Management Algorithm Research Articles

The predictive value of systemic inflammatory markers in 902 patients with tunneled hemodialysis catheter.

This study aimed to assess the predictive role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and mean platelet volume, on catheter survival in chronic hemodialysis patients, analyzing both infectious and non-infectious complications. A retrospective analysis encompassed 1279 tunneled catheter insertion procedures involving 902 patients between March 2014 and October 2018. Patients were categorized into two main groups: (i) initial placement and (ii) exchange. The exchange group was further stratified into four subgroups: infection, dysfunction, displacement, and transitioning temporary hemodialysis catheters to long-term ones. Hematologic ratios were calculated from baseline hemogram data, including neutrophil, lymphocyte, monocyte, and platelet counts, while mean platelet volume was derived from the same hemogram. The patients in theexchange groupdisplayed significantly higher lymphocyte and monocyte values (p < 0.001), while lower values were noted for neutrophil-lymphocyte ratio and platelet-lymphocyte ratio (p < 0.001). The transition group displayed higher monocyte values and lower mean platelet volume and lymphocyte-monocyte ratio values (p < 0.05). In the infection-related exchange subgroup, higher neutrophil count, mean platelet volume, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values were observed compared to other groups (p < 0.05). Cases related to catheter dysfunction exhibited increased lymphocyte-monocyte ratio but lower neutrophil, monocyte, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values (p < 0.05). This study highlights the interest of specific inflammatory markers, particularly monocytes, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio, in the management of tunneled catheters, notably in patients undergoing exchanges. However, cut-off values, essential for constructing management algorithms, are currently lacking, and prospective multicenter studies are neededfor further elucidation.

Energy Management Strategy for DC Micro-Grid System with the Important Penetration of Renewable Energy

This paper presents an energy management strategy using a Stateflow controller related to DC microgrids with the important penetration of renewable energy. The increase in world electricity demand is one of the principal drivers of the exhaustion of fossil fuels and increased greenhouse gas emissions. To solve these problems, several countries have adopted actions for widespread renewable energy deployment, which includes wind energy, solar power, biomass power, tidal, and hydropower. These sources are considered as significant in delivering clean energy and reducing greenhouse gas emissions for sustainable improvement. As these sources play an increasingly vital role in the global energy landscape, the efficient management of these intermittent sources is essential for grid stability and sustainability. This paper aimed to develop an energy management strategy for DC microgrids to supply power to a DC microgrid system. The main objective of this paper was to implement an energy management system to ensure the proper operation of DC microgrid systems utilizing Simulink blocks available in MATLAB/Simulink 2020b software. The simulation results demonstrated that the developed energy management algorithm was unconditionally reliable, ensuring the proper operation of the microgrid systems. Additionally, the results demonstrated that the energy management strategy exhibited robust performance across different scenarios, effectively balancing energy generation and consumption while ensuring the reliable operation of the microgrid system. Moreover, the developed algorithm model presents another advantage, as it enables users to access and to change any control parameters within the DC microgrid. By comparing these results with the literature, the developed energy management algorithm provides safety and the automatic control of the microgrid.

Investigating the relationship between physical, cognitive, and environmental factors of ergonomics with the prevalence of musculoskeletal disorders: A case study in a car-parts manufacturing industry.

Work-related musculoskeletal disorders (WRMSDs) is a multi-factorial disorder in most occupational setting and it has increased significantly in recent years. This study aimed to investigate the relationship between physical, cognitive, and environmental factors of ergonomics with the prevalence of WRMSDs in a car-parts manufacturing industry. This cross-sectional study was performed among 220 workers in a milling unit of a car parts manufacturing company in 2021-2022. The prevalence of WRMSDs was assessed using the Extended Version of the Nordic Musculoskeletal Questionnaire. Noise exposure was evaluated using dosimetry method. Mental and physical workload were evaluated by the NASA-TLX and key index methods (KIM-MHO and KIM-LHC), respectively. Data analysis was performed using SPSS version 25.0. The subjects' mean age and work experience were 36.3±6.5 and 8.35±6.41 years, respectively. Eighty-five percent of the subjects reported WRMSDs in at least one area of the body. The results of mental workload assessment revealed a high workload mean range (73.23±14.89) in all of the subjects. Mean score of KIM-LHC and KIM-MHO were 738.18±336.42 and 201.86±36.41, respectively with odds ratio of 1.32 for KIM-LHC in creating the WRMSDs. There was a significant relationship between the noise exposure, mental and physical workload and the prevalence of WRMSDs (p-value <  0.05). The results of the present study revealed that environmental, physical and cognitive factors can simultaneously be effective in the prevalence of WRMSDs. Therefore, performing effective control measures requires comprehensive attention to physical, environmental, and cognitive ergonomics in the algorithm of ergonomics management in the workplace.

The current trend of emergency airway management: a clinical review.

Airway management is a fundamental and intricate process that involves a sequence of integrated tasks. Situations requiring emergency airway management may occur in emergency department, intensive care units, and various other spaces. Emergency airway management can face a variety of challenges during preparation, intubation, and post-intubation, and may result in significant complications for the patients. Therefore, many countries are establishing step-by-step systemization and detailed guidelines, and updating the content based on the latest research. This clinical review introduces the current trends in emergency airway management, such as emergency airway management algorithms, comparison of video and direct laryngoscopy, rapid sequence intubation, pediatric airway management, pre-hospital airway management, surgical airway management, and airway management education.

The integration algorithm of digital resources in business administration based on cluster analysis

The field of business management involves a large amount of data and information sources, including market data, customer data, supply chain data, etc. In order to quantify and analyze different resources, help enterprises better plan and allocate resources, and improve resource utilization efficiency, a clustering analysis based digital resource integration algorithm for business management is studied. Build a business management digital resource integration framework, including data layer, integration layer, and storage layer, to integrate and store data from different sources of business management databases, thereby facilitating unified management and utilization of digital resources by enterprises. The data layer collects data from different business management databases and stores it in the database according to different sources; The integration layer preprocesses the collected data, simply fixes errors and missing information in the data, and improves data quality. Adopting a feature extraction method based on the projection direction uncorrelation strategy of the labeled power set conversion method, the useful feature information of digital resources in enterprise management can be effectively extracted; Based on the two-step clustering analysis method, business management digital resources are clustered according to similar characteristics to complete the classification and integration of business management digital resources, and improve the efficiency of resource utilization; The storage layer adopts the Security Information Diffusion Algorithm (IDA) storage model to store integrated and classified digital resources managed by enterprises, ensuring data security and effectively preventing data leakage and illegal access. The experimental results show that the digital resource structure of business management integrated by this algorithm is clear, with a data redundancy of less than 8% and a difference of less than 11% . The time consumption for data integration is less than 2.11 minutes, indicating good resource integration ability.

Smart Vehicle to Grid Energy Management Algorithm for Electric Vehicle Supported by Photovoltaic Energy Sources

The paper demonstrates grid improvements with results considering the integration of smart charging algorithms of electric vehicles (EVs) and photovoltaic (PV) energy sources to effectively manage energy flow. It aims to minimize energy costs by leveraging the bidirectional energy transfer capability of EVs and optimizing their interaction with the grid and PV sources. The proposed algorithm takes into account various parameters such as transformer load ratios, solar power generation, and the state of charge of vehicle batteries. The algorithms are implemented by acquiring one year’s real-time data of a predetermined transformer in a neighborhood from the electricity distribution company. The number of EV is estimated for the years 2025 and 2030. Buildings with energy management systems (BEMS), which charge EV with a controlled charging algorithm, provide renewable energy support with PV and reduce the transformer load during peak hours with the V2G algorithm. BEMS is not applied in buildings without EV or PV. Simulation results demonstrate that as the number of EVs increases, renewable energy source support and controlled charging algorithm alone are not sufficient. However, it demonstrate that energy costs and grid stress are successfully minimized by using the V2G algorithm in addition to controlled charging algorithm and PV.

Conditional scenario-based energy management algorithm with uncertain correlated forecasts

This paper introduces the application of the novel approach known as Conditional Scenario-Based Model Predictive Control (CSB-MPC) into energy management in a low voltage distribution system (LVDS). The LVDS comprises renewable energy sources (RES) and an energy storage system, with correlated power generation and demand under uncertainty. This correlation is leveraged to derive a reduced set of conditional scenarios and their associated probabilities. This reduced set retains the essential characteristics of a larger set of equiprobable scenarios generated based on information about uncertainties in power generation and demand forecasts. Instead of computationally demanding methods using the larger set, a feasible Scenario-Based Mixed-Integer Linear Program (MILP) is solved by employing the reduced set. This optimisation minimises costs associated with energy consumption from the main grid and the potential waste of generated power. In the objective function, the scenarios are weighted by their probabilities to mitigate the impact of less likely forecasts, leading to efficient LVDS component utilisation and reduced operating costs. Simulation results comparing the performance of the LVDS with CSB-MPC against other MPC approaches, including classic scenario-based, chance-constrained, and deterministic methods, reveal that CSB-MPC consistently exhibits higher probabilities of operational constraint satisfaction, with differences of up to 10% or even 30%. Notably, CSB-MPC achieves these results with similar solution times to classic scenario-based MPC but with lower LVDS operating costs, between 6.62% to 11.31% less.

A comprehensive Exdia TRF-LFIA for simultaneous quantification of GFAP and NT-proBNP in distinguishing ischemic and hemorrhagic stroke

The goal of this study is to create a highly sensitive time-resolved fluorescence lateral flow immunoassay (TRF-LFIA) capable of concurrently measuring glial fibrillary acidic protein (GFAP) and the N-terminal fragment of B-type natriuretic peptide precursor (NT-proBNP). This assay is designed as a diagnostic tool and aims to provide an algorithm for stroke management, specifically for distinguishing between Ischemic stroke (IS) and Hemorrhagic stroke (HS). However, LFIA to quantify simultaneous serum NT-proBNP and GFAP are not yet available.We have developed and validated a novel TRF-LFIA for the simultaneous quantitative detection of NT-proBNP and GFAP. The sensitivity and reproducibility of the immunoassay were significantly improved by employing specific monoclonal antibodies linked to europium nanoparticles (EuNPs) that specifically target NT-proBNP and GFAP. The detection area on the nitrocellulose membrane featured sandwich-style complexes containing two test lines for NT-proBNP and GFAP, and one Control line. The fluorescence intensity of these test lines and control line was measured using an in-house developed Exdia TRF-Plus analyzer. As proof-of-concept, we enrolled patients suspected of having a stroke who were admitted within a specific time frame (6 h). A small amount of clinical specimen (serum) was used.To optimize the LFIA, an EuNPs conjugated antibodies were investigated to improve the detection sensitivity and decrease the background signal as well shorten the detection time. The Exdia TRF-LFIA cartridge offers a wide linear dynamic detection range, rapid detection, high sensitivity, and specificity. The limit of detection was determined to be 98 pg/mL for NT-proBNP and 68 pg/mL for GFAP, with minimal cross-reactivity. There were 200 clinical human serum samples that were used to evaluate this platform with high correlation. By combining the results of NT-proBNP and GFAP, we formulated an algorithm for the clinical assessment of Ischemic Stroke (IS) and Hemorrhagic Stroke (HS). According to our proposed algorithm, the combination of GFAP and NT-proBNP emerged as the most effective biomarker combination for distinguishing between IS and HS.Exdia TRF-LFIA shows great potential as a supplemental method for in vitro diagnostics in the laboratory or in other point-of-care testing (POCT) applications. Its development substantially decreases the diagnosis time for IS and HS. The proposed algorithm not only minimizes treatment delays but also lowers medical costs for patients.

Post Cholecystectomy Bile Duct Injury in an Acute Setting: Categorization, Triaging, and Management Algorithm.

Background Postcholecystectomy bile duct injury (BDI) is a management challenge with significant morbidity, mortality, and effects on long-term quality of life. Early referral to a specialized hepatobiliary center and appropriate early management are crucial to improving outcomes and overall quality of life. In this retrospective analysis, we examined patients who were managed at our center over the past 10 years and proposed a triage and management algorithm for BDI in acute settings. Methods Patients referred to our center with BDI from January 2011 to December 2020 were reviewed retrospectively. The primary objective of initial management is to control sepsis and minimize BDI-related morbidity and mortality. All the patients were resuscitated with intravenous fluid, antibiotics (preferably culture-based), correction of electrolyte deficiencies, and organ support if required. A triage module and management algorithm were framed based on our experience. All the patients were triaged based on the presence or absence of bile leaks. Each group was further subdivided into red, yellow, and green zones (depending on the presence of sepsis, organ failure, and associated injuries), and the results were analyzed as per the proposed algorithm. Results One hundred twenty-eight patients with acute BDI were referred to us during the study period, and 116 patients had BDI with a bile leak and 12 patients were without a bile leak. Out of bile leak patients, 106 patients (91.38%) had sepsis with or without organ failure (red and yellow zone) and required invasive intervention in the form of PCD insertion (n=99, 85.34%) and/or laparotomy, lavage, and drainage (n=7, 6.03%). Another 10 patients (8.62%) had controlled external biliary fistula (green zone), of which four were managed with antibiotics, four underwent endoscopic retrograde cholangiopancreatography stenting, and only two (1.7%) patients could undergo Roux-en-Y hepaticojejunostomy upfront due to late referral. Among patients with BDI without bile leaks, nine (75%) had cholangitis (red and yellow zones). Out of these, five required PTBD along with antibiotics and four were managed with antibiotics alone. Only three (25%) patients in this group could undergo definitive repair without any restriction on the timing of referral and were sepsis-free at presentation (green zone). A total of nine patients had a vascular injury, and four of them required digital subtraction angiography and coil embolization. There were three (2.34%) mortalities; all were in the red zone of rest and had successful initial management. In total, five patients were managed with early repair in the acute setting, and the rest underwent definitive intervention at subsequent admissions after being converted to green zone patients with initial management. Conclusion The presented categorization, triaging, and management algorithm provides optimum insight to understand the severity, simplify these complex scenarios, expedite the decision-making process, and thus enhance patient outcomes in early acute settings following BDI.

A Unified Data Profile for Microgrid Loads, Power Electronics, and Sustainable Energy Management with IoT

Controllable devices in a classical centralized grid work independently, providing desired functionalities for the owner only, making grid stability and efficient energy management challenging. Therefore, the dynamically developing communication infrastructure has been crucial in improving local energy management and stability, introducing the Internet of Things and, finally, creating micro- or smart grids. Communication technology already allows for exchanging data and information with high bandwidth in practical industrial and grid applications. However, considering the increasing number of electrical devices with different purposes, parameters, and possibilities to work as an energy source or storage, the challenge is device profile standardization, especially for power electronics devices. As many devices as possible should be able to exchange information with the grid operator or local area/home energy management device, like industrial agents, energy routers, or smart transformers. The number and types of parameters, outputs, and input signals available in the devices from the communication point of view are significantly different, making it extremely difficult to apply the advanced energy management algorithm. Therefore, the unified data profile for modern loads was developed and discussed. The proposed device model was standardized, including mandatory information about the device’s work and parameters, with the possibility of reading the control commands from the supervisor device. The proposed unified model was studied in simulation research, integrating self-balanced and self-control areas.

Algorithm of innovation project risk management

Aim. To develop a risk management algorithm that can be used in risk management of innovations.Objectives. On the basis of the current international standards of risk management and scientific publications to study the existing practice of risk management, highlighting the main elements of the risk management process into a single generalized risk management algorithm; based on the results of the first task, as well as taking into account the identified features of the process of innovation implementation, to develop an algorithm for risk management of innovation projects.Methods. The work is based on the study of scientific publications in the field of risk management and analysis of international standards on risk management in order to adapt them to the peculiarities of innovation management.Results. The problem of risk management of innovation projects is one of the most difficult in project management because of the significant degree of uncertainty inherent in innovation. The article reflects the problem of investors’ acceptance of increased risk during the realization of an innovation project. The peculiarity of risk management of innovations is the need to accept increased risk, and in return the opportunity to present a new product or technology to the market. Taking into account the considered peculiarities, an algorithmic approach to risk management of innovation projects is given. The practical significance of the study lies in the possibility of applying the developed algorithm of innovation project risk management by economic entities, which will improve the quality of corporate risk management and increase the efficiency of resource utilization. The authors point out the necessity of selecting a project with positive NPV (discounted cash flow, DCF) and accepting the increased risk of the innovation project in the process of innovation management.Conclusions. The authors have created a comprehensive methodological approach to innovation project risk management in the form of a sequence of actions algorithm. The purpose of its application is to increase the efficiency of risk management and to achieve a successful result of innovation implementation.

A qualitative analysis of algorithm-based decision support usability testing for symptom management across the trajectory of cancer care: one size does not fit all

BackgroundAdults with cancer experience symptoms that change across the disease trajectory. Due to the distress and cost associated with uncontrolled symptoms, improving symptom management is an important component of quality cancer care. Clinical decision support (CDS) is a promising strategy to integrate clinical practice guideline (CPG)-based symptom management recommendations at the point of care.MethodsThe objectives of this project were to develop and evaluate the usability of two symptom management algorithms (constipation and fatigue) across the trajectory of cancer care in patients with active disease treated in comprehensive or community cancer care settings to surveillance of cancer survivors in primary care practices. A modified ADAPTE process was used to develop algorithms based on national CPGs. Usability testing involved semi-structured interviews with clinicians from varied care settings, including comprehensive and community cancer centers, and primary care. The transcripts were analyzed with MAXQDA using Braun and Clarke’s thematic analysis method. A cross tabs analysis was also performed to assess the prevalence of themes and subthemes by cancer care setting.ResultsA total of 17 clinicians (physicians, nurse practitioners, and physician assistants) were interviewed for usability testing. Three main themes emerged: (1) Algorithms as useful, (2) Symptom management differences, and (3) Different target end-users. The cross-tabs analysis demonstrated differences among care trajectories and settings that originated in the Symptom management differences theme. The sub-themes of “Differences between diseases” and “Differences between care trajectories” originated from participants working in a comprehensive cancer center, which tends to be disease-specific locations for patients on active treatment. Meanwhile, participants from primary care identified the sub-theme of “Differences in settings,” indicating that symptom management strategies are care setting specific.ConclusionsWhile CDS can help promote evidence-based symptom management, systems providing care recommendations need to be specifically developed to fit patient characteristics and clinical context. Findings suggest that one set of algorithms will not be applicable throughout the entire cancer trajectory. Unique CDS for symptom management will be needed for patients who are cancer survivors being followed in primary care settings.

Application of management algorithm to a series of patients of disorders of sexual differentiation from Southern India: A case series&amp;nbsp;

No abstract available

Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm.

Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42-73% of patients with Staphylococcus species being the most common invading organisms, while Staphylococcus aureus is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2-4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management.

A framework for prosumer-centric peer-to-peer energy trading using network-secure export–import limits

This paper presents a new prosumer-centric peer-to-peer (P2P) energy trading framework incorporating the network-secure export–import limits, known as dynamic operating envelope (DOE), for prosumers considering their preferences to trade in the local market. In the proposed framework, a DOE-integrated energy management algorithm is developed for prosumers considering electric vehicles (EVs) charge–discharge and photovoltaic (PV) systems. The framework allows prosumers to operate within defined DOE, aligning with the preferences of EV-owning prosumers by managing the desired EV battery charge levels at their departure. An auction-based P2P energy trading mechanism for prosumers is proposed incorporating the allocated DOE to ensure secure network operation and valuing prosumers’ preferences to benefit them. The proposed framework is implemented on a 78-node low-voltage (LV) residential distribution network to evaluate its performance. The results and comparative analyses verify the effectiveness of the proposed framework in addressing network issues such as voltage and line congestion problems, meeting prosumers’ preferences in asset management, and providing benefits to all participants in the energy trading process.

Femoral bone defect classifications in revision total hip arthroplasty: a comprehensive review and proposal of a new algorithm of management.

The number of primary total hip arthroplasties (THAs) and revisions is expected to steadily grow in the future. The femoral revision surgery can be technically demanding whether severe bone defects need to be addressed. The femoral revision aims to obtain a proper primary stability of the stem with a more proximal fixation as possible. Several authors previously proposed classification systems to describe the morphology of the bony femoral defect and to drive accordingly the surgeon in the revision procedure. The previous classifications mainly considered cortical and medullary bone at the level of the defect of poor quality by definition. Therefore, the surgical strategies aimed to achieve a distal fixation bypassing the defect or to fill the defect with bone impaction grafting or structured bone grafts up to the replacement of the proximal femur with megaprosthesis. The consensus on a comprehensive and reliable classification system and management algorithm is still lacking. A new classification system should be developed taking into account the bone quality. The rationale of a new classification is that 'functional' residual bone stock could be present at the level of the defect. Therefore, it can be used to achieve a primary (mechanical) and secondary (biological) stability of the implants with a femoral fixation more proximal as possible.

Reducing Osteopenia of Prematurity-related Fractures in a Level IV NICU: A Quality Improvement Initiative.

Osteopenia of prematurity (OOP) is often a silent disease in the neonatal intensive care unit (NICU). Despite its association with increased neonatal morbidity, such as fractures, wide variation exists in screening, diagnostic, and management practices. We sought to decrease the rate of OOP-related fractures in our level IV NICU by 20% within 1 year. A multidisciplinary quality improvement team identified inconsistent screening, diagnosis, and management of OOP, as well as handling of at-risk patients, as primary drivers for OOP-related fractures. Using the model for improvement, we implemented sequential interventions, including screening, diagnosis, and a management algorithm as a "handle-with-care" bundle in infants at risk for fractures. 194 at-risk infants were included, 59 of whom had OOP. There was special cause variation in OOP-related fractures, with a reduction from 0.43 per 1000 patient days to 0.06 per 1000 patient days with our interventions. There was also an improvement in days between fractures from 62 to 337 days. We achieved these improvements despite a similar prevalence of OOP throughout the initiative. We showed special cause variation with increased patients between missed OOP documentation and improved collection of OOP screening laboratories at 4 weeks of life without increased blood testing. A multidisciplinary team approach with standardized OOP screening, diagnosis, and management guidelines, including a handle-with-care bundle, reduces OOP-related fractures in a level IV NICU.

Utilizing Hybrid Sine Cosine Shuffled Frog Leaping Algorithm for Optimal Energy Management in the Residential building with Renewable Energy Resources and Corresponding Uncertainties

Utilizing Hybrid Sine Cosine Shuffled Frog Leaping Algorithm for Optimal Energy Management in the Residential building with Renewable Energy Resources and Corresponding Uncertainties

Antibody-mediated rejection (AMR) in pediatric lung transplantation-Current state and future directions.

Lung transplantation is considered as the ultimate therapy for children with advanced pulmonary disease. International data show a median conditional 1-year post-transplantation survival of 9.1 years. Recently, antibody-mediated rejection (AMR) has increasingly been recognized as an important cause of allograft dysfunction although pediatric reports are still scarce. Donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are known to play a role in AMR development post-transplant but AMR pathogenesis is still poorly understood. Central to the concept of pulmonary AMR is immune activation with the production of allo-specific B-cells and plasma cells directed against donor lung antigens. The frequency of pulmonary AMR in children is currently unknown. Due to the lack of AMR data in children, the diagnostic approach for pediatric pulmonary AMR is solely based on adult literature. This personal viewpoint article evaluates the rational for the creation of age-based thresholds for different diagnostic categories of pulmonary AMR and data on the management of pulmonary AMR in children. To the authors' knowledge, there have been no randomized controlled trials comparing different management regimes in pulmonary AMR, and thus, management and treatment algorithms for pulmonary AMR in children are only extrapolated from adults. To advance the knowledge of AMR in children, the authors propose that children be included in collaborative, multi-center trials. It is vital that future decisions on internationally agreed upon guidelines for pulmonary AMR take its impact on children into consideration. Research is needed to fill the current knowledge gaps in the field of pulmonary AMR in children focused on optimizing outcomes.

Management of floating hip injury: a review of the literature.

The aim of this study was to provide a comprehensive overview of floating hip injury and attempt to provide a management algorithm. PubMed was searched using the terms 'Floating hip' or 'acetabular fracture' and 'Ipsilateral femoral fracture' or 'pelvic fracture' and 'Ipsilateral femoral fracture'. One author performed a preliminary review of the abstracts and references of the retrieved articles. The mean injury severe score reported was higher than 20. Chest and abdominal injuries, as well as fractures at other sites, were the most common associated injuries. Despite the high disability rate, surgery remained the preferred option for managing these injuries. The surgical timing varied from a few hours to several days and was subjected to the principles of damage control orthopedics. Although, in most cases, fixation of femoral fractures took precedence over pelvic or acetabular fractures, there was still a need to consider the impact of damage control orthopedics, associated injuries, and surgeon's considerations and preferences. Posttraumatic arthritis, neurological deficits, heterotopic ossification, femoral head necrosis, femoral nonunion, and limb inequality were common complications of the floating hip injury. The severity of such injuries often exceeds that of an isolated injury and often requires specialized multidisciplinary treatment. In the management of these complex cases, the complexity and severity of the injury should be fully assessed, and an appropriate surgical plan should be developed to perform definitive surgery as early as possible, with attention to prevention of complications during the perioperative period.