Effective Management Approach Research Articles

Novel Multimodal Treatment Regimen for the Management of Primary Sacrococcygeal Cystic Echinococcosis.

Introduction:Osseous hydatidosis is a rare condition most commonly involving the spine. Among spinal segments, sacrococcygeal involvement is even rarer. Moreover, the lesion is more prone to recurrence owing to the infiltrative nature of microvesicular lesions involving the spine. In this case report, we describe an effective multimodal management approach toward the management of primary sacrococcygeal cystic echinococcosis.Case Report:A 56-year-old female presented with complaints of severe back pain and urinary incontinence for 3 months. She presented with a slow-onset cauda equina syndrome with radiating pain to both lower limbs. Radiographic evaluation showed an expansile lytic lesion affecting the right iliac wing with near-complete cortical bone destruction of the sacrum. Magnetic resonance imaging revealed neural involvement with sacral destruction by a multiloculated cystic mass, extending to the spinal canal. No coexisting lesions were noted anywhere. Echinococcosis was diagnosed with serum enzyme-linked immunosorbent assay. She underwent neoadjuvant therapy with albendazole and praziquantel, followed by ultrasound-guided percutaneous aspiration injection and reaspiration (PAIR) with hypertonic saline followed by sclerosant (95% ethyl alcohol) into the residual cyst cavity. Later, she open excision of the residual multiloculated cystic mass was performed. Adjuvant medical therapy was continued for 3 months post-surgery. The patient regained her neurological functions by 6 months without any residual sequelae or symptomatic recurrence until 4 years of follow-up.Conclusion:Multimodal treatment regimen comprising of oral medical therapy by albendazole and praziquantel along with PAIR and surgical in toto excision of the cyst followed by post-operative oral medical therapy for 3 months has given excellent results in sacrococcygeal cystic echinococcosis.

Identification and characterization of zero population growth (zpg) gene in Plutella xylostella

AbstractThe diamondback moth (DBM), Plutella xylostella, is one of the most destructive insect pests on cruciferous plants, which causes huge economic losses annually across the world. Due to its resistance to all classes of insecticides, new effective management approaches are urgently needed. The innexin genes encode gap junction proteins in invertebrates, which play critical roles in cell‐to‐cell interactions for electrical currents, small molecules and ions. Zero population growth (zpg), one germline‐specific innexin protein, is required for survival of differentiating early germ cells during gametogenesis in many insect species. In this study, nine innexin genes were identified from the P. xylostella genome, and named as Pxylinx1.1, Pxylinx1.2, Pxylinx2, Pxylinx3, Pxylinx4, Pxylinx7.1, Pxylinx7.2, PxylshakB.1 and PxylshakB.2. The expression profiles of P. xylostella innexin genes in different developmental stages and tissues were examined, revealing Pxylinx4 was specifically expressed in eggs and female ovaries, which is the candidate zpg gene in P. xylostella. RNA interference (RNAi) was utilized to investigate the functions of Pxylinx4 in egg‐laying and egg‐hatching. The results showed that RNAi treatment on Pxylinx4 in female P. xylostella, lead to the decrease of the egg‐laying but not the egg‐hatching. This study improves our understanding of P. xylostella innexin genes and provides a candidate molecular target (Pxylinx4) for developing new approaches to control this economically important pest.

Interrupted versus uninterrupted anticoagulation therapy for catheter ablation in adults with arrhythmias.

Interrupted versus uninterrupted anticoagulation therapy for catheter ablation in adults with arrhythmias.

Characterizing Billbug (Sphenophorus spp.) Seasonal Biology Using DNA Barcodes and a Simple Morphometric Analysis.

Simple SummaryBillbugs (Sphenophorus spp.) are a group of grass-feeding weevils considered to be one of the most important and widespread insect pests of turfgrass. However, our limited understanding of regional variation in billbug species composition and inability to identify the damaging larval stage to species level, has hindered our ability to resolve the seasonal biology of many billbug species and constrained development of effective management approaches. In this study, we developed a robust DNA barcoding approach for identification of morphologically cryptic billbug larvae. Using this molecular tool combined with larval head capsule measurements we characterized regional variation in billbug species and developed larval phenology charts. Our approach provides researchers with the molecular tools necessary to fill critical gaps in our understanding of billbug seasonal biology and will facilitate the development of improved turfgrass pest management programs.Billbugs (Sphenophorus spp.) are a complex of grass-feeding weevil species that reduce the aesthetic and functional qualities of turfgrass. Effective billbug monitoring and management programs rely on a clear understanding of their seasonal biology. However, our limited understanding of regional variation in the species compositions and seasonal biology of billbugs, stemming primarily from our inability to identify the damaging larval stage to species level, has hindered efforts to articulate efficient IPM strategies to growers. We used a combination of DNA barcoding methods and morphometric measures to begin filling critical gaps in our understanding of the seasonal biology of the billbug species complex across a broad geographic range. First, we developed a DNA barcoding reference library using cytochrome oxidase subunit 1 (COI) sequences from morphologically identified adult billbugs collected across Indiana, Missouri, Utah and Arizona. Next, we used our reference library for comparison and identification of unknown larval specimens collected across the growing season in Utah and Indiana. Finally, we combined our DNA barcoding approach with larval head capsule diameter, a proxy for developmental instar, to develop larval phenology charts. Adult COI sequences varied among billbug species, but variation was not influenced by geography, indicating that this locus alone was useful for resolving larval species identity. Overlaid with head capsule diameter data from specimens collected across the growing season, a better visualization of billbug species composition and seasonal biology emerged. This approach will provide researchers with the tools necessary to fill critical gaps in our understanding of billbug biology and facilitate the development of turfgrass pest management programs.

Explicit incorporation of spatial variability in a biomass dynamics assessment model

Abstract The sustainable management of fisheries has largely relied on stock assessment models that assume stocks are homogeneous throughout their domain. However, ignoring complex underlying spatial patterns can lead to increased risk of failures in management. Utilizing geostatistical approaches in conjunction with a traditional fishery biomass dynamics model, we develop a spatially-explicit modelling framework that treats the underlying population dynamics as spatial processes. Simulation experiments demonstrate that this approach reliably estimates variance parameters and accurately captures true patterns of population change. We further demonstrate the utility of our modelling framework in a real setting using data from the Canadian Maritimes Inshore Scallop Fishery. The model captures time-varying spatial patterns in both population characteristics and fishing pressure without explicit knowledge of the underlying mechanisms and retains the ability to scale up to the whole spatial domain with less associated uncertainty than for temporal models. These results lead to improved scientific advice for management, future-proofing of the assessment to shifts in stock productivity and fishing effort, and provide information that can be used to develop more effective management approaches.

Phytoavailability and transfer of mercury in soil-pepper system: Influencing factors, fate, and predictive approach for effective management of metal-impacted spiked soils

Mercury (Hg) contamination and accumulation in food crops is a global threat posing potential health risk to humans. However, Hg phytoavailability in soil-pepper system and its influencing factors largely remain unknown. In this study, a greenhouse pot experiment was conducted to grow peppers using 21 Chinese agricultural soils with varied soil properties and aged Hg levels. Mercury concentration in pepper leaves and fruits ranged from 0.021 to 0.057 mg kg−1 and 0.005–0.022 mg kg−1 respectively, while fruit Hg content in three soils (Anhui, Hubei, Beijing) exceeded the safety limit. Fruit Hg concentration was better positively correlated with soil Mg(NO3)2-extractable Hg content (r = 0.7, P < 0.0001) than soil total Hg content (r = 0.45, P < 0.0001). Highest bioconcentration factor (BCF, ratio of Hg plant to Hg soil) yielded in acidic soils, while the lowest BCF occurred in alkaline soils. Path analysis indicated available-Hg (R2 = 0.40) and total-Hg (R2 = 0.40) had direct positive effects on the pepper fruit Hg concentration, while direct negative effects including pH (R2 = −0.86), organic matter (R2 = −0.7), crystalline-Fe (R2 = −0.68). Those agreed with the stepwise multiple linear regression analysis which yielded a regression predictive model (R2 = 0.73, P < 0.0001). Soil available-Hg, total-Hg, pH, organic matter and crystalline-Fe & Mn were the most influencing factors of Hg phytoavailability. These results provide new insights into the phytoavailability of Hg in soil-pepper system, thus facilitating the management of pepper cultivation in Hg-enriched soils.

Mitigation Approach for Significant Causes of Contractor’s Delays in Construction Projects in Sri Lanka

The construction industry has a dynamic and complex environment. The successful completion of a construction project depends on various factors. Accordingly, construction delay is observed to happen in construction projects. It is highly affecting the construction sector and the economy of the country too. Although previous research studies identified the causes, effects, and mitigation methods separately, this study adopts a linked approach and directs to identify the effective applicable mitigation methods and their practices on each significant cause of delay in construction projects. Moreover, contractors are noted as one of the main sources of construction delay from the previous studies. Hence, this research aims to develop a framework to determine the applicable mitigation strategies and the practices of each mitigation strategy for each significant cause of contractor’s delays in construction projects in Sri Lanka. A mixed research approach was adopted to generate the research process. A literature review was conducted on construction delays, organizational and project management factors, and professional competency, mitigation strategies in delay management. The significant causes of delays and effective mitigation strategies were ranked through a questionnaire survey using a Likert scale. Project Managers and Quantity Surveyors in the Sri Lankan construction industry were selected in the ratio of 1:3 respectively for the interview as they are mostly engaged with delay management. Also, the respondents were limited to 68 and the collected data were analysed through the Relative Important Index (RII) method, to rank the significant causes and mitigation strategies. Then techniques and possible mitigation strategies were found through interviews and content analysis was used to analyse the data. The findings indicated that most of the contractor’s delays can be mitigated through applying proper mitigation strategies as effective management approaches in the construction projects such as effective project planning and schedules of construction works, maintain positive financial stability and well qualified and experienced professionals and staff, effective strategic planning, risk analysis, and management, selection of suitable sub-contractor and management and effective site management and supervision. In addition to that, inaccurate planning and scheduling of the project, financial dishonesty, poor procurement of construction materials, ineffective time management of contractors, and incompetence of management professionals and staffs were identified as the most significant contractor’s causes of delays in construction management.&#x0D; Keywords: Delays, Significant Causes, Mitigation, Construction Management, Construction Projects.

Koala retrovirus genetic diversity and transmission dynamics within captive koala populations

Koala populations are currently in rapid decline across Australia, with infectious diseases being a contributing cause. The koala retrovirus (KoRV) is a gammaretrovirus present in both captive and wild koala colonies that presents an additional challenge for koala conservation in addition to habitat loss, climate change, and other factors. Currently, nine different subtypes (A to I) have been identified; however, KoRV genetic diversity analyses have been limited. KoRV is thought to be exogenously transmitted between individuals, with KoRV-A also being endogenous and transmitted through the germline. The mechanisms of exogenous KoRV transmission are yet to be extensively investigated. Here, deep sequencing was employed on 109 captive koalas of known pedigree, housed in two institutions from Southeast Queensland, to provide a detailed analysis of KoRV transmission dynamics and genetic diversity. The final dataset included 421 unique KoRV sequences, along with the finding of an additional subtype (KoRV-K). Our analysis suggests that exogenous transmission of KoRV occurs primarily between dam and joey, with evidence provided for multiple subtypes, including nonendogenized KoRV-A. No evidence of sexual transmission was observed, with mating partners found to share a similar number of sequences as unrelated koala pairs. Importantly, both distinct captive colonies showed similar trends. These findings indicate that breeding strategies or antiretroviral treatment of females could be employed as effective management approaches in combating KoRV transmission.

Biology, Ecology and Management of the Invasive Navua Sedge (Cyperus aromaticus)-A Global Review.

Navua sedge (Cyperus aromaticus (Ridley) Mattf. & Kukenth) is an invasive perennial sedge, native to tropical Africa, which is threatening many natural ecosystems and agroecosystems, especially in northern Queensland, Australia. Crop and pasture production have been impacted by Navua sedge and it is also directly causing reductions in dairy and beef production in affected regions. This review documents the biology, ecology and potential management options to minimise the spread and impact of Navua sedge. The weed reproduces both sexually (seeds) and vegetatively (via underground rhizomes). Its tiny seeds can be spread easily via wind, water, vehicles, farm machinery and animals, whilst the rhizomes assist with establishment of dense stands. The CLIMEX model (which uses distribution and climate data in native and novel ranges) indicates that in Australia, Navua sedge has the potential to spread further within Queensland and into the Northern Territory, New South Wales and Victoria. Several management strategies, including mechanical, chemical and agronomic methods, and their integration will have to be used to minimise agricultural production losses caused by Navua sedge, but most of these methods are currently either ineffective or uneconomical when used alone. Other management approaches, including biological control and mycoherbicides, are currently being explored. We conclude that a better understanding of the interaction of its physiological processes, ecological patterns and genetic diversity across a range of conditions found in the invaded and native habitats will help to contribute to and provide more effective integrated management approaches for Navua sedge.

Germline CDH1 G212E Missense Variant: Combining Clinical, In Vitro and In Vivo Strategies to Unravel Disease Burden.

Simple SummaryHereditary diffuse gastric cancer (HDGC) is an inherited cancer syndrome associated with CDH1 germline mutations. The increasing detection of CDH1 genetic variants due to multigene panel testing poses a serious clinical challenge and urges the development of effective classification strategies. In this study, we describe the identification of the novel CDH1 G212E variant in a large family strongly affected by diffuse gastric cancer. Through a comprehensive characterization pipeline, we provide evidence of the damaging nature of this genetic alteration, thus impacting patient management and family screening.E-cadherin, encoded by CDH1, is an essential molecule for epithelial homeostasis, whose loss or aberrant expression results in disturbed cell–cell adhesion, increased cell invasion and metastasis. Carriers of CDH1 germline mutations have a high risk of developing diffuse gastric cancer and lobular breast cancer, associated with the cancer syndrome Hereditary Diffuse Gastric Cancer (HDGC). The ubiquitous availability of cancer panels has led to the identification of an increasing amount of “incidental” CDH1 genetic variants that pose a serious clinical challenge. This has sparked intensive research aiming at an accurate classification of the variants and consequent validation of their clinical relevance. The present study addressed the significance of a novel CDH1 variant, G212E, identified in an unusually large pedigree displaying strong aggregation of diffuse gastric cancer. We undertook a comprehensive pipeline encompassing family data, in silico predictions, in vitro assays and in vivo strategies, which validated the deleterious phenotype induced by this genetic alteration. In particular, we demonstrated that the G212E variant affects the stability and localization, as well as the adhesive and anti-invasive functions of E-cadherin, triggering epithelial disruption and disorganization. Our findings illustrate the clinical implication of a complementary approach for effective variant categorization and patient management.

Role of dietary therapy in managing epilepsy in children

Ketogenic diets have been proposed as effective management approaches that have been validated by many studies in the literature. The efficacy of administering these treatment modalities has been validated by many studies within epilepsy-related syndromes as Rett syndrome, infantile spasms, GLUT-1 deficiency and Dravet syndrome. As a result, it has been noticed that observable favorable outcomes within the first three months from starting the administration of these treatment regimens. In this literature review, we have discussed the dietary therapeutic approaches for managing epilepsy in children. The findings have been combined from different studies in the literature. Many of them are comparative investigations that have indicated the efficacy of these treatment plans in reducing both the frequency of seizures and adequately inhibiting the development of further epilepsy events. Many mechanisms have been proposed for these treatment modalities to inhibit seizures that are adequately discussed in this article. Based on the current evidence, further awareness approaches should be conducted to increase the administration of these products, especially in pharmaco-resistant cases.

IN SEARCH OF EXCELLENCE IN SOCIAL ENTREPRENEURSHIP PROJECT MANAGEMENT: EXPERIENCE AND STANDARDS OF THE EUROPEAN UNION

The development of social entrepreneurship has required new effective management approaches and tools. The authors refer to European experience and standards in the field of project management in order to develop a methodological approach to organizing project management for achieving the outstanding results in social entrepreneurship projects.The article presents the results of the quasi-experiment aimed to identify differences in the achieved results among projects using the European PM2 methodology and projects carried out within the PMI methodology. The assessment technique developed by the authors is based on EFQM model.No significant difference among the project results in the experimental and control groups has been found, which indicates the importance of applying the project management methodology, regardless of its origin. By clustering project results, it was found that projects adapted the European methodology were more focused on strategic development and integration into the ecosystem on the principles of long-term cooperation, while the projects of the control group paid more attention to the effective organization and coordination of processes, resources and activities.

Case study of event risk management with options strangles and straddles

AbstractEvent risk environments may involve an elevated probability of both volatility regime shifts and sharp, abrupt price changes, either up or down. Purely direction‐oriented risk management approaches are not necessarily well‐suited for these market conditions. In this exploratory case study, we look at the possibility that non‐directional options strategies, such as straddles and strangles, may offer interesting benefits in the management of potential event risk environments. Our research involves only the case of the S&amp;P500® Index from 2018 through 2020. We utilize the Market Sentiment Meter from CME Group to identify periods in which event risk may be present and particularly when the probability of sharp, abrupt price changes may be elevated. Our findings in this specific case suggest that selling option straddles and strangles during typical market conditions and then buying option straddles and strangles when the market sentiment switches to a more extreme state offers potential as an effective risk management approach for event risk. More research is needed over longer periods and for different securities, including international equity indices, to explore the usefulness of options strategies for event risk management.

Understanding the behavioural gap between perceived and actual environmental behaviour: Investigating the clam-harvesting pattern in Hong Kong SAR, China

At every given site with conservation value, there is a dilemma between conservation and the use of natural resources. Here we describe the first in-depth investigation of the differences between perceived and actual behaviour in clam harvesting, with a view to determine a more sustainable approach to conserve a previously unprotected tourist and clam-harvesting site, Shui Hau, in Hong Kong. We assessed harvesting pressure by conducting a clam-harvest photographic survey and collected self-reported questionnaires in 2018. More than 90% of visitors per sampling day were assessed for the survey, resulting in 86 sets of completed questionnaires and clam harvest photographs, in which we counted the number of clams harvested and recorded the shell length of each clam. We found that the clam-diggers had high self-reported environmental attitudes and behaviour, and a higher new ecological paradigm score was associated with a better clam-digging related attitude and perceived clam-digging behaviour. The low correlation between self-reported behaviour and actual behaviour indicated that most clam-diggers had different concepts or definitions of the appropriate size of the clam harvest and the size of a mature clam, even though each digger reported that he/she had the highest level of environmental attitudes and behaviour. This differentiation may imply a transition problem between environmental attitudes and actual environmental behaviour. An effective management approach is needed to foster clam-diggers’ sense of biodiversity to embrace the long-term sustainable use of coastal resources.

Pedagogical Approaches for an Effective Classroom Management

This study aimed to find out the pedagogical approaches for effective classroom management. The study is also undertaken to explore the teacher's opinions on effective classroom management. The study has addressed the research question ''how teachers can effectively manage a classroom with a wide range of learning abilities and styles, in a student-centered way''. It is adopted the qualitative research design. Qualitative data were taken from in-depth interviews. Thematic analysis and verbatim analysis have been done. Data were analyzed on the themes of student-centered classroom management, reactive and proactive classroom management strategies, cooperative discipline, culturally responsive teaching teacher’s role, and classroom management. The study's findings entail that a well-managed classroom is a powerful motivator for students’ learning. Reactive and proactive classroom, cooperative and collaborative learning atmosphere, culturally responsive teaching and learner-friendly teaching by the teacher, has been identified as the pedagogical approaches for effective classroom management. Based upon the findings, it can be suggested that the school principals should constantly organize seminars and workshops for teachers to get them aware of effective classroom-management techniques. The study further implies a constant need to introduce and use new-classroom-management behaviors from the side of teachers.

English

BACKGROUND Increased levels of urinary biomarkers can be detected in type 2 diabetic patients before the onset of significant albuminuria and may be used as an early marker of renal injury in diabetic nephropathy (DN) which would play a significant role for the effective management and treatment approaches in diabetic care. We wanted to evaluate cystatin C and microalbumin as effective early biomarkers in assessing nephropathy in patients with type 2 diabetes mellitus in this study. METHODS A cross-sectional study was conducted among 180 subjects grouped into healthy controls, clinically proven T2DM without nephropathy and type 2 DM with nephropathy comprising 60 participants in each group. Fasting and postprandial blood samples and urine samples were collected and analysed by standard methods. eGFR was calculated using CKD-EPI 2012 equation. IBM - SPSS version 20 was used for statistical analysis. RESULTS Diabetic nephropathy patients had significantly elevated serum cystatin C and microalbumin (2.43 ± 0.59, 700.5 ± 591.8 mg / L, respectively), compared to T2DM (0.98 ± 0.26, 63.7 ± 102.9 mg / L, respectively), and the control study subjects (0.81 ± 0.16, 11.15 ± 8.9 mg / L, respectively). Serum cystatin C showed AUC of 0.994 (95 % CI, 0.986 - 1.00) whereas microalbumin showed 0.944 (95 % CI, 0.907 - 0.981). Serum cystatin C showed a sensitivity of 96.7 % and a specificity of 91.7 % at a cutoff point of 1.34 mg / L whereas at a cut-off point of 138.5 mg / L for microalbumin, the sensitivity and specificity were 90 % and 83.3 % respectively. CONCLUSIONS Serum cystatin C and microalbumin both could be considered as markers for early detection of nephropathy in T2DM patients. The more prominent rise in serum cystatin C values provide an earlier diagnosis of diabetic nephropathy among T2DM patients. KEY WORDS Biomarker, Type 2 Diabetes Mellitus, Cystatin C, Diabetic Nephropathy, Microalbumin

An Evaluation of Growth Characteristics of Faba Bean Cultivars

Resistance to herbicides and the lack of new herbicide options have led researchers to explore alternate methods to manage weed populations in large-scale cropping systems. Crop competition is an effective weed management approach that can reduce the pressure on herbicides. Faba bean (Vicia faba L.) is an important winter legume crop in Australia. Crop traits such as, height, biomass, growth rate, tillering capacity, leaf area, and root growth have been suggested as indicators of the competitive ability of crops against weeds. Based on pot studies at Narrabri and Toowoomba, we assessed the growth traits (biomass, height, leaf area, relative growth rate, and branch number) of six faba bean cultivars and ranked them for their potential ability to compete with weeds. PBA Marne and PBA Zahra were identified as highly competitive faba bean cultivars based on their higher overall ranking score achieved at both locations. PBA Nasma and PBA Samira were ranked highly and moderately competitive at Narrabri and Toowoomba sites, respectively. At Narrabri, PBA Nanu was ranked poorly competitive based on its lower biomass, height, and leaf area than the other cultivars. The weed suppressive ability of these cultivars needs to be assessed in the presence of weeds under field conditions.

The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality.

Acute mesenteric ischemia (AMI) is a disease with high mortality and requires a multidisciplinary approach for effective management. A pathway and care bundle were developed and implemented with the objective to reduce mortality. The aim of this retrospective comparative study was to analyze the effects of the pathway on patient management and outcome. All consecutive patients operated in a secondary and tertiary referral center because of occlusive arterial AMI were identified between 2014 and April 2020. The pathway aimed to increase overall awareness, and hasten and improve diagnostics and management. Patients treated before implementation of the pathway (pregroup, years 2014-2017) were compared with patients treated using the pathway (postgroup, May 2018 to April 2020). Univariate and multivariate analyses were used to compare the groups. There were 78 patients in the pregroup and 67 patients in the postgroup with comparable baseline characteristics and disease acuity. The postgroup was more often diagnosed with contrast-enhanced computed tomography (58 [74%] vs. 63 [94%], p = 0.001) and had shorter mean in-hospital delay to operating room (7 hours [interquartile range, 3.5-12.5] vs. 3 hours [interquartile range, 2-11], p = 0.023). Revascularization was done more often in the postgroup (53 [68%] vs. 56 [84%], p = 0.030) especially using endovascular treatment (26 [33%] vs. 43 [64%], p < 0.001). Thirty-day mortality was lower in the postgroup (23 [51%] vs. 17 [25%], p = 0.001). Being managed in the postgroup remained as a protective factor (odds ratio, 0.32; 95% confidence interval, 0.14-0.75; p = 0.008) for 30-day mortality in the multivariate analysis. Implementing a pathway and care bundle resulted in enhanced regional and in-hospital awareness of AMI, more appropriate computed tomography imaging, shorter in-hospital delays, increased number of revascularizations, and, hence, lower mortality. Therapeutic/Care Management, level IV.

Effect of spent engine oil contamination on the soil properties in selected automobile mechanic villages in Enugu, Enugu State, Nigeria

AbstractThis study was carried out to determine the effect of spent engine oil on the soil properties in selected automobile mechanic villages in Enugu, Enugu State, Nigeria. Spent engine oil (SEO) was collected and characterized according to ASTM test methods. Soil samples were collected at 0–30 and 30–60 cm depths from the mechanic villages and uncontaminated agricultural farmlands 500 m away as control and properties analyzed. The extent of contamination of heavy metals in soils was assessed. The results of the SEO characterization showed the values of 2.87 wt%, 218°C, 13.18 mg/kg, 0.75 mg/kg, 4.06 mg/kg, and 0.94 mg/kg for toluene insoluble, flash point, Pb, As, Cr and Cd. The soil bulk density, pH, TOC, TOM, N, P, Cu, Cd, Pb, and Fe decreased with increasing depth while particle density, TSP, S, Cr, and As increased with increasing depth. The ANOVA results showed that a statistically significant difference existed between values of soil parameters (p &lt; 0.05), indicating that SEO has a significant effect on soil properties (α = 0.05). The study will provide useful insights for developing a precautionary strategy and inform environmental policy implementation for an effective risk management approach in the study area.

Management of individuals with multiple chronic conditions: a continuing challenge.

Individuals with multiple chronic conditions (MCCs) represent a growing proportion of the adult population in the United States, particularly among lower-income individuals and people of color. Despite ongoing efforts to characterize this population and develop approaches for effective management, individuals with MCCs continue to contribute substantially to health care expenditures. Based on a review of recent literature, several identified barriers limit the effectiveness of care for patients with MCCs. Health care delivery system structural limitations, evidence-based care concerns, patient-clinician relationship constraints, and barriers to inclusion of patient-centered priorities may singly or in combination negatively affect outcomes for individuals with MCCs. The COVID-19 pandemic has shed further light on inequities contributing to suboptimal MCC patient management. Awareness of the prevalence and demographic attributes of patients with MCCs and the identified barriers to care may help improve patient engagement and treatment outcomes for this high-cost population. This paper provides recommendations for enhancing MCC patient care outcomes in the current and post-COVID-19 health care delivery settings.