Choice Of Management Strategy Research Articles

Navigating EU-Sweden forestry disputes

This meta-empirical study delves into the conflicts between Sweden and its forestry industry in response to the EU-commission's demands for sustainable forest management. Combining theoretical foundations with empirical analysis of existing research, this study grounds itself in a clear definition of forests as intricate, adaptive, and ever-evolving systems. The central research question revolves around the efficacy of Sweden's guiding principle, "freedom under responsibility," in shaping forest policy and fostering long-term sustainability.To dissect the core of this conflict, two fundamental hypotheses are explored. The first centers on the clash of interests between the Swedish government and forest industry stakeholders, while the second delves into the tension between monetarily valued ecosystem services and those without a market value, a natural market being absent. These questions are scrutinized using a novel method tailored for conflict analysis. A model article and two specific analysis articles are developed, each focusing on distinct facets of forest management, and are subsequently compared to reveal insightful contrasts.This contrasting approach unveils a comprehensive socio-economic framework underlying these conflicts—a framework that often remains concealed due to deeply ingrained patterns of thought and behavior within homogeneous groups. The method's greatest strength lies in its ability to render the invisible visible and the "silent" audible. It clarifies what might be obscured in the model article, bringing the contours of the conflict into sharp relief.The study findings affirm the value and democratic nature of the "freedom under responsibility" principle. However, for it to yield the intended outcomes, substantial and continuous educational efforts directed at relevant forest management stakeholders are imperative. This meta-empirical study highlights the necessity of a robust educational campaign to ensure the principle's success.Moreover, this study contributes theoretical insights that could serve as a foundation for conflict resolution:•Forests are complex, adaptive, and dynamic systems.•Human intervention prompts responses and adaptations within this system.•The choice of management strategies plays a pivotal role in achieving specific outcomes, whether biomass production or the preservation of natural forest characteristics.•The production of forest ecosystem services necessitates active management and does not occur automatically.

Choice of management strategy for papillary thyroid microcarcinoma: active surveillance or immediate surgery?

Overdiagnosis of papillary thyroid microcarcinoma (PTMC) is prevalent, and effective management of PTMC is an important matter. The high incidence and low mortality rate of papillary thyroid carcinoma (PTC) justify the preference for active surveillance (AS) over immediate surgery (IS), particularly in cases of low-risk PTMC. Japan began AS in the 1990s as an alternative surgical option for PTMC and it has shown promising results. The safety and efficacy of AS management in PTMC have been verified. However, AS may not be suitable for all PTMC cases. How to find the balance between the decision-making of AS and IS requires careful consideration. Therefore, we collected and analyzed the relevant evidence on the clinical strategies for PTC and discussed AS and IS from the perspectives of health, economic, and psychological aspects, to help clinicians in choosing a more appropriate clinical strategy for PTC.

Risk factors and management strategies for atrial fibrillation

Atrial fibrillation (AF) is a cardiac arrhythmia characterised by the irregular and frequently fast depolarization of the atrial myocardium resulting from a disturbance of the usual electrical conduction routes within the atria, which causes disorganised and ineffective atrial contractions. The management of AF involves a multidisciplinary approach that includes identifying and treating underlying risk factors, managing symptoms, and preventing complications. The risk factors for AF include age, hypertension, obesity, diabetes mellitus, valvular heart disease, coronary artery disease, congestive heart failure, alcohol consumption, sleep apnea, and family history. The management strategies for AF include rate control, rhythm control, anticoagulation, left atrial appendage closure, lifestyle modifications, surgical ablation, catheter ablation, cardioversion, and education and support. The choice of management strategy should be tailored to the individual patient’s risk profile, comorbidities, and other factors. Further research is needed to improve our understanding of the pathophysiology of AF and to develop more effective management strategies for this condition.

Comorbidity of mental health and autism spectrum disorder: perception of practitioners in management of their challenging behaviour

The relationship between mental health problems, Autism Spectrum Disorder (ASD) and challenging behaviour among children and adolescents is complex and multifaceted. The study investigated practitioners’ perception of comorbidity of mental health and ASD in the management of challenging behaviours among children and adolescents in Kenya. Target population was 3490 practitioners. Sample size was 1047, comprising of 38 assessment staff, 27 mental health workers 548 regular teachers, 294 teachers from special schools, and 140 teachers from special units for children with ASD. Stratified and purposive sampling techniques were used. Interviews and structured questionnaires were used. Test-retest yielded a coefficient of 0.78 while Cronbachs’ reliability coefficient was 0.830. There was a positive significant correlation between perception of challenging behaviours and mental health problems (r = .415, p = .000). Challenging behaviour perceptions have a negative significant effect on behaviour management strategies, (β = −0.163, p = .000) implying that the choice of management strategies is dependent on the perceptions. Challenging behaviours accounts for 2.7% variance in the choice of the management strategies, R2 = .027, F(1,1045) = 28.471, p = .000.The practitioners’ perception of mental health and comorbid ASD, showed that children with ASD, when enduring life stressors, can be at a higher risk of mental health difficulties than their peers There is need for multidisciplinary synergy in developing effective challenging behaviour programmes for children and adolescents with ASD

경영전략에 따른 기업혁신과 기업가치

A Corporate management strategy can be defined as embodying the propensity of top management that can affect the overall management activities. In particular, research was conducted in that management strategies can have an important influence on the study of the value relevance of corporate innovation. In this study, the management strategy analyzed the impact of corporate innovation on corporate value using Miles and Snow (1978, 2003)’s defense (prospector) strategy and ESG management strategy. The analysis results can be divided into two main categories：the analysis of the relationship between management strategy and corporate innovation, and the relationship between corporate innovation and corporate value according to management strategy. First, the results of the analysis of the relationship between management strategy and corporate innovation were first analyzed that defensive strategies had a significant (＋) effect on corporate innovation. As a result of the defense strategy, which is a stable manager’s strategy using cost reduction and economies of scale, has a positive effect on corporate innovation rather than prospective strategies, different results from expectations were confirmed. The prospective strategy was expected to be significant with corporate innovation indicators due to uncertainties such as new product development, new market development, and R&D, but there was no significance. Second, only ESG (integration) and social responsibility (S) were significantly positively (＋) related to corporate innovation, and the remaining governance and environmental responsibilities were not significant. From these results, it was partially confirmed that the more ESG management companies, the stronger the corporate innovation tendency. Next, the analysis of the value relevance of corporate innovation according to management strategy showed that the more defensive strategic companies and the more defensive innovative companies have a significant positive (＋) relationship with corporate value than those that do not (prospective innovative companies. These results can be estimated that participants in the capital market evaluate corporate innovation of defensive strategy companies that seek cost reduction and stable profitability more important than prospective strategies with high uncertainty in determining corporate value. Second, as a result of analyzing the value relevance of corporate innovation using ESG integrated indicators and individual indicators, it was analyzed that the value relevance of corporate innovation was significant (＋) for ESG management strategy companies. Research on the relationship between corporate innovation and corporate value has long been conducted. This study is meaningful in that it confirmed the importance of CEO's choice of management strategy, believing that corporate innovation and corporate value(Tobin Q) relationship will have different information effects and value relationships depending on the choice of management strategies.

Modeling Conflicts at Work: The Case of Elementary School Employees in Croatia

This paper aims to explore conflict as a process that includes antecedents, management strategy, and outcomes while examining the role of affective states in an elementary school working environment. After a theoretical overview and systematization of the conflict elements, a questionnaire was developed that satisfies internal reliability and construct validity. Conflicts at the workplace were modeled with Bayesian SEM, and the results point out the prominent role of affective states in conflicts. Findings confirmed that (1) affective states affect the conflict management strategy choice; (2) different conflict management strategies lead to different conflict consequences; and (3) different affective states lead to differently perceived conflict consequences/outcomes. In addition, we conclude that conflicts with dominantly positive and negative affective states behave structurally differently. The revealed role of affective states facilitates future intervention possibilities in education about conflict management strategies and control of emotions and affective states. Raising awareness about affective states’ role in the conflict might increase mutual un-understanding and contribute to a healthy school social environment as a safe space for learning, sharing ideas, and joint actions toward a common goal.

Long-term effects of percutaneous coronary intervention versus coronary artery surgery in elderly with multi-vessel coronary artery disease

BackgroundThe most prevalent illness among the elderly is coronary artery disease (CAD), and most of this population present with multi-vessel CAD which constitutes a common management difficulty among elderly people. This study aimed to compare long-term consequences of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) revascularization in elderly patients with multi-vessel coronary artery disease.ResultsThis retrospective study evaluated 100 elderly patients with multi-vessel CAD divided into two groups, group 1 the PCI group and group 2 the CABG group. The main findings of the study showed that CABG group had a longer hospital stay than the PCI group (8.16 vs. 2.02 days; P < 0.001). A considerably higher mean residual SYNTAX score was observed in the PCI group than CABG group which was 1.15 and 0.2, respectively (p-value < 0.001). The in-hospital major adverse cardiac events rate (MACE) in both groups was not statistically significant. Regarding the in-hospital mortality rate, although it was higher in the CABG group (6%) versus 2% in the PCI group, yet it was not statistically significant. The long-term MACE in this study revealed that 12.2% of PCI patients had heart failure compared to 6.4% in the CABG group, which was statistically insignificant. In the long-term follow-up, the revascularization rate of CABG group was higher than the PCI group; however, it was statistically insignificant. CABG group had a higher rate of stroke than PCI group being 4.3% and 2%, respectively; yet this difference was not statistically considerable. The long-term mortality rate among the PCI and CABG group was 10.2% and 4.3%, respectively.ConclusionsElderly patients with multi-vessel CAD, PCI with stenting, and CABG were statistically equivalent in long-term death and MI rates, stroke, repeat revascularization. A non-statistically notable distinction between the two groups as regards MACE, composite of death or MI, and all-cause mortality was found. This may have implication on choice of management strategy among elderly patients with multi-vessel CAD.

Study on the Evolutionary Game of Information Security Supervision in Smart Cities under Different Reward and Punishment Mechanisms

At present, the information security problems of smart city show a high incidence, and it is necessary to strengthen the information security supervision of smart city. In the process of supervision, there is a game relationship between local government and smart city enterprises. This paper firstly constructs the game matrices of local government and enterprises under the static and three dynamic reward and punishment mechanisms, then conducts numerical simulation with the help of MATLAB to arrive at the optimal reward and punishment mechanism through comparison, and finally explores the influence of the change of the upper limit value of each key variable on the directionality and sensitivity of the decision-making behavior of game subjects under the optimal mechanism. The result shows that initial value is one of the decisive factors influencing the choice of management strategy by enterprise. Dynamic reward and dynamic punishment mechanism is the best reward and punishment mechanism for information security supervision in smart cities. In case the upper limit value of key parameters is increased, a larger punishment has a strong influence on the positive strategy choice of the enterprise, and a reasonable adjustment of the reward policy can likewise mobilize the probability that the enterprise actively chooses to strengthen information security management. Based on the simulation results, we propose a feasible strategy.

Visceral and renal malperfusion syndromes in acute aortic dissection type A: the fate of the branch vessel.

Malperfusion in acute aortic dissection is not uncommonly observed and associated with a highly significant increase in mortality and morbidity. Of the various malperfusion syndromes, visceral and renal involvement is the most challenging in terms of correct and timely diagnosis as well as the choice of management strategy. The aim of this study was to identify the pathology and associated fate of each visceral and renal vessel in acute type A dissections. Over a 12-year period, 167 consecutive patients with acute dissection type A extending into the thoracoabdominal aorta were included and radiographic images analyzed with a focus on individual branch vessel pathology and dependent organ perfusion. Sixty-five patients (39%) were diagnosed with radiological signs of malperfusion on the CT Images. Of those, 20% expired during the hospital stay, compared to 8% without malperfusion. The left renal artery was the most frequently affected by dissection (31%) or false lumen supply (28%). False lumen perfusion was more often associated with manifest malperfusion than an extension of the dissection flap into the branch vessel. During the study period, there was no preference of surgical procedure treating the malperfusion. Malperfusion of the visceral/renal branches of a dissected aorta represents a manifest indicator for postoperative mortality and morbidity. Neither clinical outcome, nor the fate of individual vessels can reliably be predicted prior to proximal reconstruction and thus, surgical strategy cannot generally be defined alone by radiological findings.

Drug-Induced Atrial Fibrillation / Atrial Flutter

Drug-induced atrial fibrillation / flutter (DIAF) is a serious and potentially life-threatening complication of pharmacotherapy. Purpose of the work: systematization and analysis of scientific literature data on drugs, the use of which can cause the development of DIAF, as well as on epidemiology, pathophysiological mechanisms, risk factors, clinical picture, diagnosis and differential diagnosis, treatment and prevention of DIAF. Analysis of the literature has shown that many groups of drugs can cause the development of DIAF, with a greater frequency while taking anticancer drugs, drugs for the treatment of the cardiovascular, bronchopulmonary and central nervous systems. The mechanisms and main risk factors for the development of DIAF have not been finally established and are known only for certain drugs, therefore, this section requires further study. The main symptoms of DIAF are due to the severity of tachycardia and their influence on the parameters of central hemodynamics. For diagnosis, it is necessary to conduct an electrocardiogram (ECG) and Holter monitoring of an ECG and echocardiography. Differential diagnosis should be made with AF, which may be caused by other causes, as well as other rhythm and conduction disturbances. Successful treatment of DIAF is based on the principle of rapid recognition and immediate discontinuation of drugs (if possible), the use of which potentially caused the development of adverse drug reactions (ADR). The choice of management strategy: heart rate control or rhythm control, as well as the method of achievement (medication or non-medication), depends on the specific clinical situation. For the prevention of DIAF, it is necessary to instruct patients about possible symptoms and recommend self-monitoring of the pulse. It is important for practitioners to be wary of the risk of DIAF due to the variety of drugs that can potentially cause this ADR.

Rapid progression to Richter’s syndrome in patient with chronic lymphocytic leukemia and near-triploid karyotype

Introduction. The presence of aneuploidy in patients with chronic lymphocytic leukemia (CLL), except trisomy 12, is quite uncommon. The frequency of hyperdiploidy or near-tetraploidy ocurrs in 1-3% of the CLL patients and usually confer poor prognosis. Case report. We report a patient in a progressive phase of CLL with near-triploid karyotype. Cytogenetic analysis was performed and complemented with molecular methods and pathohistological examination. The complex karyotype was accompanied with the TP53, C-MYC and IGH gene disruptions, the most probable cause of rapid evolution into Richter's syndrome. Conclusion. Utilization of comprehensive diagnostic techniques is highly recommended in patients with progressive phase of CLL, primarily for the adequate choice of management strategy. The current case confirms poor prognosis of the previously reported CLL patients with aneuploidy.

Novel therapies vs hematopoietic cell transplantation in myelofibrosis: who, when, how?

Abstract Myelofibrosis is one of the classical Philadelphia chromosome–negative myeloproliferative neoplasms characterized by progressive marrow failure and chronic inflammation. Discovery of the JAK2 mutation paved the way for development of small molecular inhibitors and further facilitated the research in understanding of molecular biology of the disease. Development of novel medications and synergistic combinations with standard JAK inhibitor (JAKi) therapy may have the potential to improve depth and duration of disease control and symptomatic benefit, whereas advancements in allogeneic hematopoietic stem cell transplantation (HCT) have improved tolerability and donor availability, allowing for more patients to pursue this potentially curative therapy. The increase in options for medical therapy and changing risk profile of HCT is leading to increased complexity in counseling patients on choice of management strategy. In this case-based review, we summarize our approach to symptom-directed medical therapy, including the use of novel drugs and combination therapies currently under study in advanced clinical trials. We outline our recommendations for optimal timing of HCT, including risk-adapted selection for early HCT as opposed to delayed HCT after upfront JAKi therapy, as well as the use of pretransplant JAKi and alternative donor sources.

Perforations from Endoscopic Dilation of Corrosive Strictures in Adults: A Systematic Review and Meta-Analysis.

Endoscopic dilation is an important therapeutic option for treatment of corrosive strictures. Its safety is unclear with variable perforation rates in previous studies. We aimed to evaluate its safety with regard to perforations and the effect of dilator type to perforation risk. A systematic review of published literature from inception to April 24, 2021, using PubMed and EMBASE databases was conducted. Studies in adult subjects (mean age ≥ 18years) reporting perforation rates of endoscopic dilation of corrosive esophageal and/or gastric strictures were included. Pooled cumulative perforation rates were computed as primary outcome. Secondary outcomes included, perforation with each dilator subtypes, surgical or conservative modes of management and mortality. Random effect meta-analysis was used to estimate the frequency of each of these outcomes. Variables were reported as percentages with 95% CI. A total of 712 subjects (N) who underwent 4840 dilations (n) were noted in the 15 studies that were included. Of which, eight were retrospective, while the remaining seven were prospective. On meta-analysis, the cumulative pooled perforation rate was 1% (1-2%) of the number of dilations (n%). The perforation rates with SG (1%, 0-3%) and balloon (1%, 0-5%) dilators were similar (p value < 0.01). 45/64 (59%, 11-94%) perforations were subjected to surgery while the remaining 14/64 (41%, 6-89%) was managed conservatively. Choice of management strategy was biased to the norms of the treating team. About 3/712 patients (0%, 0-2%) succumbed following perforation. Perforation from endoscopic dilation of corrosive strictures occurs rarely, and there is no significant difference in perforation risk related to the type of dilator.

Ранняя задержка роста плода: новый подход к выбору тактики ведения

Ранняя задержка роста плода: новый подход к выбору тактики ведения

PECULIARITIES OF BUSINESS ASSET MANAGEMENT

The article is devoted to the generalization of theoretical aspects and practical recommendations for improving the asset management system in modern conditions. To build an effective system, the object of management — assets — is studied in detail. The approaches to understanding the essence of assets, namely value, financial and property, are singled out. The ratio of such concepts as “current assets”, “working capital” and “working capital” is studied, their common and different characteristics are determined. The current assets are grouped according to different classification features and their significance in the production process is determined. It is substantiated that the grouping of current assets is primarily of practical importance, allowing to build a clear system of accounting and analysis of the availability and movement of current assets and to form an effective system of their management by individual types. A thorough analysis of the interpretations of the concept of “asset management” available in the scientific literature has been made, and several approaches to its understanding have been identified. The conducted research made it possible to form an author's definition of the current assets management system. It is determined that the current assets management system should be based on an integrated approach, the components of which are objects and subjects of management, purpose, basic principles and functions, methods and tools of influence, formalized quantitative and qualitative criteria for achieving goals, and factors forming the operating environment of the object. The characteristic of each element of the system is given, in particular the subjects and objects of management are concretized, their interaction is considered, the purposes and tasks are outlined. It is determined that the functions of the management system are controlling, stabilizing and analytical, and the principles on which it is based — timeliness, unity, continuity, optimality and rationality. The implementation of the current assets management system involves the implementation of a number of successive measures in the form of certain stages, which are considered in the work. The proposed system of current assets management will predict the choice of management strategy of the entity in the long run and increase the overall efficiency of its operation.

REM-associated bradyarrhythmia (a clinical case)

The article presents an observation of a rare clinical arrhythmia — REM-associated advanced atrioventricular block 2nd degree. The absence of structural abnormalities of the heart, the young age and the need for additional methods of instrumental examination for diagnosis (polysomnography, test with the active orthostasis test) are important features of the case. Despite the orphan nature of this arrhythmia, the correct diagnosis is important for the choice of the management strategy choice.

How Do Physiotherapists Treat People with Knee Osteoarthritis and their evidence awareness: A cross-sectional survey among Indian Physiotherapists

Background: Evidence-based practice in the field of physiotherapy is of utmost importance and is the way ahead. Physiotherapists' knowledge of evidence in terms of assessment and management of knee OA may influence the implementation of evidence-based practice. However, physiotherapist’s practice patterns are usually based on their professional experience or expert opinions. The present study aimed to explore the evidence awareness among Indian physiotherapists and identify their practice patterns in patients with knee OA. Methods: An online cross-sectional survey was conducted among Indian physiotherapists. The survey was designed using current clinical practice guidelines and previously published similar studies. The survey consisted of three sections: (1) demographic details, (2) questions related to evidence awareness, (3) questions related to the practice patterns of Indian physiotherapists. The evidence awareness and practice patterns of physiotherapists were explored. Results: A total of 165 responses were received and analyzed. Most participants perceived footwear modifications (21.2%) and resistance exercises (44.2%) as having very strong evidence. Range of motion assessment and functional assessment was regarded as a must during the patient's initial visit. In terms of management strategies majority of the participants considered patient education (n=122), strengthening exercises (n=81), and therapeutic ultrasound (n=79) as their treatment of choice. Conclusion: Most physiotherapist assessment strategies were aimed at identifying impairments in patients. In line with the clinical practice guidelines, most physiotherapists use patient education and strengthening exercises to treat patients with knee OA. However, treatment modalities like ultrasound, TENS, and dry needling, which lack scientific support, are still being used by the physiotherapist. There is a lack of coherence between physiotherapists' evidence awareness and their choice of management strategies. KEY WORDS: Knee, Osteoarthritis, Survey, Resistance exercises.

Основные направления изучения клиентоориентированности: предпосылки формирования, уровни, результативность

Customer orientation as one of the mainstream concepts of contemporary marketing has been actively developed since 1990s. The purpose of the article is to develop a conceptual model of customer orientation relationships in a company based on a systematic analysis of existing studies and their adaptation to practical use. As a result of the analysis, the approaches to determining customer orientation are systematized on the basis of two determinants: the level of customer orientation (personal, organizational) and the approach of customer orientation interpretation (value, process). To determine customer orientation, the author uses an integrated approach, which includes value and process characteristics of customer orientation, as it gives companies a more comprehensive understanding for the development of a customer-oriented approach. Within this approach, customer orientation is defined as activities of a company to collect information on existing and potential customers, disseminating this information in the company and developing actions to meet current and future customer needs by creating the highest value. The developed model reflects the relationship between customer orientation and various aspects of company's business and the prerequisites for its development. The data obtained show that customer orientation affects not only performance, but also employees, competitive advantage, customers and the choice of management strategies. The conceptual model allows to take an overall look at customer orientation in the company and devise a plan for its development.

Developing a framework for sacred grove management using stakeholder analysis: evidence from sacred groves in Gujarat, India

PurposeThe purpose of this study is to use the framework of stakeholder analysis in a participatory democracy, used in forest management planning, for arriving at the best management option for selected sacred groves of Kachchh. This is achieved by accounting for economic, cultural and ecological values and the resulting outcomes in the complex institutional mechanism. Additionally, this study provides a framework for complex decision-making that characterizes the management of sacred groves involving multiple criteria and options accounting for multiple stakeholders that involve conflicting interests.Design/methodology/approachThe analytical hierarchy process was used to calculate the global priorities of management options using the relative importance of stakeholders, weights of different decision criteria to arrive at the best management practice for selected groves of Kachchh. The global priorities of management options rank management practices based on stakeholders' values and their effects on the choice of management strategy as well as on the potential to attain a compromise between competing interests. For this purpose, survey responses of 141 individuals belonging to seven different stakeholder categories were analyzed. Along with focus group discussions, and personal interviews, a stratified random sampling technique was used to survey respondents.FindingsBased on the global priority weights of the alternatives, it is determined that the restoration management option (guggal is restored by planting new guggal sapplings, cattle grazing is prohibited and high levels of ecosystem goods and services are provided) had the highest score, followed by the preservation management option (grazing is allowed on the periphery, juvenile guggal is preserved and moderate ecosystem goods and services are provided). Therefore, restoration of sacred groves is the best management practice of sacred groves in West Kachchh, offering a compromise between maximizing provision of ecosystem services and economic benefits in terms of allowing cattle grazing.Originality/valueThough there are several studies on best management practices for community-owned forests, irrigation systems, and pasture lands, and the role of local institutions in sustaining these common-pool resources; such studies for sacred groves are absent, despite sacred groves being one of the longest surviving common-pool resources that has sustained it over several decades. This is the first study that uses the framework of stakeholder analysis to arrive at the best management practice for sacred groves. The uniqueness of the study lies in a comprehensive evaluation of ecological–economic–cultural interests of multiple stakeholders toward management of sacred groves.

Surgery as a Viable Option in Neutropenic Appendicitis.

A major clinical challenge in the care of children with cancer is how to take care of those patients with chemotherapy-induced neutropenia who develop acute appendicitis. How do we weigh the risk of perforation and sepsis against the risk of surgery in these high-risk patients? In this issue of Pediatrics, Many et al1 report a 7-year retrospective review across 15 North American pediatric tertiary-level institutions comparing management strategies and outcomes for 66 children with neutropenia and image-confirmed acute appendicitis. The authors found that those who undergo appendectomy within 24 hours of diagnosis have fewer postoperative complications, shorter length of stay, and fewer delays in chemotherapy compared with those who are initially treated nonoperatively, with the worst outcomes occurring among children with a delayed appendectomy during the admission.1 Although the sample size of this study is relatively small, the authors have amassed the largest study to date to evaluate the management of acute appendicitis in children with neutropenia. A notable strength is that the subjects are similar across treatment groups by factors such as age and important clinical characteristics including malignancy type, symptom duration, maximum temperature, and absolute neutrophil count.In this report, the authors also describe significant practice variability in the rate of upfront appendectomy across institutions (0%–100%). There was also likely heterogeneity across different institutions in the antibiotic choice, duration, and resistance patterns in those managed nonoperatively; we are thus unclear as to how this may have influenced outcomes. The hemodynamic status and degree of systemic sepsis of the patients at the time of diagnosis is not reported and we cannot know (a limitation of a retrospective study of this kind) whether this influenced the choice of management strategy. Also unknown is the impact, if any, of the administration of granulocyte colony-stimulating factor in the 29 patients to whom it was given. Assuming count recovery occurred more frequently in this subpopulation, did that influence outcomes in any way? In this review, those with count recovery who subsequently underwent appendectomy were not analyzed separately from those who had failure of nonoperative management, so we are unable to determine if this subgroup fared better nor if there is any benefit to waiting on count recovery if the outcomes are ultimately equivalent or better. It is also interesting that the majority of patients in this study who successfully completed initial nonoperative management went on to require no further treatment (75%). Prospectively acquired long-term outcomes data comparing this subgroup to those who underwent upfront appendectomy may add strength to the argument for initial surgery.Concerns about operative interventions in patients with neutropenia have been largely focused on wound and infectious complications. Consistent with smaller studies, the authors provide additional evidence that timely appendectomy should be the priority in these patients.2,3Although the authors demonstrate delays in chemotherapy administration among those patients treated nonoperatively, the immediate and long-term effects on oncologic outcomes of these delays are unknown. Given that these children were all receiving chemotherapy and became neutropenic as a result, these likely represent interruptions in treatment as opposed to delays in initiation. Studies in which authors have examined the effects of delays in chemotherapy on oncologic outcomes have been largely focused on delays in initiation, and even among these studies, the data are mixed with some researchers suggesting no effect.4,5 The clinical relevance of the interruptions in treatment shown by the authors is therefore unknown.Nevertheless, we congratulate the authors on tackling an important question on surgery in neutropenic appendicitis. They have nicely laid the groundwork for a potential algorithm for the management of acute appendicitis in children with neutropenia, in which upfront appendectomy can be safely offered and may likely be preferred in those patients most likely to benefit. Decreases in hospital length of stay, postoperative complications, and, as a result, cost of care in this particularly vulnerable population can only serve to improve the overall quality of care that they receive.