Management Challenges Research Articles

Advanced thermoconversion technology for municipal solid waste energetic valorization

This paper presents a novel approach to tackle the dual challenges of energy scarcity and municipal solid waste management by exploiting the potential of municipal solid waste gasification. The performance of the modified updraft gasifier is evaluated using computational modeling with Aspen Plus V14 software. The reliability of the gasification model is confirmed by comparing it with experimental data, highlighting its accuracy in estimating key gas composition parameters. A detailed analysis of the percentage error between the gas's experimentally measured lower heating value and the model-estimated value is performed. Results show a 12.2 % error for municipal solid waste gasification, meaning the experimental lower heating value is higher than the model's estimation. On the other hand, a 27,2 % error is observed for pellet gasification, implying a lower experimental lower heating value than the model's estimation. These findings provide useful information for future optimization and improvement of the gasification process, further advancing the field of waste-to-energy conversion and promoting sustainable energy generation.

Challenges in diagnosis and management of silent corticotroph adenomas: insights from three case studies and literature review

Challenges in diagnosis and management of silent corticotroph adenomas: insights from three case studies and literature review

Endovascular and percutaneous embolization of a giant post traumatic arteriovenous fistula of inferior epigastric vessels

BackgroundArteriovenous fistulas involving the anterior abdominal wall can result from trauma. Such fistulas may remain asymptomatic and undetected for a prolonged duration of time. They tend to recruit multiple arterial feeders with remodelling in the feeding arteries, making them challenging to treat.Case presentationWe discuss a rare case of a 60-year-old male who presented with complaints of a progressive painless swelling in right lower abdomen. There was a history of blunt injury to abdomen at the same site during alleged road traffic accident 3 years ago. On CT angiography, an arteriovenous fistula was localised to the anterior abdominal wall arising predominantly from the right inferior epigastric artery with a giant venous sac and terminating as a tortuous single venous channel into the right external iliac vein. Few other small feeders were also seen arising from branches of right superior epigastric artery along Winslow’s pathway. The main challenge in endovascular management of this patient was embolization of a high flow shunt with a large venous sac and multiple arterial feeders. The dominant arterial feeder was embolized using vascular plug. The superficial location of the lesion offered an additional percutaneous window besides endovascular approach. The venous sac was percutaneously accessed and embolized using n-butyl cyanoacrylate after balloon occlusion of outflow vein. On follow up ultrasonographic evaluation at 3 months, near complete thrombosis of the venous sac was achieved.ConclusionsTraumatic arteriovenous fistulas involving the inferior epigastric vessels are rare clinical entities. CT angiogram and digital subtraction angiography help in the optimal diagnosis and treatment planning. The use of mechanical embolization devices to cause flow arrest offers an opportunity to use liquid embolic agents which offer better percolation within the lesion. Interventional radiology offers an ideal management of these complex high flow fistulas with a good technical success and acceptable safety profile.

Lay of the (wet)land: manager practices and challenges in wetland revegetation

Despite providing essential ecosystem services, wetlands are one of the most threatened ecosystems worldwide. Revegetation of wetlands is a critical aspect of restoring ecosystem services, yet little is known about common practices, the challenges managers face, or what resources they require to improve revegetation outcomes. We assessed current revegetation practices, obstacles, and potential solutions by surveying wetland managers in the Intermountain West of the United States, a vast, ecologically diverse region containing hundreds of millions of hectares of public lands. Survey results indicate that managers revegetate wetlands for erosion control, invasion resistance, enhanced wildlife habitat, and improved water quality despite small budgets and limited personnel. Drought, invasive species, and the timing and availability of water are the biggest ecological challenges that managers face and point to the need to prioritize wetland revegetation research to improve revegetation practices in a changing climate with dwindling water resources. Additionally, access to genetically‐ and species‐diverse native plant materials is a concern for many managers. To address these challenges, managers need additional financial and human resources, accessible information relating to revegetation methods, and greater collaboration with research institutions and native plant vendors. Our findings underscore the need for funding entities to prioritize money for wetland revegetation efforts, a natural resource management area that has been neglected relative to many other ecosystems. The results of this study provide insight into challenges and potential solutions for wetland revegetation in regions of the world, such as the western United States, where increasing water scarcity threatens wetlands and their restoration.

The spectrum of movement disorders in young children with ARX-related epilepsy-dyskinesia syndrome.

Children with developmental and epileptic encephalopathies often present with co-occurring dyskinesias. Pathogenic variants in ARX cause a pleomorphic syndrome that includes infantile epilepsy with a variety of movement disorders ranging from focal hand dystonia to generalized dystonia with frequent status dystonicus. In this report, we present three patients with severe movement disorders as part of ARX-associated epilepsy-dyskinesia syndrome, including a patient with a novel pathogenic missense variant (p.R371G). These cases illustrate diagnostic and management challenges of ARX-related disorder and shed light on broader challenges concerning epilepsy-dyskinesia syndromes.

Indigenous Water Engineering and Aquaculture Systems in Australia: The Budj Bim Cultural Landscape and Baiame’s Ngunnhu (the Brewarrina Aboriginal Fish Traps)

In Australia, First Peoples have practiced sustainable forms of water management for millennia. They have done so by respectfully caring for Country through their use of engineering and maintenance processes, including sophisticated fish and eel trapping structures and weir systems. Some of the largest continuing sites of water engineering and aquaculture in the world are still visible and used by local Aboriginal groups – the Budj Bim in Victoria and Baiame’s Ngunnhu (Brewarrina Aboriginal fish traps) in New South Wales (NSW). Recent scholarship and successful heritage listings, including the World Heritage listing of the Budj Bim Cultural Landscape and work by and with traditional custodians in these river systems, are starting to bring into public discourse and knowledge these sophisticated and important places of global cultural significance. The principles used in the design of these systems, and the social and environmental contexts of their maintenance and convening power over millennia, are particularly important as we navigate new technologically mediated forms of water management today and into the future. These management challenges include communities in Australia and globally working on the importance of significant places, values, rights, justice and voice for Indigenous peoples in building sustainable futures, including through innovation and safe, sustainable and responsible cybernetic approaches to water governance and the SDGs.

Challenges in Diagnosis and Management of Recurrent Uterine Arteriovenous Malformation: A Case Report

Challenges in Diagnosis and Management of Recurrent Uterine Arteriovenous Malformation: A Case Report

The Effects of Organizational Inertia and Dynamic Capability on Firm Performance: Business Model Innovation as a Mediating Variable at Small Industry of Rendang in West Sumatera

This study aims to explore the knowledge management challenges faced by Rendang IKMs in the context of organizational inertia as a barrier and unordinary competencies as antecedents to achieving superior performance in the domestic and global markets. At the same time, know the role of business model innovation in relation to the performance of the IKM business. The research analyzed data from 105 IKM Rendang in West Sumatra and found that despite being in a state of stagnation or inertia, these businesses can still generate profits. However, inertia must still be minimized by innovating. Meanwhile, the unordinary capability (dynamic capability) that dominates rendang entrepreneurs is absorptive capability, indicating that while SMEs have enough knowledge to understand tastes and market conditions, they struggle to transform this knowledge into viable companies. Business model innovation plays a vital role in reducing company stagnation and enhancing dynamic capabilities in implementation. Moreover, it can mitigate the risk of innovation failure, a fear often faced by rendang entrepreneurs, and provide space for converting knowledge into effective strategies and products

Priorities and potential challenges of sustainable management of ultra-deep groundwater resources in Iran

The water crisis in Iran, and the large share of water allocated to the agricultural sector from groundwater resources has led to access to ultra-deep groundwater (UDGW) resources. Exploration projects have confirmed the presence of UDGW sources of fault origin in Iran. Deciding on the sustainable extraction of UDGW resources is very challenging. In order to better understand the scope and nature of the UDGW literature, our research combines a methodological framework of systematic literature review with an approach to synthesize manifest and latent content. Additionally, we describe expert predictors for and against inductive content analysis, which extracts necessary concepts, priorities, organization, and coding from the data. MFA tool has analyzed sustainability indices, compositions, correlations perceptual behavior of sustainability dimensions of groups in the variables predicting the exploitation of UDGW. In the proposed model, the synthetic index has determined weighting commensurate with the variability of data, to balance the effect of groups of variables. The most important dimensions of sustainability are Proxy/flexibility measures (69.4), Fund (63.3), Safety (63.2) and Extent and possibility of access and exploitation (63.06) of UDGW resources from engineering, social and environmental groups, respectively. However, the performance of Evaluation of quantity and quality of UDGW resources (39.8) and Fairness (42.3) groups were the lowest due to the environmental and social sustainability, respectively. In fact, a fair and sustainable expedient strategy and a restructuring of hydro-social networks that clearly acknowledge the political aspect of resource management and its intricacies are required. The ministry and the UDGW decision-makers themselves must solve these shortcomings.

The Source-to-Sea Landscape: A hybrid integrative territory management approach

Whether fresh or salty, water is a unique resource, a continuum interlinked by the hydrological cycle. It forms a complex system connected to the landscape. When the landscape is altered, water flows and their benefits are impacted. Degraded land compromises water resources. The governance and management of landscape and water resources are handled in a fragmented manner and in separate contexts. The Source-to-Sea approach offers an integrative vision based on systems thinking that focuses its concerns on the interaction among parts, flows, and processes. It proposes a framework for the governance and management of freshwater and marine water but does not bring the landscape into the context of the approach. This research used an analytical-deductive method to explore the interactions and connections between the Source-to-sea approach, landscape concepts and approaches, and the guidelines of the European Landscape Convention. The main objective was to identify and assess the feasibility of integrating these elements. The integration resulted in a governance and management approach termed the S2S Landscape approach. It is grounded in systems thinking, practical learning, active participation, and adaptive governance and management, providing an integrated vision between landscape and water. The approach includes four essential steps (Comprehension, Involvement, Planning, and Execution and Monitoring) that address the complex connections that freshwater and marine water maintain in the landscape, considering physical, biological, socio-environmental, and economic aspects across all segments, from the land to the open sea. This S2S Landscape approach may be the path to address the challenges of governance and sustainable management of resources in an interconnected and constantly changing world.

Bmi1 facilitates the progression of cholangiocarcinoma by inhibiting Foxn2 expression dependent on a histone H2A ubiquitination manner

Cholangiocarcinoma (CCA), an exceptionally aggressive malignancy originating from the epithelium of the bile duct, poses a formidable challenge in cancer research and clinical management. Currently, attention is focused on exploring the oncogenic role and prognostic implications associated with Bmi1 in the context of CCA. In our study, we assessed the correlation of Bmi1 and Foxn2 expression across all types of CCA and evaluated their prognostic significance. Our results demonstrated that Bmi1 exhibits significantly upregulated expression in CCA tissues, while Foxn2 expression shows an inverse pattern. Simultaneously, the high expression of Bmi1, coupled with the low expression of Foxn2, indicates an unfavorable prognosis. Through in vitro and in vivo experiments, we confirmed the crucial role of Foxn2 in the proliferation, metastasis, and epithelial-mesenchymal transition (EMT) of CCA. Mechanistically, Bmi1 promotes the ubiquitination of histone H2A (H2AUb), leading to chromatin opening attenuation and a decrease in Foxn2 expression, ultimately driving CCA progression. Additionally, we described the potential value of Bmi1 and H2AUb inhibitors in treating CCA through in vitro experiments and orthotopic models. This study is of significant importance in deepening our understanding of the interaction between Bmi1 and Foxn2 in CCA and has the potential to advance the development of precision therapies for CCA.

Valuation of Internet of Energy (IoE) Platforms in Smart Cities: A Hybrid Multi-Criteria Decision Making Approach

A smart city is a place where people live using computing, sensing, and networking technology in a variety of ways, including smart buildings, smart homes, smart transportation, smart workplaces, smart offices, smart industries, and smart agriculture. These smart technologies need to connect so; we need to use the Internet of Things (IoT) that has applications in many areas of our smart lives. IoT has been used due to the growing usage of renewable energy sources and the challenges of network management. Internet of Energy (IoE) integrates the IoT and smart grid capabilities. The basic role of smart grids or IoE is an essential element in creating smart cities. In this work, we present some IoE platforms that represent the alternatives and their criteria. The proposed study treats the uncertainty of multi-criteria decision-making (MCDM) modified by single value triangular neutrosophic number (SVTrN) by choosing the optimal IoE platform based on the criteria importance through inter-criteria correlation (CRITIC) method and multi-attributive ideal-real comparative analysis (MAIRCA). The proposed model proved its effectiveness by applying it to an experimental case. The results show that the DCC (A3) platform is the best one.

Rhythm Disorders in Pulmonary Arterial Hypertension (PAH) - What Therapeutic Options are Available?

Rhythm disorders in PAH are rare. In practice, they pose a therapeutic management challenge. Right ventricular dysfunction associated with hypoxia influences the prescription of antiarrhythmics; some of them are even contraindicated. We report three cases of idiopathic PAH complicated by atrial flutter (2 cases) and atrial fibrillation (1 case). The patients experienced right heart failure after a stabilization phase with specific vasodilators (bosentan, sildenafil, iloprost). They were treated with oral amiodarone, alongside treatment for right heart failure. Potassium levels were normal. Beta-blockers were not prescribed due to severe right ventricular dysfunction with arterial hypotension. Unfortunately, two patients developed hyperthyroidism secondary to amiodarone. Through these observations, we will discuss the different therapeutic options in these situations, referencing the literature.

Deriving ecological risk thresholds for soil molybdenum in China based on interspecies correlation estimation and quantitative ion character–activity relationship models

Soil molybdenum (Mo) levels can reach ecologically hazardous levels. China has not yet established the relevant thresholds, posing challenges for environmental management. Therefore, we present our data relevant to Mo toxicity for several important species. By normalizing soil properties, we obtained a correlation model of Mo toxicity to Hordeum vulgare, as well as 31 models for the toxicity of other elements including Cu and Ni to invertebrates and microbial processes. Using interspecies correlation estimation (ICE) extrapolation, the sensitivity coefficient (0.12–0.71) for five plants were found. For invertebrates and microbial processes lacking Mo data, we used regression analysis to establish Mo toxicity models based on the soil quantitative ion character–activity relationships (s–QICAR; R2 =0.70–0.95) and known toxicities of other metal elements to invertebrate and microbial processes. Furthermore, combining species sensitivity distribution calculations, the HC5 values for protecting 95% of soil species from Mo in three typical soil scenarios in China were calculated. After correction, the predicted no-effect concentrations were 6.8, 4.8, and 3.4 mg/kg, respectively. This study innovatively combined ICE and s − QICAR to derive soil Mo thresholds. Our results can provide a basis for decision-making in the assessment and management of soil Mo pollution.

Clinical diagnosis of Fat embolism syndrome with septic shock following polytrauma: A case report

Introduction and importance: Fat embolism syndrome (FES) arises from the systemic effects of fat emboli in microcirculation, while sepsis is characterized by pathological, physiological, and metabolic abnormalities caused by infection. Septic shock is identified by elevated blood lactate (>2 mmol/L) and the need for vasopressors to maintain a mean arterial pressure of 65 mm Hg or higher in the absence of hypovolemia.1 Case presentation: This case report discusses the clinical course and treatment of a 50-year-old male involved in a road traffic accident resulting in polytrauma. The patient presented with multiple fractures, hemopneumothorax, lung contusions, and rib fractures. He was then stabilized following which fractures were reduced and managed operatively. Postoperatively, the patient developed FES with septic shock, manifested by altered consciousness, petechial rashes, and respiratory distress. He was managed with intubation, chest drainage, and a combination of antibiotics, anticoagulants, and vasoactive agents. Tracheostomy was performed due to respiratory insufficiency. Following 29 days in the SICU, the patient’s condition was stabilized and shifted to the general ward for further management. He was discharged after 48 days, with complete recovery and a two-week follow-up. This case report depicts the challenges in management of fat embolism syndrome with septic shock following polytrauma. Conclusion: This case report is a comprehensive overview of FES complicated with septic shock. It highlights the importance of supportive care as the primary treatment modality, incorporating various medical interventions. The successful outcome and complete recovery of the patient underline the significance of prolonged monitoring, wound care, and physiotherapy.

Clinicopathological profile and management challenges of congenital encephaloceles in a tertiary hospital in southwest Nigeria.

A congenital encephalocele is the herniation of intracranial contents through skull defects of various sizes. Depending on the site, content, and size, it is associated with significant morbidity and mortality in children. There is a paucity of recent and comprehensive local clinical data regarding this anomaly. Understanding the peculiarities, clinical-pathologic profiles, and management challenges will help prevent and effectively manage congenital encephalocele to improve outcomes. This was a retrospective study of all cases of congenital encephalocele managed between July 2000 and December 2023 at a tertiary hospital in the southwest region of Nigeria. Relevant demographic, clinicopathological, and management data were retrieved and analysed. There were 31 females and 11 males. Their ages ranged from 3hours to 24years. Sixteen (35.3%) were delivered in a non-health facility. Birth asphyxia was reported in 5 babies. Few mothers (4.8%) used preconception folic acid. Anaemia (n = 5) and sepsis (n = 4) were the common preoperative morbidities. All patients had definitive surgery, with 18 operated on within the first month of life. Cerebrospinal fluid (CSF) leak was the most common postoperative complication and was significantly observed in the sincipital group (p = 0.018). Thirty-one patients (73.8%) presented for follow-up after surgery, and the mean follow-up duration was 26.6weeks. Mortality was recorded in a patient (2.4%) due to Klebsiella meningitis. Congenital encephaloceles are relatively common in our setting. Therefore, there is a need to address the associated poor maternal and neonatal health conditions. Early surgery can be performed with a favourable outcome.

Inhibiting Nav1.7 channels in pulpitis: An in vivo study on neuronal hyperexcitability

Pulpitis constitutes a significant challenge in clinical management due to its impact on peripheral nerve tissue and the persistence of chronic pain. Despite its clinical importance, the correlation between neuronal activity and the expression of voltage-gated sodium channel 1.7 (Nav1.7) in the trigeminal ganglion (TG) during pulpitis is less investigated. The aim of this study was to examine the relationship between experimentally induced pulpitis and Nav1.7 expression in the TG and to investigate the potential of selective Nav1.7 modulation to attenuate TG abnormal activity associated with pulpitis. Acute pulpitis was induced at the maxillary molar (M1) using allyl isothiocyanate (AITC). The mice were divided into three groups: control, pulpitis model, and pulpitis model treated with ProTx-II, a selective Nav1.7 channel inhibitor. After three days following the surgery, we conducted a recording and comparative analysis of the neural activity of the TG utilizing in vivo optical imaging. Then immunohistochemistry and Western blot were performed to assess changes in the expression levels of extracellular signal-regulated kinase (ERK), c-Fos, collapsin response mediator protein-2 (CRMP2), and Nav1.7 channels. The optical imaging result showed significant neurological excitation in pulpitis TGs. Nav1.7 expressions exhibited upregulation, accompanied by signaling molecular changes suggestive of inflammation and neuroplasticity. In addition, inhibition of Nav1.7 led to reduced neural activity and subsequent decreases in ERK, c-Fos, and CRMP2 levels. These findings suggest the potential for targeting overexpressed Nav1.7 channels to alleviate pain associated with pulpitis, providing practical pain management strategies.

Defining the optimization strategy for solar energy use in large water distribution networks: A case study from the Valle Inferior irrigation system, Spain

Irrigation modernization in Spain has brought significantly increased energy requirements. To provide the needed power, solar energy is rising in popularity. However, matching the availability of solar energy to irrigation demand remains a challenge. In the Valle Inferior irrigation system, while enough solar energy is produced on an annual basis, only 52 % of the energy consumed for irrigation is from own solar production, mainly due to the practice of night-time irrigation. For this system, this study explores two solar energy optimization scenarios. The first aims to optimize use of own solar energy by adjusting the current 24-h irrigation schedule to 8 or 12 h. The analysis finds that in situations where water availability is limited, this change can enable the annual percentage of own solar energy to be increased to 98 % of the total energy consumed. Nonetheless, such optimization of solar energy use gives rise to difficulties in the system itself, as farmers prefer to irrigate at night. In the second scenario, economic profits are optimized with the sale of excess solar energy. In this scenario, besides water availability and irrigation schedule, the optimum also depends on energy prices. Optimization is thus found to differ, depending on the optimization target, as well as water availability and the irrigation schedule used. This poses new operational challenges for large irrigation system management.

PERANCANGAN SISTEM WAREHOUSE BERBASIS TEKNOLOGI OCR UNTUK MENINGKATKAN EFEKTIVITAS DAN EFISIENSI

PERANCANGAN SISTEM WAREHOUSE BERBASIS TEKNOLOGI OCR UNTUK MENINGKATKAN EFEKTIVITAS DAN EFISIENSI

Journey to Safety: Innovations and Challenges in Road Safety Management across Indian Highways

In India, the number of traffic accidents has significantly increased as a result of inadequate transportation infrastructure, appropriate roads, and effective government. India has the highest number of collisions worldwide each year and is among the least safest nations on the road. The purpose of the study is to evaluate the safety of the current road infrastructure and identify any potential risks or hazards. To assess the safety performance of interchanges, motorways, and other transportation facilities and pinpoint areas in need of improvement, comprehensive safety audits of the infrastructures included in the study are required. Through this study, stakeholders may enhance road safety for all users by gaining a better understanding of the safety risks associated with the current road infrastructure and the capacity to make data-driven decisions. The primary goals of this study are to provide a thorough assessment of the security of the road network, identify potential hazards, and develop recommendations