Management Goals Research Articles

Severe Respiratory Acidosis in Acute Exacerbation COPD, Is that Possible to Treat?

Introduction: Chronic obstructive pulmonary disease (COPD), currently the third leading cause of death worldwide, is a common condition characterized by progressive airflow limitation and tissue destruction. Patients with COPD may present to the Emergency Room (ER) with severe acute exacerbations (AECOPD), which can be associated with acute respiratory failure—a life-threatening condition with a mortality rate approaching 50% in Indonesia—requiring rapid intervention and ICU admission. In this report, we present a severe respiratory acidosis in AECOPD case with successful emergency followed by ICU management and the frequent pitfalls. Case Illustration: In this report we present a-67 years old male, pedicab driver and smoker came to the ER with acute onset shortness of breath and decrease of consciousness with history of shortness of breath in last 10 years. In primary survey we found clear wheezing sound, tachypnea, intercostal retraction, decrease of peripheral oxygen saturation, tachycardia and verbal respond of consciousness. Blood gas analysis result interpreted severe respiratory acidosis with pH 6.90 and pCO2 128.5 mmHg. Chest radiograph showed infiltrate that became the cause of exacerbation. Endotracheal intubation was performed due to decreased consciousness, persistent tachypnea and pCO2 over 100 mmHg. This patient was hospitalized for 12 days including 9 days in ICU followed by 3 days in regular ward. Conclusion: The goal for AECOPD management is to minimize and prevent the negative effects of the exacerbation.

Estimating mean groundwater levels in peatlands using a Bayesian belief network approach with remote sensing data

Large-scale management, protection, and restoration of wetlands require knowledge of their hydrology, i.e., the status and dynamics of the groundwater table, which determine the evolution of the wetland ecosystem, its conservation value, and possible economic use. Unfortunately, in many cases, hydrological monitoring data are unavailable, resulting in the search for a proxy for the average annual depth of the groundwater level (GWL). This study presents an approach to estimating the mean GWL in peatlands using a Bayesian belief network (BBN) model, leveraging long-term hydrological and remote sensing data in the Biebrza National Park in Poland. The remote sensing data employed includes the synthetic aperture radar (SAR) backscatter coefficient, peat subsidence, rate and distance to watercourses. The BBN model achieved a predictive accuracy of 83.3% and 73.1%, depending on the validation approach used. Among the remote sensing variables considered, the SAR backscatter coefficient was the most sensitive in predicting the GWL in the peatlands. However, the model presents multiple uncertainties resulting from limitations of the available remote sensing data, low variability of class combinations in the conditional probability table, and lack of upscaling to other regions performed. Despite these uncertainties, the developed BBN model remains a valuable next step in reaching the goal of efficient peatland monitoring and management.

Changing dominance of invasive Phragmites australis and native plant colonization with variation in management, wildfires, and soils in a desert wetland

Abstract Among the most widely distributed species globally, common reed (Phragmites australis (Cav.) Trin. ex Steud.) has generated extensive interest in invasive plant science and management because its introduced strains are highly invasive and often form monocultures that alter ecosystem properties. In desert wetlands in Las Vegas, Nevada, USA, where management goals included reducing hazardous P. australis fuels and increasing native plant diversity, we assessed variation in P. australis cover, the degree of native plant colonization, and soil seed banks after P. australis management treatments (cutting, glyphosate-imazapyr herbicide) and wildfires across gradients in soil properties. Based on change in P. australis cover during six measurement events over 24 months, 24 study sites formed three groups: 1) decreasing cover, where initially high P. australis cover (60-85%) decreased to < 5% following multiple cutting or herbicide treatments; 2) sustaining low cover, where wildfire or clearing was associated with initially low P. australis cover which remained low (< 30%) after multiple herbicide applications; and 3) sustaining high cover (45-100% initially and remaining 30-100%), including sites unmanaged or treated/burned only once. High soil salinity correlated with low post-management P. australis cover. No native plants were detected in the sustaining high P. australis cover group, despite natives occurring in the seed bank. Where management reduced P. australis cover, minimal native plant colonization did occur. Secondary invasion by other non-native plants was nearly absent. Our results suggest that if P. australis can be initially cleared, multiple herbicide applications can persistently keep cover low, especially on drier, saline soils. Slow native plant colonization suggests that a phased approach may be useful to initially reduce P. australis cover, keep it low via repeated treatments, and actively revegetate sites with native species tailored to the moisture-salinity gradient across P. australis-invaded habitats.

Effects of SGLT-2i and GLP-1RA in vascular function parameters: the impact of the weight loss

Abstract Background Arterial stiffness and endothelial function markers flag increased cardiovascular disease risk in patients with type 2 Diabetes Mellitus (T2DM), while weight management plays a crucial role for the management of glycemic control and prevention of complications in these patients. Purpose To investigate the effects of novel antidiabetic agents on arterial stiffness and endothelial function as well as the metabolic parameters of HbA1c and Weight in T2DM patients. Patients and Methods: We enrolled 99 consecutive patients under stable antidiabetic therapy who did not reach therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; glucagon like peptide-1 receptor agonist (GLP-1RA, n=50) or sodium/glucose cotransporter-2 inhibitor (SGLT-2i, n=49). Glycosylated hemoglobin (Hba1c) and weight expressed through Body Mass Index (BMI) along with carotid-femoral pulse wave velocity (PWV) and flow-mediated dilatation (FMD), as biomarkers of arterial stiffness and endothelial function accordingly, were measured at baseline and 3 months after treatment intensification. Results There were no differences between the study groups in traditional risk factors of age and sex or baseline HbA1c, BMI, PWV, and FMD levels (ps=NS for all). In both groups PWV values displayed a statistically significant improvement from 11.2±2.5 to 9.3±2.2 m/sec (p<0.001) in the GLP-1RA group and from 10.7±2.4 to 8.9±2.0 m/sec (p=0.001) in the SGLT-2i group, as presented in Figure 1 through the differences in the values of PWV. FMD values were also significantly improve in both groups from baseline to follow-up; from 6.04±1.22 to 6.50±1.26% (p<0,001) for the GLP-1RA group and from 6.38±1.21 to 6.81±1.29% (p<0.001) for the SGLT-2i group. Moreover, both groups achieved better weight management goals in terms of BMI values between baseline and follow-up; from 33.6±4.9 to 31.5±4.6 kg/m2 for the GLP-1RA group (p<0.001) and from 31.8±5.5 to 30.5±5.6 kg/m2 for the SGLT-2i group (p<0.001), in addition to achieving better glycemic control in terms of HbA1c values, as seen in their paired differences: for GLP-1RA: 1.3±0.7% and for SGLT-2i: 0.8±0.5%. Interestingly, in the SGLT-2i group the magnitude of the PWV improvement was correlated with the weight loss (r=0.368, p=0.007). Conclusion These data provide evidence that the newer antidiabetic drugs, both GLP1-RA and SGLT-2i, have actions that benefit both vascular function, endothelium as well as metabolic parameters. Interestingly, in the patients receiving SGLT-2i the magnitude of the PWV improvement was correlated with the weight loss.delta PWV for SGLT-2i & GLP-1RA groupsCorrelation of deltaWeight & deltaPWV

Water quality–fisheries tradeoffs in a changing climate underscore the need for adaptive ecosystem–based management

Changes driven by both unanticipated human activities and management actions are creating wicked management landscapes in freshwater and marine ecosystems that require new approaches to support decision-making. By linking a predictive model of nutrient- and temperature-driven bottom hypoxia with observed commercial fishery harvest data from Lake Erie (United States-Canada) over the past century (1928-2022) and climate projections (2030-2099), we show how simple, yet robust models and routine monitoring data can be used to identify tradeoffs associated with nutrient management and guide decision-making in even the largest of aquatic ecosystems now and in the future. Our approach enabled us to assess planned nutrient load reduction targets designed to mitigate nutrient-driven hypoxia and show why they appear overly restrictive based on current fishery needs, indicating tradeoffs between water quality and fisheries management goals. At the same time, our temperature results show that projected climate change impacts on hypoxic extent will require more stringent nutrient regulations in the future. Beyond providing a rare example of bottom hypoxia driving changes in fishery harvests at an ecosystem scale, our study illustrates the need for adaptive ecosystem-based management, which can be informed by simple predictive models that can be readily applied over long time periods, account for tradeoffs across multiple management sectors (e.g., water quality, fisheries), and address ecosystem nonstationarity (e.g., climate change impacts on management targets). Such approaches will be critical for maintaining valued ecosystem services in the many aquatic systems worldwide that are vulnerable to multiple drivers of environmental change.

Weight status underestimation and weight management goals among adults in the rural South of the United States.

To examine factors associated with weight status underestimation and the relationship between weight status underestimation and weight loss as a weight management goal among adults living in the rural South. An anonymous survey was distributed at six primary care clinics and two churches in rural, South Carolina counties. Weight status underestimation was determined based on the difference between perceived weight status using standard body mass index (BMI) categories (underweight, normal weight, overweight, and obese) and BMI category from self-reported height and weight. Participants reported whether their weight management goal was to lose, maintain, or gain weight. Chi-square and binary logistic regressions were used for data analysis. A total of 185 respondents (76% female) at least partially completed the survey. Nearly 60% underestimated their weight status. Increasing BMI was associated with higher odds of weight status underestimation (OR: 1.10, 95%: 1.04, 1.15) and perceptions of being in fair or poor health was associated with lower odds of weight status underestimation relative to perceiving health as good or better (OR: 0.21, 95% CI: 0.06, 0.66). Among those with overweight and obesity, the association between underestimating weight status and having weight loss as a weight management goal was strong but not statistically significant (OR: 0.20, 95% CI: 0.04, 1.04). Underestimating weight status was common among adults in the rural US South and was related to BMI and health status. Research is needed to determine if improving the accuracy of weight perceptions can promote weight management in the rural South.

Development and Initial Evaluation of a Digital Phenotype Collection System for Adolescents: Proof-of-Concept Study.

The growing concern on adolescent mental health calls for proactive early detection and intervention strategies. There is a recognition of the link between digital phenotypes and mental health, drawing attention to their potential use. However, the process of collecting digital phenotype data presents challenges despite its promising prospects. This study aims to develop and validate system concepts for collecting adolescent digital phenotypes that effectively manage inherent challenges in the process. In a formative investigation (N=34), we observed adolescent self-recording behaviors and conducted interviews to develop design goals. These goals were then translated into system concepts, which included planners resembling interfaces, simplified data input with tags, visual reports on behaviors and moods, and supportive ecological momentary assessment (EMA) prompts. A proof-of-concept study was conducted over 2 weeks (n=16), using tools that simulated the concepts to record daily activities and complete EMA surveys. The effectiveness of the system was evaluated through semistructured interviews, supplemented by an analysis of the frequency of records and responses. The interview findings revealed overall satisfaction with the system concepts, emphasizing strong support for self-recording. Participants consistently maintained daily records throughout the study period, with no missing data. They particularly valued the recording procedures that aligned well with their self-recording goal of time management, facilitated by the interface design and simplified recording procedures. Visualizations during recording and subsequent report viewing further enhanced engagement by identifying missing data and encouraging deeper self-reflection. The average EMA compliance reached 72%, attributed to a design that faithfully reflected adolescents' lives, with surveys scheduled at convenient times and supportive messages tailored to their daily routines. The high compliance rates observed and positive feedback from participants underscore the potential of our approach in addressing the challenges of collecting digital phenotypes among adolescents. Integrating observations of adolescents' recording behavior into the design process proved to be beneficial for developing an effective and highly compliant digital phenotype collection system.

Studying of Mechanical Behavior of Waste Materials Modified Cement Mortar

Large-scale environmental problems have been triggered by ceramic tiles from demolished buildings and animal bone waste. Therefore, optimizing their potential for reuse and recycling is an important goal of sustainable solid waste management. The primary objective of this study is to evaluate the feasibility of partial replacement of the fine aggregates in cement mortar with a combination of natural animal bone powder and industrial waste materials which is wall tiles ceramic powder. This study measures thermal and mechanical characteristics. Recycling construction waste is one of many ways to deny waste material from entering landfills and create new eco-friendly material that reduces energy consumption in buildings. Modified mortar cement specimens with 5% up to 25% mixtures were combined using a 1:3 ratio and a 0.5 W/C ratio to see how the ratios would affect the material’s properties. The addition of a superplasticizer boosted the cement mortar’s workability and compressive strength. The compressive strength, flexural strength, density, and thermal conductivity were evaluated for each mortar mixture ratio. Results showed that compared to regular cement mortar, cement mortar combined with 20% bone and ceramic powder wastes reached the optimal replacement percentage. Compressive strength increased by 54% and flexural strength by about 67%. At the 28-day mark, thermal insulation was lowered by 25%.It is concluded from this study that it is possible to use bone waste as a natural material with ceramic waste as an industrial material to modify the insulation and mechanical properties of cement mortar.

An individual‐based model trained on multiple data sources estimates population connectivity and facilitates aggregation of harvest management units

Abstract Management boundaries are often delimited by political and social factors, whereas animal movements are affected by ecological and geophysical constraints. Thus, understanding connectivity among distinct management units is of considerable importance, particularly for harvested species, where quotas set in ignorance of connectivity may fail to meet management goals. We constructed an individual‐based model (IBM) to better understand wild turkey movements at large scales, benefiting from multiple data sources that are often available for harvested species. We built an IBM from spring seasonal movements of wild turkey, using data from ringed, radio‐, and GPS‐marked turkeys captured in Maine, USA. Our IBM accommodated variation in individual turkey response to landscape connectivity metrics and identified emergent migratory connectivity dynamics among harvest management regions. We calculated a low degree of connectivity among wildlife management districts (WMD) which, in combination with the substantial number of boundary crossings observed, indicated a more diffuse distribution of turkeys among WMDs. Synthesis and applications: Estimates of turkeys moving between districts provided a clear delineation of where immigration was strongest, identifying which WMDs should be managed as singular population units. This approach has widespread utility for any species or system where harvest management decisions are made at finer spatial scales than the movement dynamics affecting population processes.

The economic impacts of living habitat changes in the Virginia Middle Peninsula, Chesapeake Bay

Living habitats support ecologically and commercially important species but are threatened by anthropogenic stressors, including climate change. The populations of two living habitats in the Chesapeake Bay, Eastern Oyster (Crassostrea virginica) and Eelgrass (Zostera marina), are depleted compared to historical levels, but recent Oyster restoration efforts have created new reef habitat and enhanced existing Oyster reefs. Other animals (e.g., commercially important fish and invertebrates) consume organisms that associate with these living habitats, suggesting the regional economies that rely on the commercial fishing industry may be impacted by changes in living habitat coverage. Ecosystem models were developed for two rivers that have undergone Oyster restoration in the Virginia Middle Peninsula, and simulations were conducted to estimate the potential influence that changes to living habitats may have on commercial fisheries harvests. Additionally, commercial fishers were interviewed to document expenditures needed to link ecological model estimates to an economic input-output model via IMPLAN that estimated the regional economic impacts of these changes. Increases to Oyster and Eelgrass populations are predicted to enhance commercial fisheries populations and in turn, harvests, while decreases to living habitats are predicted to have negative effect on fisheries harvests. The driving factor behind landed value trends is changes with the lucrative Blue Crab (Callinectes sapidus) fishery. The primary expenses of watermen are repairs/maintenance, fuel, and bait, but greater than 37 % of the annual revenue is retained as proprietor and crew income. Oyster reef restoration alone is predicted to increase the regional economic impact of the commercial fishing industry by $1.1 M yr-1 and support 12 more full-time jobs at the end of a 20-year simulation. Oyster restoration in combination with a continued decline of Eelgrass led to a negligible increase (∼$150 K yr-1) in the regional economic impact. Eelgrass restoration to the current management goal without the influence of Oyster restoration is anticipated to elevate the regional economic impact to $16.8 M yr-1 and 152 full-time jobs, and smaller increases to the Eelgrass population, relative to current levels, will still have a positive impact on the regional economy. Combined Oyster and Eelgrass restoration are predicted to enhance economic impacts to the greatest extent, while continued Eelgrass decline is likely to minimize these benefits.

Review of One Health in the Galápagos Islands (Part 1): historical perspective, invasive species, and emerging infectious diseases

The Galápagos archipelago is a vast reservoir of terrestrial and marine biodiversity, owing in large part to its relatively recent volcanic genesis and colonization by humans. This unique ecological system is particularly susceptible to human, animal, and environmental impacts. Climate change, globalization, and the blurring of human-domestic animal-wildlife interfaces are poised to bring new threats and challenges to the region. A One Health perspective that simultaneously considers human, animal, and environmental health is imperative in assessing and mitigating the challenges facing the Galápagos Islands. In Part I of this review, we provide the historical context for biodiversity in the archipelago; discuss the role of invasive species in habitat destruction, fragmentation, and competition with endemic species; and summarize the established and emerging infectious disease threats. We also discuss the imperative to implement research, surveillance, and preventative measures to identify and manage future threats from a One Health perspective, with a specific emphasis on implications for wildlife health. In Part II of this review, we outline the socioeconomic context of life in the Galápagos Islands, evaluate the current and predicted effects of climate change, and discuss direct anthropogenic factors affecting Galápagos biodiversity, such as tourism, fishing, pollution, and the illegal wildlife trade. We also examine the impact of the COVID-19 pandemic in the region. We build a cohesive picture of One Health in the Galápagos Islands by integrating past work, current needs, and emerging threats. We also consider overarching goals for conservation, ecosystem management, and socioeconomic sustainability that have been previously defined by both governmental and non-governmental stakeholders, and we identify discrete, implementable, and interdisciplinary recommendations that will facilitate achievement of those goals.

From data silos to seamless integration and coordination: a data-asset centric approach to smart hospital facility management

PurposeExisting hospital building operations involve numerous information technology applications and complex building systems; therefore, an intelligent facility management (FM) platform is required to ensure their continuous operation. To address the persistent issues of data silos, inefficient data interoperability, and workflow incoordination that have been identified in the current body of FM practice and literature, the present study develops a data-asset (DA) centric FM platform specifically designed for hospital buildings.Design/methodology/approachThis study proposes a semi-customized approach to develop the DA-centric FM platform for hospital buildings. To elucidate the precise function requirements of the hospital FM platform, focus group interviews are employed. By seamlessly integrating the as-built BIM model, IoT sensor data and FM workflow data, the BIM-based DA model with a data transfer mechanism is developed. The development of the FM platform with function modules in a case study is guided by a five-tier architecture and the coordination theory (CT). The case study provides an in-depth introduction to the applications of DA management, space management and maintenance management modules.FindingsThe capabilities of the developed DA-centric hospital FM platform are validated through the case application and user satisfaction survey, which assess data quality, automation level, operation efficiency, flexibility and functionality. For hospital FM activities, this DA-centric FM platform realizes data integration and seamless transformation, optimizes workflow coordination and enhances operation performance.Originality/valueThe initial scholarly contribution is the establishment of the BIM-based DA model, which serves as the data middle platform for continuous data integration, transmission and sharing within the FM platform. Subsequently, under the guidance of the CT, the business process of function modules is designed, improving the intra-module and inter-module workflow coordination. The developed DA-centric FM system along with its performance benchmarking application, assists facility managers and decision-makers in implementing smart operations for hospital buildings and achieving the management goals of safety, efficiency, energy savings and convenience.

Patient-centered care model based on self-efficacy to improve self-care and quality of life of people with type 2 diabetes mellitus: A PLS-SEM approach.

The current model for managing type 2 diabetes mellitus (T2DM) is healthcare provider-centered rather than patient-centered. This approach may overlook individual patients' unique needs, potentially impacting the effectiveness of T2DM management goals. This study aimed to develop a patient-centered care model based on self-efficacy to enhance self-care and improve the quality of life for individuals with T2DM. The study employed a cross-sectional design with a sample size of 250 respondents recruited through multistage random sampling, Jember regency, East Java, Indonesia. The study variables included exogenous factors (people with T2DM, situational treatment, family, and healthcare services) and endogenous factors (self-efficacy, self-care, and quality of life). Data were collected from August to December 2022 using a questionnaire and analyzed descriptively and inferentially using SEM-PLS. The developed model was a good fit with strong predictive relevance (SRMR = 0.065; Q2 = 0.049). All exogenous factors-people with T2DM, situational treatment, family, and healthcare services-significantly affected self-efficacy (42.2%, 37%, 8.1%, and 17.3%; p <0.001). Self-efficacy had a 61.6% effect on self-care, and self-care had a 27.1% effect on quality of life (p <0.001). Only situational treatment factors had a direct effect on self-care (21.7%; p <0.001). All exogenous factors also influenced the quality of life through self-efficacy and self-care (7%, 6.2%, 1.3%, and 2.9%; p <0.05). A patient-centered care model based on self-efficacy for managing T2DM can improve self-care behaviors and quality of life for individuals with T2DM. This model can be utilized by nurses in healthcare services to enhance the management of T2DM.

Identifying influential individuals and predicting future demand of chronic kidney disease patients

ABSTRACTTo ensure high service quality, managers need to personalize treatment options and meet their customer demands. Our research is motivated by the need to better anticipate and prepare for that. We develop a generalizable framework that is the first to address two healthcare risk management goals: (1) identifying high risk and stable‐demand customers and (2) predicting the medium‐term demand for services of stable‐demand customers. We also design a model‐agnostic method for variable evaluation. It can rank predictors based on their global impact, and highlight their effect on a model's local accuracy. In this research, we leverage a large electronic medical records' data set, which comprised of 48,344 chronic kidney disease patients treated across geographically diverse Veterans Affairs regions. Our framework indicates that although only 1.3% of the examined individuals are high‐risk patients, it can correctly identify 35% of them and highlight an additional 8.9% as having important demand implications. Identifying high‐risk individuals can be used in (1) monitoring prioritization, (2) patients' motivation, and (3) patients' stabilization. Furthermore, our model accurately predicts the monthly need for care of stable‐demand individuals up to 3 years into the future and outperforms popular statistical and data mining models. This information is especially critical for hospital management in identifying future hiring needs.

Predictors of carnivore tolerance among census-designated and self-identified rural and urban residents in Idaho, USA

ABSTRACT Carnivore tolerance is a common management goal in a rapidly changing Intermountain West. In recent decades, Idaho and other states with historically rural populations now contain highly urbanized regions. Given known tolerance differences between rural and urban populations and increased urbanization, residents may self-identify as rural but reside in a Census-designated urban area. To explore differences between Census-designated and self-reported residency, a stratified random sample of Idaho residents was used to estimate mountain lion (Puma concolor) and gray wolf (Canis lupus) tolerance based on past wildlife experience, perceived carnivore risk, and emotional response. Regression analyses indicated statistically significant models; risk, experience, and negative emotions were significant predictors of tolerance with observed variation among objective and subjective residency segments. Findings suggest Census-designated and self-identified residency may be a consideration to effectively diagnose and manage human–carnivore interaction issues in states with shifting rural–urban demographics.

Применение экосистемного подхода к ликвидации и возмещению накопленного вреда окружающей среде

The process of formation and recognition of responsibility for accumulated environmental damage is considered. The possibilities of applying the ecosystem approach to the legal regulation of organizing the elimination of accumulated environmental harm are explored, including assessing the results of the restoration measures taken and the formation of criteria for recognizing objects of accumulated harm as liquidated. A justification is given for the need to apply an ecosystem approach to eliminating accumulated environmental damage in order to achieve the goal of rational environmental management (restoring and increasing the sustainability of natural ecological systems and ensuring their equilibrium state).

Health locus of control, perceived health competence, and satisfaction of patients with rheumatological conditions versus periodic health examination patients

ABSTRACT Important health management goals include building patient loyalty, predicting patient behavior and adherence, and understanding treatment outcomes. This study focused on health locus of control (HLC), perceived health competence, and satisfaction with care in an outpatient sample by comparing chronic care patients and periodic health examination (PHE) patients in the same clinic. The study sample consisted of 146 adult patients from a rheumatology outpatient clinic. Participants responded to validated measures of psychosocial variables and answered a sociodemographic and health status information form. The findings showed that while both patient groups were similarly satisfied with care, chronic care patients perceived lower levels of health competence and internal HLC and higher levels of chance HLC than PHE patients. Satisfaction with care was negatively associated with chance HLC in the chronic care group, while health competence was negatively associated with chance HLC in the PHE group. The findings of the current study suggest that although chronic care patients were satisfied with care, they had stronger chance beliefs and weaker beliefs about internal factors. Hence, for better management of rheumatological conditions, it is important to focus on improving patients’ coping skills through effective health education strategies.

Components of the hr management process of a medical organization

Successful development of any sphere of human activity is unthinkable in modern society without management. The implementation of management goals and objectives is carried out through personnel policy, which is a strategic line of behavior in working with personnel. In the healthcare system, an important role is assigned to the mid-level medical worker, therefore, personnel development management is recognized throughout the world as a priorit y task of management in the field of nursing. Target. To study and analyze the process of professional selection, training and management of nursing personnel. Results. The aspects of selection of nursing personnel were studied, the level of quality of knowledge obtained by nursing personnel and the degree of their application in practical activities were determined, the features of the organizational activities of nursing service managers were identified. Conclusion. Trained medical personnel should take a place in accordance with the needs of national health care and taking into account the personal interests and needs of the medical workers themselves. This can be achieved with the appropriate organization of the personnel management process, when specialists will find adequate use for their qualifications in the system.

Key Issues and Challenges in Establishing Regionally Differentiated Water Quality Standard in China

The goal of environmental management in China is transitioning from pollution control to the improvement of ecological quality. The establishment of regional differential water quality standards can better adapt to the ecological characteristics and development needs of different regions. Given the shortcomings of current water quality standards and the needs of technological development, this study analyzed the causes and influencing factors of regional differences in water quality standards and summarized China's regional variations in areas such as the characteristics of receiving water bodies, social attributes, climate conditions, physicochemical properties of water, and aquatic biotic populations. It also examined the impact of regional characteristics on the assessment of biological toxicity. Based on these analyses, the study identified key scientific questions that may arise in the development of regional differential water quality standards in China and outlined future critical research directions in this field. These directions include developing theories and methods for determining the effluent dilution coefficient, establishing methods for identifying regional key water quality indicators and assessing their impact on water quality standards, determining regional characteristic species and their influence on water quality standards, and formulating theories and methods for categorizing different regions across the country. The aim of the study was to provide a reference for the scientific establishment of water quality standards in China.

A multi-theoretical approach to supply chain management

The article examines the supply chain as a modeling object. The multi-criteria and contradictory goals in supply chain management are: on the one hand, the maximum level of service, on the other hand, minimizing logistics costs. Solving strategic optimization problems for this class of objects using classical optimization methods is difficult. The theoretical and methodological basis of the supply chain was considered from the perspective of a set-theoretic approach. The purpose of the study is to analyze the behavior of many different agents (suppliers, clients, etc.) with different needs and goals when making decisions. An agent is an active element of the system, possessing a certain autonomy and the ability to make independent decisions, relying on the information it has about the state of the environment and the actions of other agents. In turn, supply chains are a complex organizational (active) system, i.e. associated with human participation. The study of behavioral aspects and interorganizational interaction, the formation of new organizational forms are an extremely important aspect in the management and modeling of supply chains, a factor in the dynamic behavior of the logistics system. The conducted research represents an important contribution to the development of knowledge about the application of the set-theoretic approach in supply chain management. It demonstrates the applicability of this approach in practice through an analysis of a specific company, LLP «Knauf», on the Kazakhstan market.