Initial Benefit Research Articles

Did the resurgence of childhood lower respiratory infections offset the initial benefit of COVID-19-related non-pharmaceutical interventions in children? A time-series analysis

BackgroundFollowing non-pharmaceutical interventions (NPI) lifting in 2021, an important surge in childhood lower respiratory tract infections (LRTI) was reported in several countries, raising major concerns about the middle-term consequences of such interventions. Whether this recent upsurge overwhelms the initial benefit of NPI remains unknown.MethodsWe conducted an interrupted time-series analysis based on exhaustive national surveillance systems. All hospitalisations from January 2015 to March 2023 and all ambulatory visits for LRTI from a network of 110 paediatricians from June 2017 to March 2023 were included. The main outcome was the monthly incidence of children hospitalised for LRTI per 100,000 over time, assessed by a seasonally adjusted quasi-Poisson regression model.ResultsWe included 845,047 hospitalisations. The incidence of hospitalisation for LRTI significantly decreased during the NPI period (− 61.7%, 95% CI − 98.4 to − 24.9) and rebounded following NPI lifting, exceeding the pre-NPI baseline trend (+ 12.8%, 95% CI 6.7 to 19.0). We observed similar trends for hospitalisation due to bronchiolitis, pneumonia and pneumonia with pleural effusion, along with ambulatory LRTI. Overall, despite the recent rebound, 31,777 (95% CI, 25,375 to 38,179) hospitalisations for paediatric LRTI were averted since NPI implementation up to 2023.ConclusionsThree years after their implementation, despite an increase in LRTI incidence, the middle-term impact of NPI remains highly beneficial in preventing overall paediatric LRTI. The implementation of some societally acceptable NPI, particularly during epidemics, may be considered in the future to further reduce the burden of paediatric LRTI.

The crossover of the bevacizumab and panitumumab survival curves in the PARADIGM study: A clue to time-related effects of bevacizumab on the risk of tumor progression.

159 Background: The PARADIGM study in CRC patients demonstrated a cross over of the bevacizumab survival curve below the panitumumab survival curve at 28 months, followed by a steady decrease of the bevacizumab survival curve below the panitumumab survival curve up to 11% by 5 years. Similar differences were seen in the FIRE3, CALGB-80405 and PEAK trials starting at 20 months, suggesting an unsuspected time-related effect of bevacizumab on patient’s survival starting at about 2 years after its 1st administration. Methods: Review of time related effects of bevacizumab in 1st and 2nd line trials conducted in CRC, breast, ovary and renal cancer showed a significant PFS but no OS survival benefit, with a detrimental effect on survival in the adjuvant setting (AVANT, NSABP-08 studies). Preclinical data on tumor biology, intratumor-heterogeneity, clonal evolution and the cross talk between bevacizumab and the diverse tumor microenvironments, was correlated to the clinical data, in an attempt to explain the time-related effects of the biological. Results: In the NSABP-08 trial, bevacizumab reduced relapse for 6 months, effect diminished and lost at 12 months. At 24 months after bevacizumab's 1st administration, the relapse of the bevacizumab treated population increased steadily over the control. Identical kinetics were shown in AVANT study and metastatic ovarian patients suggesting that these time-related effects of bevacizumab are universal. The biologic explanation of the clinical data is that short-term treatment with bevacizumab (plus chemotherapy) induces initial tumor stasis and shrinkage, followed by selection and emergence of more aggressive and resistant tumor clones, characterized by an accelerated growth, invasiveness and metastasis shifting the overall tumor growth kinetics to a steeper angle. Bevacizumab appears to be effective for the time of its administration, followed by a slow rebound after its discontinuation. The initial survival benefit will be lost at about 20-24 months after its first administration, as clearly demonstrated in the PARADIGM, FIRE-3, CALGB 80405 and the PEAK studies. Conclusions: As bevacizumab benefit persist for about 2 years after its 1 st administration, it explains the "survival benefit" obtained in studies with with median survival of 20 months but not in studies with survivals >30 mo. (PARADIGM, FIRE-3, CALGB 80405 and the PEAK). This phenomenon also explains the crossover of the survival curves in PARADIGM study and the benefits of bevacizumab obtained preferentially in patients with short survival (rt. sided tumors), high tumor burden, and 2 nd and 3 rd line CRC.

Real-world comparative effectiveness of sacubitril/valsartan versus RAS inhibition alone in patients with de novo heart failure.

Large-scale, real-world data on early initiation of sacubitril/valsartan in patients newly diagnosed (de novo) with HF with reduced ejection fraction (HFrEF) are limited. We examined the effectiveness of sacubitril/valsartan versus angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) on all-cause and cause-specific hospitalizations among patients with de novo HFrEF from the Optum® dataset in the United States. This retrospective cohort study included adult patients with de novo HFrEF (diagnosed ≤30days) with left ventricular ejection fraction (LVEF) ≤40% who were first prescribed with sacubitril/valsartan or ACEi/ARB from 1 January 2016 to 31 March 2020. The primary endpoint (all-cause hospitalization) and secondary endpoints were analysed in propensity score-matched cohorts. A cohort of 3290 patients with de novo HFrEF who were prescribed with sacubitril/valsartan and a propensity-matched cohort of 6580 patients who were prescribed with ACEi/ARB were analysed. Overall, the mean (SD) age of patients was 63 (14) years, 34% were women, and baseline characteristics were balanced across treatment groups. Hypertension (67%), diabetes (33%) and chronic kidney disease (28%) were highly prevalent comorbidities. Patients in the sacubitril/valsartan cohort when compared with the ACEi/ARB cohort had lower annual rates of all-cause hospitalizations [incidence rate ratio (IRR): 0.81, 95% confidence interval (CI): 0.75-0.89, P<0.001], cardiovascular (CV) hospitalizations (IRR: 0.80, 95% CI: 0.73-0.87, P<0.001) and HF hospitalizations (IRR: 0.86, 95% CI: 0.78-0.95, P=0.002). Among patients with de novo HFrEF, sacubitril/valsartan (compared with that of ACEi/ARB) was associated with fewer all-cause, CV and HF hospitalizations. These findings are consistent with clinical trial evidence suggesting potential benefits of early initiation of sacubitril/valsartan in patients with HFrEF, including those soon after diagnosis.

Take your PIC (Program Improvement Committee): The benefits of a resident-run initiative to improve graduate medical education.

The evolving landscape of graduate medical education (GME) necessitates innovative approaches to residency program evaluation and improvement. At Detroit Medical Center/Wayne State University, a novel resident-led Program Improvement Committee (PIC) was established in June 2022 within the Diagnostic Radiology Residency Program. The PIC serves as a flexible, resident-driven structure designed to enhance engagement, provide continuous feedback, and implement actionable solutions in collaboration with residency leadership. Unlike traditional Program Evaluation Committees (PECs) and Clinical Competency Committees (CCCs), the PIC promotes a more democratized approach, empowering residents to take ownership of their training. By convening monthly and fostering fluid subcommittees, the PIC has successfully driven initiatives including increased research engagement, mentorship programs, social media enhancement, and system-level improvements such as the establishment of a dedicated WiFi network for hospital employees. The PIC represents a paradigm shift in residency enhancement, offering a responsive, adaptable mechanism for fostering innovation, inclusivity, and collaboration. Further research is needed to evaluate its broader impact, but the PIC has the potential to revolutionize residency training and improve medical education.

P0898 Comparative Study on the Efficacy of Biologics with Dietary Intervention in Crohn's Disease: Evaluating the Impact of Crohn's Disease Exclusion Diet and partial Entral nutrition Combination with Biologics

Abstract Background Crohn's disease (CD) is a chronic inflammatory condition with significant impact on patient health. While the Crohn's Disease Exclusion Diet (CDED) and partial enteral nutrition (pEN) have shown therapeutic efficacy in CD, real-world study data are limited, and there is a lack of research on the benefits of their combination use with biologic therapies. Methods This retrospective study included CD patients divided into two groups, starting at the initiation of biologics treatment: those receiving biologics alone and those receiving biologics with CDED + pEN for 12 weeks. Clinical outcomes were assessed at baseline, 12, 24, and 48 weeks. Results A total of 51 CD patients were included in the study: 35 received biologics alone, while 16 received biologics with CDED + pEN for 12 weeks. While Crohn’s Disease Activity Index (CDAI) reduction, hemoglobin (Hb) increase, albumin levels, and fecal calprotectin reduction showed no significant differences between groups, notable findings emerged in body weight and C-reactive protein (CRP) levels. The biologics + CDED + pEN group demonstrated a continuous increase in body weight over 48 weeks, whereas the biologics-only group showed a less pronounced trend. Additionally, CRP levels in the CDED + pEN group decreased more rapidly, with significant differences observed by week 12, indicating an early anti-inflammatory effect. Beyond 12 weeks, CRP levels in both groups gradually aligned, but the initial rapid reduction in the combination group highlights the potential of dietary intervention in achieving quicker inflammation control. Despite the discontinuation of CDED + pEN after week 12, the initial benefits in body weight gain and CRP reduction persisted, suggesting lasting effects of the dietary approach when combined with biologics. Conclusion Short-term use of CDED + pEN with biologics may offer early advantages in reducing inflammation and supporting body weight gain in CD treatment.

Project Governance Practices: Influence on the Appropriation and Sustainability of the Values of Infrastructure Projects

Project governance practices play a central role in the performance and success of initiatives, yet their contribution to the appropriation and sustainability of values remains underexplored, particularly in the infrastructure sector. This research, focused on La Grande Alliance (LGA) in the Baie-James region, investigates the effectiveness of governance practices through a mixed-methods approach combining semi-structured interviews, evaluation reports, and stakeholder surveys. The findings highlight the critical role of participative management at every stage of the process. During the definition of values, regular consultation, delegation of responsibilities, transparency, and decentralized leadership foster their appropriation. During the awareness and integration phases, collaborative leadership strengthens stakeholder engagement. Finally, in the monitoring and evaluation phase, ethical and collaborative decision-making ensures not only the appropriation of values but also their sustainability, encompassing aspects such as durability, socio-economic impact, and ecosystem protection. In conclusion, effective governance practices establish a participatory and coherent structure, enabling stakeholders to appropriate project outcomes while ensuring the long-term benefits of infrastructure initiatives in the region.

Exploring the Impact of ESG Practices on Financial Performance: The Moderating Effect of Green Innovation in the Indonesian Energy Sector

This study explores the impact of Environmental, Social, and Governance (ESG) practices on the financial performance of energy companies in Indonesia, with green innovation serving as a moderating variable. The research utilizes secondary data from Indonesian energy firms. It employs a cross-sectional analysis to evaluate the relationships between ESG practices, green innovation, and financial performance, measured by Return on Assets (ROA). The findings reveal that ESG practices alone do not significantly affect financial performance. However, when moderated by green innovation, ESG practices positively and significantly impact financial performance. This suggests that green innovation enhances the benefits of ESG initiatives by improving operational efficiency, reducing costs, and bolstering market competitiveness. The study's results have important implications for corporate managers and policymakers, emphasizing the need for integrating green innovation with ESG strategies to achieve sustainable financial growth.

Body composition changes and clinical outcomes in pediatric cystic fibrosis during 24 months of lumacaftor ivacaftor therapy based on real-world data

Clinical trials demonstrate the short-term efficacy of dual CFTR modulators, but long-term real-world data is limited. We aimed to investigate the effects of 24-month lumacaftor/ivacaftor (LUM/IVA) therapy in pediatric CF patients (pwCF). This observational study included pwCF homozygous for F508del mutation treated between 2021 and 2023. We report data for the first 24 months from therapy initiation. Variables were analyzed separately for ages 2–5, 6–11, and over 12. Data from 49 pwCF (median age: 9.3 years (5.5–14.2)) showed that ppFEV1 values after a transient increase at 12 months, decreased from 102% (82–114) at baseline to 87% (74–96) at 24 months. The decrease was more pronounced with higher initial ppFEV1. Median sweat chloride concentration decreased from 75 mmol/L (69–82) to 57 mmol/L (43–70) without any association with respiratory function change. Median BMI z-score increased from − 0.81 (− 1.37–0.49) to − 0.39 (− 0.88 to − 0.04) (p = 0.288), and the proportion of underweight and overweight children decreased. Skeletal muscle mass remained stable, while fat mass significantly increased (p = 0.011). Fecal elastase levels improved, especially among younger patients. These findings underscore the potential benefits of early initiation of CFTR modulator therapy in pediatric CF patients, highlighting improvements in nutritional status and pancreatic function.

Medication underuse in real-life practice: the impact of galcanezumab towards achieving very low frequency episodic migraine in a southeast Asian middle-income nation

BackgroundMigraine progression, particularly from episodic to chronic migraine (CM), increases disease burden and healthcare costs. Understanding the new concept of “Medication Underuse Headache” should encourage the health care provider to consider early intervention with calcitonin gene-related peptide (CGRP) monoclonal antibodies. Galcanezumab given early in the course of the disease, may prevent migraine chronification and have a robust response, moreso than when initiated in later stages of migraine. We aimed to determine the efficacy of galcanezumab in achieving very low-frequency episodic migraine (VLFEM) among patients with high-frequency episodic migraine (HFEM) and CM in a real world-setting in Thailand.MethodsA single-center, retrospective real-world, cohort study was conducted between 2023 and 2024. Adults aged 18 years or more who were diagnosed with HFEM or CM were included in this trial and categorized into two groups: galcanezumab and oral migraine preventive medication (OMPM). In the galcanezumab group, oral preventive medications were slowly tapered off within 3 months. The primary outcome was the differences in percentage of patients achieving VLFEM at months 3 and 6 between the two groups. Secondary outcomes included the differences in migraine class improvement, sustained response, and headache day reduction.ResultsA total of 62 patients (31 in each group) were included: median age was 36.5 (IQR: 29.0–48.0) and 82% were female. There were no significant differences in the baseline demographic features between the two groups. The cumulative incidence of patients achieving VLFEM was significantly higher among the galcanezumab group compared to OMPM group (45.2% vs. 19.4% at month 3 and 52.9% vs. 32.4% at month 6, p = 0.03). After 6 months of follow-up, patients with HFEM who received galcanezumab were significantly more likely to achieve any improvements in migraine class compared to those who received OMPM (92.9% vs. 46.7%, p = 0.01). Among 15 patients who achieved VLFEM at month 3, 81.8% (9/11) of those who received galcanezumab and 50.0% (2/4) of those who received OMPM were able to sustain VLFEM at month 6.ConclusionsThis study emphasizes the benefit of early anti-CGRP therapy initiation, especially in patients with fewer headache days, and highlights the need for accessible migraine-specific treatments in low- to middle-income countries.

Initiation and sequencing of guideline-directed medical therapy for heart failure across the ejection fraction spectrum.

Strong evidence supports the importance of rapid sequence or simultaneous initiation of quadruple guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) for substantially reducing risk of mortality and hospitalization. Barring absolute contraindications for each individual medication, employing the strategy of rapid sequence, simultaneous, and/or in-hospital initiation at the time of HF diagnosis best ensures patients with HFrEF have the opportunity to benefit from proven medications and achieve large absolute risk reductions for adverse clinical outcomes. However, despite guideline recommendations supporting this approach, implementation in clinical practice remains persistently low, with less than one-fifth of eligible patients being prescribed the quadruple GDMT regimen. Additionally, for heart failure with mildly reduced or preserved ejection fraction (HFpEF), sodium-glucose co-transporter 2 inhibitors (SGLT2i) and non-steroidal mineralocorticoid receptor antagonists (MRA)constitute foundational therapy for all eligible patients with significant clinicalbenefits within just weeks of medication initiation. Nonetheless, the burden of symptoms, functional limitations, and hospitalizations remains substantial for many of these patients, even with SGLT2iand non-steroidal MRA therapy. Additional evidence supports consideration of adjunctive therapies for HF with EF > 40% that can be tailored to the patient phenotype, including glucagon-like peptide-1 receptor agonists (GLP-1 RA) for patients with obesity, as well as angiotensin receptor-neprilysin inhibitors (ARNI) for patients with EF below normal. This article reviews the evidence-based sequencing of GDMT for HF across the spectrum of EF, emphasizing the rationale and benefits of early up-front initiation of quadruple medical therapy for HFrEF, rapid initiation of SGLT2i for HF regardless of EF, and prompt phenotype-specific tailored approach to adjunctive therapies for HF with EF > 40%.

Development of treatment strategies for advanced HER2-positive gastric cancer: Insights from clinical trials.

HER2-positive gastric cancer (GC), a unique molecular subtype, has garnered significant interest in recent years. Here, we review clinical trial data on advanced HER2-positive GC from the past 15 years. Trastuzumab plus standard chemotherapy remain the first-line treatment. The initial survival benefits conferred by immune checkpoint inhibitors plus trastuzumab and standard chemotherapy are encouraging. The combination of ramucirumab and mono-chemotherapy, as well as the antibody conjugated drug trastuzumab deruxtecan, is the recommended second-line regimen. Treatment with immune checkpoint inhibitors plus ramucirumab and mono-chemotherapy shows promise. Despite the limited treatment options for third line and beyond, development of novel therapeutic strategies is expected. Although clinical cure of advanced HER2-positive GC is unlikely, current clinical studies offer valuable insight into regimens that prolong survival.

National Patient Satisfaction Survey as a Predictor for Quality of Care and Quality Improvement - Experience and Practice.

Patient satisfaction is an important predictor of quality of care and hospital services. Patient satisfaction survey provides not only valuable insight into patient experience of care but also evidence that guides quality improvement in both system and organization levels. The paper aims to prove the value of system-wide satisfaction survey of patients and demonstrate whether data collected from a national patient satisfaction survey in three-year period can predict trends in patient experience of care. Patient satisfaction data of 148hospitals were extracted from the annual National Public Hospital Patient Satisfaction Survey (NPHPSS) for Shandong Province between 2019 and 2021. Pearson test or Spearman test was performed to clarify the differences in satisfaction and relationship between variables. A linear regression model was established to describe the impact of variables on satisfaction. From 2019 to 2021, there was a significant enhancement in overall patient satisfaction, particularly in communication areas, for both outpatients and inpatients (p = 0.000). A strong and positive correlation between outpatient and inpatient satisfaction was observed over three years (p = 0.000). However, outpatients reported lower satisfaction than inpatients regarding the hospital environment and communication (p < 0.05). Patient care experiences also varied across different hospital categories. In addition, the maturity of the Health Information Management System (HIMS) positively influenced inpatient satisfaction (p < 0.05). A nationwide patient satisfaction survey can predict benefits of quality improvement initiatives and identify changing trends in the quality of hospital care. The strong correlation between outpatient and inpatient satisfaction underscores the importance of consistent medical service quality across the hospitals. HIMS upgrades are a worthwhile investment in enhancing patient experiences in public hospitals. Tailoring service improvement strategies to specific hospital contexts, such as type, location, and patient demographics, is crucial.

Furosemide Stress test guided early versus late renal Replacement therapy in mechanically ventilated patients with Acute kidney injury

ABSTRACT Background Acute kidney injury (AKI) in the ICU is one of the life-threatening situations that may need renal replacement therapy (RRT). Survival benefit of early initiation of RRT is still not proven. There is still a debate whether early or late RRT significantly affects morbidity and mortality. Methods This is a randomized controlled trial (RCT) that was conducted on 94 critically ill subjects with stage 2 AKI, according to KDIGO classification, who were on invasive mechanical ventilation. Recruited subjects were selected only if they failed to respond to furosemide stress test after volume status optimization. Subjects were randomly assigned into two groups according to timing of RRT initiation. In the early group, RRT was initiated without the presence of urgent indications for hemodialysis, whereas in the late group, RRT was implemented only in the presence of one or more of urgent indications such as severe metabolic acidosis or hyperkalemia. Primary outcomes of the study were ICU mortality and length of stay. Secondary outcomes included recovery of renal function in addition to duration of mechanical ventilation. Results There was no statistically significant difference in the primary outcomes, namely ICU mortality and ICU length of stay. About 51.1% of the subjects survived in the early RRT group, whereas 46.8% survived in the late group (p = .680). Although duration of mechanical ventilationwas not significantly different (p = .486), recovery of renal functionand less dependency on RRT after discharge, were significantly higher in the early RRT group (p = < .001). Conclusion Even after choosing AKI patients who failed to respond to furosemide stress test, timing of RRT initiation did not affect survival, ICU length of stay or duration of mechanical ventilation. However, early RRT may have positive effect on RRF for survived patients.

The distributional implications of pension benefit indexation

AbstractSocio‐economic differences in longevity have fuelled a debate on whether pension systems have a regressive bias favouring groups with a high life expectancy. We show that the distributional implications of such pooling depend critically on the benefit profile across age/time, which in turn is determined by how benefits are indexed to prices and wages. Choosing an indexation scheme involves a choice between a low initial benefit with an increasing profile and a high initial benefit with a flat/decreasing profile, where the former benefits groups with a high life expectancy, and vice versa. We analyse how indexation affects the trade‐off between insurance and distribution when groups with different mortality are separated or pooled, and the optimal benefit profile under both standard preferences and temporal risk aversion with respect to the length of life.

‘Going Above and beyond’: Residential Aged Care Staff Experiences of Providing Care During the Changing Context of COVID-19

ABSTRACT The COVID-19 pandemic required residential aged care facilities (RACFs) to meet the high care needs of residents in the context of stringent public health measures and staffing pressures. Given the likelihood of ongoing COVID-19 waves and seasonal surges in acute respiratory infection outbreaks, this study explored RACF staff experiences in providing care while limiting COVID-19 risk. Ten focus groups were conducted across six RACFs in metropolitan and regional New South Wales, Australia. Findings highlighted the impact of negative media representation on staff and the need for risk-based clear public health messages to reduce complacency. Findings also highlighted challenges in meeting clinical needs while keeping residents safe, and the benefit of new initiatives and opportunities for future training. Clear, targeted communication is essential to ensure ongoing understanding and adoption of public health measures when required. Awareness of the challenges provides RACFs and policymakers valuable insights for future planning including staff support and training needs. Key areas that require attention include promoting work in RACFs as a valued profession, clear public health risk messaging, strategies to facilitate prioritizing care, and broadened scope of skills.

Clean Customer Master Data for Customer Analytics: A Neglected Element of Data Monetization

Despite the demonstrable benefits of data monetization initiatives for achieving competitive advantages, many of these efforts struggle to realize their potential. Companies often find it challenging to sustain even initially successful data monetization initiatives due to formidable data quality issues. This reflects a disconnect between advancements in data monetization research—which range from digitization to digitalization and digital transformation—and their practical implementation within companies. Consequently, misguided approaches to data monetization are relatively common. A critical prerequisite for successful data monetization is the establishment and maintenance of clean, high-quality data. This study underscores the importance of data quality by conducting an in-depth analysis of Medical Inc., a company that prepares pristine customer master data for advanced customer analytics. The investigation aims to elucidate Medical Inc.’s approach for addressing data cleanliness challenges and developing a general framework for the process of cleansing customer master data. This framework illuminates a relatively unexplored aspect of data monetization, thereby supplementing existing research on digitization, digitalization, and digital transformation.

An Update on Kawasaki Disease.

To summarize advances in research on the epidemiology, pathogenesis, diagnosis, and treatment of Kawasaki Disease (KD), a systemic inflammatory illness of unknown etiology that affects children globally. The epidemiology of KD was affected by the COVID-19 pandemic and advances in molecular immunology and machine learning have enabled research into its pathogenesis. There is ongoing research into agents that can be used to intensify initial treatment and accumulating evidence supporting the use of certain rescue regimens for refractory disease over others. There is promise surrounding a new coronary artery aneurysm prediction model. Research into the post-acute morbidity of KD continues. The COVID-19 pandemic temporarily reduced the incidence of KD. The NLRP3 inflammasome plays a key role in KD pathogenesis. Intensified initial treatment benefits high-risk patients, yet no intensification regimen shows superiority over another. Corticosteroids, infliximab, or combination therapy with IVIg plus another agent may be superior rescue regimens compared to IVIg alone for refractory KD. The Son score, developed in North America, predicted coronary artery lesions in Japanese and Italian cohorts. Patients with a history of KD may carry long-term physical and emotional burdens that persist into adulthood yet appear to have typical neurocognitive development. Successful transition to adult healthcare presents a challenge.

Direct Initiation of Levodopa-Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease.

Levodopa-carbidopa intestinal gel (LCIG) is an established treatment option in advanced Parkinson's disease (PD). LCIG treatment is usually initiated with a nasojejunal tube (NJT) test phase before percutaneous endoscopic transgastric jejunostomy (PEG-J) tube installation. However, some centers have used direct initiation with PEG-J. Data comparing these approaches are scarce. The objective of this study was to analyze the risks and benefits of direct PEG-J initiation after a positive levodopa challenge test (LCT) for selected patients compared to initiation with a temporary NJT test phase. Thirty-three consecutive advanced PD patients commenced LCIG-treatment between February 2016 and December 2019 at Helsinki University Hospital. Of them, 11 (33%) selected patients had direct initiation without an NJT test phase. Treatment discontinuations and adverse events during the first 6months of treatment were evaluated retrospectively. The duration of hospital stay related to the initiation of the treatment was compared between the groups. Between the direct initiation and NJT test phase groups, there were no significant differences in treatment discontinuations (0 vs. 1, respectively); the number of inner tube or PEG-J tube replacements (1 vs. 3); or infection complications (1 vs. 3) during the first 6months of treatment. Direct initiation significantly reduced the hospital stay related to treatment initiation (mean 7 vs. 9days, p=0.001). For selected patients, the direct initiation of LCIG after a positive LCT, without a temporary NJT test phase, appears safe and does not lead to additional treatment discontinuations or complications.

Promotion of cooperation in a structured population with environmental feedbacks.

Cooperation is a representative altruistic behavior in which individuals contribute public goods to benefit their neighborhoods and even larger communities in social networks. The defective behavior is more likely to bring higher payoffs than the cooperative behavior, which makes the cooperative behavior hard to maintain and sustain. Many mechanisms were proposed to promote cooperation within a social dilemma, in which some recent studies introduced the impact of dynamically changing environments on players' payoffs and strategies in social-ecological systems, and evolutionary-ecological systems. However, degree heterogeneity, an important structural property of many real-world complex networks such as social networks, academic collaboration networks, and communication networks, is rarely explored and studied in such eco-evolutionary games. In this research, we propose a Public Goods Game model on social networks with environmental feedback and analyze how the environmental factor and network structure affect the evolution of cooperation. It is found that as the initial environmental factors and the cooperation-enhancement defection-degradation ratio increase, the steady cooperation level of the social network significantly increases, and the dynamic environment will eventually evolve into a high-return environment; On the other hand, even if the initial environmental benefit coefficient is high, when the cooperation-enhancement defection-degradation ratio is less than a threshold, the dynamic environment will gradually degrade into a low-return environment. The steady cooperation level of the social network first gradually increases as the network structure becomes more heterogeneous, but it will decrease once the heterogeneity of the social network exceeds a certain threshold.

The Sustainable Practices of Coal Mining Industry in One Local Government in China

This study investigates the effectiveness and challenges of sustainable practices within the coal mining industry in Handan, Hebei, China. Coal remains a vital component of China’s energy security and is central to its carbon neutrality goals, yet it also contributes to significant environmental impacts. While the Chinese government has implemented policies to curb coal consumption, coal mining is still integral to the country’s energy landscape. This research examines sustainable practices in coal mining, focusing on technological innovations, reclamation efforts, and community engagement. It also assesses the challenges faced by the industry, including regulatory compliance, financial constraints, and workforce development. Using a mixed-method approach of surveys, interviews, and data analysis, the study aims to comprehensively understand the current state of sustainable practices in Handan’s coal industry. Findings will offer insights into the benefits of sustainability initiatives, such as emissions reduction and economic efficiency while identifying key barriers to implementation. The study’s results are intended to inform policymakers, industry leaders, and local communities about effective strategies to enhance sustainability in coal mining, contributing to the broader goal of achieving environmentally and economically sustainable resource management.