Evidence-based Management Strategies Research Articles

Experiences of patients and nurses with thirst in advanced chronic heart failure: a mixed methods study

Abstract Background Many patients with chronic heart failure (CHF) express thirst. Perceptions of thirst and strategies for reducing this symptom can differ between patients and nurses. Purpose As part of a study to develop and evaluate a nurse-based counselling intervention on thirst in patients with advanced CHF waiting for heart transplantation, we aimed to assess patients' and nurses' perceptions on thirst, possible strategies, as well as information needs and information transfer. Methods Mixed methods study consisting of semi-structured interviews with hospitalized patients waiting for a heart transplantation in Germany. Interviews focussed on experiences with thirst, needs and requirements, and experiences with the information provided by healthcare professionals. We also conducted focus groups and an online survey with German nurses with experiences in the care of cardiac patients. Topics of the focus groups were the perceptions and handling of the symptom in nursing practice as well as the provision of information and counselling. The survey was based on the results of the focus groups and current research findings. In addition to work-related data, we asked questions about the relevance of thirst, the causes of this symptom, recommended interventions and the need for counselling. We analysed quantitative data descriptively and qualitative data using content analysis. Results We conducted 10 interviews with patients (mean age: 43.5 years; 30% female; duration of CHF: 25 days to 21 years; length of stay: 7 to 116 days). All participants had a prescribed fluid restriction. Perceived thirst markedly differed between patients, with some reporting thirst to be very distressing. Most patients described that the feeling of thirst increased especially at mealtimes. Individual strategies for reducing thirst also differed between patients depended on disease durations and their therapeutic regiment. Some patients rated the information provision by healthcare professionals concerning thirst as insufficient. In addition, we conducted two focus groups with respectively 5 nurses from two university hospitals in Germany. 59 nurses participated in the survey. Nurses (81.4% working in a hospital; 54.2% already have at least 5 years of experience in care of cardiac patients) stated that the feeling of thirst in patients with CHF is of great importance in nursing practice, but only 44.1% specified to regularly assess thirst. The perceived most common cause of thirst was a prescribed fluid restriction (93.2%) and diuretics (79.7%). Among others, most nurses recommended ice cubes as intervention to reduce thirst and considered counselling interventions as important. Conclusion(s) The occurrence of thirst is an important issue for patients with advanced CHF. The perception of the symptom varies greatly. Individualised, evidence-based strategies for symptom management are required.

Virtual Reality for Sub-Acute Pain After Orthopedic Traumatic Musculoskeletal Injuries: A Mixed Methods Pilot Study.

Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx), integrating mindfulness and cognitive behavioral therapy, for pain self-management at home following orthopedic injury. We enrolled 10 adults with recent orthopedic injuries and elevated pain catastrophizing or pain anxiety from Level 1 Trauma Clinics within the Mass General Brigham healthcare system. Participants completed daily RelieVRx sessions at home for 8 weeks, which included pain education, relaxation, mindfulness, games, and dynamic breathing biofeedback. Primary outcomes were a-priori feasibility, appropriateness, acceptability, satisfaction, and safety. Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and mechanisms (pain self-efficacy, mindfulness, and coping). The VR and study procedures met or exceeded all benchmarks. We observed preliminary improvements in pain, physical functioning, sleep, depression, and mechanisms. Qualitative exit interviews confirmed high satisfaction with RelieVRx and yielded recommendations for promoting VR-based trials with orthopedic patients. The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.

Educator Knowledge of Childhood Conduct Problems and Callous-Unemotional Traits.

Research evaluating mental health literacy (MHL) of adults who support children with mental health difficulties is relatively scarce. To date, no studies have investigated educator knowledge of conduct problems and callous-unemotional (CU) traits. This is a significant gap in the literature since conduct problems are among the most prevalent childhood mental disorders, while CU traits are associated with poor academic, behavioral, and social outcomes in school settings. In the current study, we assessed educators' knowledge of the characteristics and management of conduct problems and CU traits. Participants were N = 390 preschool and primary/elementary school educators (Mage = 38.62 years, SD = 11.66; 91% woman-identifying; 71% White) who completed a Knowledge Test and survey assessing educator characteristics and various student-educator outcomes. Averaged across items, educators scored 57.1% on the Knowledge Test. We identified gaps in educator knowledge with respect to identifying characteristics associated with distinct domains of externalizing difficulties and evidence-based management strategies. Educators' years of experience and accreditation status were not associated with knowledge. Paraeducators had significantly lower knowledge scores than teachers and leadership. Unexpectedly, greater knowledge was not associated with better student-teacher relationship quality or more positive perceptions of students with conduct problems. Findings support the need for universal MHL programs focused on conduct problems and CU traits, especially among paraeducators, while also suggesting that more intensive interventions may be required to improve educator-student relationship quality.

Clinical and electroencephalographic correlates of carbamazepine-associated hiccups in epileptic patients.

Carbamazepine, a commonly prescribed antiepileptic drug, is known to induce hiccups in a subset of epileptic patients. Although relatively uncommon, can have significant clinical implications. This comprehensive review delves into the clinical and electroencephalographic correlates of carbamazepine-associated hiccups, aiming to enhance understanding and management of this neurological side effect. The authors' review synthesizes qualitative epidemiological data, revealing that carbamazepine-induced hiccups occur in a subset of patients receiving the medication, with reported incidence rates ranging from 2.5 to 40%. Despite its relatively low prevalence, hiccups pose substantial challenges for patients and healthcare providers. Complications associated with carbamazepine-induced hiccups include disruption of sleep, impaired social functioning, and decreased quality of life, underscoring the clinical significance of this side effect. Effective management strategies can be implemented through a multidisciplinary approach, including collaboration among neurologists, pharmacists, and other healthcare professionals. These may include dose adjustments, medication discontinuation, and adjunctive therapies such as diaphragmatic breathing exercises or acupuncture. Additionally, close monitoring for adverse effects and timely intervention are essential to mitigate the impact of hiccups on patient well-being. Essentially, carbamazepine-induced hiccups represent a clinically relevant phenomenon that warrants attention in the management of epilepsy. By recognizing the clinical manifestations, understanding the underlying pathophysiology, and implementing evidence-based management strategies, healthcare providers can optimize patient care and improve outcomes in this patient population.

Management of vaginoplasty canal complications.

Increasing uptake of gender affirming surgery has allowed for a wider breadth of publication examining complications associated with vaginoplasty. This review aims to provide a comprehensive overview of complications associated with vaginoplasty procedures, focusing on intraoperative, early postoperative, and delayed postoperative complications across different surgical techniques. Intraoperative complications such as bleeding, injury of the rectum, urethra and prostate, and intra-abdominal injury are discussed, with insights into their incidence rates and management strategies. Early postoperative complications, including wound dehiscence, infection, and voiding dysfunction, are highlighted alongside their respective treatment approaches. Moreover, delayed postoperative complications such as neovaginal stenosis, vaginal depth reduction, vaginal prolapse, rectovaginal fistula, and urinary tract fistulas are assessed, with a focus on their etiology, incidence rates, and management options. Vaginoplasty complications range from minor wound issues to severe functional problems, necessitating a nuanced understanding of their management. Patient counseling, surgical approach, and postoperative care optimization emerge as crucial strategies in mitigating the impact of complications. Standardizing complication reporting and further research are emphasized to develop evidence-based strategies for complication prevention and management in vaginoplasty procedures.

Prevalence, Overview, and Treatment Strategies for Pancreatitis

Pancreatitis is an inflammatory condition of the pancreas, with acute pancreatitis being the most prevalent form. The primary etiologies are gallstones and excessive alcohol consumption, accounting for 70-80% of cases. While most acute pancreatitis cases are mild and self-limiting, approximately 20-30% progress to a severe form characterized by pancreatic necrosis and organ failure, leading to a high mortality rate of around 15%. Chronic pancreatitis is a progressive, debilitating condition resulting from repeated inflammatory episodes or other factors, causing irreversible pancreatic damage and impaired exocrine and endocrine function. Accurate diagnosis and timely intervention are crucial in pancreatitis management. Mild acute pancreatitis is typically managed with supportive care, including fluid resuscitation, pain control, and early enteral nutrition. Severe cases may require intensive care, antibiotic prophylaxis, and interventions for complications like infected necrosis. Chronic pancreatitis necessitates lifestyle modifications, pain management, enzyme supplementation, and potential endoscopic or surgical interventions for duct decompression or resection. This review aims to provide a comprehensive overview of pancreatitis, encompassing its epidemiology, etiology, classification systems, and evidence-based management strategies. Recent advances in diagnostic modalities, novel therapeutic approaches, and surgical techniques are discussed. Additionally, the review highlights the importance of a multidisciplinary approach and the need for tailored treatment plans based on individual patient factors and disease severity

Ziabetus (Prediabetes): A Harbinger of Critical Stage in the Continuum of Glucose Metabolism Disorder: A Review

Background: Prediabetes is a metabolic condition characterized by blood glucose levels higher than normal but below the threshold for diabetes mellitus. It represents a critical stage in the progression towards type 2 diabetes mellitus (T2DM) and is associated with an increased risk of cardiovascular disease and other complications. The two major pathophysiologic defects responsible for losing glucose tolerance are insulin resistance and β-cell glucose insensitivity, both appearing in subjects of Intermediate Hyperglycaemia. In classical literature, Unani physicians have described the initial symptoms and factors leading to the pathology, the risk factors are described in terms of ‘Su-e-mizaj’ as per the concept of Tibb. So, it is considered in the context of Ziabetus which is described as a disease that develops due to Sue-mizaj haar (abnormal hot temperament). The symptoms mentioned in Unani medicine are increased frequency of micturition (ants and flies are attracted to urine), increased thirst, nocturia, dryness of mouth and whole body, fatigue, loss of weight, malaise, and cramps in lower extremities. The modern drug-based approach for the management of Intermediate Hyperglycaemia is associated with inherent drawbacks, including toxicity, tolerability, cost, and efficacy. Objective: The purpose of this review is to provide an in-depth understanding of prediabetes concerning the classical literature of Greek medicine based on the analysis of certain parameters like etiopathophysiology, current diagnostic criteria, risk factors, and evidence-based management strategies. By synthesizing findings from epidemiological studies, and clinical trials, this paper aims to enhance understanding of prediabetes and facilitate effective preventive measures and interventions. Keywords: Prediabetes, Intermediate hyperglycaemia, Impaired Glucose Tolerance, Impaired Fasting Glucose, Insulin Resistance.

Using an mHealth approach to collect patient-generated health data for predicting adverse health outcomes among adult survivors of childhood cancer.

Cancer therapies predispose childhood cancer survivors to various treatment-related late effects, which contribute to a higher symptom burden, chronic health conditions (CHCs), and premature mortality. Regular monitoring of symptoms between clinic visits is useful for timely medical consultation and interventions that can improve quality of life (QOL). The Health Share Study aims to utilize mHealth to collect patient-generated health data (PGHD; daily symptoms, momentary physical health status) and develop survivor-specific risk prediction scores for mitigating adverse health outcomes including poor QOL and emergency room admissions. These personalized risk scores will be integrated into the hospital-based electronic health record (EHR) system to facilitate clinician communications with survivors for timely management of late effects. This prospective study will recruit 600 adult survivors of childhood cancer from the St. Jude Lifetime Cohort study. Data collection include 20 daily symptoms via a smartphone, objective physical health data (physical activity intensity, sleep performance, and biometric data including resting heart rate, heart rate variability, oxygen saturation, and physical stress) via a wearable activity monitor, patient-reported outcomes (poor QOL, unplanned healthcare utilization) via a smartphone, and clinically ascertained outcomes (physical performance deficits, onset of/worsening CHCs) assessed in the survivorship clinic. Participants will complete health surveys and physical/functional assessments in the clinic at baseline, 2) report daily symptoms, wear an activity monitor, measure blood pressure at home over 4 months, and 3) complete health surveys and physical/functional assessments in the clinic 1 and 2 years from the baseline. Socio-demographic and clinical data abstracted from the EHR will be included in the analysis. We will invite 20 cancer survivors to investigate suitable formats to display predicted risk information on a dashboard and 10 clinicians to suggest evidence-based risk management strategies for adverse health outcomes. Machine and statistical learning will be used in prediction modeling. Both approaches can handle a large number of predictors, including longitudinal patterns of daily symptoms/other PGHD, along with cancer treatments and socio-demographics. The individualized risk prediction scores and added communications between providers and survivors have the potential to improve survivorship care and outcomes by identifying early clinical presentations of adverse events.

Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study

IntroductionIn critically ill patients, delirium is a prognostic indicator of morbidity and mortality. This study investigates the impact of a delirium diagnosis on outcomes after Left Ventricular Assist Device (LVAD) implantation. MethodsThis retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared pre-implantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as re-intubation rate, length of stay (LOS), discharge disposition, and readmission rates. ResultsIn total, 361 patients (26.7% women, 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Pre-implantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P=0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P=0.007), 6-month (P=0.004), and in-hospital mortality (P<0.001), unplanned re-intubations (P<0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and ICU LOS were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant. ConclusionsIn this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse post-surgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.

Integrating MDT Tumor Board Shadowing into the Undergraduate Medical Curriculum: Perspective of Medical Students.

Site-specific multidisciplinary team (MDT) tumor boards are valuable resources for medical students, enabling them to familiarize themselves with the latest evidence-based cancer management strategies and observe effective teamwork in action. In this study, we looked at the awareness and perceptions of medical students about incorporating MDT tumor boards in the medical curriculum. A cross-sectional study was conducted among medical students from year 1 to year 5 at the Aga Khan University after exemption from ethical review committee. A 20-item self-administered questionnaire was used to evaluate the awareness and perceptions of medical students regarding MDT tumor boards. A total of 285 medical students participated in this study, with their mean age (± standard deviation) being 21.91 ± 1.67years. A majority of 183 (64.2%) had no prior knowledge of the existence of a site-specific MDT tumor board for cancer management. Of the 285 students, 252 (88.4%) demonstrated sufficient awareness of the effectiveness of MDT tumor boards; similarly, 232 (81.4%) responded positively to the idea of mandatory tumor board rotations being incorporated into the undergraduate curriculum. No significant association was found between the student's year of study (χ2 = 6.03, p = 0.20) or gender (χ2 = 35, p = 0.84) and their perceptions of the effectiveness of MDT tumor boards. However, it was found that students who had prior knowledge of their existence had a stronger association with sufficient awareness (χ2 = 4.2, p = 0.04). The results indicate that while the majority of the medical students have no prior attendance or knowledge regarding MDT tumor boards, there is an overwhelming willingness among students to incorporate them into the medical curriculum.

Clonal hematopoiesis and inflammation in the vasculature: CHIVE, a prospective, longitudinal clonal hematopoiesis cohort and biorepository

AbstractClonal hematopoiesis (CH) is an age-associated phenomenon leading to an increased risk of both hematologic malignancy and nonmalignant organ dysfunction. Increasingly available genetic testing has made the incidental discovery of CH clinically common yet evidence-based guidelines and effective management strategies to prevent adverse CH health outcomes are lacking. To address this gap, the prospective CHIVE (clonal hematopoiesis and inflammation in the vasculature) registry and biorepository was created to identify and monitor individuals at risk, support multidisciplinary CH clinics, and refine taxonomy and standards of practice for CH risk mitigation. Data from the first 181 patients enrolled in this prospective registry recapitulate the molecular epidemiology of CH from biobank-scale retrospective studies, with DNMT3A, TET2, ASXL1, and TP53 as the most commonly mutated genes. Blood counts across all hematopoietic lineages trended lower in patients with CH. In addition, patients with CH had higher rates of end organ dysfunction, in particular chronic kidney disease. Among patients with CH, variant allele frequency was independently associated with the presence of cytopenias and progression to hematologic malignancy, whereas other common high-risk CH clone features were not clear. Notably, accumulation of multiple distinct high-risk clone features was also associated with cytopenias and hematologic malignancy progression, supporting a recently published CH risk score. Surprisingly, ∼30% of patients enrolled in CHIVE from CH clinics were adjudicated as not having clonal hematopoiesis of indeterminate potential, highlighting the need for molecular standards and purpose-built assays in this field. Maintenance of this well-annotated cohort and continued expansion of CHIVE to multiple institutions are underway and will be critical to understanding how to thoughtfully care for this patient population.

Fundus Bleeding

Abstract Fundus bleeding, commonly known as retinal haemorrhage, is a significant ocular manifestation associated with various systemic and ocular conditions. This abstract provides a comprehensive overview of the pathogenesis, diagnosis and management strategies of fundus bleeding. The abstract begins by discussing the underlying pathophysiology of fundus bleeding, which involves the rupture of retinal blood vessels leading to the extravasation of blood into the retinal layers. It highlights the diverse aetiologies of retinal haemorrhage, including trauma, vascular diseases, hypertension, diabetes, blood dyscrasias and ocular conditions such as retinal vein occlusion and macular degeneration. The manuscript further delves into the diagnostic modalities used to assess fundus bleeding, including fundus examination, optical coherence tomography (OCT), fluorescein angiography (FA) and fundus photography. It emphasizes the importance of accurate diagnosis to identify the underlying cause and guide appropriate management. The management strategies for fundus bleeding are discussed, considering both the underlying aetiology and severity of the haemorrhage. This includes conservative approaches, such as observation and control of systemic risk factors, as well as specific interventions like antivascular endothelial growth factor (anti-VEGF) therapy, laser photocoagulation and vitrectomy. In conclusion, this abstract provides a comprehensive overview of the pathogenesis, diagnosis and management of fundus bleeding or retinal haemorrhage. It serves as a valuable resource for clinicians and researchers involved in the care of patients with retinal haemorrhage, aiding in the understanding of its multifactorial aetiology and guiding evidence-based management strategies for improved visual outcomes.

Outdoor Recreation and Environmental Conservation

Purpose: The general objective of this study was to examine different types of outdoor recreation activities and their impact on environmental conservation efforts.&#x0D; Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.&#x0D; Findings: The findings reveal that there exists a contextual and methodological gap relating to technology and traditional arts in modern sporting events. The study provided a comprehensive analysis of the complex relationship between outdoor recreation and conservation efforts. It concluded that while outdoor recreation offered various benefits, including economic contributions and fostering a connection to nature, it also posed challenges such as habitat degradation and natural resource depletion. Collaborative efforts among stakeholders, including policymakers and the public, were highlighted as crucial for achieving a balance between recreational use and conservation objectives. Additionally, education and outreach played a vital role in promoting environmental awareness and encouraging sustainable behaviors among outdoor recreationists. Overall, the study underscored the importance of integrating principles of sustainability and stewardship into outdoor recreation practices to ensure the long-term health of natural landscapes.&#x0D; Unique Contribution to Theory, Practice and Policy: Social-Ecological Systems theory, Environmental Psychology model and Ecological Modernization theory may be used to anchor future studies on outdoor recreation and environmental conservation contributed significantly to theory, practice, and policy by elucidating the complex interactions between outdoor recreation and conservation. It provided insights into theoretical frameworks such as Social-Ecological Systems theory and Environmental Psychology, informing evidence-based management strategies and policy interventions. Recommendations included integrating outdoor recreation into policy agendas, prioritizing stakeholder collaboration, and investing in educational initiatives. Research priorities emphasized longitudinal studies, interdisciplinary collaborations, and comparative research to address complex socio-ecological challenges. These contributions aimed to promote the sustainable coexistence of outdoor recreation and environmental conservation, fostering a culture of stewardship and ensuring the long-term well-being of natural landscapes and communities.

Increasing Teacher Retention by Improving Self-Efficacy and Classroom Management Skills in Pre-Service Teachers

Pre-service teacher preparation programs are often ineffective in preparing new teachers to use classroom management skills and strategies. This contributes to high teacher-turnover rates for new teachers and ultimately influences principal retention and student outcomes. The crisis of teacher retention in the aftermath of the pandemic threatens U.S. global competitiveness and national security. Teacher preparation programs can address job stress and job satisfaction by better preparing teachers for the challenges of the post-pandemic classroom. The purpose of this longitudinal, mixed-methods improvement science study was to determine if embedding evidence-based classroom management skills and strategies into the instructional methods coursework programs, augmented by structured applied learning opportunities to improve the IE, would improve pre-service teachers&amp;rsquo; self-efficacy in classroom management. The research used the Classroom Management Self Efficacy Instrument, focus groups, and written reflections. Five themes emerged from the data: student-teacher relationships, orderly classrooms, preventative measures, difficult students, and use of technology. Scores for seven practice-oriented items on the CMSEI showed strong improvement (M = 93.75%, post-intervention). Responding to the CMSEI question &amp;ldquo;I can manage a class very well,&amp;rdquo; 87.50% of students strongly agreed or agreed after the intervention. On eight items pertaining to self-efficacy on the post-survey, students reported strong efficacy (M = 85.16% agree or strongly agree). The major conclusion from this study is that embedding evidence-based classroom management skills and strategies into the instructional methods coursework, supported by structured applied learning opportunities, improves pre-service teachers&amp;rsquo; self-efficacy and holds tremendous potential to reduce teacher attrition.

Temporal analysis of settlement areas and city footprints on construction and demolition waste quantification using Landsat satellite imagery

Municipal solid waste management has seen a surge in the use of satellite imagery in decision-making processes, yet its application to analyze quantitative variations in construction and demolition (C&D) waste remains under-investigated. This study employs satellite imagery and multivariate analysis to comprehensively assess and predict C&D waste generation in four diverse urban jurisdictions of Canada (Regina) and the USA (Seattle, Buffalo, and Philadelphia). Factors such as settlement area expansion, economic activities, and population growth significantly influence C&D waste rates. Stepwise multivariate regression models tailored to different city types, such as moderately populated (Group 1) and highly populated (Group 2), showcase acceptable predictive capabilities. For moderately populated cities, settlement area, average humidity, and GDP are identified as key predictors, while for highly populated cities, settlement area, unemployment rate, and building permit value prove effective indicators. These models, characterized by R² values from 0.70 to 0.94, provide tailored insights for distinct demographic conditions, aiding waste management planning. This research underscores the importance of satellite imagery and multivariate analysis in understanding C&D waste dynamics and empowers policymakers and waste management agencies with evidence-based strategies for effective waste management in urban centers.

The Current Evidence of Pulmonary Embolism Response Teams and Their Role in Future.

Acute pulmonary embolism (PE) remains a critical medical condition requiring prompt and accurate management. The introduction and growing significance of pulmonary embolism response teams (PERT), also termed EXPERT-PE teams, signify a paradigm shift toward a collaborative, multidisciplinary approach in managing this complex entity. As the understanding of acute PE continues to evolve, PERTs stand as a linkage of optimized care, offering personalized and evidence-based management strategies for patients afflicted by this life-threatening condition. The evolving role of PERTs globally is evident in their increasing integration into the standard care pathways for acute PE. These teams have demonstrated benefits such as reducing time to diagnosis and treatment initiation, optimizing resource utilization, and improving patient outcomes.

Irrigation water economic value and productivity: An econometric estimation for maize grain production in Italy

Climate change, characterized by rising temperatures and limited precipitation, has intensified the demand for irrigation water while simultaneously restricting its availability. This challenge poses significant risks to agricultural and food production, particularly in the Mediterranean regions where, recently, water deficits have led to substantial production losses and quality issues. Water is a critical determinant of crops' economic viability, especially for water-intensive crops, making it essential to estimate its economic relevance, especially in the absence of reliable water market prices. This study has two primary objectives: first, to evaluate the shadow price of irrigation water for maize grain at the farm level, which is defined as the value generated by the marginal unit of water consumed; and second, to analyse its heterogeneity. Leveraging a Farm Accountancy Data Network (FADN) panel of 1625 Italian farms over a decade (2010–2020), an econometric production function approach is employed. Moreover, quantile regressions reveal variations in the shadow price linked to geographical, managerial, and structural farm characteristics. Our findings underscore water’s key role in economically viable maize grain production, significantly enhancing the productivity of other inputs like fertilizers and pesticides. The average shadow price is 0.29 €/m³, with a median of 0.20 €/m³ and water total productivity accounts for one-third of maize’s average gross output. Quantile regressions uncover how factors like geographic location, altitude, farm management, irrigation water source, and farm size influence the distribution of water productivity, reflecting either efficient use or scarcity of this resource. Our estimation provides valuable insights for policymakers by offering accurate shadow price estimates for irrigation water in Italian maize grain production. Furthermore, it enhances our understanding of irrigation water’s role in the economic viability of this crop, while contributing to support evidence-based water management strategies, identifying vulnerable areas and farms and allowing for future methodological developments.

The relationship between humble leadership and employee innovative behavior in Chinese Intangible Cultural Heritage (CICH) SMEs: Mediated-moderating effect of knowledge sharing and absorptive capacity

This research focuses on small and medium-sized enterprises (SMEs) within China's intangible cultural heritage (CICH) sector and investigates the relationships between employee innovative behavior (EIB), humble leadership (HL), knowledge sharing (KS) and absorptive capacity (AC). It examines how knowledge sharing, as a mediator, impacts EIB, considering the moderating role of AC. This study aims to address the knowledge gap regarding how leadership and knowledge management processes affect individual-level outcomes, such as creative behavior and problem-solving skills. This research is especially vital for the CICH sector in China, as it offers the first systematic exploration of employee innovative behavior in this area. By providing evidence-based management strategies, the study contributes to both theoretical understanding and practical application, supporting the innovation, sustainable growth, and international competitiveness of CICH SMEs. It also offers policymakers empirical insights to nurture the sector, ensuring the preservation and evolution of China's intangible cultural heritage.

A data-driven approach for PM2.5 estimation in a metropolis: random forest modeling based on ERA5 reanalysis data

Air pollution in urban environments, particularly from fine particulate matter (PM2.5), poses significant health risks. Addressing this issue, the current study developed a Random Forest (RF) model to estimate hourly PM2.5 concentrations in Ankara, Türkiye. Utilizing ERA5 reanalysis data, the model incorporated various meteorological and environmental variables. Over the period 2020–2021, the model’s performance was validated against data from eleven air quality monitoring stations, demonstrating a robust coefficient of determination (R2) of 0.73, signifying its strong predictive capability. Low root mean squared error (RMSE) and mean absolute error (MAE) values further affirmed the model’s precision. Seasonal and temporal analysis revealed the model’s adaptability, with autumn showing the highest accuracy (R2 = 0.82) and summer the least (R2 = 0.51), suggesting seasonal variability in predictive performance. Hourly evaluations indicated the model’s highest accuracy at 23:00 (R2 = 0.93), reflecting a solid alignment with observed data during nocturnal hours. On a monthly scale, November’s predictions were the most precise (R2 = 0.82), while May presented challenges in accuracy (R2 = 0.49). These seasonal and monthly fluctuations underscore the complex interplay of atmospheric dynamics affecting PM2.5 dispersion. By integrating key determinants such as ambient air temperature, surface pressure, total column water vapor, boundary layer height, forecast albedo, and leaf area index, this study enhances the understanding of air pollution patterns in urban settings. The RF model’s comprehensive evaluation across time scales offers valuable insights for policymakers and environmental health practitioners, supporting evidence-based strategies for air quality management.

Using local ecological knowledge to determine the status of Cantor's giant softshell turtle Pelochelys cantorii in Kerala, India

AbstractThe Critically Endangered Cantor's giant softshell turtle Pelochelys cantorii is a freshwater turtle found in South and Southeast Asia. Its population is declining because of habitat destruction and alteration, and hunting for its meat. Data on the species’ ecology, behaviour, population size, distribution and threats are limited, and previous surveys undertaken in India have failed to detect individuals in the wild. This lack of data hinders strategic conservation planning. Ecologists and conservationists increasingly utilize local ecological knowledge to determine the status and gain insights into the ecology of threatened and rare species that are difficult to detect in field studies. To examine the historical and current occurrence of Cantor's giant softshell turtle, we conducted community interviews along the Chandragiri River in Kerala, India. With data from these interviews, we identified multiple sites where the species continues to occur. Older respondents and those that used the river for fishing and irrigation were more likely to report sightings of the species. Our findings also improved knowledge about the turtles’ seasonal and diel activity patterns. A network of key informants identified through the interviews provided information on turtle bycatch, sightings and nesting. This network is being utilized for the continued monitoring of the species and could help in devising evidence-based management strategies for softshell turtles in India. These methods can also be adopted more widely for other threatened species of freshwater turtles globally.