Guidelines For Decisions Research Articles

Optimized strategy for real-time qPCR detection of Onchocerca volvulus DNA in pooled Simulium sp. blackfly vectors.

Onchocerca volvulus is a filarial parasite that is a major cause of dermatitis and blindness in endemic regions primarily in sub-Saharan Africa. Widespread efforts to control the disease caused by O. volvulus infection (onchocerciasis) began in 1974 and in recent years, following successful elimination of transmission in much of the Americas, the focus of efforts in Africa has moved from control to the more challenging goal of elimination of transmission in all endemic countries. Mass drug administration (MDA) with ivermectin has reached more than 150 million people and elimination of transmission has been confirmed in four South American countries, with at least two African countries having now stopped MDA as they approach verification of elimination. It is essential that accurate data for active transmission are used to assist in making the critical decision to stop MDA, since missing low levels of transmission and infection can lead to continued spread or recrudescence of the disease. Current World Health Organization guidelines for MDA stopping decisions and post-treatment surveillance include screening pools of the Simulium blackfly vector for the presence of O. volvulus larvae using a PCR-ELISA-based molecular technique. In this study, we address the potential of an updated, practical, standardized molecular diagnostic tool with increased sensitivity and species-specificity by comparing several candidate qPCR assays. When paired with heat-stable reagents, a qPCR assay with a mitochondrial DNA target (OvND5) was found to be more sensitive and species-specific than an O150 qPCR, which targets a non-protein coding repetitive DNA sequence. The OvND5 assay detected 19/20 pools of 100 blackfly heads spiked with a single L3, compared to 16/20 for the O150 qPCR assay. Given the improved sensitivity, species-specificity and resistance to PCR inhibitors, we identified OvND5 as the optimal target for field sample detection. All reagents for this assay can be shipped at room temperature with no loss of activity. The qPCR protocol we propose is also simpler, faster, and more cost-effective than the current end-point molecular assays.

Research on the Improvement Path of Total Factor Productivity in the Industrial Software Industry: Evidence from Chinese Typical Firms

The high-quality development of the industrial software industry is of strategic significance to enhancing the core competitiveness of the manufacturing industry and promoting the high-quality development of China’s industrial economy. By integrating the “capital-technology-environment-human” production factor theory and configuration perspective, this paper constructs a comprehensive analysis framework that drives the total factor productivity (TFP) of the industrial software industry. This paper uses 40 typical industrial software firms in 2018–2020 as case samples and uses fuzzy set Qualitative Comparative Analysis (fsQCA) to empirically explore the influencing factors and complex mechanisms that achieve high-quality development of the industrial software industry. It is found that: (1) a single industrial factor is hardly a necessary condition to drive the industrial software industry; (2) there are four paths to achieving high TFP, which are summarized as “technical-human-environmental” balanced driving type, “capital-human-environmental” balanced driving type, “technical-capital” dual driving type, and “capital” single driving type. There are four driving mechanisms. There are also four not-high TFP configurations with asymmetric characteristics; (3) under certain conditions, the combination of capital factors, technical factors, environmental factors, and human factors can drive TFP in an “all roads lead to Rome”. In this process, the government’s attention plays a more universal role. The study not only expands the application scenarios of fsQCA but also provides decision guidelines for the practice of strategic emerging industrialization represented by the industrial software industry.

Antiepileptic therapy algorithms in patients with primary and metastatic brain tumors

Up to date the brain tumors incidence keeps growing worldwide. Epilepsy and epileptic seizures are one of the most common clinical features of brain tumors. The aim of the study was to invent the algorithms antiepileptic treatment of patients with primary and metastatic brain tumors based on literature data. We searched eLIBRARY, PubMed databases by keywords. We concluded, that preventive antiepileptic drugs administration in patients with primary or metastatic brain lesions does not lower the risk of acute symptomatic postoperative seizures or epilepsy incidence, and therefore should not be recommended. Experts’ opinion states that in patients with brain tumors even one unprovoked seizure makes it feasible to initiate antiepileptic drugs therapy as soon as possible. In case of two or more unprovoked episodes (with over 24 hours difference) the diagnosis of “epilepsy” is legitimate and antiepileptic therapy should be started. The treating physician’s choice of antiepileptic therapy is based on type of seizures, age and sex of the patient, the comorbidity and potential antiepileptic drugs pharmacokinetic interactions with other drugs (including chemotherapy), in particular, one should avoid the use of liver microsomal-inducing antiepileptic drugs. The presented algorithms provide the decision-making guidelines in case of intraoperative focal seizures, acute symptomatic seizures and status epilepticus occurrence in early postoperative period.

Fermatean Fuzzy Group Decision-Making Based CODAS Approach for Taxation of Public Transit Investments

The provision of public goods is always a controversial issue in many aspects. Even some additional financial resources can provide public transit systems, the tax revenues constitute a significant part of the investments in practice. Yet, governments should make an important decision regarding tax schemes. This article focuses on how to identify the best tax scheme to finance public transit investments. A three-phase Fermatean fuzzy group decision-making approach is developed to solve the highlighted problem. Qualifications and experience of experts are considered to distinct their reputations. A Fermatean fuzzy direct rating method is introduced to evaluate criteria importance. A Fermatean fuzzy combinative distance-based assessment method is formulated to assess tax schemes. The study provides valuable policy implications and decision-making guidelines using a real-life case. The results show that beneficiaries of public services should pay more, and tax collectors are encouraged to use progressive tax schemes instead of the equal distribution of the cost to the taxpayers. The sensitivity analysis to changes in the threshold parameter is given. The comparative analysis with all state-of-the-art Fermatean fuzzy set based multicriteria decision-making methods is provided. The Fermatean fuzzy group decision-making approach is highly robust and reliable. The approach can solve other public transportation problems.

Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review.

Snakebite-related fatalities disproportionately affect populations in impoverished socio-economic regions, marked by limited access to adequate healthcare and constrained antivenom availability. Early medical intervention is pivotal in mitigating mortality and morbidity associated with snakebite envenoming (SBE). While clinical assessment remains fundamental in treating SBE, this review aims to spotlight objective parameters that could also affect outcomes. Selected studies that identify factors associated with poor outcomes are predominantly region-specific, single-site, and observational, yet collectively reveal similar findings. They consistently report factors such as treatment delays, susceptibility in vulnerable groups such as children and pregnant women, as well as various biochemical and haematological abnormalities. Acute kidney injury (AKI), low platelets, leucocytosis, abnormal coagulation, and elevated creatine kinase (CK) all show an association with poor outcomes. Furthermore, recognising rare and unusual SBE presentations such as adrenal insufficiency, severe hypertension, intracranial haemorrhage, acute angle closure glaucoma, and bowel ischaemia also has a bearing on outcomes. Despite the integration of these parameters into clinical decision tools and guidelines, the validation of this evidence is limited. This review underscores the imperative for high-quality, multi-centre studies aligned with consensus-driven Core Outcome Sets (COS) and Patient-Reported Outcome Measures (PROMS) to validate and strengthen the current evidence.

El Niño’s Effects on Southern African Agriculture in 2023/24 and Anticipatory Action Strategies to Reduce the Impacts in Zimbabwe

The frequency of El Niño occurrences in southern Africa surpasses the norm, resulting in erratic weather patterns that significantly impact food security, particularly in Zimbabwe. The effects of these weather patterns posit that El Niño occurrences have contributed to the diminished maize yields. The objective is to give guidelines to policymakers, researchers, and agricultural stakeholders for taking proactive actions to address the immediate and lasting impacts of El Niño and enhance the resilience of the agricultural industry. This brief paper provides prospective strategies for farmers to anticipate and counteract the El Niño-influenced dry season projected for 2023/24 and beyond. The coefficient of determination R2 between yield and ENSO was low; 11 of the 13 El Niño seasons had a negative detrended yield anomaly, indicating the strong association between El Nino’s effects and the reduced maize yields in Zimbabwe. The R2 between the Oceanic Nino Index (ONI) and rainfall (43%) and between rainfall and yield (39%) indirectly affects the association between ONI and yield. To safeguard farmers’ livelihoods and improve their preparedness for droughts in future agricultural seasons, this paper proposes a set of strategic, tactical, and operational decision-making guidelines that the agriculture industry should follow. The importance of equipping farmers with weather and climate information and guidance on drought and heat stress was underscored, encompassing strategies such as planting resilient crop varieties, choosing resilient livestock, and implementing adequate fire safety measures.

Impact of Digitalization on Process Optimization and Decision-Making towards Sustainability: The Moderating Role of Environmental Regulation

Digitalization has brought a significant improvement in process optimization and decision-making processes, in particular in pursuing the goal of sustainability. This study examines how digitalization has affected process optimization and decision-making towards sustainability, focusing on Pakistan’s manufacturing sector. This study also examines the moderating role of environmental regulations between digitalization and sustainable practices. This study is based on quantitative methodology. Purposive sampling was used to gather primary data from 554 managers and engineers working in manufacturing industries in Pakistan through a closed-ended questionnaire. Smart PLS was used for data analysis. The findings show digitalization’s positive and significant influence on process optimization and decision-making. The results also show that environmental regulations have a significant moderating effect on the digitalization of processes and decision-making towards sustainability practices. The findings provide a guideline for industries, decision-makers, and researchers for developing strategies that effectively use digitalization for sustainability and assist in achieving the Sustainable Development Goals (SGD-9, SGD-11, SGD-12, and SGD-13).

Opportunities and Challenges of Prognostic Models for Extremely Preterm Infants.

Predicting the short- and long-term outcomes of extremely preterm infants remains a challenge. Multivariable prognostic models might be valuable tools for clinicians, parents, and policymakers for providing accurate outcome estimates. In this perspective, we discuss the opportunities and challenges of using prognostic models in extremely preterm infants at population and individual levels. At a population level, these models could support the development of guidelines for decisions about treatment limits and may support policy processes such as benchmarking and resource allocation. At an individual level, these models may enhance prenatal counselling conversations by considering multiple variables and improving transparency about expected outcomes. Furthermore, they may improve consistency in projections shared with parents. For the development of prognostic models, we discuss important considerations such as predictor and outcome measure selection, clinical impact assessment, and generalizability. Lastly, future recommendations for developing and using prognostic models are suggested. Importantly, the purpose of a prognostic model should be clearly defined, and integrating these models into prenatal counselling requires thoughtful consideration.

Optimization of Fixations for Additively Manufactured Cranial Implants: Insights from Finite Element Analysis.

With the emergence of additive manufacturing technology, patient-specific cranial implants using 3D printing have massively influenced the field. These implants offer improved surgical outcomes and aesthetic preservation. However, as additive manufacturing in cranial implants is still emerging, ongoing research is investigating their reliability and sustainability. The long-term biomechanical performance of these implants is critically influenced by factors such as implant material, anticipated loads, implant-skull interface geometry, and structural constraints, among others. The efficacy of cranial implants involves an intricate interplay of these factors, with fixation playing a pivotal role. This study addresses two critical concerns: determining the ideal number of fixation points for cranial implants and the optimal curvilinear distance between those points, thereby establishing a minimum threshold. Employing finite element analysis, the research incorporates variables such as implant shapes, sizes, materials, the number of fixation points, and their relative positions. The study reveals that the optimal number of fixation points ranges from four to five, accounting for defect size and shape. Moreover, the optimal curvilinear distance between two screws is approximately 40 mm for smaller implants and 60 mm for larger implants. Optimal fixation placement away from the center mitigates higher deflection due to overhangs. Notably, a symmetric screw orientation reduces deflection, enhancing implant stability. The findings offer crucial insights into optimizing fixation strategies for cranial implants, thereby aiding surgical decision-making guidelines.

Develop a Nonlinear Regression Model Using Box-Cox Transformation with Application

This article introduces an algorithm designed for utilizing power transformations in the estimation of nonlinear regression models. The algorithm outlines a series of steps for selecting the most suitable power parameter estimate through a combination of the conventional Maximum Likelihood Estimation technique and specific criteria for enhancing statistical modeling effectiveness. Supplementary decision guidelines involve the utilization of the determination coefficient and the p-value from the errors normality test. The algorithm's application was demonstrated using actual data. The article's conclusion highlighted the ability to identify a range of feasible solutions for selecting the optimal power parameter. However, it was acknowledging the challenge of identifying a single optimal value that satisfies the requirements of all estimation and decision methodologies.

The Role of Primary Care in Bridging Adolescents Awaiting Eating Disorder Treatment.

The striking rise in adolescent eating disorders since the severe acute respiratory coronavirus syndrome 2 pandemic has amplified demands for specialty eating disorders services and contributed to protracted delays in care. In the context of these delays, patients are at risk for increased weight loss, medical instability, escalating disease progression and poor prognosis. Primary care providers (PCPs) are frequently the first point of contact for young patients with eating disorders and are often left to bridge the gap while families struggle to establish specialty care. Yet, beyond case detection and medical comanagement, there are no evidence-based guidelines that can assist PCPs to prepare families for treatment, halt disease progression, and begin the lengthy process of weight and nutritional restoration in efforts to reduce medical complications and support a favorable prognosis. We present the case of a 13-year-old girl with a restrictive eating disorder to illustrate how PCPs can use intervention principles and strategies derived from evidence-based eating disorder treatment to successfully manage adolescent patients until they can access specialty treatment. We offer concrete guidelines for decision-making, as well as suggested behavioral and medical interventions for the PCP. With evidence-based tools, PCPs are well-positioned to support young patients with restrictive eating disorders and their family members as they begin the process of recovery from an eating disorder.

A guide for selecting the intraoral scan extension when fabricating tooth- and implant-supported fixed dental prostheses.

To describe a new classification for intraoral scans based on the scan extension and to introduce a decision guideline to choose the scan extension for fabricating tooth- and implant-supported fixed dental prostheses (FDPs). Multiple operator- and patient-related factors have been identified that can decrease the scanning accuracy of intraoral scanners (IOSs), including scan extension. However, the decision criteria for selecting scan extension for fabricating tooth- and implant-supported restorations is unclear. Based on the extension of the intraoral digital scans, three types of scans can be defined: half-arch (anterior or posterior), extended half-arch, and complete-arch scan. Variables to consider when choosing the scan extension include the number and location of units being restored, as well as the extension and location of edentulous areas. Additionally, the accuracy of the virtual definitive cast and the accuracy of the maxillomandibular relationship captured by using IOSs should be differentiated. A decision tree for selecting the scan extension is presented. The decision is based on the number and location of units being restored, and the extension and location of edentulous areas. Intraoral scans with reduced scan extension are indicated when fabricating tooth- and implant-supported crowns or short-span fixed prostheses, when the patient does not have more than one missing tooth in the area of the dental arch included in the scan. For the remaining clinical conditions, complete-arch intraoral scans are recommended. Scan extension is a clinician's decision that should be based on the number and location of units being restored and the extension and location of edentulous areas. Intraoral scans with a reduced scan extension is recommended, when possible.

Environmental Assessment of Demolition Tools Used in Townhouse Demolition: System Dynamics Modeling

To accommodate population growth and migration to cities, many infrastructures have been demolished to build new residential units. Demolition processes cause various environmental problems globally and locally. The selection of methods used in demolition is crucial to reduce the long-term environmental impact. This study considers various combination tools used in townhouse demolition in Thailand, examines their environmental impacts, and suggests the combination of the tools to be used in the long term. The system dynamics (SD) modeling approach is utilized in this study to capture the changes in townhouse units, sizes, demolition tools, demolition time, and the work rates of tools and their effects on the environment. This approach has the capability to model complex relationships and examine long-term trends. Secondary data are employed to identify variables necessary for SD model development, such as the different sizes of townhouses in Thailand, the various types of demolition tools used in the construction industry, and environmental impacts from building demolition. The simulation results revealed that Combination 4, i.e., the use of demolition robots and hydraulic splitters, is the most effective combination to reduce the final impact percentage in the long term. Compared with the other three combinations, it generates the lowest CO2eq emissions, energy consumption, noise, dust, and heat. If demolition robots are not yet available, Combination 1 (i.e., the use of excavators, jackhammers, and flame-cutters) offers the lowest environmental impact in the long term. This study provides guidelines for decision-makers in the construction industry to make sustainable choices of demolition tools and techniques used for townhouse demolition to reduce long-term environmental impacts.

An early warning for better planning of agricultural expansion and biodiversity conservation in the Orinoco high plains of Colombia

The eastern high plains of the Orinoco region in Colombia are known as ‘Altillanura’. They are considered the future agricultural frontier of Colombia. Unfortunately, an agricultural expansion without taking in consideration areas of high biodiversity and conservation of fragile ecosystems that are ecologically irreplaceable will likely fail in providing a sustainable grow. An orderly management planning of the territory based on scientific evidence is currently lacking for this region. Specifically, studies that combine biodiversity data and agricultural information are a major research gap. This study analyses the spatial patterns of species richness and endemism of flora and fauna at the site and subregional levels. We compared the spatial changes of biodiversity patterns with aspects related to the expansion of the agricultural frontier and its possible impacts. We found a west-to-east pattern; sites closer to the Andes were more exposed to ecological degradation than those in the east. Santa Rosalía and Puerto Lopez are the municipalities with the most remarkable species diversity. Conversely, La Primavera municipality has the most significant number of endemic species. Our spatial changes results raise the alarm showing that hotspots of diversity closer to the municipalities of Puerto Lopez and Puerto Gaitan are under more pressure than underdeveloped municipalities (La Primavera and Puerto Carreño). Our results could serve as a baseline to identify spatial changes of agrobiodiversity and a guideline for land-use planning, regional policies and local decision-makers to improve regional development in Colombia’s eastern plains region.

Further Progress Toward Automating Functional Analysis Interpretation.

It is considered best practice to conduct a functional analysis and visually inspect data collected to determine the function of problem behavior, which then informs the intervention approaches applied. Visual inspection has been described as a "subjective" process that may be affected by factors unrelated to the data. Structured decision-making guidelines have been established to address some of these shortcomings. The current paper is a follow-up to earlier work describing positive outcomes related to the viability of a decision support system based on structured criteria from Roane et al. Here, we demonstrate important improvements in a computer script's interpretation of functional analysis data, including improvement in agreement between the updated computer script version and experienced human raters (89%) compared to our original agreement outcomes (81%). This paper further supports the use of decision support systems for functional analysis interpretation.

Pentingnya Penerapan Strategik Manajemen Di Rumah Sakit: Kajian Teoritis

Hospital service institutions should understand how appropriate strategic management is to make their business stronger. This is important so that the process of making every decision is in accordance with the hospital's vision and mission. Strategic management provides overall direction for a company and is closely related to the field of organizational behavior. Current strategic management must provide a basic foundation or guideline for decision making within an agency. The aim of this theoretical study is to find out how important strategic management is in hospitals. The research method used is descriptive theoretical study, namely a method that discusses several possibilities for solving actual problems by collecting data, compiling or classifying it, analyzing and interpreting it with existing theories and comparing it from literature sources. The results of the study show that the importance of strategic management in hospitals is to design basic finances, plan forecasts, plan external strategies, and strategic management in hospital marketing. It can be concluded that strategic management requires leadership skills that are able to make major decisions, overcome existing obstacles or problems, and take full advantage of opportunities. In Hospital Agencies, strategic management is carried out continuously, meaning it is sustainable by evaluating and also controlling internal business, conducting competitor analysis, and establishing strategies to be able to compete with other hospitals and have excellent programs that can improve service quality and patient satisfaction. For hospital agencies, it should be able to be applied by all management and service parties so that they can face competition and show the excellence of the hospital and improve service quality.

Proposed Standards For Cadmium And Lead Concentration In Biosolids As Applied As Soil Conditioner In The Philippines Using WHO Guidelines For Decision-Making

Proposed Standards For Cadmium And Lead Concentration In Biosolids As Applied As Soil Conditioner In The Philippines Using WHO Guidelines For Decision-Making

GUIDELINES FOR INSTALLING MULTI-USE AND ECO-FEATURES DURING BREAKWATER UPGRADES

Many breakwaters along the New South Wales (NSW) coastline that train river entrances or form armoured harbours were designed and built more than 100 years ago. They were built to support coastal shipping, transport and trade which was important in European settlement along coastal NSW prior to the construction of rail and road networks. Breakwater construction was undertaken without rigorous environmental impact assessment and often caused unintended, and lasting, estuary-wide hydrological impacts and interruptions to sand movement. The structures themselves also replaced and fragmented natural ecosystems. A decision-making framework (Mamo et al, 2022) and guidelines (Dwyer and Dengate, 2021) have been developed to inform the planning of upgrade works. The framework and guidelines promote adoption of elements that can maximise multi-use opportunities and incorporate eco-features to add environmental value. They can inform decision-making for an individual breakwater or an organization’s portfolio of structures.

Dens Invaginatus: Literature Review and Case Report

Dens invaginatus (DI) represents a structural defect in the tooth, resulting from invagination of enamel organ into the dental papilla. This rare anomaly, which often goes unnoticed during a clinical examination, is a risk factor for the development of carious lesions and consequently pulpopathies. The knowledge of this type of lesions allows to ensure early diagnosis and thus avoid any complications. This article represents a case report of dens invaginatus along with a literature review regarding etiology, classification, clinical appearance, and diagnosis. It provides also guidelines for decision-making and treatment of invaginated teeth

One-Year Mortality in Patients Undergoing an Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy Pulse Generator Replacement: Identifying Patients at Risk.

Implantable cardioverter defibrillators (ICDs) significantly contribute to the prevention of sudden cardiac death in selected patients. However, it is essential to identify those who are likely to not have benefit from an ICD and to defer a pulse generator exchange. Easily implementable guidelines for individual risk stratification and decision making are lacking. This study investigates the 1-year mortality of patients who underwent an ICD or cardiac resynchronization therapy with defibrillator function (CRT-D) pulse generator replacement in a contemporary real-world tertiary hospital setting. The cause of death and patient- and procedure-related factors are stratified, and predictive values for 1-year mortality are evaluated. Patients with a follow-up of ≥365 days (or prior mortality) after an ICD or CRT-D exchange at the Leiden University Medical Center from 1 January 2018 until 31 December 2021 were eligible. In total, 588 patients were included (77% male, 69 [60-76] years old, 59% primary prevention, 46% ischemic cardiomyopathy and 37% mildly reduced left ventricular ejection fraction (LVEF)). Patients undergoing a CRT-D replacement or upgrade had a significantly higher 1-year all-cause mortality (10.7% and 11.9%, respectively) compared to patients undergoing ICD (2.8%) exchange (p = 0.002). LVEF ≤ 30%, New York Heart Association class ≥ 3, estimated glomerular filtration rate ≤ 30 mL/min/m2 and haemoglobin ≤ 7 mmol/L were independently associated with mortality within 1 year after pulse generator replacement. There is a growing need for prospectively validated risk scores to weight individualized risk of mortality with the expected ICD therapy benefit and to support a well-informed, shared decision-making process.