Management Goals Research Articles

Ranking of power grid facilities as a tool for choosing a repair management system

In the long-term planning of repairs at power grid facilities in conditions of limited operational and investment resources, it is important to determine the "points of maximum return", that is, the objects whose repair will cause the greatest effect in terms of the company's target priorities. This requires an operational assessment and ranking of electric grid facilities, taking into account the technological and resource characteristics of the energy company. The article presents a decision-making methodology that, based on operational calculations and priority assessment, enables to identify power grid facilities with the highest repair efficiency in the sense of criteria characterizing the strategic goals of asset management of an energy company. The methodology combines methods of modeling and calculating the probabilities of failure in consumer power supply systems (PSS) with the determination of indices of the technical condition of equipment, methods for calculating labor costs for maintaining and restoring reliability and assessing damage from its disruptions.The developed methodology allows the energy company — the owner of assets, when choosing the most effective repair management system according to enlarged indicators and simplified models, to form prioritization lists of objects for which the critical repair rank corresponds to its strategic priorities. The possibility of cost estimation of the total labor costs for the maintenance of facilities for each of the received prioritization lists in comparison with the repair fund stated by the energy company expands the scope of the methodology and increases the validity of the decisions made. The methodology has been verified and confirmed by consideration on the example of a real PSS of oil fields using up-to-date operational information.

Clinical efficacy of three plating systems in management of mandibular parasymphyseal fractures: a retrospective study.

The main goal of management of the mandibular fracture is to obtain the pre-injury contour of the bone and pre-injury occlusion as well as regain function early. For Parasymphyseal fractures, the ideal fixation method is still debatable. It could range from rigid to semi-rigid fixation. The current study aimed to compare the clinical and radiographic effect of two miniplates, 2.3 high-profile Miniplates, and three-dimensional (3D) Miniplates for internal fixation treatment of mandibular para-symphyseal fractures. The study reviewed 240 medical records, dividing 60 patients into three treatment groups: Group I (25 patients received 2.0 mini plates), Group II (22 patients received 2.3 high profile miniplate), and Group III (13 patients received 3D miniplate). Data included demographics, fracture diagnosis, radiographs, maxillomandibular fixation use, surgical time, intervention, postoperative stability, and complications. The present study included 60 patients with mandibular parasymphyseal fractures, divided into three treatment groups: Group I (n = 25, 41.67%), Group II (n = 22, 36.67%), and Group III (n = 13, 21.67%). The study found no significant differences in age and sex distribution among the three groups, but the mean surgery time varied significantly. Group II had the highest rate of complications at 22.73%, followed by Group I at 20% and Group III at 7.69%. In conclusion, the (3D) Miniplates could provide better internal fixation treatment of mandibular para-symphyseal fractures in terms of easy use, short surgery time and less complication such as malocclusion and infection.

Goal Setting and the Emergence of the Safety-Efficiency Trade-off in Organizations

This article aims to shed light on the trade-off between safety and efficiency that arises in organizations when management sets overly demanding efficiency goals. To explore the dynamics and relationships between management's goal setting and the safety-efficiency trade-off, we have chosen to analyze the extreme and illustrative case of the Herald of Free Enterprise disaster – a ferry that sank on March 6, 1987, resulting in the deaths of 193 passengers and crew members. The case shows how the management's imposition of very tight schedules for embarkation and disembarkation operations at the port of Zeebrugge promoted the emergence of risky practices, namely the regular violation of procedures by the crew. We argue that these violations, aimed at increasing the speed of operations to meet the time goals, were a central factor, though not the only one, in the etiology of the accident. The case provides evidence that when management sets overly strict performance goals, it directs employees' attention and efforts toward efficiency at the expense of safety. As a result, safety is compromised, leading to an increased risk of incidents, which can harm employees' health and cause economic and legal damage to the organization.

Research on Hydraulic Characteristics of Water Leakage Phenomenon of Waterproof Hammer Air Valve in Water Supply Pressure Pipeline Based on Sustainable Utilization of Water Resources in Irrigation Areas

To investigate the causes of water leakage in the waterproof hammer air valve and its impact on sustainable water resource management, the DN100 waterproof hammer air valve was taken as the research object. By using the overset grid solution method of ANSYS Fluent 2021 R1 software, the flow field simulation of the waterproof hammer air valve was carried out. The transient action during the ascent phase of the key structural component floating ball, and the velocity and pressure distribution of the flow field inside the air valve are analyzed. The results showed that by giving different inlet flow velocities, the normal flow velocity range for the floating ball to float up was below 35 m/s and above 50 m/s. When the inlet flow velocity was between 35 m/s and 50 m/s, the growth rate of the pressure difference above and below the floating ball increased from 1.48% to 5.79% and then decreased to 0.4%. The floating ball would not be able to float up due to excessive outlet pressure above, which would cause the DN100 waterproof hammer air valve to leak water and fail to provide water hammer protection. When the inlet flow rate is 5 m/s, the velocity and pressure inside the valve body increase with time during the upward movement of the floating ball inside the waterproof hammer air valve and tend to stabilize at 400 ms. Through the generated pressure and velocity cloud maps, it can be observed that the location of maximum pressure is at the bottom of the buoy, directly below the floating ball, and at the narrow channels on both sides of the outflow domain. The location of the maximum velocity is at the small inlet of the bottom of the buoy. When the inlet speed of the valve is constant, a large amount of water flow is blocked by the floating ball, reducing the flow velocity and forming partial backflow below the floating ball, with an obvious vortex phenomenon. A small portion of the water flow passes through the air valve at a high velocity from both ends of the channel, and the water flow below the floating ball is in an extremely unstable state under the impact of high-speed water flow, resulting in a large gradient of water flow velocity passing through the valve. The research results not only help to improve the operational efficiency of water resource management systems but also reduce unnecessary water resource waste, thereby supporting the goal of sustainable water resource management.

دور العلاقات العامة في تشكيل الصورة الذهنية لموظفي القطاع البلدي بالمنطقة الشرقية

The study showed that effective public relations activities, including media campaigns and direct communication with employees, contribute significantly to improving the mental image of the municipal sector. These activities play a major role in enhancing employees’ confidence in their management and raising their level of job satisfaction. The study also found that continuous and comprehensive internal communication increases employee satisfaction and enhances their sense of belonging. Public relations contribute to achieving alignment between management goals and employee aspirations, which helps achieve a stable and supportive work environment. The results indicated that transparency in communication processes between management and employees is one of the essential elements for building a positive and reliable relationship. This transparency contributes to reducing rumors and misunderstandings, which increases positive interaction between management and employees and enhances their impressions of the institution. The study also highlighted the effectiveness of modern technical tools in enhancing internal communication, as the use of these tools contributes to facilitating the exchange of information and clarifying procedures, which leads to improving the effectiveness of communication and enhancing the positive mental image of the municipal sector. The study stressed the importance of adopting sustainable public relations strategies aimed at continuous and constructive communication with employees, to support the long-term goals of the sector. She recommended the need to focus public relations efforts on transparency, continuous communication and the use of modern technologies, which contributes to creating a positive work environment and enhances job satisfaction and belonging among employees, thus achieving a positive and supportive mental image of the municipal sector in the Eastern Region.

TEP in the ER: After Hours Tracheoesophageal Prosthesis Management for the Otolaryngologist.

Tracheoesophageal voice puncture and prosthesis (TEP) is a common method of voice restoration following total laryngectomy. A variety of complications, both minor and major, can be associated with the TEP and require timely intervention/management. Some of those complications include premature leakage, periprosthetic leakage, granulation tissue growth, TEP dislodgement, or embedding of the TEP. Patients may present with problems and/or complications with the voice prosthesis in an emergency setting or after clinic hours when a trained speech pathologist is not present or readily available for evaluation and management. This manuscript aims to provide guidance for management of acute TEP complications to otolaryngology responders, especially those who may be less familiar with TEP troubleshooting. Experiential and literature review was undertaken by a group of head and neck specialized Speech Language Professionals in high volume Head & Neck Oncology practices, to develop consensus guidelines for emergency TEP management. TEP emergencies were categorized as (1) leakage through, (2) leakage around, (3) sudden loss of voicing, (4) loss of prosthesis, still in tract, (5) loss of prosthesis, not in tract. Management strategies for each form of emergency were developed to achieve patient safety and stability until definitive measures could be performed by the patient's Speech Language Professional. The goals of emergency management of TEP problems focused on minimizing risk of aspiration pneumonia, risk of foreign body aspiration, risk of wound complications at the puncture site. A simple management algorithm was developed for emergency or on-call otolaryngology responders.

People or predators? Comparing habitat‐dependent effects of hunting and large carnivores on the abundance of North America's top mesocarnivore

Variation in animal abundance is shaped by scale‐dependent habitat, competition, and anthropogenic influences. Coyotes Canis latrans have dramatically increased in abundance while expanding their range over the past 100 years. Management goals typically seek to lower coyote populations to reduce their threats to humans, pets, livestock and sensitive prey. Despite their outsized ecological and social roles in the Americas, the factors affecting coyote abundance across their range remain unclear. We fit Royle–Nichols abundance models at two spatial scales in a Bayesian hierarchical framework to three years of data from 4587 camera trap sites arranged in 254 arrays across the contiguous USA to assess how habitat, large carnivores, anthropogenic development and hunting regulations affect coyote abundance. Coyote abundance was highest in southwestern USA and lowest in the northeast. Abundance responded to some factors as expected, including positive (soft mast, agriculture, grass/shrub habitat, urban–natural edge) and negative (latitude and forest cover) relationships. Colonization date had a negative relationship, suggesting coyote populations have not reached carrying capacity in recently colonized regions. Several relationships were scale‐dependent, including urban development, which was negative at local (100‐m) scales but positive at larger (5‐km) scales. Large carnivore effects were habitat‐dependent, with sometimes opposing relationships manifesting across variation in forest cover and urban development. Coyote abundance was higher where human hunting was permitted, and this relationship was strongest at local scales. These results, including a national map of coyote abundance, update ecological understanding of coyotes and can inform coyote management at local and landscape scales. These findings expand results from local studies suggesting that directly hunting coyotes does not decrease their abundance and may actually increase it. Ongoing large carnivore recoveries globally will likely affect subordinate carnivore abundance, but not in universally negative ways, and our work demonstrates how such effects can be habitat and scale dependent.

Концептуальні рамки управління борговим фінансуванням публічних бюджетів

Introduction. Overcoming the consequences of the COVID-19 pandemic and full-scale Russian aggression against Ukraine caused the destruction of a stable system of managing financial flows not only in our country, but also in many states. Market and regulatory mechanisms for mobilization and the use of financial resources were undermined. Fiscal consolidation measures were changed in favor of expansion. The need to increase the resource base on the basis of state debt has intensified. The use of standardized approaches in the field of fiscal policy did not make it possible to limit risks under new conditions. The task of implementing new conceptual approaches to the management of public budget financing based on the use of debt instruments has arisen. Problem Statement. An increase in debt financing of public budgets helps to expand the volume of resources for the implementation of state plans. At the same time, the pressure on the financial system is growing, which requires making significant changes to the formation of the structure of debt instruments, their placement on domestic and foreign financial markets, attraction of resources on preferential terms from foreign partners, fulfillment of repayment and servicing obligations, refinancing and restructuring of loans. Determining rational management decisions on these issues involves the development of a conceptual framework for public debt financing. The purpose is to study the formation of a conceptual framework for managing debt financing of public budgets and their use in the practice of public administration. Methods. Research methods are used: historical, logical, abstraction, description, generalization, comparison, grouping, analysis and synthesis. Results. The adoption of the debt framework guides the definition of debt strategy, debt management goals, indicators of its volume and structure, debt management tasks, as well as mechanisms and tools for their implementation. The debt strategy reflects the orientation of the debt policy, the goals of public debt management for long and medium-term periods, its indicators, the use of tools and mechanisms for achieving the adopted goals, the formation of the debt portfolio for the specified terms, the classification of risks of government debt management taking into account their impact on the performance of state budget, the application of refinancing and restructuring mechanisms for state liabilities. Conclusions. The conceptual framework for managing debt financing of public budget is an important guiding document aimed at taking into account the conditions for placing debt obligations among investors (state institutions, non-state depositors, non-residents), access to international financial markets, cooperation with international organizations and financial institutions, acceptance of debt portfolio (the structure of state budget financing), built according to types of debt instruments, sources of financing, currencies of loan repayment and servicing, repayment terms, loan servicing rates and debt refinancing. The development and implementation of the conceptual framework for the management of public debt transactions is important for Ukraine. In the conditions of overcoming the consequences of the war and post-war reconstruction, it is necessary to apply a comprehensive approach to the formation, distribution and use of resources raised on the basis of the use of public debt instruments.

Rapid Zooplankton Assessment: Evaluating a Tool for Ecosystem‐Based Fisheries Management in the Large Marine Ecosystems of Alaska

ABSTRACTEcosystem‐based fisheries management (EBFM) remains an aspirational goal for management throughout the world. One of the primary limitations of EBFM is the incorporation of basic lower trophic level information, particularly for zooplankton, despite the importance of zooplankton to fish. The generation of zooplankton abundance estimates requires significant time and expertise to generate. The rapid zooplankton assessment (RZA) is introduced as a tool whereby nontaxonomic experts may produce rapid zooplankton counts shipboard that can be applied to management in near real time. Zooplankton are rapidly counted shipboard and placed into three broad groups of zooplankton relevant to higher trophic levels: large copepods (> 2 mm), small copepods (< 2 mm), and euphausiids. A Bayesian, hierarchical linear regression modeling approach was used to validate the relationship between RZA abundances and laboratory‐processed abundances to ensure the rapid method is a reliable indicator. Additional factors likely to impact the accuracy of the RZA abundance predictions were added to the initial regression model: RZA sorter, survey, season, and large marine ecosystem (Bering Sea, Chukchi/Beaufort Sea, and Gulf of Alaska). We tested models that included the random effect of sorter nested within survey, which improved fits for both large copepods (Bayes R2 = 0.80) and euphausiids (Bayes R2 = 0.84). These factors also improved the fit for small copepods when the fixed effect of season was also included (Bayes R2 = 0.65). Additional RZA data were used to predict laboratory‐processed abundances for each zooplankton category and the results were consistent with model training data: large copepods (Bayes R2 = 0.80), small copepods (Bayes R2 = 0.64), and euphausiids (Bayes R2 = 0.88). The Bayesian models were therefore able to predict laboratory‐processed abundances with an associated error when accounting for these fixed and random effects. To demonstrate the utility of zooplankton data in management, zooplankton time series from the Bering Sea shelf were shown to vary in relation to warm and cold conditions. This variability impacted commercially important fish, notably Walleye Pollock (Gadus chalcogrammus), and these time series were used by managers using a risk table approach. The RZA method provides a rapid zooplankton population estimation in near real time that can be applied to the management process quickly, thus helping to fill a gap in EBFM.

Integrating Multisource Data and Machine Learning for Supraglacial Lake Detection: Implications for Environmental Management and Sustainable Development Goals in High Mountainous Regions

The accurate detection and monitoring of supraglacial lakes in high mountainous regions are crucial for understanding their dynamic nature and implications for environmental management and sustainable development goals. In this study, we propose a novel approach that integrates multisource data and machine learning techniques for supra-glacial lake detection in the Passu Batura glacier of the Hunza Basin, Pakistan. We extract pertinent features or parameters by leveraging multisource datasets such as radar backscatter intensity VH and VV parameters from Sentinel-1 Ground Range Detected (GRD) data, near-infrared (NIR), NDWI_green, NDWI_blue parameters from Sentinel-2 Multi-spectral Instrument(MSI) data, and surface slope, aspect, and elevation parameters from topographic data. The entire dataset is partitioned into training and testing sets, with machine learning models including the artificial neural network (ANN), the support vector machine (SVM), logistic regression (LR), random forest (RF), and K-nearest neighbour (KNN) trained on the training data (70%). Accuracy assessment employs testing data and involves the evaluation of metrics such as ROC curves and confusion matrices. The best-performing model, ANN, is validated against manually digitized lake polygons derived from Sentinel-2 and Google Earth Pro imagery. Furthermore, the digitized lake polygons are used to analyze glacial lake dynamics from 2016 to 2022. Key findings of this research presented that the NDWI_green, Sigma0_VH, and elevation are the most significant predictors in detecting supra-glacial lakes. Among the various trained and evaluated models, the Artificial Neural Network (ANN) achieved the highest performance (accuracy: 95%, AUC: 0.99) and accurately mapped supra-glacial lakes regardless of their small size. The findings have significant implications for understanding glacial lake behavior in the context of climate change and informing future research and monitoring efforts.

Study of the economic consequences and phthalate emission caused by centralized and decentralized patterns of infectious waste management

The development of health services of hospitals in developing countries has led to a significant increase in the production of infectious waste, which has important economic and environmental consequences. Therefore, reducing pollutant leakage caused by disinfection and reducing infectious waste management costs are important in achieving sustainable development goals in hospital management. In this study, the centralized and decentralized patterns of infectious waste management were studied in three hospitals in Behbahan, Iran. Economic analysis was done based on the financial model. Phthalate emission from disinfection equipment was measured for investigating the level of exposure to the pollutant in the studied patterns. The results showed that the cost of waste transportation for studied hospitals in the centralized patterns increased by 12.1%. However, reductions in disinfection and transfer costs up to 32.4% were available by increasing the segregation ratio of infectious waste. The average emission of phthalates from disinfection equipment in the studied hospitals was 0.260 ng/kg. But emission of phthalate types was not the same, so that the emission of BEHP, IBP, and DBP was 35.97, 4.90, and 1.55 μg/m3, respectively. Considering the hospital waste reduction plan and increasing the segregation ratio to reduce the costs of the hospital led to economic justification of the centralized pattern of infectious waste management as a safe option.

Epidural anesthesia as a sole anesthetic for a parturient with cardiac disease and low ejection fraction – a case report in resource limited setup

Introduction and importance: The effective care of pregnant women with cardiac conditions relies on collaboration among the obstetrician, cardiologist, and anesthesiologist throughout the peripartum period. Limited research exists regarding the safety of specific anesthetic approaches for patients with congestive heart failure (CHF), particularly in the context of pregnancy. Case presentation: This was a 28-year-old woman who was pregnant with her third child (gravida III, para II) and has not had a menstrual period for the past 8 months. She had been receiving antenatal care at a local health center. Currently, she was experiencing symptoms including coughing, difficulty breathing, epigastric pain, and chest pain, which had been present for 1 week. Upon examination, she was diagnosed with New York Heart Association class IV CHF with pulmonary edema, and preeclampsia with severe features, and she was in the third trimester of pregnancy. Clinical discussion: Pre-existing medical conditions can adversely affect pregnancy outcomes for women and their offspring, especially in resource-poor settings in Africa. The goals of anesthetic management are avoidance of myocardial depression, maintaining normovolemia, avoiding an overdose of drugs during induction as the circulation time is slow, and avoiding sudden hypotension when regional anesthesia is the choice. Conclusion: We believe that successful management of anesthesia for this critical case depends on a thorough understanding of the pathophysiology of the disease condition, the selection of anesthetic techniques, and the decision-making of our team. We showed epidural anesthesia could be safely used to manage high-risk cardiac patients, however, further interventional study is needed to prove safety.

Clinical remission in patients with biologic-naïve asthma: a multicenter study in Japan

BackgroundClinical remission (CR) is a new realistic management goal for patients with asthma, regardless of the disease severity. ObjectiveTo investigate the rate of achievement of CR in patients treated with inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) and non-biologics, and the characteristics of patients who achieved CR. MethodsWe performed a post hoc analysis from a multicenter, cross-sectional survey in Japan. 3-way CR was defined as the absence of exacerbation, no use of maintenance oral corticosteroids, and the absence of significant asthma symptoms (5-item Asthma Control Questionnaire [ACQ] < 1.5). We defined 4-way CR as 3-way CR plus having normalized lung function (forced expiratory volume [%FEV1] ≥ 80%). Deep remission (DR) was defined as 4-way CR plus suppressed type-2 airway inflammation (fractional exhaled nitric oxide [FeNO] < 35 ppb). ResultsThe criteria for 3-way CR, 4-way CR, and DR were met by 56.9%, 35.0%, and 24.7% of patients, respectively. Compared to patients who achieved the 3-way CR, unachieved patients have lower %FEV1 (77.6% vs. 85.4%, p<0.0001), higher FeNO levels (42 ppb vs. 34 ppb, p=0.0182), and there were more discordances in asthma control perception between patient-physicians (38.5% vs. 9.3%, p<0.0001). Physician-patient discordance was an independent factor that prevented the achievement of the 3-way CR in the logistic regression analysis, even when adjusted for %FEV1 and FeNO (odds ratio 0.397, p<0.0001). ConclusionAchieving CR in patients treated with ICS/LABA without biologics is challenging. Discrepancies between patient and physician perceptions on asthma control are significant barriers to achieving CR.

Donor and Recipient Factors Associated with Primary Graft Dysfunction Following Lung Transplantation: A DMG Registry Analysis

Current risk-adjusted models to predict primary graft dysfunction (PGD) following lung transplantation (LTx) do not include bedside donor critical care data. Donor management goals (DMG) represent predefined critical care endpoints aimed at optimizing multi-organ donor management. Here, we sought to identify novel predictors to better understand the relationship between donor management and PGD following LTx. We used the national DMG registry to identify a cohort of LTx recipients linked to their respective donors between January 1st, 2015 and March 1st, 2023. Grade 3 PGD (PGD3) was defined according to modified ISHLT criteria. Multivariable modeling was performed to identify risk factors for the development of PGD3. A total of 2704 eligible patients were identified of which 643 (23.8%) developed PGD3. After multivariable modeling, the likelihood of PGD3 was greater with increased donor age (OR 1.06 [1.02, 1.10] per 5 year change, p=0.003), increased donor serum pH at the time of authorization (OR 1.14 [1.02, 1.25] per 0.1 increase, p=0.016), donor history of cocaine use (OR 1.34 [1.05, 1.71], p=0.020), and increased recipient central venous pressure (1.03 [1.01, 1.06], p=0.005). Recipients who received donor lungs in which the DMG for PF ratio was met had a lower likelihood of developing PGD3 (OR 0.63 [0.46, 0.86], p=0.006). This study leverages a novel detailed donor management database to identify factors associated with the development of PGD3. These factors may be used to recognize donors and recipients that may benefit from early interventions to improve short-term outcomes.

Research progress on topology and energy management of fuel cell hybrid power ships

Abstract With the increasing awareness of environmental protection, the maritime industry is moving towards green and low-carbon development. Fuel cells, due to their pollution-free and high-efficiency characteristics, are one of the key technologies driving the green transformation of traditional ships. However, fuel cells have relatively soft output characteristics and often require other energy storage components to provide supplementary power. This paper reviews the types, advantages, and disadvantages of the topologies of fuel cell hybrid power ships, analyses the current development status of energy management goals and methods, and finally provides an outlook on the development of fuel cell hybrid power ships.

Investment Value Analysis of Internet Companies Based on the FCFF Model

With the continuous progress and development of society, China's capital market has experienced successive waves of investment enthusiasm. As investors’ perspectives become increasingly rational, companies' management objectives have shifted from an initial focus on profit maximization to a broader goal of maximizing corporate value. Throughout this evolution in management goals, investors have become more concerned with the intrinsic value of companies. With the advent of the 5G era, the internet industry is experiencing a new wave of development. Against this backdrop, how investors can reasonably assess the value of internet companies and capture their intrinsic investment value has become critically important. This paper evaluates the corporate value of Internet Company A based on the Free Cash Flow to Firm (FCFF) model, exploring the model's applicability in the internet industry and providing a reference for investors seeking to assess corporate value.

A Study on the Development of a Filtration System for Drainage Discharge Capacity

This study analyzes the social and economic characteristics of an area affected by chemical emission facilities and proposes policy measures to respond to social disasters such as hazardous chemical emission accidents. Even within the area affected by chemical discharge facilities, social and economic disparities existed depending on the proximity to the chemical discharge facility, child population ratio, and land value. However, the elderly population ratio decreased. It is believed that the presentation of response plans based on the study’s analysis will contribute to protecting people's health and property, which is the ultimate goal of chemical management.

Paradigm shift from glucocentric to organ protection for the management of hyperglycemia in patients with type 2 diabetes

The UK Prospective Diabetes Study was the first study to investigate the effectiveness of glycemic control in patients with type 2 diabetes. Since then, many studies have evaluated the impact of intensive glycemic control on diabetes-related morbidities and mortality. The results of these studies were intended to change the paradigm for controlling glycated hemoglobin and preventing diabetes-related complications, but the beneficial outcomes were limited to microvascular diseases rather than diabetes-related cardiorenal diseases and deaths. This has emphasized the need for comprehensive management of other risk factors (hypertension, dyslipidemia, renal failure, etc.) in addition to hyperglycemia to prevent atherosclerotic cardiovascular diseases and end-stage renal disease in type 2 diabetes. Since 2008, clinical trials to demonstrate cardiovascular safety have shown a beneficial effect of sodium-glucose transporter 2 inhibitors or glucagon-like peptide-1 receptor agonists on macrovascular or renal complications in patients with type 2 diabetes. Recently, major societies around the world including the Korean Diabetes Association, have shifted the goals of diabetes management from the typical glucocentric view to cardiorenal outcome-oriented (organ protection) care, which has been widely accepted and is gradually applied to primary care.

Controversies in the Management of Type II Odontoid Fractures.

The management of type II odontoid fractures in the elderly is controversial, as these patients often have numerous medical comorbidities that increase the risks of surgery, but they may also fail to achieve fracture healing with nonsurgical management. Recent changes in technology and surgeon attitudes may influence the preferred approach to both surgical and nonsurgical treatments for many clinicians. While bony fracture healing remains the goal of management, a stable fibrous union is increasingly considered a satisfactory outcome. The optimal surgical approach remains debated, with some authors raising concerns about the risk of swallowing dysfunction being particularly problematic with odontoid screw placement in the elderly. The use of BMP-2 applied either anteriorly into the fracture site or posteriorly in the interlaminar space and placement of temporary posterior fixation to be removed upon demonstration of anterior bony healing are novel surgical techniques that are presently the subject of investigation. A clearer understanding of the currently available treatment options and the associated controversies may improve clinician decision-making and potentially better patient outcomes in the management of type II odontoid fractures for the growing geriatric population.

The Utility of Electroencephalograhy in Guiding General Anesthesia in Children.

Traditional pediatric anesthetic dosing using pharmacokinetic estimates based on age and weight is often imprecise, frequently leading to oversedation. Intraoperative electroencephalography (EEG) allows visualization of the brain's response to anesthetic agents in real time, facilitating precise titration of anesthetic drug doses optimized for the individual child. The goal of EEG-guided anesthesia management is to maintain an optimal state of hypnosis during various stages of the procedure while minimizing hemodynamic instability and other adverse effects of anesthesia. This is especially important in children with less predictable anesthetic requirements, such as children with atypical neurodevelopment, altered levels of consciousness before anesthesia, or those receiving total intravenous anesthesia, neuromuscular blockers, or a combination of anesthetic agents with different mechanisms of actions. Children with limited cardiorespiratory reserves and those undergoing high-risk procedures such as cardiopulmonary bypass also benefit from EEG guidance as they have a narrower therapeutic window for optimal anesthetic dosing. Various processed EEG (pEEG) monitors are available for intraoperative monitoring in children. These monitors display a pEEG index based on the manufacturer's algorithm, purportedly indicating the patient's hypnotic state. Due to differences in developmental neurophysiology and EEG dynamics in children, pEEG indices may not always reliably indicate the hypnotic state, especially in neonates and infants. Learning to interpret nonproprietary EEG parameters including the raw EEG, spectral-edge frequency 95% (SEF95), and density spectral array can prevent overreliance on pEEG indices. This review provides an overview of the advantages of EEG guidance during clinical anesthesia, including potential reduction in anesthetic dosage, prevention of EEG suppression, and reduction in peri-operative adverse events. We describe the use of nonproprietary EEG parameters in guiding anesthesia in children for various clinical end points including laryngoscopy, surgical incision, and maintenance of anesthesia, as well as sedation. We illustrate these principles with various case examples commonly encountered during pediatric anesthesia. Lastly, we discuss strategies to expand intraoperative EEG monitoring in children through education and training programs, as well as advocate for further research to assess clinical outcomes associated with EEG guidance to support its routine use in clinical care.