bleeding risk has not been fully elucidated. This review summarizes recent evidence of low-LDL-C-related bleeding risk in patients on antithrombotic therapy and discusses potential measures for reducing this risk, underscoring the importance of carefully weighing the pros and cons of aggressive LDL-C lowering in patients on antithrombotic therapy.

Role of bempedoic acid in patients with hypercholesterolemia and statin intolerance

introduction: Atherosclerotic cardiovascular disease is a leading cause of death and disability worlwide. The LDL-C causes atherosclerosis and therefore lowering the levels of these lipoproteins reduces the risk of acute myocardial infarction and other cardiovascular events. Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase and are the most cost-effective medicines for lowering LDL-C. Up to 80% of patients treated with statins do not achieve optimal LDL-C levels, explained by high baseline LDL-C levels, aggressive LDL-C treatment goals, lack of sufficient statin efficacy or drug intolerance. Objective: This review discusses the characteristics of statin intolerance and the mechanism of action, efficacy, and safety of Bempedoic Acid as a lipid-lowering agent. Methods: We searched PubMed, ScienceDirect, the Virtual Health Library and Latin American and Caribbean Health Sciences Literature for articles published in the last five years using the following health descriptors: “bempedoic” OR “ATP-citrate lyase” AND hypercholesterolemia AND “coronary artery disease”. Results: Bempedoic acid is a prodrug that is converted to its active form (bempedoyl-CoA) by the acyl-CoA synthetase-1 enzyme. Acts two steps upstream from HMG-CoA reductase, the target of statins, in the same metabolic pathway, representing an additional lipid-lowering therapy. Conclusions:Bempedoic Acid’s active metabolite is an effective treatment option, alone or in combination with statin or ezetimibe, to lower LDL-C and reduce hsCRP, which is a marker of systemic inflammation associated with future risk of cardiovascular events, suggesting an anti-inflammatory response. Outcomes and cost-effectiveness are currently being investigated in the CLEAR Outcomes study, with results expected in 2023.

Abstract WP26: Multidisciplinary Case Reviews Reduce "Door-to" Times

Background: Rapid reperfusion is critical for positive outcomes in stroke patients. To improve patient outcomes, the organization reduced program goals for all door-to metrics. To reach the aggressive new goals, a door-to task force led by the Stroke Program Coordinator was created. The multidisciplinary task force meets monthly and consists of members from Pre-Hospital, ED, Stroke, CT, and Neurointerventional Radiology (NIR). Interventions: Door-to data is shared monthly and case reviews on all door-to fall-outs are performed. The task force reviews door-to-CT, door-to-thrombolytics, and door-to-puncture metrics. An RCA is conducted on each case that exceeds our time goals looking for areas for improvement. Each case is evaluated from initial EMS contact through initiation of treatment; with all members of the multidisciplinary team participating. A trend in prolonged door-to-puncture was seen; so further investigation into the causes for the delays was done by the task force. This led to several improvement initiatives that addressed each of the delays. Education was completed for ED, CT, and NIR staff on the significance of a rapid initial evaluation and transport to NIR. An outside hospital (OSH) transfer notification process was created for OSH transfers eligible for thrombectomy. A direct-to-angio process was also developed to allow transport from CT to the NIR suite without stopping in an ED room. Results: The combination of these initiatives had a positive impact on door-to-puncture times. When comparing 2021 data to year-to-date 2022 post-implementation data, a reduction in door-to-puncture has been seen. Median time for door-to-puncture in 2021 was 60 minutes. This time has reduced to 48 minutes for the January through June 2022 timeframe. Conclusion: A multidisciplinary door-to task force reduces door-to-puncture times by keeping constant focus on door-to metrics and by creating a shared accountability for the process. With the door-to task force, real-time case reviews can be completed to allow for rapid identification of areas of opportunities and initiation of process improvement initiatives to reduce door-to times.

ІДЕЙНІ ЗАСАДИ РОСІЙСЬКОЇ ІМПЕРСЬКОЇ ПОЛІТИКИ У ПРАЦЯХ ЮРІЯ ШЕВЕЛЬОВА

The article examines the contribution of outstanding Ukrainian scientist Yury Shevelov about understanding of ideological prerequisites of Russian imperial policy and its basic manifestation in relation to Ukraine. It`s asserted that this problem is present in different works of the scientist and is important for understanding his historiosophical and cultural concepts. It is noted that Yury Shevelov categorically denied a simplified a superficial approach of certain aspects of Russian history, in particular the role of Finno-Hungarian origin in the ethnogenesis of Russians. In a number of his works the researcher pointed out the special importance of Byzantine traditions of state and social life in formation of foundations of Russian imperial policy. Yury Shevelov argued that the omnipotence of the state and the lawlessness of an individual became the defining essential features of the of the existence of the Russian colonial empire. The state skillfully camouflaged its aggressive goals with the interests of the entire nation, which became the basic for intellectual manipulation and speculation. The researcher shows how a distorted understanding of the people takes root in the environment of the Russian intelligentsia, proves that the hypertrophied idealization of the people has nothing to do with its true essence. Yury Shevelov demonstrated this on the example of the work of the world-famous Oleksandr Solzhenitsyn, who was unable to overcome imperial complexes in their attitude towards the colonized nations of the Soviet Union. The article points out Yury Shevelov`s emphasis on the continuity between the Russian Empire and the communist USSR, which the researcher regarded as a new form of Russian chauvinism. In some issues the Soviet government even surpassed its predecessors. In particular, as the outstanding linguist Yury Shevelov argued, it was the Soviet innovation that became the intervention in the internal laws of the Ukrainian language, which even the tsarist administration in pre-revolutionary Russia did not resort to. Among the negative consequences of the Russian imperial rule for Ukrainian nation Yury Shevelov particularly singled out the emergence of a complex of provincialism, slave psychology, and orientation towards external power. The constant struggle with provincialism in all its forms became pervasive in the scientist`s creative activity. It is emphasized that in his writings YuryShevelov considered the Russian state as a colonial empire, and the relations between Ukraine and Russia as colonies and metropolises, which are in a state of a great and still unfinished war.

The economic consequences of the war in the 21st century at the regional and global levels

The article examines the theoretical and practical effects of wars in the 21st century on the economy. The concept of “military economy” is highlighted. The dynamics of military expenditures are analyzed. The reasons behind and types of wars that have occurred in the past and are currently occurring are made clear. Emphasis is placed on studying the economic consequences of Russia’s war in Ukraine. The assessment of the potential of countries before the war testified and confirmed the aggressive goals of a large country that attacked a much smaller one. The war against Ukraine put the issue of preserving the independence of small countries on the agenda. The main focus of the essay is on examining the economic effects of the conflict, not just on the economies of the participating nations but also on the world economy. The instability of individual commodity markets, inflation, and migration became the main mechanisms of the war’s influence. As a result, the indicators of economic growth of many countries of the world are deteriorating. The raised questions actualize the task before the world community of finding new methods of solving the problems of wars.

Have renewable energy leaders announced aggressive emission reduction goals? Examining variations in the stringency of country-level net-zero emission pledges

The 2015 Paris Agreement outlined the goal to limit temperature increases below 2°C, preferably to 1.5°C. In response, several countries have announced net-zero emission pledges (NZEP). The credibility of these pledges varies because countries have committed to different target years. Moreover, some pledges outline sectoral as opposed to economy-wide targets and vary in how they monitor progress. To assess the pledge’s credibility, we create a novel NZEP stringency score. We find that climate leaders with a higher share of renewable energy in final energy consumption are more likely to have announced more stringent NZEPs. However, economic development, the size of the economy, countries’ embeddedness in international environmental treaties, and the robustness of domestic civil society are not associated with NZEP stringency.

(Invited) The U.S. Department of Energy’s Hydrogen Energy Earthshot: Addressing Important Challenges and Opportunities in the Research, Development, Demonstration, and Deployment of Clean Hydrogen Technologies

On June 7th of 2021, Secretary of Energy Granholm announced the Hydrogen Energy Earthshot (also know as the Hydrogen Shot) - an initiative to enable clean, low cost hydrogen within a decade. In addition, the Bipartisan Infrastructure Investment and Jobs Act (IIJA), signed by President Biden in November of 2021, includes $9.5 billion for clean hydrogen, which is made up of $8 billion for at least four regional clean hydrogen hubs and $1.5 billion for electrolysis and clean hydrogen manufacturing and recycling research, development, and demonstration. In addition to accelerating the research, development, demonstration, and deployment of clean hydrogen technologies (including foundational electrochemical process for production and utilization), these investments are expected to provide exciting regional opportunities for jobs creation, economic growth, energy independence, and environmental justice. The presentation will discuss key challenges and major opportunities being addressed through the U.S. Department of Energy’s Hydrogen Program (coordinated through its Hydrogen and Fuel Cell Technologies Office); with the aggressive but achievable ten-year goal put forward by the Hydrogen Shot of $1 for 1 kg of clean hydrogen.

From Low Initial Interest to Electric Vehicle Adoption: “EV Converts” in New York State’s Rebate Program

To meet aggressive transportation-electrification goals, electric-vehicle (EV) sales must expand beyond enthusiastic early adopters and deeper into mainstream markets. To support that expansion, this research examined a strategic market segment that points the way: EV adopters who had little to no interest in adopting an EV when they started looking for a new car—or “EV Converts.” It utilized survey responses from 5,216 recipients of New York State’s Drive Clean Rebate, separately examining consumers of plug-in hybrid EVs, Teslas, and non-Tesla battery EVs. Weighted descriptive statistics and logistic regressions were used to identify factors that predict EV Convert status, and dominance analysis was used to rank factors for prioritization. The results were combined into summary profiles for each vehicle category, summarizing their current characteristics and describing top opportunities for reinforcing each segment. Across categories, high-ranking factors associated with increased odds of being an EV Convert included giving relatively less importance to societal factors like energy independence or environmental impacts, lack of consumer awareness of the rebate before the first dealership visit, the essentiality of the rebate to the EV purchase/lease, having no plans to install solar, giving no importance to the desire for the newest technology, and/or identifying as female. Significant factors were ranked and compared across vehicle categories. Recommendations for program design, outreach, and dealer education are provided.

Optimal Bilevel Operation-Planning Framework of Distributed Generation Hosting Capacity Considering Rival DISCO and EV Aggregator

The aggressive goal of having a 100% renewable energy system requires preparing an appropriate infrastructure for deploying as much distributed generation (DG) as possible into the electricity network. This article aims at proposing a new framework to maximize the hosting capacity (HC) of DGs in a distribution network. This operation-planning framework provides a suitable and interactive environment for the electricity market, distribution company (DISCO), electric vehicle (EV) aggregator, and rival DISCOs to increase the HC. The problem is modeled via a bilevel conditional-value-at-risk-constrained stochastic programming approach. The DISCO, in the upper level (UL), tries to maximize the HC and minimize the operating costs while interacting with a passive electricity market and an EV aggregator. The aggregator, in the lower level, aims to maximize their profit by interacting with the primary DISCO in the UL and the rival DISCO, to satisfy the EV owners. The Karush–Kuhn–Tucker conditions are used to recast the model into an equivalent single level. The proposed framework is tested on a 33-node distribution network. Results show how an interactive-based framework can contribute to maximizing the HC of DGs.

Stretching the success in reward-based crowdfunding

The use of crowdfunding as a funding method has increased considerably over the last decade. However, competition for crowdfunding money is tough, and goal setting is critical for fund seekers. We investigate the impact of initially set stretch goals and the project creators' communication openness on project funding performance. Empirical results based on a large dataset from Kickstarter show that the stretch goals and higher levels of communication openness increase the likelihood of project funding success. Furthermore, communication openness positively moderates the relation between stretch goals and funding success. Moreover, projects with aggressive stretch goals are more likely to succeed if the goals are communicated well. The results provide practical implications for project creators to increase funding performance by communicating openly with the crowd.

Reasons for oncologist and urologist treatment choice in metastatic castration-sensitive prostate cancer (mCSPC): A physician survey linked to patient chart reviews in the United States.

5065 Background: Based on level 1 evidence of overall survival, ASCO/NCCN/AUA guidelines uniformly recommend novel hormonal therapy (NHT) or chemotherapy (CHT) added to androgen deprivation therapy (ADT) as standard of care in mCSPC. However, real-world evidence across US healthcare systems suggests most patients receive ADT +/- first generation non-steroidal antiandrogens (NSAA). Reasons behind the lack of treatment intensification (TI) in mCSPC have not been studied. Methods: Data from medical charts of patients initiating mCSPC treatment from Jul ’18-Nov ‘21 were retrospectively extracted from multiple US academic/community practices. Oncologists and urologists who treated these patients were surveyed to provide reasons for treatment choices including prostate specific antigen (PSA) goals and explicit reasons for not prescribing NHT. Descriptive statistics (Fishers exact tests) were used to compare outcomes between groups; p-values for odds ratios (OR) were generated via Wald test. Results: 65 oncologists and 42 urologists provided data on 621 patients. Median age at initial mCSPC treatment start was 68.0 years, 58% were White, 25% Black, 84% had de novo metastases, 30% had high-volume disease including 22% with visceral metastases, and 83% had ECOG PS score ≤1. In the first-line (1L) setting, most mCSPC patients received ADT±NSAA alone (69%), while TI rates with ADT+NHT (26%) or ADT+CHT (4%) were low. An additional 27% (n = 166/621) received subsequent TI while still castration-sensitive. According to the physician survey, the top 5 reasons why their patients did not receive initial NHT were perceptions about: drug tolerability (38%), lack of clinical trial evidence of overall survival improvement (31%), lack of reimbursement (26%), patient financial constraints (20%), and questions about sequencing NHTs earlier vs later in disease (21%). Regarding treatment goals for PSA response, physicians more frequently reported a relative (%) reduction than an absolute PSA reduction (85% vs 51%). Oncologists considered a median PSA reduction of 50% (IQR 25-75) adequate vs 75% (IQR 50-90) among urologists. Urologists had higher rates of TI at 1L and/or subsequent treatment in patients who were still castration-sensitive (p < 0.01). Physicians who aimed for deeper PSA reduction of 75-100% were more likely (OR = 1.63; p = 0.034) to provide TI in 1L compared with physicians with less aggressive PSA goals (0-49%). Conclusions: To our knowledge, this is the first study identifying reasons for underutilization of intensified treatment in mCSPC. While survey results suggest perceptions of tolerability and lack of efficacy and financial considerations affect NHT use, in practice, non-guideline driven PSA reduction goals are associated with low rates of TI. These results demonstrate the need for further medical education.

Evidence for intensive LDL-C lowering for acute coronary syndrome: Recommendations from the Lipid Association of India

Patients with acute coronary syndrome (ACS) have a high risk of subsequent adverse cardiovascular outcomes, particularly within the first 30 days. Although it is well documented that initiation of statin therapy in the setting of ACS improves short- and long-term cardiovascular outcomes, and achievement of lower levels of low density lipoprotein cholesterol (LDL-C) incrementally improves outcomes, many patients with ACS have persistent hypercholesterolemia after discharge from the hospital. This is a missed opportunity that prompted the Lipid Association of India to develop recommendations for earlier initiation of more aggressive LDL-C lowering treatment, particularly for patients of South Asian descent who are well-documented to have earlier onset of more aggressive atherosclerotic cardiovascular disease. The Lipid Association of India recommends individualized aggressive LDL-C goals after ACS, which can be rapidly achieved with high intensity statin therapy and subsequent goal-directed adjunctive treatment with ezetimibe and PCSK9 inhibitors. Improved treatment of hypercholesterolemia achieved within weeks after ACS has the potential to reduce the high rate of morbidity and mortality in these high risk patients.

THE IMAGE OF JERUSALEM IN HEBREW CHILDREN'S LITERATURE: THE PLAY (JERUSALEM TO ME) AS A MODEL

The Zionist movement, in all its stages, relied on Hebrew literature in order to achieve its aggressive and colonial goals. The celebration of Hebrew literature, in its various expressive and poetic forms, was a celebration of describing the conditions of the Jews, and directing them to emigrate to Palestine. Hebrew education books at various school levels described many Zionist concepts and in accordance with smart educational policies. Likewise, Hebrew literature directed at children played an important and vital role that differs from the rest of other literatures, as it carried with it Zionist ideological orientations according to ideological and political ideas and thus succeeded in creating children of a nature. Especially, Jewish writers focused on raising children through literature and focused on important historical issues and special educational trends. All this led to the success of the Zionist project. Zionism began caring for the Jewish child from the beginning, as it issued newspapers for children next to public libraries, and the movement began to revive the Hebrew language and enrich Hebrew children's literature from 1890-1891. Many Hebrew works directed to children have appeared, including story, poetry, and drama. In 1893, the first Hebrew magazine directed at children was published, entitled ( ולם קטן) (a small world). The Zionist movement did not neglect those who direct and take care of children’s literature because the child is the first building block of the state. Therefore, it placed the Jewish child within the framework of its project to accommodate the various Jewish immigrations to Palestine and the production of Hebrew children's literature. With the revival of the Hebrew language at the end of the nineteenth century and the increase of the Zionist presence in Palestine, it became one of the goals of Zionism to make the Hebrew language a language of dialogue between children and to consolidate the values of secular Zionism. One of these methods was to stage theatrical performances in the Hebrew language in front of young children. In this research, I will deal with the play (Jerusalem is mine) by the writer Galia Yei, as this play is concerned with Jewish assimilation in Jerusalem and linking the past with the present. And the Hebrew theater tried to prove the Jewishness of Jerusalem through historical events