Management Center Research Articles

Leveraging survival analysis in cost-aware deepnet for efficient hard drive failure prediction

AbstractMany real-world datasets, such as those used for failure and anomaly detection, are severely imbalanced, with a relatively small number of failed instances compared to the number of normal instances. To address these issues, this paper leverages the Backblaze hard disk drives (HDDs) data and makes several contributions to hard drive failure prediction. This research explores 1D convolutional neural networks (CNN) to utilize the sequential nature of hard drive sensor data. The performance of 1D CNN models is compared to traditional machine learning (ML) algorithms, such as the synthetic minority over-sampling technique (SMOTE) and weighted logistic regression (WLR), demonstrating superior results, suggesting the potential effectiveness of the proposed approaches. In addition to these efforts, this paper aims to provide a comprehensive understanding of hard drive longevity and the critical factors contributing to their eventual failure through survival analysis. The 1D CNN models employ weighted binary cross-entropy (WCE) loss and modified focal loss (MFL) functions to manage class imbalanced issues commonly observed in hard drive data. The findings suggest that 1D CNN models outperform traditional ML models, with regularization techniques like dropout and early stopping proving effective in controlling overfitting. Notably, the 1D CNN model with WCE loss demonstrated the best overall performance with a $$G_{mean}$$ G mean of 0.692, successfully maximizing the FDR without increasing the FAR. In parallel, the research also employs Cox regression to identify key SMART parameters influencing drive failure. The high concordance index (c-index) of the Cox model (0.958) adds confidence to the insights derived. The research thus sets a solid groundwork for data center management strategies, with a future focus on practical implementation and evaluation of these findings.

Energy efficient resource management in data centers using imitation-based optimization

Cloud computing is the paradigm for delivering streaming content, office applications, software functions, computing power, storage, and more as services over the Internet. It offers elasticity and scalability to the service consumer and profit to the provider. The success of such a paradigm has resulted in a constant increase in the providers’ infrastructure, most notably data centers. Data centers are energy-intensive installations that require power for the operation of the hardware and networking devices and their cooling. To serve cloud computing needs, the data center organizes work as virtual machines placed on physical servers. The policy chosen for the placement of virtual machines over servers is critical for managing the data center resources, and the variability of workloads needs to be considered. Inefficient placement leads to resource waste, excessive power consumption, and increased communication costs. In the present work, we address the virtual machine placement problem and propose an Imitation-Based Optimization (IBO) method inspired by human imitation for dynamic placement. To understand the implications of the proposed approach, we present a comparative analysis with state-of-the-art methods. The results show that, with the proposed IBO, the energy consumption decreases at an average of 7%, 10%, 11%, 28%, 17%, and 35% compared to Hybrid meta-heuristic, Extended particle swarm optimization, particle swarm optimization, Genetic Algorithm, Integer Linear Programming, and Hybrid Best-Fit, respectively. With growing workloads, the proposed approach can achieve monthly cost savings of €201.4 euro and CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\hbox {CO}_2$$\\end{document} Savings of 460.92 lbs CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\hbox {CO}_2$$\\end{document}/month.

Ketone Management in Pediatric Diabetes Centers in the USA: Current Practices and a Call for Improved Standardization

Introduction: Diabetic ketoacidosis (DKA) is the leading cause of mortality among youth with type 1 diabetes (T1D). Guidelines for DKA prevention exist; however, specific guidance about when to check ketones and how to manage youth using insulin pumps and automated insulin delivery (AID) systems is lacking. Methods: A 35-item online survey exploring clinical ketone management practices for youth with T1D in the USA was distributed to diabetes healthcare professionals (HCPs). Survey responses, including multiple-choice and Likert scale questions, were summarized and rates of agreement and disagreement (Likert scale 4, 5 vs. 1, 2, 3) are reported. Results: In total, 123 HCPs (51% physicians, 26% diabetes educators, 19% nurse practitioners) from 47 institutions completed the survey. Seventy percent worked at academic specialty centers. Ninety-seven percent reported >50% continuous glucose monitoring use in their clinic and 72% reported >50% insulin pump use. Although 79% reported having ketone management protocols, the level and duration of hyperglycemia at which ketone monitoring was advised ranged from >200 to 350 mg/dL and from 0 min to >6 h of duration. While 72% had distinct ketone management protocols for pump users, only 29% had specific protocols for AID. Sixty-two percent agreed that DKA due to infusion site failure was a significant problem in their practice, and 70% agreed there was a need to standardize ketone management guidelines. Conclusions: The preventable nature and high incidence of DKA highlight the need to build consensus for clinical ketone management and to develop tools to facilitate management, especially as the use of diabetes technologies continues to increase.

Reshaping disaster management: An integrated community‐led approach

AbstractThe management of disasters has traditionally involved public, private, and nongovernmental organisations working together. While scholars have examined the value of collaborations among these entities, less is known about how to successfully engage and empower communities in disaster management. Based on network governance theory, this article contributes to the growing body of public management literature on community engagement by presenting findings from an Australian research initiative conducted after the 2019/20 Black Summer bushfires in New South Wales. Through workshops and semi‐structured interviews with a total of 58 members from local communities and emergency agencies, this paper identifies differing perspectives on power distribution among stakeholders, indicating complexities in achieving an integrated and community‐led disaster management approach. The findings underscore the need to shift from exclusively centralised to more inclusive systems, recognising the unique contributions of nonofficial community‐based groups. To address this, the study suggests: a funded community consultation committee, ensuring government and local community representation; collaborative debriefing sessions, leveraging technology for knowledge capture; and the adoption of different leadership styles able to identify, include, and integrate communities as both steerers and rowers within established hierarchical arrangements.Points for practitioners The current centralised emergency management system, which relies on recognised experts and state‐controlled facilities, limits the integration of nonofficial resources and community‐based knowledge. A shift towards a more community‐centric and integrated approach (collaborative polycentric governance) is needed to enhance disaster resilience and response in Australia. Different stages of disaster reduction could and should have different leadership styles: a transformational, collaborative community‐based style should be implemented before and after the disaster, while a transactional leadership style, more focused on restructuring the system or how it is applied, should be adopted during the disaster.

Construction Jobsite Image Classification Using an Edge Computing Framework

Image classification is increasingly being utilized on construction sites to automate project monitoring, driven by advancements in reality-capture technologies and artificial intelligence (AI). Deploying real-time applications remains a challenge due to the limited computing resources available on-site, particularly on remote construction sites that have limited telecommunication support or access due to high signal attenuation within a structure. To address this issue, this research proposes an efficient edge-computing-enabled image classification framework for support of real-time construction AI applications. A lightweight binary image classifier was developed using MobileNet transfer learning, followed by a quantization process to reduce model size while maintaining accuracy. A complete edge computing hardware module, including components like Raspberry Pi, Edge TPU, and battery, was assembled, and a multimodal software module (incorporating visual, textual, and audio data) was integrated into the edge computing environment to enable an intelligent image classification system. Two practical case studies involving material classification and safety detection were deployed to demonstrate the effectiveness of the proposed framework. The results demonstrated the developed prototype successfully synchronized multimodal mechanisms and achieved zero latency in differentiating materials and identifying hazardous nails without any internet connectivity. Construction managers can leverage the developed prototype to facilitate centralized management efforts without compromising accuracy or extra investment in computing resources. This research paves the way for edge “intelligence” to be enabled for future construction job sites and promote real-time human-technology interactions without the need for high-speed internet.

Determination of Cross-Border Post Points Based on Geospatial Intelligence for Territorial Defense of the Unitary State of the Republic of Indonesia: Literature Review

The location of cross-border posts is crucial for Indonesia's land and maritime security and combating illegal activity. Geographical intelligence technology like sensors and machine learning can help find crucial sites. GEOINT and international cooperation enable monitoring, threat detection, and trade regulation. This study uses a literature review to examine how GEOINT helps Indonesia defend its territory. This research collects, analyzes, and synthesizes important scientific studies using a literature review. Our literature search used relevant terms in scientific databases. The selected literature covers GIS, GEOINT, Satellites, Drones, and cross-border posts. Analysis identified major conclusions and research gaps. Geospatial intelligence technology (GEOINT), which uses drones and satellites to monitor and provide high-resolution data, is effective at detecting and responding to threats in Indonesia's extensive border areas. Additionally, this technology helps find the right cross-border post. Geographic information systems (GIS) must assist centralized data management and defense agency collaboration to strengthen border security. GEOINT supports strategic cross-border post placement decisions to secure Indonesia's borders. For regional defense, national security, and stability in the face of complex global problems, the latest and most effective technologies must be developed and used.

Impact of Virtual Reality Intervention on Anxiety and Level of Cooperation in Children and Adolescents with Autism Spectrum Disorder during the Dental Examination.

Background: Individuals with Autism Spectrum Disorder (ASD) frequently encounter increased levels of anxiety and display resistant behaviors during dental examinations, which negatively affects their oral care and maintenance. This study employed a cross-sectional design to evaluate the impact of virtual reality (VR) intervention on the anxiety and level of cooperation in children and adolescents with ASD during dental examinations. Methods: A total of 140 participants diagnosed with ASD, aged from 4- to 18-years-old, were selected from two specialized ASD management centers in Riyadh/Saudi Arabia. The participants were randomly allocated into either the control group or the VR group. Control group participants were subjected to a conventional dental examination, while the VR group utilized VR intervention to immerse themselves in a simulated natural and soothing environment. The Venham anxiety and behavior scale (VABS) was utilized to measure anxiety levels, while the Frankl behavior rating scale (FBRS) was employed to assess the level of cooperation. Data were analyzed using a Mann-Whitney U test with a significance level of p < 0.05. Results: The baseline anxiety and level of cooperation between the groups were comparable (p > 0.05). During the dental examination, the VR group had significantly reduced anxiety scores (2.48 ± 1.76) compared to the control group (1.50 ± 1.74) (p < 0.001). Regarding the level of cooperation, the VR group exhibited significantly greater levels of cooperation (3.41 ± 0.96) than the control group (2.86 ± 1.03) (p = 0.002). Conclusions: These findings suggest that VR intervention is a successful technique for decreasing anxiety and enhancing cooperation among children with ASD during dental examination. Integrating VR technology in dental environments can potentially improve the dental experience and results for children diagnosed with ASD.

The Impact of Leadership and Management on the Implementation of Electronic Health Record Systems in the Primary Healthcare Centers.

In the last three decades, Electronic Health Records Systems (EHRSs) have become one of the top priorities of policymakers globally. Nowadays, EHRS reform is fast becoming a priority in developed countries. The introduction of EHRSs in Saudi healthcare organizations is considered one of the highest priorities of policymakers. Saudi Arabian e-health strategy pays reasonable attention to the EHRS implementation project. According to Saudi Vision 2030, the e-health transformation will be on top of IT projects in the country. However, an estimated 50% of EHRS implementations have failed. Project leadership and type of project management have been found to be crucial components of effective EHRS implementation. To evaluate the role of centralized project management (CPM) in the implementation of large-scale EHRSs in Primary Healthcare Centers (PHCs) in Saudi Arabia (SA). A sequential explanatory mixed-methods approach involving a survey and semi-structured qualitative interview methods were utilized. A total of 39 (75%) out of 53 policymakers at the Saudi Ministry of Health completed the survey, and 14 project team members were interviewed. Findings from both illustrated that adopting centralized project management approaches to implementation was beneficial in facilitating large-scale EHRS implementation and helped to overcome barriers that may have otherwise led to the failure of the project. EHRS interoperability and software selection were the factors that CPM influenced most positively.

The Impact of the Corona Pandemic on the Revenues and Expenditures of the Jordanian General Government and the Gross domestic Product

The research aimed to know The impact of the Corona pandemic on the revenues and expenditures of the Jordanian general government and the gross domestic product And reached the following results: The Corona Covid-19 pandemic is greater than being limited to a health crisis, it is a humanitarian disaster that led to changes and transformations that attacked the heart of societies and their economies, so it was imperative for countries to work on the continuity of economic activity and the preservation of the wheel of production in the country while limiting the spread of the disease. It led to a complete and total halt to any economic activity, which caused the cancellation of many capital expenditures scheduled in the context of strict measures, as the restrictions imposed on travel and trade resulted in a decrease in revenues and an increase in expenditures, and the Corona pandemic caused an increase in the deficit rate in the state's general budget, as a result of the large expenses incurred by the state, with a clear decrease in annual revenues, but the state was able in the years following the pandemic to reduce the deficit rate in the budget and cancel many capital expenditures and freeze the performance of some economic activities, which is considered a severe blow to the domestic product, considering that revenues and expenditures enable the state to play its role effectively, as the decrease in revenues and the increase in expenditures call for a review of the structure of government institutions and the duties assigned to them The services it provides, which calls for a mix of its services to ensure mitigation of the pandemic and any crisis that the country may be exposed to, which confirms the validity of the first hypothesis and in light of such crises, and practicing that pivotal role that links the actors in the economic sectors, which allows them to be stronger than before, which confirms the validity of the second hypothesis. They recommended the following: Establishing permanent centers for crisis and risk management at the state level and at the level of the various economic sectors, and activating coordination between them to deal with various crises and risks, and developing training programs for workers on how to deal with crises and how to deal with their effects, and appointing experts and specialists to monitor, analyze and prepare reports on the various crises that the various sectors are going through and building a comprehensive database to predict crises before they occur. 10- Strengthening relations between the various governmental, civil and economic sectors with the media institutions due to their importance in spreading awareness and participating in conferences and interviews that help spread knowledge, and the need to benefit from the experiences of other countries in how to overcome crises.

Разработка DLP-модуля для защиты персональных данных в распределенной автоматизированной системе

The importance of personal data protection in automated systems is being considered. A study is provided on the development of a software module for protecting confidential information, including personal data, in a distributed automated system. The primary goal of the study: to create is to create software that prevents leaks of confidential information. The developed software module is designed to block the leakage of confidential information through network channels and removable media using a machine learning model with centralized security administrator management. The practical significance: the use of this module in organizations includes ensuring centralized information security management, reducing the risk of confidential data leaks, and supporting the investigation of security incidents. The research can be used as a temporary measure during the period of updating and adapting the system to new realities until a full-fledged protection system is achieved.

Implementing Evidence-Based Pain Management Interventions Into an Emergency Department: Outcomes Guided by Use of the Ottawa Model of Research Use.

To implement strategies to improve the care of patients with acute pain in the emergency department (ED). Pre-post implementation study using a Type 2 hybrid effectiveness-implementation design. Implementation strategies were introduced and monitored through the Ottawa Model of Research Uses' assessment, monitoring and evaluation cycles, supported by focused and sustained facilitation. Improvements in time-to-analgesia within 30 min (21%-27%), administration of nurse-initiated analgesia (NIA) (17%-27%) and measurement of pain (65%-75%) were achieved post-implementation. NIA was the strongest predictor of receiving analgesia within 30 min. Adoption of pain interventions into practice was not immediate yet responded to sustained facilitation of implementation strategies. Collaboration with local clinicians to introduce simple interventions that did not disrupt workflow or substantially add to workload were effective in improving analgesia administration rates, and the proportion of patients receiving analgesia within 30 min. The assessment, monitoring and evaluation cycles enabled agile and responsive facilitation of implementation activities within the dynamic ED environment. Improvements took time to embed into practice, trending upward over the course of the implementation period, supporting the sustained facilitation approach throughout the study. Sustained adoption of evidence-based pain interventions into the care of people presenting to the ED with acute pain can be achieved through sustained facilitation of implementation. NIA should be at the centre of acute pain management in the ED. This study addressed the lingering gap between evidence and practice for patients with acute pain in the ED. Implementation of locally relevant/informed implementation strategies supported by focused and sustained facilitation improved the care of patients with acute pain in the ED. This research will have an impact on people presenting to EDs with acute pain, and on clinicians treating people with acute pain in the ED. Relevant equator guidelines were followed and the StaRI reporting method used. No Patient or Public Contribution in this study.

A landmark federal interagency collaboration to promote data science in health care: Million Veteran Program-Computational Health Analytics for Medical Precision to Improve Outcomes Now.

In 2016, the Department of Veterans Affairs (VA) and the Department of Energy (DOE) established an Interagency Agreement (IAA), the Million Veteran Program-Computational Health Analytics for Medical Precision to Improve Outcomes Now (MVP-CHAMPION) research collaboration. Oversight fell under the VA Office of Research Development (VA ORD) and DOE headquarters. An Executive Committee and 2 senior scientific liaisons work with VA and DOE leadership to optimize efforts in the service of shared scientific goals. The program supported centralized data management and genomic analysis including creation of a scalable approach to cataloging phenotypes. Cross-cutting methods including natural language processing, image processing, and reusable code were developed. The 79.6 million dollar collaboration has supported centralized data management and genomic analysis including a scalable approach to cataloging phenotypes and launched over 10 collaborative scientific projects in health conditions highly prevalent in veterans. A ground-breaking analysis on the Summit and Andes supercomputers at the Oak Ridge National Laboratory (ORNL) of the genetic underpinnings of over 2000 health conditions across 44 million genetic variants which resulted in the identification of 38270 independent genetic variants associating with one or more health traits. Of these, over 2000 identified associations were unique to non-European ancestry. Cross-cutting methods have advanced state-of-the-art artificial intelligence (AI) including large language natural language processing and a system biology study focused on opioid addiction awarded the 2018 Gordon Bell Prize for outstanding achievement in high-performance computing. The collaboration has completed work in prostate cancer, suicide prevention, and cardiovascular disease, and cross-cutting data science. Predictive models developed in these projects are being tested for application in clinical management. Eight new projects were launched in 2023, taking advantage of the momentum generated by the previous collaboration. A major challenge has been limitations in the scope of appropriated funds at DOE which cannot currently be used for health research. Extensive multidisciplinary interactions take time to establish and are essential to continued progress. New funding models for maintaining high-performance computing infrastructure at the ORNL and for supporting continued collaboration by joint VA-DOE research teams are needed.

Enhancing Healthcare Information Systems in Ethiopian Hospitals: Exploring Challenges and Prospects of a Cloud-based Model for Smart and Sustainable Information Services

Hospitals are the primary hubs for healthcare service providers in Ethiopia; however, hospitals face significant challenges in adopting digital health information systems solutions due to disparate, non-interoperable systems and limited access. Information technology, especially via cloud computing, is crucial in healthcare for efficient data management, secure storage, real-time access to critical information, seamless provider communication, enhanced collaboration, and scalable IT infrastructure. This study investigated the challenges to standardizing smart and green healthcare information services and proposed a cloud-based model for overcoming them. We conducted a mixed-methods study in 11 public hospitals, employing quantitative and qualitative approaches with diverse stakeholders (N = 103). The data was collected through surveys, interviews, and technical observations by purposive quota sampling with the Raosoft platform and analyzed using IBM SPSS. Findings revealed several shortcomings in existing information systems, including limited storage, scalability, and security; impaired data sharing and collaboration; accessibility issues; no interoperability; ownership ambiguity; unreliable data recovery; environmental concerns; affordability challenges; and inadequate policy enforcement. Notably, hospitals lacked a centralized data management system, cloud-enabled systems for remote access, and modern data recovery strategies. Despite these challenges, 90.3% of respondents expressed interest in adopting cloud-enabled data recovery systems. However, infrastructure limitations, inadequate cloud computing/IT knowledge, lack of top management support, digital illiteracy, limited innovation, and data security concerns were identified as challenges to cloud adoption. The study further identified three existing healthcare information systems: paper-based methods, electronic medical catalog systems, and district health information systems2. Limitations of the paper-based method include error-proneness, significant cost, data fragmentation, and restricted remote access. Growing hospital congestion and carbon footprint highlighted the need for sustainable solutions. Based on these findings, we proposed a cloud-based model tailored to the Ethiopian context. This six-layered model, delivered as a Software-as-a-Service within a community cloud deployment, aims to improve healthcare services through instant access, unified data management, and evidence-based medical practices. The model demonstrates high acceptability and potential for improving healthcare delivery, and implementation recommendations are suggested based on the proposed model.

Hepatitis B infection: Evaluation of demographics and treatment of chronic hepatitis B infection in Northern-western Tanzania.

Chronic hepatitis B virus (HBV) infection is still a major public health problem. In response to the World Health Organization (WHO), Tanzania implemented immunization and treatment to achieve the eradication of HBV infection by 2030. To achieve this goal, frequent updates of demographic data, antiviral therapy eligibility, and uptake are essential. We therefore evaluated demographic data, antiviral therapy eligibility, and uptake among chronically HBV-infected patients attending at Bugando Medical Centre (BMC), Tanzania. A cross-sectional study enrolled 196 chronic HBV patients from April 23, 2023, to October 10, 2023, at BMC, where 100 and 96 patients were retrospectively and prospectively enrolled, respectively. Study's ethical clearance and permission were observed by the Catholic University of Health and Allied Sciences/Bugando Medical Centre research ethics and review committee and the Bugando Medical Centre management respectively. For all patients, socio-demographic data and whole blood samples were obtained. Full blood picture, alanine and aspartate amino transferases, and HBV viral load parameters were determined. Aspartate-Platelet Ratio Index (APRI) and Fibrosis Four (FIB-4) scores were calculated according to their respective formulas. Therapy eligibility and uptake were evaluated according to the 2015 WHO HBV prevention, treatment, and care guidelines. The data were summarized and analysed using STATA version 15. The median age for all patients was 39 [IQR: 32-47.5] years. Nearly all study patients, 99% (194/196), were older than 20 years old, with significant male dominance (73.5% [144/196] versus 26.5% [52/196]; p<0.0001). Anti-HBV antiviral therapy eligibility was 22.4%, while uptake was 6.8% (3/4), which was significantly lower than the WHO expectation of 80% (p <0.0001). Almost all chronically HBV-infected patients attending at BMC were older than 20 years old and were significantly dominated by males. Antiviral therapy uptake was remarkably lower than expected by the WHO towards combating HBV infection by 2030.

A Certificate-Less Distributed Key Management Scheme for Space Networks

The specificity and complexity of space networks render the traditional key management mechanism no longer applicable. The certificate-less-based distributed spatial network key management scheme proposed in this paper combines the characteristics of space networks, solving the problems regarding the difficulty of implementing centralized key management in space networks and the excessive overhead required for maintaining public key certificates by constructing a distributed key generation center and establishing strategies such as private key updates, master key component updates, and session key negotiation. This method also avoids the key escrow problem inherent in existing identity-based key management schemes. This scheme provides the DPKG construction method for space networks; designs the update strategy for the DPKG node’s master key sharing, providing a specific update algorithm; introduces the batch private key update mechanism; and uses the mapping function to evenly distribute the node’s update requests throughout the update time period, avoiding the problem of overly concentrated update requests. After analysis and simulation verification, it was proven that the scheme can meet the necessary security requirements, offering good stability and scalability.

8104 Rare Case Of Ectopic Cushing’s Syndrome Secondary To Metastatic Parotid Pleomorphic Adenocarcinoma

Abstract Disclosure: B.S. Neutel: None. P. Manroa: None. Background: Pleomorphic adenocarcinoma of the parotid gland is a rare malignancy and ectopic ACTH secretion from these tumors is very rarely described. We report a case of ectopic Cushing’s syndrome (CS) in such a patient and describe the clinical course. Clinical Case: A 69-year-old female with left parotid pleomorphic adenocarcinoma status post surgery and adjuvant radiotherapy presented to her local hospital approximately 7 months after initial treatment with proximal muscle weakness and near-syncope. Workup revealed profound hypokalemia at 1.6 mmol/L (n 3.5-5.3 mmol/L) along with new-onset hypertension (BP 175/110 mm Hg) and hyperglycemia with a HbA1c 6.5 % (n &amp;lt;5.7%), as well as metabolic alkalosis with a bicarbonate level of &amp;gt;40 mmol/L (n 22-32 mmol/L). A CT scan showed multiple liver metastases and a biopsy confirmed metastatic parotid pleomorphic adenocarcinoma. She was then transferred to our comprehensive cancer center for further management. She reported muscle weakness, easy bruising, and facial edema. She denied acne, hirsutism, or abdominal striae. Endocrine workup revealed a random cortisol of 56 mcg/dL (n 3-18 mcg/dL) and ACTH of 378 pg/mL (n 7.2-63.3 pg/mL). Her AM cortisol level remained unsuppressed at 79.2 and 59.4 mcg/dL (n&amp;lt; 1.8 mcg/dL) after 1 mg and 8 mg overnight dexamethasone suppression tests respectively. Late-night salivary cortisol was 7.9 mcg/dL (n &amp;lt;0.112 mcg/dL). An MRI of the sella was negative for any pituitary lesions. After stabilizing her clinical condition and correcting electrolyte abnormalities, she was started on chemotherapy with paclitaxel and carboplatin by the oncologist. Based on clinical suspicion of ectopic CS, ketoconazole was started and titrated upwards with rapid improvement of blood pressure, hypokalemia, and hyperglycemia. She was discharged home and antihypertensives were tapered off. ACTH staining on the liver biopsy was unable to be performed due to paucity of the specimen. A Ga-68-DOTATATE PET CT revealed increased radiotracer uptake in the liver lesion suggestive of SSTR 2 receptor positivity. Despite initial clinical improvement, her disease progressed with widespread liver, lymph node, and osseous metastases within 3 months necessitating escalating doses of ketoconazole, spironolactone, and potassium supplementation. The patient elected to pursue hospice care due to intolerance to chemotherapy and passed away shortly afterward. Conclusion: Although ectopic CS caused by parotid pleomorphic adenocarcinoma is rare, prompt recognition and treatment is necessary because ectopic ACTH production is associated with poor prognosis in these patients. Presentation: 6/3/2024

Conceptualization of student support by university support staff in an open distance e-learning environment

Student support is seen as a necessity to better students’ progress. For students to succeed when studying at a distance, they need a great deal of support to adjust to the institution of higher learning. Independence theory was used as a lens to understand the role of student support staff in providing services to students. A qualitative case study was employed with a purposive sample of sixteen support staff to explore the role of regional academic coordinators, counsellors, centre managers and librarians, referred to as support staff, in supporting students in an open distance e-learning institution and also to determine their understanding of student support. The results reveal that most of the support staff members were aware of their role in contributing to student success in the institution. They indicated that there is a gap between academics and professional staff where a referral system is lacking to fully support and trace students needing support. Support staff seemed to lack marketing skills to inform and attract students to utilize the services. The results further reveal a lack of technological skills among some of the support staff to facilitate online services for students. The study recommends collaboration among all role players in the institution in order to give holistic support to students and to be trained in technological skills to assist students online.

Validation of a Questionnaire for Emotional Leadership in Educational Center Managers

The primary objective of the research was to validate the Emotional Leadership Questionnaire for Training, as proposed by McKee et al. (2008). The study included a sample of 97 school principals. An analysis of the original questionnaire was conducted, which comprises four factors and 25 items. Of these, three items and 13 factors were retained. The results demonstrated an optimal fit of the model and high-reliability indices. This instrument provides a practical self-perception tool to assess emotional leadership, underscoring the importance of empathy, adaptability, and self-knowledge in the training of school principals. The content validity was established through the assessment of 15 experts using Lawshe's formula, which demonstrated the validity of all items and dimensions. The reliability was evaluated through Cronbach's alpha and Omega indices, which yielded values between 0.77 and 0.86 and between 0.79 and 0.87, respectively. These results indicate high reliability for all factors. Construct validity was confirmed through confirmatory factor analysis.

Evaluation of a new classification system for measuring the progression of ocular cystinosis: an analysis of 64 patients

AimsTo analyse the correlation between the physician categories defined by the 3C classification (crystal-complication-compliance) and the ocular manifestations of nephropathic cystinosis.MethodsThe last visit data of 64 patients aged between 2...

Metastatic Malignant Pseudomyogenic Hemangioendothelioma: An Exceedingly Rare Entity That Challenges Conventional Paradigms.

Pseudomyogenic hemangioendothelioma (PMHE), a rare soft tissue tumor predominantly affecting young adults, often presents as multiple nodules in various tissue planes of a limb. Malignant transformation and metastatic disease are unusual and pose diagnostic and therapeutic challenges. A 17-year-old patient from Western India, with a history of recurrent excisions for a toe swelling presented to our center for evaluation and management. A below-knee amputation was performed, and histopathology revealed PMHE. Adjuvant therapy was deemed unnecessary given the borderline nature of the tumor. Shortly thereafter, he developed features of local recurrence and underwent above-knee amputation. An expert histopathological review confirmed the diagnosis and noted features of malignant transformation-progression to a higher grade with greater cytological atypia, confluent growth, and increased mitotic activity over time. Upon further distant progression in the lung, he was started on a palliative regimen of weekly paclitaxel, vinblastine, and propranolol but eventually succumbed to his illness. In contrast to conventional descriptions of low mitotic activity, minimal nuclear atypia, and absence of necrosis, our patient exhibited increased mitotic rates, nuclear atypia, and evolving necrosis in serial histopathological evaluations. The fulminant clinical progression within a short interval was also atypical. Our patient's clinical course underscores the need for meticulous histopathological and molecular characterization and vigilant clinical surveillance after resection in patients with PMHE. Providing the standard of care for malignant disease in the adjuvant setting is challenging owing to the rarity and the lack of treatment guidelines.