Management Challenges Research Articles

Pain Management in Pediatrics: What the IR has to Offer.

Pediatric pain management presents unique challenges due to the intrinsic characteristics of children such as their developmental stages, communication barriers, and varying pain perceptions. Life-limiting conditions affecting children are a growing medical concern, requiring a comprehensive, multidisciplinary approach to improve quality of life or ensure a dignified end of life. Interventional radiology (IR) plays a critical role in this strategy, similar to its role in adult care. Not only life-limiting conditions pose a challenge in pediatric chronic pain management, but also other benign chronic diseases (e.g., cystic fibrosis, muscular dystrophy, neurodegenerative disorders, metabolic disorders). This review focuses on specific IR strategies for pediatric pain management, including ablation, embolization/chemoembolization, and nerve blocks. It emphasizes the importance of tailored approaches for pediatric patients, considering genetic disorders and oncological diseases, which may require a diverse range of IR treatments. The aim is to provide a summary of these interventional techniques and highlight the unique considerations necessary for effective pediatric pain management.

Resource Management Challenges in Rural Dermatological Care: A Mapping Review

Resource Management Challenges in Rural Dermatological Care: A Mapping Review

Modern soccer industry management and current challenges: systematic literature review

Introduction: Soccer is known as the "global game" because it is very popular in many parts of the world. Numerous studies have been conducted in different parts, segments, and levels of the soccer industry. However, the findings are inconclusive, unidirectional, and contradictory. Objective: to analyze contemporary soccer industry management practices, challenges, and future perspectives in the football industry. Methodology: A systematic literature review was used. 540 articles were initially recorded from Google Scholar, SCOPUS, and JSTOR databases. Through inclusion and exclusion criteria, 83 published materials that met the inclusion criteria were thematically analyzed. Results: The findings reveal that a global outlook with fidelity to local roots, changing commercial partnerships, a changing media landscape, cultural aspects in the football playground, and game attractiveness are major patterns identified in globalization and its development. In particular, specific rules and regulations, the nature of competition, ownership, leadership, and governance are also current variants in the management of soccer Discussion: Therefore, these are crucial ingredients for understanding the future dynamics of global soccer and represent challenges and dilemmas for the industry. Conclusions: As a result, a massive or single research study on the current practices, issues, and possibilities of the modern soccer industry at the local, sub-regional, continental, and international levels is feasible.

Biofloc technology significantly reshapes water microbiome and improves survival rates in Japanese eel (Anguilla japonica).

This study is significant as it addresses a critical gap in the application of Biofloc Technology (BFT) to Japanese eel (Anguilla japonica) aquaculture, a high-value species in East Asia. BFT's potential to reduce water consumption and enhance growth through the use of beneficial microorganisms presents a sustainable solution to the challenges of nitrogenous waste management in global aquaculture. Our research provides the first comprehensive analysis of how BFT influences both the growth and microbiome composition of Japanese eels compared with traditional flow-through systems. By identifying specific microbial residents potentially linked to improved feed consumption and growth, this study opens new avenues for optimizing BFT in eel farming. The findings contribute to the broader understanding of microbial roles in aquaculture, highlighting the potential for BFT to support more sustainable and productive aquaculture practices.

An Intelligent Fuzzy-Based Routing Protocol for Vehicular Opportunistic Networks

Opportunistic networks are characterized by intermittent connectivity and dynamic topologies, which pose significant challenges for efficient message delivery, resource management, and routing decision-making. This paper introduces the Fuzzy Control Routing Protocol, a novel approach designed to address these challenges by leveraging fuzzy logic to enhance routing decisions and improve overall network performance. The protocol considers buffer occupancy, angle to destination, and the number of unique connections of the target nodes to make context-aware routing decisions. It was implemented and evaluated using the FuzzyC framework for simulations and the opportunistic network environment simulator for realistic network scenarios. Simulation results demonstrate that the Fuzzy Control Routing Protocol achieves competitive delivery probability, efficient resource utilization, and low overhead compared to the Epidemic and MaxProp protocols. Notably, it consistently outperformed the Epidemic protocol across all metrics and exhibited comparable delivery probability to MaxProp while maintaining significantly lower overhead, particularly in low-density scenarios. The results demonstrate the protocol’s ability to adapt to varying network conditions, effectively balance forwarding and resource management, and maintain robust performance in dynamic vehicular environments.

Anesthetic Management of Renal Tumor with Level 3 Inferior Vena Cava Extension at a University Hospital in Vietnam: A Case Report

Background: Renal tumors with inferior vena cava (IVC) invasion pose significant challenges for surgical and anesthetic management. This report presents the anesthetic management of a patient with a level 3 IVC-invading renal tumor, emphasizing the complexity and multidisciplinary approach required. Case Presentation: A 55-year-old woman with a large left renal tumor causing complete obstruction of the left renal vein and near-total obstruction of the IVC was admitted for surgery. Multidisciplinary planning included a nephrectomy with removal of tumor from the IVC. The patient underwent general anesthesia with extensive hemodynamic monitoring and fluid management to mitigate potential blood loss and cardiovascular instability. The surgery, lasting 5 h, involved successful radical nephrectomy, tumor removal from the IVC, and resection of liver metastases. Postoperative recovery was without complications, and the patient was discharged 7 days. Conclusion: Managing anesthesia for renal tumors with IVC invasion requires careful preoperative planning, invasive monitoring, and multidisciplinary approach.

Application of Artificial Intelligence in Healthcare: Trends, Challenges in Disease Diagnosis and Management

This study thoroughly reviews the status of applications of artificial intelligence (AI) in healthcare, trends regarding AI usage for different disease types and problems that hamper their further progress. The study used a literature review and data analysis by locating relevant current articles on AI in healthcare through the PubMed database. The work analyzes AI use in cancer, cardiovascular diseases and neurological disorders as well as the bottlenecks in the real-world deployment of healthcare. The findings of the study indicate that, while AI has demonstrated the potential to improve diagnostic precision, several obstacles persist in relation to data privacy, ethical considerations, and model interpretability. In conclusion, this review offers an assessment of the current state of AI applications in healthcare and identifies key areas of concern that necessitate further investigation. By addressing these challenges, future innovations can be more effectively developed and broadly implemented, ultimately contributing to the advancement and optimization of AI-driven healthcare solutions

Key insights into recent advances and challenges in COVID-19 management

Key insights into recent advances and challenges in COVID-19 management

Intrathecal Baclofen Pump Wean and Risk of Exposure in a Large TBSA Burn Wound Patient: A Case Report.

Burn injuries in patients with significant pre-existing medical conditions provide unique challenges in both medical management and surgical planning. Spasticity, if left untreated, can be one of the most disabling consequences of a neurologic injury. Treatment is largely dependent on pharmacologic management with anti-spasmodic agents such as baclofen. Baclofen's effectiveness when taken orally is often limited by its systemic side effects, which mostly affect the central nervous system (CNS). Intrathecal baclofen (ITB) can circumvent these intolerable adverse effects while achieving symptom relief via a more targeted therapeutic route. However, abrupt cessation of chronic baclofen use can precipitate an acute life-threatening withdrawal syndrome. We present a case of a 47-year-old female who sustained 54% total body surface area (TBSA) full-thickness flame burns to the circumferential bilateral lower extremities, left arm, left anterior and posterior trunk, flank, and perineum. She had a pre-morbid C5 spinal cord injury resulting in spastic paraplegia for which she had an ITB pump implanted into her left abdominal wall for symptom management. This pump was directly beneath her operative burn wounds. We discuss the complex issues that were encountered throughout her care related to medication reservoir supply, life-threatening risk of baclofen withdrawal, pain-specialist availability, medical-legal barriers, and the multi-staged surgical plan for coverage, balancing proper wound debridement with risk of device exposure and infection. To our knowledge, this is the only case report detailing the cohort of obstacles that may be associated with these devices, specifically with burn patients.

A bibliometric analysis of the economic effects of using artificial intelligence and ChatGPT tools in higher education institutions

One of the main challenges in higher education management is the complexity of resource optimization and increasing volumes of data, which limits the efficiency and accuracy of decision-making. The application of artificial intelligence can address these issues.The present study aims to identify the key trends, knowledge gaps, and opportunities for further research into the economic effects of using artificial intelligence and ChatGPT tools in higher education. For this purpose, a systematic literature review was conducted to identify and screen the scientific articles related to the topic of this study indexed in Web of Science and Scopus from 1986 to 2024. A total of 234 articles were selected, all demonstrating positive growth both in scholarly output and citation count. The study identified the key contributors to scientific research on this topic by region (the United States, China, and India). It concluded that the relevant research centers are still at an early stage of their development. Based on bibliometric clusters formed by co-occurrence relations, three main areas of research were defined: 1) artificial intelligence in education for decision-making; 2) process automation and digital transformation in educational institutions; 3) artificial intelligence technologies and their application in education. The study highlights the main areas of economic effects of artificial intelligence and ChatGPT tools in higher education, including reducing administrative costs, saving time for teachers and students, and improving the quality and accessibility of educational process. AcknowledgmentsThe publication is part of the research topic “Economic Basics of Technology Diffusion into the National Economy of Ukraine Considering Best International Practices” (№0124U003482).

A prehospital protocol for geriatric agitation

Approximately 10% of geriatric patients (adults over the age of 65) transported via ambulance will have a mental status altered from baseline, otherwise known as delirium. Many of these patients will be agitated, posing a management challenge for EMS practitioners. Existing protocols for delirium in the pre-hospital setting were designed for younger adults, who have different etiologies and different levels of tolerance for medications than most older adults. ED-based protocols have already been created to aid in the treatment of patients with this condition. Yet, their applicability is limited, as many involve elaborate diagnostics not available in the prehospital environment. Furthermore, many protocols recommend using medications that are not recommended for older adults. Thus, we created an evidence-based protocol for the prehospital evaluation and treatment of agitated geriatric patients. Our protocol puts specific emphasis on safely avoiding unnecessary administration of and/or high dosages of psychotropic medications. We also emphasize practical management, including non-pharmacologic treatment of this condition in older adults.

Anaesthestic and airway management challenges in pediatric sclerothearpy for upper airway vascular malformation: A case report

Anaesthestic and airway management challenges in pediatric sclerothearpy for upper airway vascular malformation: A case report

Spatial Configuration of Market Spaces: Accessibility and Management Challenges in Bamenda City, Cameroon

Market spaces are fundamental to urban life in Cameroon, serving as key centers for commerce, social interaction, and cultural exchange. However, rapid urbanization has intensified challenges related to the spatial placement and organization of markets, particularly in Bamenda. Poor infrastructure, congestion, spatial disorganization, and inadequate parking facilities hinder accessibility and affect the efficiency of market operations. These challenges not only limit economic activities but also create difficulties for vendors, customers, and other stakeholders who rely on these markets for daily sustenance and business. The research problem centers on the inefficient spatial arrangement and poor management of market spaces in Bamenda, which contribute to accessibility constraints, safety concerns, and overall dissatisfaction among market participants. This study, therefore, aims to examine the spatial location, layout, and design of major markets in Bamenda, including Bamenda Main Market, Nkwen Market, Food Market, and Ntarikon Market. It seeks to analyze how these spatial characteristics impact accessibility and functionality, as well as to identify the major challenges faced by market participants. To achieve these objectives, the study employs both qualitative and quantitative methods, including informant interviews and the administration of 324 questionnaires to vendors, customers, and shop owners. Spatial analysis mapping is utilized to assess market locations, layouts, and proximities, providing a comprehensive understanding of their spatial organization. The findings indicate that congestion, narrow pathways, inadequate infrastructure, and unregulated market expansion significantly impede accessibility and market efficiency. Given these challenges, the study strongly advocates for the effective implementation of Bamenda’s proposed Master Plan to regulate urban spaces, particularly market infrastructure. Additionally, the proper execution of the Plan of Soil Occupation (POS) is recommended to address the haphazard arrangement of market stalls and control illegal market operations.

Peningkatan Produktivitas dan Manajemen Bisnis UMKM Kebab Vrindavan Mbaknyen melalui Teknologi Inovatif

Vrindavan Mbaknyen Kebab MSMEs are one of the business units that have great potential to grow but face challenges in productivity and business management. This service program aims to increase the productivity and business management of these MSMEs through the application of innovative technology. The methods used include needs analysis, training on the use of supporting technology, and assistance in the implementation of technology in daily operations. The results of the program showed an increase in the efficiency of the production process by 30%, as well as improvements in the financial management and inventory system. In addition, MSMEs have succeeded in increasing market reach using digital platforms. In conclusion, the application of innovative technology can improve the productivity and competitiveness of MSMEs effectively. This program is expected to be a model that can be replicated in other MSMEs to support local economic growth.

Invading and range-expanding pink salmon inform management actions for marine species on the move

Abstract Species redistributions, whether resulting from invasions or range expansions, pose similar challenges for conservation and management. Redistribution impacts on host ecosystems and species combine with those from climate change, which are already acute at northern latitudes. Using pink salmon Oncorhynchus gorbuscha, which are native to the Pacific Ocean, we employ knowledge exchange to inform decision-making in non-native marine areas: they are expanding their range to the Arctic Ocean and are invasive in the Atlantic Ocean. The predicted future marine distribution of pink salmon focuses effort on where and when pink salmon are present and informs on potential interactions with native species. Management actions taken in the Atlantic Ocean to reduce invasive pink salmon are resource-intensive, but removed salmon could be a food resource. Addressing identified gaps regarding the invasion potential of pink salmon, interactions among pink salmon and other species, and current mitigation efforts would support forward-thinking management decisions given predictions of continued environmental change. We also highlight steps that can be taken immediately to coordinate actions and better inform responses. Managed for production in the Pacific and as an invasion in the Atlantic, pink salmon provide a tangible approach to informed decision-making through collaboration for marine species on the move.

3D Printing as an Aid in Acetabular Defects Compared to Established Diagnostics - a Survey.

The treatment of acetabular defects in revision arthroplasty is an increasing challenge. Different classifications have been introduced for preoperative planning to achieve the best possible result. 3D printing is a way to better visualize and understand these defects. The aim of this study was to facilitate classification, provide young doctors with a better understanding of complex defects, and ultimately improve preoperative planning and patient safety.The study was conducted at the 2022 BOUT congress, where health care professionals were provided with X-rays, a computed tomography (CT) scan, and a 3D print to classify acetabulums according to Paprosky and ADC. A questionnaire was administered to gather information on their familiarity with the classification systems and perception of 3D models in the clinic.The study involved 14 participants, mostly resident physicians, with some familiarity with the Paprosky and ADC classifications. The 3D printing method resulted in the highest rate of correct classifications for acetabular defects compared to X-ray and CT imaging. Participants found the 3D model useful for clinical applications and rated it higher than X-ray and CT imaging for classifying acetabular defects.Acetabular defects present a challenge in assessment, preoperative planning, and surgical management due to their complex anatomy. Overall, we were able to show that the use of a 3D model increases the accuracy in the classification of acetabular defects. The use of 3D printing in orthopedics and trauma surgery is showing more and more advantages and has opened up new methods for the education of medical students and young surgeons.

A case of anti-muscle specific kinase myasthenia gravis in pregnancy with neuromuscular respiratory failure mimicking preeclampsia

Introduction: This report discusses a rare case of antimuscle specific kinase (MuSK) positive myasthenia gravis (MG) during pregnancy, presenting with respiratory failure mimicking preeclampsia with severe features. Case Report: A 29-year-old primigravida presented to triage at 36 weeks with symptoms of dyspnea, orthopnea, and tachypnea necessitating cesarean delivery. Postpartum she developed neuromuscular respiratory failure leading to multiple re-intubations. Multi-system testing ultimately revealed anti-muscle specific kinase (anti-MuSK) positive serotype. Conclusion: Despite the challenges in diagnosis and management, interdisciplinary collaboration and long-term follow-up were emphasized. Teaching points highlight the need to consider autoimmune disorders in peripartum cardiopulmonary exacerbations. The case prompts further investigation into the physiologic implications of concurrent new-onset myasthenia gravis and preeclampsia.

Probiotic Therapy as an Adjuvant in the Treatment of Periodontal Disease: An Innovative Approach.

Background and Objectives: Periodontal inflammation, often linked to oral microbiota dysbiosis dominated by pathogenic bacteria, remains a significant challenge in periodontitis management. Traditional periodontal therapies primarily reduce the bacterial load but fail to restore the microbiota balance. Probiotics offer a promising therapeutic adjunct with their ability to enhance beneficial bacteria. This study investigates the effects of probiotics on the oral microbiota, inflammatory markers (IL-1β, TNF-α), and clinical parameters (gingival index, bleeding index, and periodontal pocket depth). Materials and Methods: In this pilot study, 80 patients with moderate-to-severe periodontitis were assigned to two groups. Group A received standard periodontal therapy (non-surgical periodontal therapy (NSPT)) with probiotic supplementation (Lactobacillus reuteri, 2 × 10⁹ CFU daily for 8 weeks), and Group B received standard treatment with a placebo. Microbiological changes were assessed via quantitative PCR, while inflammatory markers (IL-1β, TNF-α) were analyzed using ELISA. Clinical parameters, including the gingival index (GI), bleeding index (BI), and periodontal pocket depth (PPD), were measured at baseline (T0), 4 weeks (T1), and 8 weeks (T2) using standardized methods. Results: Probiotic therapy (Group A) significantly reduced the pathogenic bacteria and increased the beneficial bacteria levels compared to the placebo (p < 0.01). Inflammatory markers decreased by 37% (IL-1β) and 42% (TNF-α), while clinical parameters improved, with reductions in the gingival and bleeding indices (-1.5, -1.3) and a 2 mm decrease in the periodontal pocket depth (p < 0.01). Conclusions: Probiotics, as an adjunct to periodontal therapy, effectively restore the microbiota balance, reduce inflammation, and improve clinical outcomes in periodontitis.

Adaptive Energy Management Strategy for Sustainable xEV Charging Stations in Hybrid Microgrid Architecture

Integrating electric vehicles (EVs) into power grids presents critical energy management challenges, especially in microgrid systems powered by renewable energy sources. This study introduces a novel energy management strategy for EV charging stations utilizing an Adaptive Neuro-Fuzzy Inference System (ANFIS) controller. The system dynamically optimizes the coordination of renewable energy sources solar photovoltaic (PV) panels and wind turbines energy storage, and EV chargers. By leveraging real-time data and predictive algorithms, the ANFIS controller adapts to fluctuations in energy supply and demand, ensuring optimal performance. The innovation of this work lies in combining fuzzy logic with neural network-based learning to enhance decision-making under uncertain and variable renewable energy conditions. The proposed approach employs a robust design methodology, integrating neural network training with fuzzy logic system development, to create an adaptive and intelligent control system. Simulation results using MATLAB/Simulink demonstrate a 92% increase in energy efficiency and an 89% enhancement in load-handling capacity compared to conventional methods. The system effectively manages renewable energy variability, battery state-of-charge, and load demand, maintaining stable electrical characteristics even under dynamic wind and solar conditions. This work underscores the importance of advanced AI-driven control strategies in enabling sustainable EV charging infrastructure within microgrid environments.

Keyhole decompression surgery for holospinal epidural abscess: a novel approach for spinal stability preservation.

Spinal epidural abscesses are rare yet serious conditions, often necessitating emergency surgical intervention. Holospinal epidural abscesses (HEA) extending from the cervical to the lumbosacral spine are even rarer and present significant challenges in management. This report aims to describe a case of HEA with both ventrally-located cervical and dorsally-located thoracolumbar epidural abscesses treated with a combination of anterior keyhole decompression and posterior skip decompression surgeries. A 73-year-old woman with diabetes and hypertension presented with severe neck and back pain, fever, and a marked increase in leukocytes (29980/µL) and C-reactive protein (CRP; 24.26mg/dL) levels. Magnetic resonance imaging revealed epidural abscesses extending from the cervical to lumbar spine, confirming the diagnosis of HEA. At the cervical lesion, spinal cord was compressed by ventrally-located epidural abscess. Due to the patient's poor general condition, conservative treatment was initially pursued, followed by surgical intervention targeting the most severely compressed spinal segments. Managing ventrally-located epidural abscesses poses greater challenges. In this patient, a novel anterior keyhole decompression surgery was employed to evacuate the ventrally-located cervical epidural abscess while preserving intervertebral discs and endplates. Posterior skip decompression surgery was performed, successfully reducing thoracolumbar epidural abscesses. Subsequently, anterior keyhole decompression was performed to evacuate ventrally-located epidural abscess, preserving intervertebral discs and endplates. Postoperatively, the patient's symptoms improved, and leukocyte count and CRP gradually normalized. Follow-up imaging showed resolution of the abscesses and bone remodeling within the keyhole without evidence of spinal instability and postoperative kyphosis. Management of HEA poses significant challenges, particularly in cases with ventrally-located cervical epidural abscesses. Our case highlights the efficacy of a combined surgical approach involving anterior keyhole decompression and posterior skip decompression in achieving abscess drainage and preserving spinal stability. This novel technique offers advantages over existing methods by preserving intervertebral motion and minimizing the risk of postoperative kyphosis. Further studies are warranted to validate the long-term outcomes and generalizability of this approach.