Centers Of Excellence Research Articles

Model of Organizational Creativity Strategy in Improving Positional Advantage of Vocational Schools in West Java

<span lang="EN-US">Vocational high schools play an important role in Indonesia's education system, particularly in vocational education, which prepares a ready-to-work labor force. This research, which is novel and groundbreaking, examines the organizational creativity strategy in enhancing the positional advantage of State Vocational High Schools (SMKN) Centers of Excellence in West Java, grounded by environmental turbulence and transformational leadership. The study is quantitative in design, using questionnaires as the main instrument, with an analysis unit of 288 SMKN Centers of Excellence in West Java and a sample size of 165 schools. Data analysis was conducted descriptively, and hypothesis testing was carried out using the Partial Least Squares (PLS) method. The findings show that environmental turbulence and transformational leadership significantly influence positional advantage, with transformational leadership having a more significant impact. Additionally, the organizational creativity strategy and partnership program serve as mediators, both in parallel and serial, in the relationship between environmental turbulence, transformational leadership, and positional advantage. The key implication of these findings is the importance of strengthening organizational creativity in addressing external and internal environmental dynamics, with the novelty lying in integrating these two factors in the development of positional advantage in vocational schools</span>

Uniri Digital Library – Supporting Open Science at the University of Rijeka

Goal: The main objective of this paper is to investigate, analyse and present how the Uniri Digital Library is organised. Methodology: The paper gives an overview of important activities which the University of Rijeka Library has in cooperation with the University of Rijeka and the University constituents[1] taken to increase the number of objects stored and published in the institutional repositories. Results: The paper analyses digital objects stored and published in the Uniri Digital Library by the type of papers and openness. The analysis has identified insufficient openness of objects in spite of legal regulations and storage obligations on the national and institutional levels. Data suggests that it is necessary to establish new evaluation and reward system in implementing the practices of open science, but also to continuously perform education and raise awareness about the importance of open scientific information. Originality: The paper presents the theoretical concept and the legal framework for the establishment of the Uniri Digital Library. Until the adoption of the Digital Library Standard, the Uniri Digital Library was called University of Rijeka[2] Repository. [1] The University constituents act as constituents to perform higher education, scientific or artistic and professional activity with legal personality and without legal personality. [2] The University of Rijeka was founded in 1973 and is now a modern European university and a centre of excellence in the region and beyond. With a total of 16 faculties, it is a research and scientific teaching university responsible for the socio-economic development of the community, the city of Rijeka and the region. The University of Rijeka is a socially responsible and open university – open to international students, teaching staff, researchers, but also to contemporary higher education trends (https://uniri.hr/o-sveucilistu/uniri/).

Conceptualising Centres of Clinical Excellence: A Scoping Review

ObjectivesCentres of clinical excellence (CoCE) are healthcare facilities that provide excellent healthcare. However, despite their increasing prevalence, it is unclear how CoCE are identified and monitored. This paper explores how...

Trends in the Management and Outcomes of Neuroendocrine Liver Metastases: A Three-decade, Multi-centre Observational Cohort Study.

To describe the evolution of management strategies for neuroendocrine liver metastases (NE LM) and trends in patient outcomes over the preceding 3 decades. Liver metastases are common in neuroendocrine neoplasms and impair prognosis. A broad therapeutic armamentarium has evolved over recent decades but there remains uncertainty regarding optimal treatment selection and sequencing. Retrospective cohort study pooling data from 4 specialist centres of excellence in the United Kingdom and Germany for individuals diagnosed with neuroendocrine liver metastases between 1st Jan 1990 and 31st December 2020. We explored trends in theranostic strategies over three decades and quantified overall survival (cohort, and by decade-defined temporal periods). We identified 551 individuals with NE LM with a median age at diagnosis of 59.1 years; 453 (82.2%) had synchronous metastases, and 402 (73.0%) underwent multimodal therapy. In all centres somatostatin receptor-based PET/CT and MRI were the preferred imaging techniques. There were significant trends in the use of somatostatin analogues and peptide receptor radionuclide therapy but the number of surgical resections remained stable. Overall survival (OS) at 5- and 10-years was 77.5% and 58.1% respectively. Across the three time periods, 5-year OS significantly improved - period I: 45.2%, period II: 66.0%, and period III: 75.7%. Ten-year OS showed overlapping confidence intervals for Period I (23.5%) and Period II (18.3%) but doubled in period III (55.5%). On multivariate analysis, the use of multimodal therapy strategies was significantly associated with improved overall survival (HR=0.59, 95% CI: 0.40 to 0.88, P=0.009). Improved imaging modalities and modifications in specific therapies as components of multimodal treatment concepts are concordant with significantly improved survival outcomes in NELM over 30 years. The use of multimodal therapy improved overall survival in patients with NE LM. Future studies should determine optimal treatment selection and sequencing, and role of novel biomarkers to guide these.

Two-Stage Mayo Clinic Class IIIb Celiac Axis Resection for Pancreatic Adenocarcinoma: Stepwise Management.

The National Comprehensive Cancer Network guidelines consider pancreatic cancer with celiac axis (CA), proper hepatic artery (PHA), and superior mesenteric artery (SMA) involvement unresectable. Thus, technical reports and video illustrations of these operations are rare. We report the stepwise management of multivascular reconstruction for Mayo Clinic class IIIb CA resections at New York University Langone Health, a dedicated center of excellence in pancreatic surgery. We illustrated the management of a 56-year-old patient with biopsy-confirmed pancreatic ductal adenocarcinoma arising from the pancreatic body and involving the CA, PHA, SMA, and mesentericoportal venous axis. The preoperative stepwise considerations include: 1) mandatory patient selection; 2) planning vascular reconstructability; 3) tailoring risk assessment while carefully considering the need for total pancreatectomy, total gastrectomy, and mesenteric/hepatic revascularization; and 4) 3D-reconstruction for arterial evaluation. The key intraoperative considerations include: 1) selective and sequential clamping for vascular reconstruction in a "domino" fashion, to minimize warm ischemic time 2) a combined multi-surgeon approach to comprehensively tackle vascular reconstructions; 3) a low threshold for total pancreatectomy to avoid pancreatic leak; and 4) two-stage surgery to reassess the blood supply to the liver and stomach for on-demand gastric preservation instead of a theoretically advised total gastrectomy. Liver, stomach, and bowel vascularization present life-threatening risks that require an extensive preoperative evaluation and a multidisciplinary approach. Our stepwise management for these extensive operations includes total pancreatectomy, "domino" vascular reconstruction, and two-stage surgery.

Challenges in developing response evaluation criteria for peptide receptor radionuclide therapy: A consensus report from the European Neuroendocrine Tumor Society Advisory Board Meeting 2022 and the ENETS Theranostics Task Force.

Assessing the response to systemic therapy in neuroendocrine tumors (NET) is challenging since morphological imaging response is often delayed and not necessarily reflective of clinical benefit. Peptide receptor radionuclide therapy (PRRT) has a complex mechanism of action, further complicating response assessment. In response to these challenges, the European Neuroendocrine Tumor Society (ENETS) Theranostics Task Force conducted a statement-based survey among experts to identify the current landscape and unmet needs in PRRT response assessment. The survey, presented at the 2022 ENETS Advisory Board (AB) meeting in Vienna, was completed by 70% of AB members, most of whom (81%) were from ENETS Centers of Excellence (CoE). It comprised a set of 13 questions with two substatements in three questions. Six (46%) of the statements achieved more than 75% agreement, while five (39%) additional statements reached over 60% consensus. Key points from the survey include: AB members agreed that lesions deemed equivocal on computed tomography (CT) or magnetic resonance imaging (MRI) should be characterized by somatostatin receptor (SST) positron emission tomography (PET)/CT before being designated as target lesions. It was agreed that interim response assessments should occur after the second or third PRRT cycle. Over half (54%) preferred using both conventional cross-sectional imaging (CT and/or MRI) and hybrid imaging (SST PET/CT) for this purpose. Almost all AB members supported further response assessment 3 months after the final PRRT cycle. A majority (62%) preferred using a combination of conventional cross-sectional imaging and SST PET/CT. For cases showing equivocal progression (ambiguous lesions or nontarget lesions) on CT and/or MRI, further confirmation using SST PET/CT was recommended. A significant majority (74%) preferred assessing pseudo-progression and delayed response by combining SST PET with diagnostic CT and/ or MRI. Though just below the 75% consensus threshold, there was substantial agreement on selecting target lesions based on SST PET/CT uptake intensity and homogeneity. Sixty-nine percent noted the importance of documenting and closely following heterogeneity in lesions in liver, lymph nodes, primary tumors, or other organs. As to the statement on parameters for new response criteria, AB members recommended exploring maximum standard unit value, tumor-to-background ratio, Hounsfield Unit (Choi Criteria), total tumor burden, and novel serum or molecular markers for future response evaluation criteria. Sixty-five percent supported the use of a single SST PET/CT for response assessment of NET lesions treated with PRRT. These findings highlight the importance of integrating advanced imaging techniques and recognizing the need for more nuanced criteria in assessing the efficacy of PRRT in NET patients. This approach aims to enhance the accuracy of treatment monitoring and improve patient outcomes.

Contributions of neurologists to diagnostic timelines of ALS and thinkALS as an early referral instrument for clinicians

Objectives: To evaluate neurologists and other clinicians’ contributions to U.S. ALS diagnostic timelines. Background: Over the past two decades, the average time to ALS diagnosis in the U.S. has remained unchanged at 12 months. ALS patients see 3-4 clinicians prior to referral to an ALS specialist for diagnosis confirmation and/or treatment initiation. There is an urgent need to identify where delays occur, so that targeted clinician awareness may be raised about early suspicion and referrals. Methods: Review of Medicare claims database for health care utilization patterns by ALS beneficiaries during diagnostic journey. Survey of typical clinic wait times for new consultations reported by 75-78 ALS Certified Treatment Centers of Excellence (2019-2021). Results: During 2011-2021, 78,520 Medicare beneficiaries were diagnosed with ALS (T0). The mean (median) timelines between first neurologist ambulatory visit and T0, is 16.5 (11.0) months; mean ± SD for ALS/neuromuscular providers being 9.6 ± 12.6 months versus 16.7 ± 17.5 months for non-neuromuscular neurologists. During the 12-months preceding T0, an ALS patient undergoes median(max) 1.5(4.0) brain-MRIs, 1.6(6.0) spine-MRIs, and 1.3(4.0) electromyography studies. Greater than 75% of ALS centers consistently report ≤ 4 week wait times for new ALS consults. This study introduces “thinkALS,” an easy-to-use clinical diagnostic and referral guide for non-ALS neurologists to tackle this challenge. Conclusions: This study is the first to provide metrics on how non-neuromuscular/ALS specialists contribute to ALS diagnostic timelines in the U.S.

Factors Contributing to Uptake of Stillbirth Evaluations: A Qualitative Analysis.

The purpose of this study was to explore individuals' beliefs, values, and experiences surrounding stillbirth evaluation decisions. Qualitative research. University of Utah Health. Parents who experienced a stillbirth in the past 5 years (n = 19) were interviewed about their experiences and decision to consent to or decline stillbirth evaluations, such as autopsy, placental histopathology, or genetic testing. Qualitative content analysis. Barriers and facilitators to parentsstillbirth postmortem decision-making. Participants communicated several facilitators and barriers that contributed to their stillbirth evaluation decision. Reasons for consenting to evaluations were belief in science, background in medicine, altruism, to inform future pregnancies, thinking about preventing another stillbirth, and how patients viewed the care of their stillborn by the medical team. Reasons for declining evaluations were receiving a diagnosis prior to being offered a postmortem evaluation, intent to avoid causing further harm to the baby, interest to spend more time with their baby, and cost of the evaluation. Stillbirth is one of the most difficult experiences of a parent. Diagnostic and emotional barriers create further challenges to decision-making for stillbirth postmortem evaluations. Parents often rely on inadequate information and personal values and beliefs during this time-sensitive decision process. Decision support for stillbirth evaluations and training for medical providers could benefit parents, may increase stillbirth evaluation uptake, and potentially prevent decisional regret. Research reported in this publication was supported by the Utah Centre for Excellence in ELSI Research (UCEER).

Influence of irrigation intervals on essential nutrient content in okra (Abelmoschus esculentus) seeds

The influence of irrigation intervals on the accumulation of essential nutrients in okra seeds, especially those intended for coffee production, has not been thoroughly documented. This study aimed to investigate the effects of irrigation intervals on essential nutrient levels in okra seeds. By exploring how different irrigation schedules impact nutrient content, this research aims to optimize water use and enhance seed quality to meet the growing demand for nutrient-dense food products. The present study was conducted during late summer (December-January) 2022 and validated in 2023 at the Green Biotechnologies Research Centre of Excellence (GBRCE), University of Limpopo, Limpopo Province, South Africa (23°53'10"S, 29°44'15"E). Okra seedlings were subjected to irrigation intervals of 2, 4, 6, 8, 10, 12, and 14 days, with each interval replicated 10 times. Each seedling received 2,000 mL of tap water per irrigation. At 59 days after transplanting, pods were harvested and shelled, with seed samples prepared for the determination of malnutrition essential element tests. Calcium, K, Mg, and P versus irrigation interval exhibited quadratic relations with the model explained by 80, 78, 79, and 77% associations, respectively. Similarly, Cu, Fe, Na, Mn, and Zn versus irrigation interval exhibited quadratic relations, with the model explained by 71, 86, 79, 81, and 68% associations, respectively. Using x = −b1/2b2 relation, the average optimal irrigation intervals for macro and micronutrient elements were 9 and 8 days, respectively, with the average suggesting that the Day-8 irrigation interval was suitable for improving malnutrition essential elements of okra seeds under field conditions.

The Epilepsy Centers of Excellence at the Veterans Health Administration.

The Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) was established in 2008 to provide specialized care for veterans with epilepsy. Although established more than a decade ago, there has been no systematic evaluation of the ECoE's performance in key mission areas. We evaluated their performance in several key mission areas-clinical care, research, education, and outreach-since inception to evaluate their success in meeting the initial mandate. We analyzed available data from relevant literature, ECoE annual reports, and the ECoE website between 2011 and 2023. Clinical care is the primary mission of the ECoE and was evaluated by examining utilization data for various clinical services and published literature. Research was assessed based on academic output and funding reported in the annual reports. Education and outreach were qualitatively assessed using recent data on the ECoE website and annual reports. Total unique patient clinical visits for therapeutic/diagnostic encounters increased by 74% (from 10,487 in 2011 to 18,285 in 2023), which was nearly twice the 39.5% growth in workforce strength (from 119 in 2011 to 166 in 2022) over a similar period. Care provided by the ECoE is associated with decreased mortality rates compared to patients who do not receive ECoE neurology care. Tele-epilepsy visits increased considerably following the COVID-19 pandemic, from 1,928 in 2019 to 4,950 in 2021 (a 157% increase over 2 years). Research grant funding in fiscal year 2023 totaled approximately $4 million for ECoE-affiliated investigators. Outreach efforts included several VHA/non-VHA collaborations. The ECoE organizational structure was found to be highly interconnected and regionally represented, with special committees devoted to many key mission areas of epilepsy care. Our analysis reveals progressive growth and improvements in the ECoE mission areas of clinical care, research, education, and outreach. Clinical utilization data have shown growth since inception, while also leading to lower mortality rates and lower costs per patient, fulfilling the organizational mandate to improve the care of veterans with epilepsy. There is substantial activity in research, education, and outreach. The ECoE governance hierarchy aims to facilitate smooth resource allocation both regionally and for the key mission areas. Our findings can help policymakers assess and prioritize future ECoE initiatives, while other clinical care organizations can seek to model their care based on the ECoE.

Startup AYUSH Portal

The AYUSH Portal is designed to promote the incorporation of India's traditional medicinal systems Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy into the nation's healthcare ecosystem. Recognizing the increasing global acceptance of AYUSH practices, the Government of India has initiated Centers of Excellence to support prominent institutions involved in research and education and drug development. Notable initiatives include collaborations with premier institutions such as AIIMS and IIT Jodhpur to explore integrative health research and address key public health challenges. Programs like the Ayurgyan and Ayurswasthya Schemes prioritize research in the AYUSH sector, promoting innovations in preventive and integrative health care. The establishment of the AYUSH-ICMR Advanced Center for Integrative Research seeks to create a vibrant ecosystem for scientific validation of traditional practices. During the COVID-19 pandemic, the Ministry of AYUSH demonstrated the efficacy of traditional medicine by releasing clinical management protocols and guidelines based on Ayurveda and Yoga, highlighting their role in public health emergencies. This paper discusses the methodology adopted in the AYUSH Portal, emphasizing collaborative research efforts, intellectual property rights, and the integration of AYUSH therapies in mainstream healthcare to achieve the goal of "One Nation, One Health."

A Feed-Forward Back-Propagation Neural Network Approach for Integration of Electric Vehicles into Vehicle-to-Grid (V2G) to Predict State of Charge for Lithium-Ion Batteries

The accurate prediction and efficient management of the State of Charge (SoC) of electric vehicle (EV) batteries are critical challenges in the integration of vehicle-to-grid (V2G) systems within multi-energy microgrid (MMO) models. Inaccurate SoC estimation can lead to inefficiencies, increased costs, and potential disruptions in power generation. This paper addresses the problem of optimizing SoC estimation to enhance the reliability and efficiency of V2G scheduling and MMO coordination. In this work, we develop a Feed-Forward Back-Propagation Network (FFBPN) using MATLAB 2024 software, employing the Levenberg–Marquardt algorithm and varying the number of hidden neurons to achieve better performance; performance was measured by the maximum coefficient of determination (R2) and the minimum mean squared error (MSE). Utilizing the NASA Prognostics Center of Excellence (PCoE) dataset, we validate the model’s capability to accurately predict the life cycle of EV batteries. Our proposed FFBPN model demonstrates superior performance compared to existing methods from the literature, offering significant implications for future V2G system developments. The comparison between training, validation, and testing phases underscores the model’s validity and precisely identifies the characteristic curves of FFBPN, showcasing its potential to enhance profitability, efficiency, production, energy savings, and minimize environmental impact.

International PCOS guideline clinical research priorities roadmap: a co-designed approach aligned with end-user priorities in a neglected women’s health condition

Polycystic ovary syndrome (PCOS) is a common endocrinopathy with significant reproductive, metabolic, and psychological complications. Consensus on PCOS clinical research priorities across end-users is fundamental and necessitates a robust co-development of a clinical research roadmap to guide international research efforts. A multistage process included: i) international surveys of women and healthcare providers to identify research priorities and unmet needs; ii) interrogation of systematic reviews conducted for the International PCOS Guideline to identify research gaps; iii) International PCOS Guideline Network consensus generated clinical research roadmap; and iv) international peer review for external validation. A codesigned survey engaging 1278 women with PCOS and 1474 healthcare providers found general concordance on research priorities. International PCOS Guideline development processes identified gaps in the literature and coproduced over 150 research priorities throughout the women's life course, affirmed in international peer review. Key themes included: 1) Optimizing PCOS diagnosis; understanding natural history across diverse populations and life stages; detecting and preventing complications, and integrating and interrogating large data assets; 2) developing evidence-based resources, exploring optimal modes for information provision and models of care; 3) exploring effective lifestyle and weight management strategies; minimising weight stigma; 4) exploring intervention effects (including treatment efficacy, safety, cost-effectiveness, and long-term follow-up) on diverse features of PCOS across subgroups; and 5) optimising preconception care and fertility treatments in PCOS. This rigorously coproduced International PCOS Guideline clinical research roadmap addresses stakeholder priorities to guide future clinical research in this common yet neglected condition. The roadmap complements the established PCOS Core Outcome Set to enhance research quality, and tackles evidence-practice gaps to improve health outcomes for women with PCOS throughout their life course. The survey, International PCOS Guideline Network and 2018 and 2023 International PCOS Guidelines were funded by the Australian National Health and Medical Research Council (NHMRC) Centres of Research excellence in PCOS (APP1078444) and in Women's Health in Reproductive life (APP1171592). Guideline partners, American Society for Reproductive Medicine (ASRM), Endocrine Society, European Society of Human Reproduction and Embryology (ESHRE), and European Society of Endocrinology (ESE), provided additional funding and assisted in guideline development. HT and AM are NHMRC Research Fellows. LM was funded by a Heart Foundation Future Leader and Veski Fellowship and CTT by the NHMRC Centres of Research excellence in Women's Health in Reproductive life. All disclosures of interest were declared before commencing GDG involvement and updated before all major milestones and are available alongside the PCOS Guideline (https://www.monash.edu/__data/assets/pdf_file/0009/3371292/Register-of-disclosures-of-interest.pdf).

Notable Programs in Neurotology Series: The University of Miami Ear Institute.

The University of Miami Ear Institute (UMEI) was conceived and founded by Dr. W. Jarrard (Jerry) Goodwin in 1990, then Chairman of the University of Miami Department of Otolaryngology-Head and Neck Surgery. Dr. Goodwin's goal was to establish a state-of-the-art institution featuring world-renowned experts in otology, audiology, cochlear implants, balance disorders, skull base surgery, and research. With the support of many within and outside the University, he succeeded in this endeavor and appointed Thomas J. Balkany the first director of the Ear Institute. Under Dr. Balkany's leadership, the institute continued to evolve alongside the growing University of Miami Department of Otolaryngology, pioneering developments in pediatric cochlear implant surgery and postoperative care and basic science research. Dr. Balkany transitioned from UMEI Director in 2010, succeeded by Dr. Fred F. Telischi, and subsequently Dr. Simon I. Angeli who is the current Ear Institute Director. The Ear Institute experienced exponential growth in clinical services, research, education, and advocacy throughout the 2nd decade of the 21st century. Renamed the UHealth Ear Institute, its organizational structure evolved to meet new challenges. In its 34-year history, the UHealth Ear Institute has transformed from an idea into a nationally and internationally recognized center of excellence. It remains dedicated to advocating for universal hearing health, ensuring access to hearing health services, providing exceptional patient care, advancing innovative research, and training future specialists.

Efficacy of solution-focused brief therapy versus case management for psychological distress in adolescents and young adults in a community-based youth mental health service in Singapore: protocol for a randomised controlled trial

IntroductionThere are insufficient scalable, evidence-based treatments to meet increasing mental health needs of young people. Offering interim, brief interventions for young persons with psychological distress can improve access to care...

Preface

Abstract Welcome to the 4th Maritime Safety International Conference (MASTIC) 2024 The Department of Marine Engineering, Faculty of Marine Technology, Institut Teknologi Sepuluh Nopember (ITS), Surabaya, in collaboration with the Center of Excellence for Maritime Safety and Marine Installation (PUI KEKAL), is proud to present the 4th MASTIC 2024. This year, we are delighted to host the conference started from August 25th to 28th in Prima Plaza Hotel Sanur, Bali, Indonesia. The conference theme, “Enhancing Maritime Safety towards Sustainable Marine Technologies and Environmental Protection”, attracted a diverse range of participants, presentations, keynote speeches and workshop session. Four prominent keynote speakers are Ir. Raymond Ivan H.A.S. that talked about the role of government to the sustainable shipping and digitalization, Professor Akira Sou of Kobe University presented about Recent Technology Development for Marine Engines, Dr. Junghan Lee as the CEO of Cluster LNG South Korea that delivered a presentation about LNG Technology in Indonesia and the last speaker, Bani Maulana Mulia, the President Director of PT Samudera Indonesia Tbk who delivers recent developments in Samudera Indonesia that support sustainable shipping and emission reduction. After being held online twice, this year the conference brings the in-person format that allows more meaningful interactions, networking opportunities, and a deeper engagement for all participants. The conference featured 49 accepted papers that authored by researchers from 6 different countries: Indonesia, Japan, South Korea, Croatia, Montenegro, and Germany. These papers represented the latest advancements in the field of maritime safety and are a valuable contribution to the conference. List of Conference Committee are available in this pdf.

An integrated practice unit tool for the Military Health System.

To develop a tool for measuring performance of a coordinated care center against the criteria of an integrated practice unit (IPU) and test it against an established care center in the Military Health System (MHS). Characteristics of 4 patient care coordination models were sorted using the 11 criteria of the IPU. Subject matter experts evaluated characteristics and criteria for inclusion or exclusion based on the needs of specialty care in the MHS. The consolidated tool was tested using the example of the National Intrepid Center of Excellence (NICoE), which provides coordinated, colocated care for patients with traumatic brain injury, using responses of yes, partial, no, not applicable, or incomplete. The final tool contained 7 IPU criteria subdivided into 18 measures. NICoE was found in 2020 to meet 11 measures fully and 6 partially, with 1 deemed not applicable. In 2023 it met 17 of 18 measures, with the remaining (translation services) available as an enterprise-wide resource. The tool was seen to need improvement in clarification of 3 measures and in 1 criterion that is evaluated differently by patients vs providers. This IPU assessment tool accurately captures both the strengths and weaknesses of a coordinated care facility within the MHS. Iterative refinement of the tool is expected to inform ongoing discussion of the transformation of care in the MHS and the US and to provide a framework by which to measure the care performance of centers wishing to reorganize as IPUs.

Jagoan : Transportation Digitalization Innovation Through Application-Based Geotrail Development to Creat a Tourism Center of Excellent in the Geopark of Pasuruan Distric

Abstract Bromo Tengger Semeru Geopark is one of the well-known tourist destinations included in the National Tourism Strategic Area in Pasuruan Regency. As for the Regional Medium-term Development Plan of East Java Province 2019-2024, the Bromo Tengger Semeru Geopark is included in the priority program for developing the National Tourism Strategic Area through increasing geotrail site connectivity and developing a tourism center of excellence. However, the implementation of this program has not been well integrated due to limited access to information and transportation regarding tourist variations gate, and alternative transportation routes. This makes tourists only focus on Mount Bromo caldera tourism, resulting in fewer visitation to geo-site tourist destinations, biodiversity tourism, and cultural tourism around aspiring national geopark. For this reason, it would be beneficial if tourists could access and obtain information regarding all variations of geopark tourism destination in one mobile application called JAGOAN. This application provides a tour package selection feature along with travel schedules, and alternative transportation routes (geotrail) which are integrated with google map directions, booking and reservations, geopark events, weather conditions, and other important information in real-time. The scenarios for tourist visits in the National Tourism Strategic Area and geo-trails were analyzed using scoring and network analysis methods. Meanwhile, making an application prototype involves the process of feature planning, creating user flow, sketching lofi, creating digital designs, and prototyping. It is hoped that the results of the analysis of determining geotrail routes and developing application-based tourism will make it easier for tourists to obtain information so that they can increase tourist visits to support the realization of a tourism center of excellence in the Bromo Tengger Semeru Aspiring Geopark, Pasuruan Regency.

Performance evaluation of irrigation outlets with physical model study in Indus basin irrigation system of Pakistan.

The efficiency of water distribution at primary, secondary, and tertiary levels in the Indus Basin Irrigation System (IBIS) has historically suffered due to poor design, suboptimal operation, and water scarcity. To address these issues, the system has been designed with ungated irrigation outlets to ensure equitable water allocation at secondary and tertiary levels. This research evaluates the hydraulic performance of three irrigation outlets: adjustable proportional module (APM), adjustable orifice semi-module (AOSM), and open flume (OF) using a physical model study. A distributary channel model with these outlets was constructed at the Centre of Excellence in Water Resources Engineering, where discharge coefficients (Cd) were calibrated and measured under various hydraulic and geometric conditions, including free and submerged flow conditions, and with adjustments to flow depths and outlet settings. The results showed variability in Cd values under free flow and submerged flow conditions with APM and AOSM ranging from 6.07 to 8.20 and 0.56 to 0.74, respectively, and OF between 2.46 and 4.31. Additionally, the behavior of outlet tampering on Cd values was also assessed under three scenarios: tampering with the half wing wall (1st), tampering with the full wing wall (2nd), and lowering the bed level downstream of the outlet (3rd). The increase in Cd values for APM and AOSM was + 10.84% and + 14.49% under 1st scenario, + 17.12% and + 22.36% under 2nd scenario, and + 24.25% and + 26.30% under 3rd scenario, respectively. The results reveal that even minor tampering with outlet structures can lead to significant deviations in performance, highlighting the importance of maintaining stringent control over outlet configurations to ensure equitable and efficient water distribution. There is a critical need for rigorous, site-specific calibration of irrigation outlets to optimize their performance under local conditions and redesigning outlet structures to minimize the impacts of tampering, thereby enhancing the overall sustainability of water use in large-scale irrigation systems. The findings from this study provide essential insights for irrigation engineers and policymakers tasked with upgrading and maintaining irrigation infrastructure. By adopting a more customized approach to outlet design and management, it is possible to significantly improve water use efficiency and achieve more sustainable irrigation practices.

Serum and urinary 5-hydroxyindolacetic acid, serotonin, chromogranin A, and NT-proBNP for the detection of carcinoid heart disease.

The aim of this study was to evaluate the performance of different biomarkers for the detection of carcinoid heart disease (CHD) in neuroendocrine tumours (NETs), in particular serum 5-HIAA (s5HIAA). An explorative ancillary study of the French CrusoeNET cohort. Patients managed in the Lyon-EURACAN Center of Excellence (CoE) were included when they were aged of at least 18 years, treated and followed for an advanced/metastatic ileum or lung NET, a NET irrespective of the primary location or from unknown primary location but with clinical CS, and/or elevation of urinary 5-HIAA (u5HIAA) twice greater than the upper limit of normal. All patients included had 1 available serum stored within the local biobank between January 2021 and April 2022. Echocardiography was performed by 1 of the 3 expert cardiologists of the Lyon-EURACAN-CoE. We included 138 patients with NETs, mainly of the small intestine and lung, and 19 of them had a CHD. Analysis showed that s5HIAA was well correlated with u5HIAA (ρ = 0.824 [0.76-0.88], P < .0001) and was a good biomarker for CHD detection (receiver operating characteristic curve = 0.85 [0.75-0.94], P < .0001). Using a threshold value of 757 nmol/L, the sensitivity and specificity for the detection of CHD were 84% and 80%, respectively. s5HIAA is highly sensitive and specific for CHD detection. It could be used as a pre-screening tool in centres where systematic and regular echocardiography by an expert cardiologist is not performed in this population.