Continuous Management Research Articles

Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients.

We aimed to assess how longitudinal body mass index (BMI) trajectories are associated with diabetes complications and all-cause mortality in Finnish patients with type 2 diabetes (T2D). In this cohort study, electronic health records from public primary and specialized healthcare services in all 13 municipalities of North Karelia, Finland, were utilized. This study included a total of 889 adults with newly diagnosed T2D in 2011 or 2012 (mean age at baseline 62.0 years). Individual BMI trajectories from the T2D diagnosis until 2014 were estimated and grouped by growth mixture modeling (GMM). Hazard ratios (HRs) with 95% confidence intervals (CIs) for microvascular complications, macrovascular complications, any diabetes complications, and all-cause mortality from 2015 to 2022 across BMI trajectory groups were estimated using Cox regression models. Three distinct BMI trajectory groups were identified using GMM and labeled as follows: "stable" (n = 774, 87.1%), "decreasing" (n = 87, 9.8%), and "increasing" (n = 28, 3.1%). During a median follow-up of 8 years, there were 119 (13.3%) patients with microvascular complications, 187 (21.0%) with macrovascular complications, 258 (29.0%) with any diabetes complications, and 180 (20.2%) deaths. Compared with the "stable" BMI, the "increasing" BMI was associated with an increased risk of microvascular complications (HR = 2.88, 95% CI: 1.32 to 6.28), macrovascular complications (HR = 2.52, 95% CI: 1.17 to 5.43), and any diabetes complications (HR = 2.21, 95% CI: 1.16 to 4.20). The "decreasing" BMI was associated with an increased risk of all-cause mortality (HR = 1.90, 95% CI: 1.14 to 3.15), compared to the "stable" BMI. Our findings underscore the significance of continuous BMI monitoring and weight management in patients with T2D. Tailored treatments are crucial for efficiently preventing weight gain and reducing the risk of diabetes complications.

Single Intravenous Dose Dalbavancin Pathway for the Treatment of Acute Bacterial Skin and Skin Structure Infections: Considerations for Emergency Department Implementation and Cost Savings

BackgroundA pathway for the treatment of acute bacterial skin and skin structure infections (ABSSSI) with a single intravenous (IV) dose of dalbavancin was previously shown to reduce hospital admissions and shorten inpatient length of stay (LOS). ObjectivesTo describe pathway implementation at the emergency department (ED) and evaluate cost-effectiveness of a single-dose dalbavancin administered to ED patients who would otherwise be hospitalized to receive usual care with multidose IV antibiotics. MethodsThe dalbavancin pathway was previously implemented at 11 U.S. EDs (doi:10.1111/acem.14258). Patients with ABSSSI, without an unstable comorbidity or infection complication requiring complex management, were treated with a single dose of dalbavancin. At the emergency physicians’ discretion, patients were either discharged and received outpatient follow-up or were hospitalized for continued management. A decision analytic cost-effectiveness model was developed from the U.S. healthcare's perspective to evaluate costs associated with the dalbavancin pathway compared with inpatient usual care. Costs (2021 USD) were modeled over a 14-day horizon and included ED visits, drug costs, inpatient stay, and physician visits. One-way and probabilistic sensitivity analyses examined input parameter uncertainty. ResultsDriven largely by the per diem inpatient cost and LOS for usual care, the dalbavancin pathway was associated with savings of $5133.20 per patient and $1211.57 per hospitalization day avoided, compared with inpatient usual care. The results remained robust in sensitivity and scenario analyses. ConclusionThe new single-dose dalbavancin ED pathway for ABSSSI treatment, which was previously implemented at 11 U.S. EDs, offers robust cost savings compared to inpatient usual care.

전공교육과정 질 관리를 위한 인증평가 루브릭 개발 연구

This study attempted to present a standard manual through the case of University A that can be applied when domestic universities want to improve or upgrade the rubric, which is the evaluation standard for curriculum certification evaluation, more than 10 years after conducting their own curriculum certification evaluation to manage and improve the quality of major curriculum. To this end, a rubric draft was first developed by revising and supplementing the evaluation criteria based on the results of analyzing related literature research and analyzing cases of major domestic universities that introduced curriculum certification evaluation through the advice of experts(N=3) in the curriculum . The draft rubric developed in this way verified the validity and feasibility of research results through a meeting with a modified Delphi survey(N=10) and a practitioner in charge of major curriculum certification evaluation(N=5) for experts in the field of education who have conducted research related to curriculum evaluation and curriculum evaluation. The results are as follows. First, evaluation criteria were developed to systematically evaluate the entire course of the major curriculum, including curriculum development, support, operation, performance, and improvement. Second, the evaluation criteria developed in this way were designed with a total of 3 items and 19 evaluation criteria, and an evaluation criterion with a content validity(CVI) of 0.80 or more was developed. Third, based on the results of the curriculum certification evaluation using this rubric, a feedback system was proposed to strengthen the quality of major education by establishing a continuous curriculum quality management system. It is expected that these findings will help improve the quality of the curriculum and operate a substantial curriculum.

Japan's healthcare delivery system: From its historical evolution to the challenges of a super-aged society.

Although Japan's healthcare delivery system is highly regarded internationally, the COVID-19 pandemic has exposed its structural problems. Behind these issues lies a history of medical care provisions supported mainly by an unrestricted, "free labeling" system, and independently financed private hospitals. In addition, patients have a high degree of freedom of choice under the Japanese medical insurance system, making it difficult to provide comprehensive and continuous health management from initial diagnosis and treatment (primary care), specialized treatment, to supporting a return to home, providing nursing care and lifestyle support. As Japan becomes a "super-aged" society with individuals over 65 making up over 30% of the population, the nature of medical care will have to undergo major changes. Medical care's basic function must still be the treatment and cure of patients, but the system will also have to provide support. That means conceiving of care in a way that treats a person's life with dignity and does not sacrifice life for treatment. The implementation of a family doctor function and the clarification of the functions and roles of small and medium-sized community-based hospitals that support this function, as well as the establishment of a community comprehensive care network with multidisciplinary cooperation that goes beyond medical care, should also be set forth in future regional medical care plans.

Perceived Health Behaviors and Learning Needs of Patients with Myocardial Infarction

Introduction: - Myocardial infarction is one of the foremost cardiovascular disease causes of mortality and morbidity worldwide. The prevention of this disease requires continuous monitoring and rehabilitative management. It can be achieved by the health promotion of patients using effective, planned educational programs and lifestyle modification by the patient. Patients perceived that their learning needs were unmet and that the information provided was too general. Hence, assessing the healthy heart habits performed by the patient and the patient’s preference regarding learning needs is crucial. The descriptive study is intended to identify the perceived health behaviors and learning needs of patients with myocardial infarction for the first time. Methodology: A quantitative descriptive design was used in this present study. The study included 102 newly diagnosed patients with MI carefully chosen by the non-probability convenience selection method. Information was collected using a patient profile (socio-demographic data, clinical data, and clinical parameters), a Modified cardiac health behavior scale (MCHBS), and a Cardiac patient's learning needs inventory (CPLNI). Results: -The present study result showed that subjects with MI for the first time had a high level of perceived learning needs of 164.11 + 22.28, with symptoms management was 27.61 + 3.763, medication information was 23.15 + 3.010, diet information was 23.12 + 3.148 were the areas perceived as high learning need information among the subjects. Only 11 (10.8%) subjects had a high perception of cardiac health behavior, among which were controlling risk habits and was 14.53 + 3.16. Medication adherence was only 6.76 + 1.89, perception of the subjects regarding dietary management was 19.47 + 4.15, and blood pressure control was 5.09 + 2.13 as considered essential in maintaining a healthy heart. Interestingly, the findings show that subjects with the perception of higher learning needs showed a negatively weak correlation with a lesser perception of health behavior, which is not a statistically significant level at p >0.05. The study highlighted that exercise, habits, and RBS had a statistically significant association with perceived health behavior (χ2= 18.52, p <0.001), (χ2=20.133, p =0.013), (χ2=9.067, p=0.037) respectively. Also, the exposure of subjects to mass media (χ2 =15.01, p<0.05), diversional activities practiced (χ2 =19.08, p <0.01), perception about the prognosis (χ2=7.22, p<0.02), habits (χ2= 13.68, p<0.03) level had a statistically significant association with the perceived learning needs. Conclusion: - Patients’ health behaviors practices and learning needs will change according to their perceptions. Determining the learning needs will help to guide the patient to achieve good cardiac health behaviors practice, subsequently reducing the reoccurrence of myocardial infarction.

S2Cloud: a novel cloud-based precision health system for smart and secure IoT big data harnessing

This study aims to demonstrate a novel cloud big data system, s2Cloud, to enabled both smart and secure transmission and management of patient big data from Internet of Things (IoT), especially in the new common of long covid. More specifically, s2Cloud allows doctors to manage patient records effectively through the interactive web server. It further enables real-time, long-term, and continuous streaming and management of biomechanical dynamics from IoT phones/wearables. The big data can be visualized in both real-time and historical modes. Besides, s2Cloud achieves big data security through secure sign up and log in, as well as data transmission protection. It also allows doctor-patient interactions through instantaneous chat. s2Cloud has been evaluated on the real-world application, in which human IoT biomechanical dynamics are streamed, managed, stored, and visualized to demonstrate the effectiveness. Overall, the proposed system, empowered by smart and secure design innovations, has demonstrated the feasibility and potential for IoT big data-driven precision health.

Business continuity plan in the management and operations of hospitals: First experience to certify the PDTA processes with the requirements defined by ISO 22301:2019 in emergency medical services.

A business continuity plan (BCP) facilitates the performance of primary functions during emergencies or other situations that can disrupt normal operations. If risk management is done analytically, a business impact analysis (BIA), according to ISO 22301 certification, makes it possible to define the best strategy for supporting the company's assets and image, optimizing the operational efficiency of service recovery and redesigning spaces for health. Since 2015, our healthcare company has embarked on a certification process for all sectors and activities through the implementation and development of diagnostic and therapeutic paths for operational diagnos-tic-therapeutic-assistance pathways (PDTAs). PDTA processes are all certified by the ISO 9001:2015 management system hospital. Our hospital is the first healthcare company to have obtained ISO 22301:2019 certification concerning PDTA processes, offering patients the highest standards of quality and safety of care in emergency medical services. The formal BCP process includes several steps prior to the creation of a BCP: create a BCP team, conduct a BIA, determine the continuity plan by using the results of the analyses, and conduct training and exercises to educate staff and improve the BCP. From the BIA analysis, the team identified the time-employee PDTAs in company paths under emergency and urgency: acute ST-elevation myocardial infarction (STEMI), TRAUMA, and STROKE, providing for a planning path that took advantage of the duration of approximately 12 months. This path included the creation of structural procedures, the redefinition and updating of the PDTA in the light of the BCP, the preparation of exercises aimed at guaranteeing the business continuity objectives, and, finally, the awareness of our stakeholders regarding its correct application. With a business continuity management (BCM) system, companies take preventative measures to ensure they can start operations again quickly in an emergency. An exhaustive BIA in a hospital company reveals the effects when processes fail, how critical each process is for the company, and the amount of time required to get up and running again, thus providing the organization with important information for risk management. The measures for handling risks derived from this analysis are incorporated into a BCM system where the emergency plans are defined, too, so that business operations continue even in the event of an emergency.

Investigating the Effectiveness of Continuous Quality Improvement Methods in Preventing the Phenomenon of Pseudo-Poor Electrocardiogram Procedure by Nurses in an Emergency Care Unit

Objective: To investigate the effect of applying continuous quality improvement methods on preventing the phenomenon of pseudo-poor electrocardiogram (ECG) procedures by nurses in the emergency care unit. Methods: The study was conducted in Shangluo Central Hospital Shaanxi from August 2020 to August 2021, and 200 emergency patients who received ECG during this period were selected for the comparative study, and grouped into two groups: the control group was given routine management, while the experimental group was managed by continuous quality improvement. The two groups were compared in terms of pseudo-differences in ECG procedures. Results: The patients in the experimental group had a higher rate of qualified ECG readings and procedures, and a lower rate of pseudo-errors and nursing disputes, all of which were significantly different from the control group (P < 0.05), which is significant, and the experimental group had a better effect. Conclusion: When ECG examination is carried out in the emergency care unit, the application of continuous quality improvement management methods is conducive to improving the quality of ECG examination, reducing the incidence of pseudo-discrepancy, and providing a reliable reference for clinical diagnosis and treatment.

Navigating turbulent waters: The impact of business continuity management (BCM) practices on financial and nonfinancial performance of tour operator companies

AbstractThis study examines the influence of Business Continuity Management (BCM) practices on tour operator companies' financial and nonfinancial performance amid the COVID‐19 pandemic. Employing purposive and cluster sampling, a survey was conducted with 331 tour operators, and the study hypotheses were evaluated using Partial Least Squares—Structural Equation Modelling. Findings reveal that the organizational preparedness and embeddedness of continuity practices significantly influence both financial and nonfinancial performance. Additionally, management support and external requirements impact either financial or nonfinancial performance. The study reveals tour operator companies' resilience demonstrated through their continuity management skills, particularly in adapting to business challenges during the pandemic. The research contributes a fresh perspective on the interplay between BCM practices and organizational performance, emphasizing the importance of robust business continuity strategic planning for the future of tourism operator companies.

Ensuring quality of life in palliative care physiotherapy in developing countries.

Palliative care (PC) focuses on the body, mind, and spirit and can also provide pain and symptom relief, clarifying and focusing the provision of care on the patient's desires and goals, and helping them understand their disease and its treatment plans. Although PC is widely recognized for its applicability near the end of life or during terminal illness, it is also applicable and beneficial for patients with diseases in their earlier stages. Near the end of life, palliative care often focuses on providing continual symptom management and supportive care. Although palliative care has been noted to improve some life expectancy, its primary aim is to improve quality of life via focusing on the comfort of the patient, maintaining dignity, reducing intensive care utilization, and avoidance of expensive hospitalizations. One major challenge to quality of life for patients in PC is the physical and functional decline that occurs with disease progression. These issues can be addressed by specialized PC physiotherapy. Uniform provision of high-quality PC services (and physiotherapy in palliative care) faces substantial challenges in resource-challenged settings, including low- and middle-income countries. When properly integrated into PC teams and adequately supported, physiotherapy within PC can address common symptoms (pain, breathlessness, weakness) and assist patients to remain in an adapted home setting to optimize their quality of life, safety, and dignity.

Personalized Medicine Transformed: ChatGPT's Contribution to Continuous Renal Replacement Therapy Alarm Management in Intensive Care Units.

The accurate interpretation of CRRT machine alarms is crucial in the intensive care setting. ChatGPT, with its advanced natural language processing capabilities, has emerged as a tool that is evolving and advancing in its ability to assist with healthcare information. This study is designed to evaluate the accuracy of the ChatGPT-3.5 and ChatGPT-4 models in addressing queries related to CRRT alarm troubleshooting. This study consisted of two rounds of ChatGPT-3.5 and ChatGPT-4 responses to address 50 CRRT machine alarm questions that were carefully selected by two nephrologists in intensive care. Accuracy was determined by comparing the model responses to predetermined answer keys provided by critical care nephrologists, and consistency was determined by comparing outcomes across the two rounds. The accuracy rate of ChatGPT-3.5 was 86% and 84%, while the accuracy rate of ChatGPT-4 was 90% and 94% in the first and second rounds, respectively. The agreement between the first and second rounds of ChatGPT-3.5 was 84% with a Kappa statistic of 0.78, while the agreement of ChatGPT-4 was 92% with a Kappa statistic of 0.88. Although ChatGPT-4 tended to provide more accurate and consistent responses than ChatGPT-3.5, there was no statistically significant difference between the accuracy and agreement rate between ChatGPT-3.5 and -4. ChatGPT-4 had higher accuracy and consistency but did not achieve statistical significance. While these findings are encouraging, there is still potential for further development to achieve even greater reliability. This advancement is essential for ensuring the highest-quality patient care and safety standards in managing CRRT machine-related issues.

Evaluating Time-Series Prediction of Temperature, Relative Humidity, and CO2 in the Greenhouse with Transformer-Based and RNN-Based Models

In greenhouses, plant growth is directly influenced by internal environmental conditions, and therefore requires continuous management and proper environmental control. Inadequate environmental conditions make plants vulnerable to pests and diseases, lower yields, and cause impaired growth and development. Previous studies have explored the combination of greenhouse actuator control history with internal and external environmental data to enhance prediction accuracy, using deep learning-based models such as RNNs and LSTMs. In recent years, transformer-based models and RNN-based models have shown good performance in various domains. However, their applications for time-series forecasting in a greenhouse environment remain unexplored. Therefore, the objective of this study was to evaluate the prediction performance of temperature, relative humidity (RH), and CO2 concentration in a greenhouse after 1 and 3 h, using a transformer-based model (Autoformer), variants of two RNN models (LSTM and SegRNN), and a simple linear model (DLinear). The performance of these four models was compared to assess whether the latest state-of-the-art (SOTA) models, Autoformer and SegRNN, are as effective as DLinear and LSTM in predicting greenhouse environments. The analysis was based on four external climate data samples, three internal data samples, and six actuator data samples. Overall, DLinear and SegRNN consistently outperformed Autoformer and LSTM. Both DLinear and SegRNN performed well in general, but were not as strong in predicting CO2 concentration. SegRNN outperformed DLinear in CO2 predictions, while showing similar performance in temperature and RH prediction. The results of this study do not provide a definitive conclusion that transformer-based models, such as Autoformer, are inferior to linear-based models like DLinear or certain RNN-based models like SegRNN in predicting time series for greenhouse environments.

A multi-channel photoplethysmography array with contact-force regulation for tonoarteriographic imaging

Aim: Photoplethysmography (PPG) has gained widespread popularity as a non-invasive method for potential cuff-less blood pressure (BP) measurement in smart devices. However, the accuracy of PPG-based devices is often hindered by motion artifacts, site variability, and inconsistent contact force (CF). This study aims to investigate the influence of CF variations on PPG signals. Methods: To address these challenges, we present a novel approach involving a multi-channel PPG array integrated with CF regulation in the form of a wearable wristband. This platform enables the visualization of regional PPG/BP distribution while simultaneously monitoring CF. Moreover, our research explored the relationship between PPG waveform characteristics and CF during wrist extension. Results: The results of this study reveal that the PPG amplitude (PPGA) and the b/a ratios, computed from the second derivative peaks of the PPG AC pulse wave, exhibit inconsistency in reaction to CF variations. Notably, a shape correlation coefficient of 0.65069 between normalized PPG and flipped CF sheds light on how changes in posture affect PPG measurements. Conclusions: The proposed platform shows promise in mitigating the effects of CF and spatial positioning on PPG, thereby improving measurement precision and offering a novel approach to image tonoarteriographic (TAG) activities for continuous hypertension management.

A Century of Change in a Mature Urban Forest: the Thain Family Forest of the New York Botanical Garden, Bronx, New York

Abstract Urban forests have long been understudied, resulting in a scarcity of long-term data to guide future management. The New York Botanical Garden in New York City has been stewarding the 20 ha Thain Family Forest since 1895. Using inventory data between 1937 and 2021, we document how structure, diversity, and composition of the forest have changed over the past century. Our results show an increase in the proportion and diversity of hardwood species, including oaks, hickories, red maple, black cherry, and American beech, following the loss of a dominant species, eastern hemlock. Despite changes in composition, we find no significant differences in the mean basal area, density, and tree diameter of canopy trees (diameter at breast height [DBH] ≥ 15 cm) from 1937 to 2021. Assessments of small diameter stems (DBH ≥ 2.54 cm) show increasing density, decreasing diameter, and increasing richness from 1985 to 2021, suggesting a period of understory recruitment/regeneration. During this time, native species have been dominant in both overstory and understory strata. These observations mirror trends recorded in hemlock–hardwood and oak–hickory forests region-wide, indicating that, with continued conservation and active management, urban and rural forests may develop in similar patterns and encouraging regional approaches to forest management. Study Implications: Urban forests have long been understudied, resulting in a scarcity of long-term data to guide future management. Over the past century, the 20 ha Thain Family Forest in New York City has experienced a significant change in species composition, with an increase in the proportion and diversity of hardwood species following the loss of eastern hemlock. Despite these changes, forest canopy structure has remained stable. These observations mirror those observed in hemlock–hardwood and oak–hickory forests regionwide, suggesting that with continued conservation and active management, urban and rural forests may develop in similar patterns. The results of this study support continued investment in the research and management of urban forests as a comprehensive part of regional forest management efforts.

Prevention of Natural Disaster-Induced Cardiovascular Diseases.

Natural disasters, such as floods and landslides caused by heavy rainfall, earthquakes, and tsunamis, can induce stress, which may contribute to the onset and aggravation of various cardiovascular diseases. The circulatory system is most susceptible to the effects of stress, and stress-related cardiovascular diseases, such as Takotsubo cardiomyopathy, pulmonary thromboembolism, hypertension, stroke triggered by increased blood pressure, and acute myocardial infarction, can occur during natural disasters. The risk of developing angina pectoris, arrhythmia, sudden cardiac death, and heart failure increases rapidly and can persist for several months. Moreover, treating cardiovascular diseases is essential during the acute phase, and continuous disease management is necessary during the chronic phase. However, disaster medical care for the victims must be given priority during natural disasters, which may cause a delay in diagnosis or access to necessary treatment for pre-existing medical conditions that could worsen or may cause death in patients with cardiovascular diseases. In this review, we summarize the predisposing factors for cardiovascular diseases that have been obtained through disasters such as major earthquakes and provide potential insights to help medical staff prevent the onset and aggravation of cardiovascular diseases during disasters.

Tree-Based Reinforcement Learning for Identifying Optimal Personalized Treatment Decisions for Hand Deformity in Rheumatoid Arthritis.

Silicone metacarpophalangeal joint arthroplasty (SMPA) can reconstruct metacarpophalangeal (MCP) joint deformities in the rheumatoid hand, but patient selection criteria for the procedure remains unclear. We used statistical learning to elucidate patient selection criteria that will enhance long-term patient-reported and functional outcomes in patients with severe hand rheumatoid arthritis (RA). This is a secondary analysis of a prospective study of 169 adults with severe hand RA (average combined ulnar deviation (UD) and extensor lag (EL) at the MCP joint ≥ 50 degrees, per finger) with one-year follow-up, conducted at three centers in the United States and England from January 1, 2004, to December 31, 2011. Primary outcomes were Michigan Hand Outcomes Questionnaire (MHQ) pain sub-score, changes in EL, UD, and Arthritis Impact Measurement Scale (AIMS2) score. A tree-based reinforcement learning (T-RL) model was used to estimate clinical decision rules for treatment. 132 patients (mean[SD], 61[9] years; 108[72%] female) were included in the SMPA (n=50) and non-SMPA (n=82) cohorts. To minimize EL and UD, patients should undergo SMPA. To minimize pain, patients older than 55 should undergo SMPA. To increase hand-related quality-of-life (QOL), patients with grip strength <12 kg should undergo SMPA. Estimations with imputed missing data were similar, aside from a lower grip strength (<8 kg) threshold for hand-related QOL. Unless there is significant comorbidity that precludes surgery, most patients older than 55 with severe hand RA will have improved QOL, pain, and function after SMPA. Patients with preserved grip strength may benefit from continued medical management.

Integrating and Transforming Business Continuity Management into the Digitalisation

Integrating and Transforming Business Continuity Management into the Digitalisation

Fuzzy comprehensive evaluation of seawater quality of Larimichthys Crocea mariculture areas in Zhoushan, China

Context Aquaculture is an essential industry and assessing its impact on the environment, particularly water quality, is crucial for sustainable practices. This study aimed to comprehensively evaluate the seawater quality in the Dongji Island yellow croaker (Larimichthys crocea) aquaculture area by using the fuzzy comprehensive evaluation method and field survey. Aims The main objective of this study was to assess the seawater quality in the aquaculture area during 2 consecutive years (2019 and 2020) on the basis of monitoring data. Methods The researchers utilised the fuzzy comprehensive evaluation method to assess seawater quality in the Dongji Island yellow croaker aquaculture area. Seawater monitoring data from 6 months in 2019 and 6 months in 2020 were collected for the evaluation. The method included an annual average evaluation, and membership degrees were calculated for each year and individual months. Qualitative interviews with 30 local fish farmers were conducted to unravel the challenges faced by aquaculture water quality management. Key results The evaluation results indicated that the seawater quality in the aquaculture area was classified as Class I water in both 2019 and 2020 on the basis of the annual average evaluation. However, the membership degrees for 2019 were higher than those for 2020, suggesting that water quality was better in 2019. Furthermore, individual monthly evaluations in 2020 showed varying membership degrees, with May and June having higher membership degrees, indicating better water quality than in other months. August had the lowest membership degree, implying poorer water quality during that month. Conclusions The study demonstrated that the fuzzy comprehensive evaluation method is effective for evaluating seawater quality in aquaculture areas. It also concluded that the water quality in 2019 was superior to that in 2020, raising concerns about potential environmental degradation. Implications The quantitative and qualitative findings of this research have important implications for aquaculture practices in the Zhoushan area. The study highlights the need for continued monitoring and management of water quality to ensure sustainable aquaculture practices and adherence to water-quality policies. Future aquaculture endeavours in the region should consider the potential impact on water quality to maintain a healthy ecosystem.

Recruitment failure of keystone trees in Phytophthora infested forest

AbstractInvasive plant pathogens cause considerable forest loss worldwide. However, little is known about how tree populations recover post‐invasion. In Western Australia, Phytophthora cinnamomi ‘dieback’ affects jarrah (Eucalyptus marginata), with historical records of mass deaths in this keystone tree species due to infestation, resulting in permanent loss of standing forest. Historical observations of marri (Corymbia calophylla), a co‐dominant keystone jarrah forest tree, suggest it is resistant to P. cinnamomi. Impacts of P. cinnamomi on the population dynamics of jarrah and marri are unknown. We recorded densities and stem diameters of jarrah and marri in a peri‐urban forest to examine their population demographics in &gt;60‐year‐old P. cinnamomi infestations compared with adjacent non‐infested forest. While seedling (&lt;0.5 cm stem diameter, ~ 2 –15 cm tall) densities were not significantly different, total tree densities were 43% (jarrah) and 48% (marri) lower for infested sites. Densities of jarrah 0.5–9 and 20–29 cm stem diameters were lower within infestations. Survival probabilities of jarrah seedlings were significantly greater in P. cinnamomi infestations, but those of mature jarrah were not different. While average marri stem density was 49% greater within infestations, densities of small marri (&lt;20 cm stem diameter) were lower within infestations. Survival probabilities for marri seedlings were significantly decreased in infestations, while there was greater survival probability for mature marri within P. cinnamomi infestations. Our data suggest recruitment of jarrah and marri has likely reduced since P. cinnamomi invasion. This is the first documented impact on marri, which indicates that we have been overlooking the risk of decline due to P. cinnamomi for this species. We stress the need for continued management and highlight the necessity of planting seedlings ~6 months old, and assisting their survival with phosphite and fertilizers, to bolster local tree populations.

Software Defined Layer 4.5 Customization for Agile Network Operation

Protocol customizations primarily come in two forms: those driven by public extensions to open standard protocols; and dialecting and performance tuning driven by an enterprise network’s private security and performance needs. Current deployment of protocol customizations is mostly ad hoc, through manual configuration or script programs that are highly specialized to each customization. This method lacks the agility necessary to support the relatively high tempo of private customizations. Also, it is common for today’s protocol customization efforts to experience middlebox interference. We propose a systematic framework of network-wide orchestration and continuous management of protocol customization to enable agile operation for enterprise and data-center networks. By introducing a logically centralized orchestrator along with a Layer 4.5 fine-grained device customization solution, our framework will allow operators to configure, deploy, and monitor customized flows from a single vantage point, providing timely detection of rogue devices as well as real-time coordination of middlebox traversal. Results from prototyping and experimentation confirm utility of our framework while incurring modest processing overhead, at the levels of 3% and 0.5% for sample customized flows and non-customized flows, respectively. Furthermore, we present two major system refinements: (i) generalizing the design of receiving modules to support customization of encrypted flows, and (ii) adding logic system wide to support seamless rotation of customization modules for live flows. Finally, we discuss specific agile network operation use cases enabled by our solution and outline future work.