Backup Plan Research Articles

8503 Analyzing Prescription Practices for Back-up Insulin and Glucagon in Type 1 Diabetes Patients Using Insulin Pumps: Findings From Cleveland Clinic

Abstract Disclosure: A. Iqbal: None. J. Ambalavanan: None. K. Alkwatli: None. P.P. Rao: None. Background: It is estimated that about 400,000 patients with type 1 diabetes (T1D) in the U.S. are using insulin pumps1. This number has been steadily increasing with expanding insurance coverage and newer, more convenient, user-friendly technology. Though these devices remarkably improve patients’ glycemic control, failure of these pumps, due to reasons such as clogging or kinking of tubing, air bubbles, pump display issues, site reaction/infection, is a frequently encountered problem. During these events, having a backup plan in the form of injectable insulin is essential to prevent severe hyperglycemia and diabetic ketoacidosis (DKA). Increasing insulin pump use also predisposes patients to severe hypoglycemia. In these cases, at-home glucagon administration can be lifesaving. Methods: Using the EPIC Cogito extracts and reporting service, data was extracted for adult patients seen at the Cleveland Clinic main campus between January 1, 2021, to January 1, 2023, using ICD codes for T1D and insulin pump status. Data collected included age, sex, prescription status for basal insulin, type of basal insulin, glucagon prescription, and current medication list.ResultsWe were able to analyze 86 patients (67% females, n=58; 33% male, n=28) with T1D utilizing an insulin pump. The average age was 48.6+18.18 years. Of the 86 patients, 51 (59%) had prescriptions for long-acting backup insulin. Only 21 patients (24%) had a prescription for glucagon. Discussion: Insulin pump failure is one of the most common causes of DKA in patients with T1D2. Educating patients on the use of long-acting injectable insulin in the event of pump failure and ensuring active prescription for every patient using an insulin pump at each visit can decrease the risk of DKA and prevent hospitalizations. Similarly, the use of a continuous subcutaneous insulin infusion (CSII) puts patients at high risk of hypoglycemia. Per Standards of Care in Diabetes 2024, glucagon should be prescribed in all patients using insulin3. Our analysis reveals that the practice of prescribing backup insulin and glucagon at Cleveland Clinic Institute needs significant improvement to potentially prevent DKA and severe hypoglycemia requiring hospitalization.

8757 Contingency Planning in the Event of Insulin Pump Failure or Malfunction - a Quality Improvement Initiative

Abstract Disclosure: S. Avula: None. H. Hashmi: None. A.R. Ankireddypalli: None. S. Inkollu: None. M. Salim: None. A. Ahmed: None. J. Kohlenberg: None. T. Harindhanavudhi: None. Background: People using insulin pump therapy are at risk of adverse outcomes, including hyperglycemia and diabetic ketoacidosis, in the event of pump failure or malfunction. A standing prescription for subcutaneous basal insulin, which can be filled as needed, has the potential to prevent these adverse outcomes. Aim: We aimed to increase the percentage of standing prescriptions for subcutaneous basal insulin by 20 % over 6-month duration for people using insulin pump therapy. Methods: Pre-intervention: We retrospectively obtained baseline electronic health record data for people with diabetes on insulin pump therapy in our health system (M Health Fairview, University of Minnesota) from January 1, 2022, to December 31, 2022. Intervention: Over a six-month duration, a multifaceted intervention was implemented. (1) During the rooming process for endocrinology appointments, the medical assistants inquired if the person using insulin pump therapy had a standing prescription for basal insulin in the event of insulin pump failure or malfunction. If not, the medical assistant encouraged the person with diabetes to review this with their Endocrinologist. (2) Informational brochures, placed in the exam rooms, encouraged people using insulin pump therapy to discuss a standing order for basal insulin. (3) Emails were sent to all endocrinology providers to encourage discussion of the provision of a standing prescription for basal insulin for people on insulin pump therapy. Post - intervention: We recorded the number of people with a standing prescription for subcutaneous basal insulin from 5/1/2023 to 5/14/2023. Results: The total number of patients with diabetes on insulin pumps prior to the intervention was 256. Of 256 patients with insulin pump therapy, 109 patients (42.6%) had standing basal insulin prescribed. A post-intervention chart review of patients with diabetes on an insulin pump was conducted for a total of 69 patients, of which 56 patients (81.2%) had backup basal insulin prescribed. The estimation of difference was - 0.3858 (p= <0.05; 95% CI for difference -0.4961, -0.2754). Conclusion: This multipronged approach increased the prescription availability and awareness among providers and patients for a standing order of basal insulin in the event of insulin pump failure or malfunction from 42% to 81%. Limitations of this study include the limited duration of intervention and the need to send repeated reminders to all providers, including clinic staff. The next plan is to create a best practice alert in EMR to alert providers to have a backup basal insulin plan for anyone on an insulin pump. Create a custom dot phrase of insulin backup plan in EMR. Presentation: 6/3/2024

Sunfuel Electric: charting a differentiated go-to-market-strategy in the EV charging space

Learning outcomes After completion of the case study, students will be able to understand the service offerings within the nascent electric vehicle (EV) sector and end-consumer needs of EV charging services, understand the reasoning behind Sunfuel Electrics (SFEs) prioritisation of destination charging for their first go-to-market (GTM) strategy and appreciate SFE’s use of community marketing and alliance partners to execute its various strategies. Connect game-theory with the proposed strategies. Case overview/synopsis SFE was an early start-up in EV charging space. The co-founders believed that any success would hinge on their ability to play a differentiated game and carve a distinct yet profitable niche in the EV charging arena. SFE deliberately focussed on “destination charging” and identified a segment that they were confident of making a difference: the discerning high-end consumer. Soon, SFE’s success caught the eye of its deep-pocketed competitors who also entered the same space. As a single service company, the co-founders set in motion a back-up plan and identified three new strategic thrust areas to maintain SFE’s competitive edge. The first involved entering the city charging segment, and the second was a pioneering concept branded “E-Trails” targeted at a community of EV owners who were motor enthusiasts. Thirdly, SFE conceptualised an EV-Roadhouse concept, promising a full-bouquet of select premium services at a pit-stops along the highway. The co-founders needed to test which and to what extent would these initiatives would translate into real gains and if returns were commensurate with investments and SFE’s ability to deliver a scalable consistent experience. Specifically, if these proposed asset-light avenues added the required heft to their GTM strategy. Complexity academic level This case study is suitable for post-graduate students in marketing, strategy, entrepreneurship and sustainability courses. Supplementary materials Teaching notes are available for educators only. Subject code CSS 8: Marketing.

443 - Clinical evaluation of automated planning in photon backup plan generation for proton therapy: A pilot study

443 - Clinical evaluation of automated planning in photon backup plan generation for proton therapy: A pilot study

An Analysis of Managing the Cloud: Obstacles and Solutions for Efficient Administration and Protection

Cloud management offers possibilities and difficulties to enterprises looking for effective management and strong data security. This essay examines the challenges associated with cloud administration and suggests workarounds for these issues. Assuring data security, upholding legal compliance, cutting expenses, and overseeing intricate multi-cloud setups are important obstacles. The use of cloud-native monitoring and governance tools, the implementation of extensive data backup and recovery plans, the use of automation for resource provisioning and administration, and the implementation of strong security measures like encryption and access restrictions are all necessary for finding solutions. Organizations may improve the security of their important data assets and expedite their cloud administration procedures by tackling these challenges with suitable solutions. Ensuring data security is a major concern in cloud administration. Organizations are concerned about data breaches, illegal access, and industry regulatory compliance when they move critical data to the cloud. Organizations need to have strong security mechanisms like identity management, access restrictions, and encryption in place to lessen these risks. Furthermore, implementing a defense-in-depth strategy that incorporates several security tiers might improve cloud environments' overall resilience. Upholding legal requirements and industry norms is another challenge for cloud managers. To secure sensitive data and uphold client confidence, businesses in regulated sectors like healthcare and finance are subject to strict compliance regulations. Adherence to frameworks like HIPAA, GDPR, and PCI DSS, as well as thorough policies and frequent audits are necessary to achieve compliance in the cloud. Organizations may minimize the risk of non-compliance penalties and expedite compliance processes by putting governance tools and compliance automation systems into place. For enterprises using cloud resources, cost optimization is another major concern. Pay-as-you-go cloud services might result in overspending and financial restrictions due to improper resource utilization.

Turn to a Backup Plan When Your Annual Goal Is in Doubt

Turn to a Backup Plan When Your Annual Goal Is in Doubt

Respond to Public Health Emergencies and The Law Preparedness Challenges and Solutions

Laws are a very powerful tool for defending human rights. These could be parliamentary enactments, local panchayat regulations, international conventions, or constitutions. Every facet of the emergency and public health response is based on law and policy. Laws made it possible to establish lockdowns, declare states of emergency, and, more recently, speed the clearance process for vaccines. The removal of antiquated laws, regulations, and backup plans frequently revealed them to be insufficient or out-of-date, necessitating the quick creation of new legislation. Never before have so many laws concerning one incident been passed in so many nations in such a short period of time. Communities are kept safe and lives are saved by domestic legal preparedness for catastrophes, which includes public health emergencies. The cornerstones of disaster risk management are law and policy, which establish guidelines for the who, what, and when of emergency response operations. When preparedness and response efforts lack a solid legal foundation, they may be disorganised and ineffectual, which frequently causes the most vulnerable individuals to wait longer for critical assistance. This essay suggests that there is a general deficiency of robust public health emergency legislation as well as a lack of legal readiness for such situations.

Do You Have a Backup Plan or Exit Strategy?

Do You Have a Backup Plan or Exit Strategy?

Crowd Control Analysis in Organizing The 2024 Religious Celebration Festival: A Qualitative Approach

One of the largest religious celebration festivals in Indonesia, attracting tens of thousands of visitors both domestically and internationally, involves complex event management. Therefore, the event is required to have a comprehensive risk management strategy to ensure safety, security, and smooth operation. This research aims to examine and analyze crowd control during the religious celebration festival in 2024. The method used by the researchers is a qualitative approach, collecting data through in-depth interviews and participatory observation. The data processed comes from sources who are event organizers involved in crowd management. Furthermore, data analysis is conducted using thematic analysis methods to identify risk categories and the mitigation strategies applied. This research shows that the highest level of risk at the religious celebration festival is crowd control. Therefore, the mitigation policies implemented by the event organizers include contingency planning, training and simulations for security personnel, backup plans for weather changes, and collaboration with various related parties. It is hoped that this research can provide insights for religious event organizers in managing and facing risks in similar events in the future

Navigating Teaching Practicum in the Real Classroom: Insights from ESL Teaching Practicum Experiences

Teaching practicum is one of the compulsory courses that pre-service ESL teachers have to accomplish prior to the completion of their study. Under the lens of experiential learning theory, this study aims to find out pre-service English teachers’ challenges of teaching practicum and how they overcome them. Interviews were used as instruments in this multiple case study, focusing on three pre-service English teachers who participated in the AJARMI program during the 2022–2023 academic year. The findings of this study were analyzed using thematic analysis. The PSETs faced challenges related to students' behaviour, preparation of instructional materials, and mentoring. They handled them with organizing lessons, acting as an assertive teacher, devising a backup plan, and adapting to the school system. The implications of this study suggest that teacher education programs should provide more comprehensive training on classroom management, instructional material preparation, and effective mentoring strategies to better prepare pre-service teachers for the realities of the classroom.

Experiences with care coordination and backup plans in home and community based services during the COVID-19 pandemic in Kansas

BackgroundThe COVID-19 pandemic was an emergency event during which backup plans became widely relevant. Although backup plans are required for Medicaid-funded Home and Community Based Services (HCBS) as a key risk management strategy, we know little about their effectiveness. ObjectiveThe purpose of this study was to explore whether backup plans and care coordination met the needs of HCBS consumers during the COVID-19 pandemic in Kansas. MethodsAn interactive, convergent mixed-methods design within a community-based participatory research framework was used. Data came from 70 in-depth interviews with HCBS consumers, caregivers, workers, and providers, as well as 100 surveys from consumers, asking about experiences receiving or providing care during the COVID-19 pandemic in Kansas. Inductive coding was used to identify major themes for the qualitative data. Descriptive and bivariate analysis were used for quantitative data. ResultsOne-third of survey respondents reported not having a backup plan and 39% went without formal homecare services for at least 2 consecutive weeks. The pandemic exacerbated and exposed deficiencies in care coordination and backup plans in a managed care environment. Interview participants expressed great need for backup workers during the pandemic but struggled to find these supports. Although family, friends, and providers stepped in to help fill gaps, there remained many unmet care needs. ConclusionsFindings indicate that improvements are needed in care coordination to support the development and maintenance of backup plans that can be successfully drawn on to avoid interruptions to care.

3-Position Biaryl Endochin-like Quinolones with Enhanced Antimalarial Performance.

ELQ-300 is a potent antimalarial drug with activity against blood, liver, and vector stages of the disease. A prodrug, ELQ-331, exhibits reduced crystallinity and improved in vivo efficacy in preclinical testing, and currently, it is in the developmental pipeline for once-a-week dosing for oral prophylaxis against malaria. Because of the high cost of developing a new drug for human use and the high risk of drug failure, it is prudent to have a back-up plan in place. Here we describe ELQ-596, a member of a new subseries of 3-biaryl-ELQs, with enhanced potency in vitro against multidrug-resistant Plasmodium falciparum parasites. ELQ-598, a prodrug of ELQ-596 with diminished crystallinity, is more effective vs murine malaria than its progenitor ELQ-331 by 4- to 10-fold, suggesting that correspondingly lower doses could be used to protect and cure humans of malaria. With a longer bloodstream half-life in mice compared to its progenitor, ELQ-596 highlights a novel series of next-generation ELQs with the potential for once-monthly dosing for protection against malaria infection. Advances in the preparation of 3-biaryl-ELQs are presented along with preliminary results from experiments to explore key structure-activity relationships for drug potency, selectivity, pharmacokinetics, and safety.

Cybersecurity Considerations in Disaster Recovery Planning

Abstract: This article talks about the important link between cybersecurity and disaster recovery planning, showing how important it is to include strong security measures in disaster recovery plans. It looks at the risks and weaknesses that come up during disaster recovery, like being more open to online threats, having security controls broken, and the chance that vulnerabilities will appear again during the recovery process. Some of the most important things that the piece talks about to lower cyber risks are strong backup and recovery plans, data encryption, access controls, and authentication measures. It also stresses how important it is to have a clear plan for how to handle an event, regular training and education programs for cybersecurity, and ongoing improvement through testing and using new technologies. Case studies and examples from real life are used to show what happens when safety measures aren't up to par and how important it is to plan for all possible disasters.

Pre-Service English Teachers’ Challenges of Teaching Practicum in Teaching Assistance (AjarMi) Program

This study aims to find out pre-service English teachers’ challenges of teaching practicum and how they overcome them. Interviews as the instruments used in this study and employed multiple case studies. Pre-service English teachers who participated in AJARMI program in the academic year 2022–2023 served as the study's subjects. Three PSETs participated in interviews. The findings of this study were analyzed using thematic analysis. The PSETs faced challenges related to students' behaviour, preparation of instructional materials, and mentoring. Then they handled them with organizing lessons, acting as an assertive teacher, devising a backup plan, and adapting to the school system.Keywords: Pre-service English Teachers, Teaching Practicum

Strategy for the development of dairy farming in kampung susu lawu in sarangan village, plaosan district, magetan regency

This study aims to determine the livestock profile and development strategy for dairy farming in Kampung Susu Lawu in Plaosan District, Magetan Regency. This research was conducted in May-June 2023. The method used to determine the location and take samples was purposive sampling with 60 dairy cattle farmers as respondents who are members of the Livestock Group of Kampung Susu Lawu in Plaosan District, Magetan Regency, East Java. The data analysis used is descriptive analysis and SWOT analysis (Strength, Weakness, Opportunity and Threats). The results of this study indicate that the dairy farming business incorporated in Kampung Susu Lawu is a small-scale community farm which is managed intensively. There are several business development strategies including SO, ST, WO and WT strategies. SO strategy by optimizing the productive age of human resources, ST strategy by strengthening the position of livestock groups and increasing efficiency in the use of production facilities, WO strategy by providing knowledge about marketing management, WT strategy by providing knowledge about pricing of dairy products. The quadrant position shown is quadrant II (0.11, -0.13) which indicates a business that has advanced but is facing challenges in trying or is in the ST quadrant. The strategy adopted is strategy diversification, meaning that it is necessary to form many tactical strategies or backup plans. The conclusion of this study is that the dairy farming business of Kampung Susu Lawu is managed intensively, oriented towards livestock business as a business, and has the potential to be developed based on SWOT analysis on quadrant 2 strategies, namely by making various strategies, maintaining strengths and minimizing these threats, such as strengthening the position of farmer-livestock groups by providing assistance, training and counseling, as well as increasing the efficiency of the use of production facilities.

A STUDY ON LOGISTICS RISK EVALUATION INVOLVED IN PIGMENT INDUSTRY

In the current worldwide economy, logistics are essential to guaranteeing the smooth movement of commodities among different businesses. The pigment business, which is necessary for colouring a wide range of goods, including paints and cosmetics, has particular difficulties with logistical management. The objective of this research is to assess the logistical risks that are common in the pigment business and provide ways to reduce them. A mixed-methods approach is used in the research, integrating quantitative and qualitative analysis. In order to identify important risk variables in pigment logistics, qualitative data is gathered through surveys and interviews with stakeholders, logistics managers, and industry experts. These elements include supplier connections, inventory management, transportation, warehousing, and regulatory compliance. Moreover, quantitative analysis evaluates the frequency and seriousness of hazards revealed by statistical techniques. This entails the creation of a methodology for evaluating logistics risk that is specific to the pigment sector and incorporates variables including regulatory changes, supply chain interruptions, demand volatility, and shipping delays. The report suggests a thorough risk-reduction plan for the logistics of the pigment sector based on its results. This plan includes preventative actions including expanding the variety of transportation routes, implementing sophisticated inventory control systems, creating backup plans, and improving supplier cooperation. This study's consequences go beyond the pigment business; it provides insights that may be applied to other areas of logistics management. Through the investigation of the particular logistical issues encountered by pigment producers, this study enhances the resilience, efficiency, and overall sustainability of the supply chain. Keywords: Supply Chain Management, Risk Mitigation Techniques, Quantitative Analysis, Pigment Industry, Logistics Risk Assessment.

Effective Sedation Strategies for Pediatric MRI: A Comprehensive Analysis

This study presents a structured sedation program for pediatric patients undergoing MRI, aiming to optimize safety and resource utilization. A total of 1857 children were included, with 48 admitted to the RCU, leaving 1809 for analysis. Children under 5 received oral sedation, while those 6 and older were assessed by referring physicians for sedation eligibility. The protocol involved chloral hydrate and paraldehyde, with a backup plan for intravenous sedation or general anesthesia overseen by an anesthetist consultant. Among 1039 scans, 597 were unsedated, and 442 were sedated successfully. Oral sedation failed in 50 cases (6.9%), predominantly in younger children (87% under 5 years). Notably, 2 out of 5 subjects using chloral hydrate experienced respiratory issues. This systematic approach led to efficient resource use and safe outcomes, highlighting the importance of tailored sedation protocols in pediatric imaging. Highlights: Reduced oral sedation failure rate to 6.9% in pediatric MRI. Anesthetist consultation enhances safety in MRI sedation procedures. Structured program optimizes resources and ensures safe outcomes in pediatrics. Keywords: Pediatric MRI, Sedation Program, Anesthetist Consultation, Oral Sedation, Resource Utilization

Delayed nerve reconstruction for brachial plexus injuries: is the risk worth the reward?

Nerve reconstruction after 6 months of denervation time in brachial plexus injuries (BPIs) can be inconsistent. A dilemma exists when the use of critical donor nerves for nerve transfers may lead to unreliable outcomes that would waste the donor nerve. The purpose of this study was to evaluate the long-term outcomes of elbow and shoulder function in patients with BPIs receiving nerve reconstruction in the delayed setting (i.e., 6-12 months after injury). Data from patients with delayed BPIs who received a nerve transfer (including proximal and distal nerve transfer/grafting) at a tertiary medical center were retrospectively collected from January 1999 to March 2020. Demographics, extent of injury, mechanism of injury, and reconstructive methods were collected. Patients were categorized into two groups: non-pan-plexus BPI (C5-6, C5-7, and C5-8) and pan-plexus BPI (C5-T1). Acceptable outcome was defined as elbow flexion ≥ M3 status or shoulder abduction ≥ 60°. Sixty-four patients were included in the study. The average time from injury to nerve reconstruction was 236 (range 180-441) days, and the average follow-up time was 66 months. In the non-pan-plexus BPI group (n = 43 patients), 74.4% of patients demonstrated M3 elbow flexion, and 48.8% of patients demonstrated M4 elbow flexion. Double fascicular transfer yielded better results and faster recovery than a single fascicular transfer. In the pan-plexus BPI group (n = 21 patients), 38.1% of patients reached M3 elbow flexion and 23.8% attained M4 elbow flexion. In the non-pan-plexus BPI group, the recovery rate of acceptable shoulder abduction was 53.5%, but only 23.5% of pan-plexus patients with BPI achieved acceptable shoulder abduction. Nerve reconstruction can effectively restore functional elbow flexion and acceptable shoulder abduction in non-pan-plexus patients with BPI in the delayed setting. However, neither acceptable elbow flexion nor shoulder abduction could be consistently achieved in pan-plexus BPI. Judicious use of the donor nerves in pan-plexus injuries is required, in addition to preserving a donor nerve for a backup plan such as free-functioning muscle transplantation or tendon transfers.

Different Scenarios of Autonomous Operation of an Environmental Sensor Node Using a Piezoelectric-Vibration-Based Energy Harvester.

This paper delves into the application of vibration-based energy harvesting to power environmental sensor nodes, a critical component of modern data collection systems. These sensor nodes play a crucial role in structural health monitoring, providing essential data on external conditions that can affect the health and performance of structures. We investigate the feasibility and efficiency of utilizing piezoelectric vibration energy harvesters to sustainably power environmental wireless sensor nodes on the one hand. On the other hand, we exploit different approaches to minimize the sensor node's power consumption and maximize its efficiency. The investigations consider various sensor node platforms and assess their performance under different voltage levels and broadcast frequencies. The findings reveal that optimized harvester designs enable real-time data broadcasting with short intervals, ranging from 1 to 3 s, expanding the horizons of environmental monitoring, and show that in case the system includes a battery as a backup plan, the battery's lifetime can be extended up to 9 times. This work underscores the potential of vibration energy harvesting as a viable solution for powering sensor nodes, enhancing their autonomy, and reducing maintenance costs in remote and challenging environments. It opens doors to broader applications of sustainable energy sources in environmental monitoring and data collection systems.

“Till we meet again!”: The Synchronous Hybrid Teaching of English in Saudi Arabia

This study explores the perceptions of Preparatory Year (PY) students and teachers at Imam Abdulrahman bin Faisal University regarding synchronous hybrid teaching. It also highlights the effectiveness of teaching English as a foreign language (EFL) within the two modes of the hybrid system (i.e., face-to-face and online). The study employed a triangulation of instruments, including a survey, an interview and three focus groups (FGs). The findings show that each mode has its characteristics. While the students viewed hybrid teaching positively in terms of its logistics, finding it convenient and time-saving. However, they believed high-quality education could be better achieved in person as they understood and enjoyed face-to-face classes more than online learning. They also preferred the online mode for receptive skills and face-to-face interaction for productive skills. On the other hand, teachers found hybrid teaching challenging regarding technical issues and managing two groups (remote and in class) simultaneously. They expressed various views regarding the preferred mode of teaching English skills; some wished to abandon hybrid classes and teach all the skills in face-to-face mode. During the pandemic, hybrid teaching may have been the best option to continue teaching English effectively. However, after the pandemic, this method should be retained as a backup plan to reach students with disabilities and enrich advanced learners of English.