Management Challenges Research Articles

Enhancing food truck entrepreneurship through quality and customer satisfaction: a cross-country study

PurposeFood trucks are a global entrepreneurial phenomenon; however, their adoption in developing countries remains underexplored. This study explores food truck quality attributes and their impact on customer satisfaction in a cross-cultural context from the perspectives of customers and entrepreneurs.Design/methodology/approachThis research presents two independent studies from distinct perspectives. Study 1 assessed customers’ perceptions of food truck quality in the metropolises of Recife, Brazil (n = 176) and La Paz, Bolivia (n = 137), using a quantitative Kano model approach. Study 2 explored entrepreneurs’ perceptions using qualitative thematic analysis to gain an in-depth understanding of food truck development. A comprehensive analysis converged to provide insights into the factors affecting customer satisfaction and dissatisfaction.FindingsQuantitative Kano analysis revealed that the quality attributes that influence customer satisfaction with food truck services vary across contexts. However, consistent customer concerns regarding food safety and service reliability have been identified as key drivers of dissatisfaction. Qualitative thematic analysis demonstrated that entrepreneurs adopt diverse strategies for customer satisfaction and retention, tailoring their approaches to the specific contexts of their target markets. Although the food truck segment evolved differently in the two countries, a partial alignment was found between entrepreneurs’ and customers’ views.Originality/valueThis study examines food truck services by exploring the drivers of customer satisfaction, dissatisfaction and entrepreneurial strategies in a cross-cultural context. By analyzing both customer and entrepreneur perspectives, this study offers an in-depth understanding of the food truck phenomenon in emerging markets, addressing regional variations and management challenges to enhance customer satisfaction and loyalty.

Urban Underground Space Geological Suitability—A Theoretical Framework, Index System, and Evaluation Method

With rapid urbanization, urban underground space (UUS) development has become crucial for sustainable urban growth. This paper systematically reviews geological suitability evaluation (GSE) methods for UUS, integrating theoretical frameworks, indicator systems, and assessment techniques. We establish a comprehensive evaluation framework based on environmental strategic assessment (ESA) principles, analyzing key geological factors, including rock/soil properties, hydrogeological conditions, geological hazards, and existing underground structures. The study compares weighting methods (AHP, EWM, CRITIC) and comprehensive evaluation models (FCE, TOPSIS, BNM), highlighting their advantages and application scenarios. A case study of Xiong’an New Area demonstrates how multi-layer UUS planning integrates geological constraints with sustainable development goals. The results show that combining 3D geological modeling with hybrid evaluation methods significantly improves decision-making accuracy. The review provides practical guidance for optimizing UUS utilization while addressing current challenges in indicator selection, weight rationalization, and heterogeneity management.

Addressing Renal sodium avidity in Chronic Heart Failure: There's always more than one way to skin a cat.

Renal sodium avidity, a hallmark of chronic cardiorenal syndrome (CRS), is characterized by persistent sodium retention despite significant fluid overload. This resistance to natriuresis and diuresis exacerbates volume overload, contributes to hemodynamic instability, and accelerates the decline of cardiac and renal function, presenting a critical challenge in long-term CRS management. Conventional diuretic therapies, while effective during acute decompensations, often fail in chronic settings due to neurohormonal activation, renal tubular adaptations, and diuretic resistance. Innovative approaches targeting sodium regulation, including sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor (GLP-1R) agonists, and extracorporeal techniques such as hemodialysis (HD) and peritoneal dialysis (PD), offer promising alternatives. HD and PD provide precise sodium and fluid removal, bypassing many limitations of pharmacological therapies, with PD showing particular efficacy in refractory cases by preserving residual renal function and enhancing diuretic responsiveness. This review focuses on strategies to overcome resistance to natriuresis and diuresis in patients with chronic CRS. By exploring the underlying pathophysiology, limitations of current therapies, and the potential of advanced interventions like ultrafiltration (UF) through HD and PD, we propose a multidisciplinary and personalized approach to breaking the pathological cycle of sodium retention and fluid overload, ultimately aiming to improve patient outcomes and quality of life. As the saying goes, "there's always more than one way to skin a cat.

Sustainability through the prism of innovative service-oriented business model in farming

The concept of sustainable development was born as a new way to solve the problems of the mature industrial economic system. Naturally, sustainability management was focused on the product-oriented business model. However, the global economy is experiencing an unprecedented expansion of the services sector through servitization processes in manufacturing and agriculture implemented through innovative service-oriented business models. This study discusses the differences between sustainability management challenges in the agricultural industry and post-industrial farming. It explores how service-oriented business models bring various benefits to farming and help overcome barriers to sustainable farm development compared to traditional product-driven business models. The research follows a case study design, with an in-depth analysis of how a new small family farm successfully integrates three dimensions of sustainability by building a service-dominant logic-based business model. The case study findings demonstrate how service-driven farming naturally solves several main challenges reported in the academic literature on sustaining business in traditional product-driven farms and agribusinesses and avoids the need to balance traditionally competing environmental, economic, and social dimensions of sustainability because of the opportunity to achieve their symbiotic integration in a natural way.

Adjunctive Efficacy of Superior Hypogastric Plexus Block in Chronic Pelvic Pain: A Comprehensive Review

ABSTRACT Chronic pelvic pain (CPP) is a prevalent and complex condition that affects millions worldwide, predominantly women, and poses significant challenges in both diagnosis and management. Despite a wide array of pharmacological and nonpharmacological treatments, many patients experience persistent pain, reduced quality of life, and limited functional capacity. The superior hypogastric plexus block (SHPB) has emerged as a promising interventional technique for the management of CPP, particularly in cases with predominant visceral pain components. This comprehensive review aims to evaluate the adjunctive efficacy of SHPB in treating CPP, exploring its anatomical basis, mechanisms of action, and clinical outcomes. SHPB targets the superior hypogastric plexus, a crucial relay center for transmitting nociceptive signals from the pelvic organs. By interrupting these pathways, SHPB can relieve pain and improve associated symptoms such as dysmenorrhea, dyspareunia, and dysuria. This review systematically analyzes the existing literature on SHPB, comparing its effectiveness with other interventional techniques and its role as an adjunct to standard therapies. Evidence suggests that SHPB can significantly reduce pain scores and improve the quality of life in selected patients with a relatively low risk of complications.

Massive Lower Gastrointestinal Bleeding From Colonic Submucosal Lipoma and Diverticular Disease: A Rare Case Requiring Surgical Interventions and Postoperative Management Challenges

Massive Lower Gastrointestinal Bleeding From Colonic Submucosal Lipoma and Diverticular Disease: A Rare Case Requiring Surgical Interventions and Postoperative Management Challenges

Mechanical, Thermal, and Flammability Properties of Eco-Friendly Nanocomposites from Recycled PET/PA-11 Blends Reinforced with Graphene Nanoplatelets

This study investigates the development of sustainable nanocomposites using recycled polyethylene terephthalate (RPET) and polyamide 11 (PA-11) blends reinforced with graphene nanoplatelets (GNPs). RPET/PA-11 blends were compatibilized with 2 phr Joncryl® and processed using melt blending followed by injection moulding. The effects of varying GNP contents (1–4 phr) on mechanical, thermal, and flame-retardant properties were analysed. The nanocomposite with 1 phr GNPs exhibited an optimal balance of mechanical, flame-retardant, and thermal properties, along with improved dispersion compared to higher GNP loadings. Higher GNP concentrations led to increased stiffness but also promoted agglomeration, which negatively impacted tensile and impact strength. Thermal analysis revealed that GNPs influenced the cold crystallization behaviour of RPET, while the TGA results indicated a moderate enhancement in thermal stability. The maximum degradation temperature (Tmax) increased from 410.38 °C to 430.06 °C with 1 phr GNPs but declined at higher loadings. Similarly, flammability tests showed an improvement in the limiting oxygen index (LOI) from 19 to 24. Morphological analysis confirmed that GNPs facilitated PA-11 dispersion within the RPET matrix, particularly at lower GNP concentrations (1 phr). These findings highlight the potential of RPET/PA-11/GNP nanocomposites for multifunctional applications, providing an optimal balance between mechanical performance, thermal stability, and flame resistance. This research highlights the synergistic effect of GNPs in achieving sustainable, high-performance materials, addressing the challenges of plastic waste management and the need for eco-friendly engineering solutions for industries such as automotive, packaging, and construction.

Road Map to Defeat Pancreatic Cancer

Pancreatic cancer is a notoriously deadly disease characterized by many challenges in clinical management. Despite important advances in our understanding of pancreatic cancer progression and its underlying molecular biology over the last decades, there is a long road ahead if we aim to meaningfully improve patient outcomes in this difficult disease. Treatment options remain limited, and patient prognosis, although improving, remains bleak. As we build toward the future, we propose a framework for targeting the seven deadly hallmarks of pancreatic cancer in an effort to cure this disease. The high mortality and aggressive nature of pancreatic cancer can be largely ascribed to (a) diagnostic deficiencies, (b) chronic inflammation, (c) desmoplastic stroma, (d) early metastasis, (e) KRAS signaling, (f) metabolism, and (g) rapid deconditioning. Here, we outline the challenges presented by each of these disease hallmarks and highlight ongoing research to tackle each one.

Advancing MRD Detection in Multiple Myeloma: Technologies, Applications, and Future Perspectives.

Multiple myeloma (MM) is a malignant hematologic tumor of plasma cells that presents significant challenges in treatment and management. Despite the advent of novel therapies in recent years, which have improved patient outcomes, complete eradication of the disease remains an elusive goal. This underscores the critical need for in-depth research and ongoing innovation to tackle MM. Minimal residual disease (MRD) detection has emerged as a vital tool for evaluating treatment efficacy and predicting prognosis in MM patients, garnering extensive attention and application in recent years. This paper provides a comprehensive review of recent advancements in major MRD detection methods for MM patients, including multiparametric flow cytometry (MFC), allele-specific oligonucleotide real-time quantitative PCR (ASO-qPCR), and next-generation sequencing (NGS). It delves into the clinical applications of MRD detection, anticipates future developments, and offers valuable insights for improving diagnostic and therapeutic strategies. Through persistent research and innovation, we hope to bring better therapeutic prospects to MM patients.

Life History Traits and Fishery Dynamics of Speckled Shrimp, Metapenaeus monoceros (Fabricius, 1798), Along the Saudi Arabian Red Sea Coast

Metapenaeus monoceros is the second most abundant commercially important shrimp species caught along the Saudi Arabian Red Sea coast. However, knowledge of its life history and population dynamics in the region remains limited, posing challenges for sustainable management. This study assessed the growth, maturity, and mortality of M. monoceros based on fishery-independent samples collected from shrimp trawling grounds off Al Qunfudhah and Jizan (October 2022–September 2023). Altogether, 10,859 specimens were examined, with a carapace length (CL) ranging from 7.98 to 49.10 mm and a total weight (W) in the range of 0.41 to 41.28 g. The observed sex ratio was 1.56:1 in favor of females. The CL–W relationship was W = 0.0024∙CL2.58. The seasonalized von Bertalanffy growth parameters were CL∞ = 50.66 mm, K = 0.35 year−1, tanchor = 0.43 years, C = 0.64, and ts = 0.61 years for females, and CL∞ = 38.97 mm, K = 0.55 year−1, tanchor = 0.51 years, C = 0.84, and ts = 0.39 years for males. Females reached their first sexual maturity at 21.12 mm CL. The exploitation rates (0.60 for both sexes) indicated overfishing. Spawning potential ratio analysis showed that the current fishing pressure reduces the spawning stock biomass to 23% of unexploited levels. A 50% reduction in fishing effort, extended seasonal closures, and selective gear modifications are recommended to rebuild the stock and ensure sustainability.

Degradation of Hydrogen Bonds Enormously Enhances Convective Heat Transfer in Nanofluidics.

The ultrafast mass transport of liquid through nanochannels holds promising potential to tackle the challenge of thermal management in high-power-density electronic devices. However, convective heat transfer in underpinned nanofluidics-based environments remains elusive. Here, we report with atomistic simulations that the convective heat transfer in nanochannels can be enhanced by ∼50% due to the deterioration of hydrogen bonds subjected to internal stress. The degraded hydrogen bonds largely weaken the intrinsic constraints by local confinement, significantly promoting the mobility of the confined liquid molecules, which facilitates phonon transmission for rapid heat transfer. The internal stress is further elucidated and quantitatively correlated with the convective heat transfer through the development of a thermal-mechanics scaling law that incorporates the Nusselt number and the interaction energy between the nanoconfined liquid and solid. This work provides theoretical insights for designing nanofluidics-based cooling strategies to meet stringent thermal dissipation requirements of high-power-density electronics.

NETs activate the GAS6-AXL-NLRP3 axis in macrophages to drive morphine tolerance

BackgroundThe development of morphine tolerance presents a major clinical challenge in the effective management of severe pain. This study aims to explore the mechanisms underlying morphine tolerance from a novel perspective, with the ultimate goal of uncovering new insights and identifying promising therapeutic targets for its treatment.MethodsC57BL/6J mice were used in the tail-flick test to evaluate morphine tolerance. Neutrophils derived from mouse bone marrow were employed to investigate the mechanisms underlying morphine-induced NETs formation. Bone marrow-derived macrophages (BMDMs) were harvested from the femur and tibia to study the role of NETs-induced inflammation in analgesic tolerance. Proinflammatory cytokines were measured using Western blotting and real-time PCR. The levels of NETs and the TLR7/9-NLRP3-related signaling pathway were assessed through Western blotting, real-time PCR, and ELISA. Confocal laser scanning microscopy was utilized to visualize NETs in the dorsal root ganglion (DRG) and in cells.ResultsOur experiments demonstrated that the levels of NETs in the plasma of patients using morphine for analgesia, as well as in morphine-tolerant animals, were significantly elevated. Genetic elimination of Pad4, neutrophil depletion, and treatment with DNase 1 and RNase A to disrupt NETs formation all effectively alleviated morphine tolerance. These findings indicate that NETs play a critical role in the development of morphine tolerance. Mechanistically, we discovered that morphine-induced NETs can be engulfed by macrophages through the GAS6-AXL axis, which subsequently triggers the activation of the TLR7/TLR9-mediated NLRP3 inflammasome, leading to significantly increased levels of IL-1β and IL-18, and ultimately contributing to tolerance. Deletion of Axl, Gas6, or Nlrp3 each significantly improved morphine tolerance. Furthermore, in the murine model, treatment with the IL-1 receptor antagonist anakinra and the IL-18 decoy receptor IL-18BP prevented the development of morphine tolerance.ConclusionsThis study identifies morphine-induced NETs as a key contributor to morphine tolerance, with the GAS6-AXL-TLR7/9 axis emerging as a potential therapeutic target. Strategies focused on disrupting NETs and modulating this axis may offer a promising approach to combat morphine tolerance.

Symptomatic irreversible pulpitis and other orofacial pain: overcoming challenges in diagnosis and management

Due to the unique sensory innervation of the teeth and face, orofacial pain can be challenging to diagnose and manage. Odontogenic pain, or ‘toothache', is the most common orofacial pain condition and encompasses the vast majority of pain which is presented to dental practitioners. While diagnosis is often straightforward, the clinical picture is occasionally unclear or contradictory, and in these situations, the clinician should be able to consider reasons other than the teeth for the patient's presenting complaint. The primary aim of managing odontogenic pain is to treat the underlying cause, often arising from the dental pulp or periapical tissues; however, several factors can make pre-, intra- and post-operative management of odontogenic pain challenging. This paper will consider key similarities and differences in the clinical presentation of odontogenic pain and other non-odontogenic causes of orofacial pain in order to help practitioners arrive at the correct diagnosis. We discuss evidence-based recommendations for intra- and post-operative management of acute odontogenic pain, and consider the underlying neurophysiological features which make orofacial pain challenging to manage.

Clinical and molecular landscapes of steroid-refractory graft-versus-host disease following hematopoietic stem cell transplantation: a narrative review

Allogeneic hematopoietic stem cell transplantation is a highly effective stem cell-based therapy, but graft-versus-host disease remains a major post-transplant complication. While first-line graft-versus-host disease treatment involves high-dose corticosteroids, up to half of patients go on to develop steroid-refractory graft-versus-host disease, where graft-versus-host disease symptoms persist or worsen despite steroid treatment. This review provides an update on the clinical and molecular landscapes of steroid-refractory graft-versus-host disease, examining the challenges in diagnosis, management, and general understanding of steroid-refractory graft-versus-host disease pathophysiology. Progression to steroid-refractory graft-versus-host disease confers a poor prognosis and is associated with increased morbidity. There are multiple mechanisms that drive steroid-refractory graft-versus-host disease, which include the overactivation of T-cell and B-cell mechanisms, a heightened inflammatory state, and cell-intrinsic factors that mediate steroid responses. Current treatment options beyond corticosteroids include JAK pathway inhibition, mesenchymal stem cell therapy, extracorporeal photopheresis, and additional therapies currently under investigation in clinical trials. Potential avenues for future directions must aim to improve patient outcomes and post-transplant survivorship. Through comprehensive elucidation of the molecular mechanisms underlying steroid-refractory graft-versus-host disease, the development of mechanism-based, regenerative medicine-targeted therapeutic strategies, and the optimization of clinical trial design, it is anticipated that the prognosis and quality of life for patients with steroid-refractory graft-versus-host disease will be significantly improved. From a clinical standpoint, these advancements are expected to catalyze a transition from empirical to more personalized, mechanism-directed therapies, ultimately providing more durable and effective treatment options for patients with steroid-refractory graft-versus-host disease.

Determinants influencing the implementation of community health management for cognitive impairment: a qualitative study

BackgroundCognitive impairment constitutes a significant global public health challenge, particularly for countries or regions experiencing the largest increases in aging populations. Most countries have reached a consensus that cognitive impairment screening, care, and intervention should be conducted within community settings.ObjectiveTo identify multilevel barriers and facilitators for community health management for cognitive impairment, this study utilized the Consolidated Framework for Implementation Research (CFIR) to systematically evaluate the implementation of strategies for managing cognitive impairment in Shanghai, China.MethodsA semi-structured interview guide was developed based on the CFIR. Purposeful sampling was used to select 14 stakeholders from diverse sectors, including public health authorities, community health service centers, and experts in health management related to cognitive impairment, for semi-structured interviews. CFIR served as the coding framework for inductive analysis to identify and clarify the facilitators and barriers to cognitive impairment health management within the existing policy environment.ResultsQualitative interviews with stakeholders in community-based cognitive impairment health management revealed eight facilitators and ten barriers. The facilitators included enhanced social engagement for older adults, efficient digital tools, a supportive policy environment, adequate funding, integration into basic public health services, sufficient community human resources, supportive internal and external teams, and health education. Collectively, these factors fostered a conducive environment for effective cognitive impairment health management. In contrast, the identified barriers comprised a lack of validation for smart tools, absence of collaborative mechanisms, insufficient incentives for primary care physicians (PCPs), a lack of long-term mechanisms, inadequate professional expertise, low energy levels, limited training channels, insufficient disease awareness among older adults, absence of standardized implementation plans, and superficial work practices. These barriers hindered the effective execution of community-based cognitive impairment health management strategies.ConclusionThis study identified the primary facilitators and barriers to community-based cognitive impairment management within the context of current policies. To enhance the effectiveness of interventions, policymakers, health departments, and community organizations should actively address the identified barriers and leverage the facilitators. Additionally, the findings provide valuable insights for other countries facing similar challenges in cognitive impairment management. Future research should focus on integrating these factors into practical applications and evaluating the effectiveness of such interventions.Clinical trial numberNot applicable.

Impact of hypertension knowledge on adherence to antihypertensive therapy: a cross-sectional study in primary health care centers during the 2024 Sudan conflict

BackgroundHypertension is a global health issue, particularly in low- and middle-income countries. Effective management requires medication adherence, which is often compromised in conflict zones such as Sudan. This study examines the relationship between patients’ knowledge of hypertension and their adherence to antihypertensive therapy in Sudan amidst ongoing conflict.MethodsA cross-sectional study conducted across six primary healthcare centers in Al-Dammer, Sudan, included 389 hypertensive patients selected through convenience sampling. Data were collected using face-to-face questionnaire that assessed sociodemographics, medication adherence (GMAS), and hypertension knowledge (HKT). Analyses were conducted in SPSS, with percentages for categorical data, means ± SD for continuous data, and nonparametric tests (Shapiro-Wilk, Kruskal-Wallis) for non-normal distributions.ResultsMost participants were female (63%), and 43.7% were over 60 years old. Knowledge levels were categorized as average (57.8%), high (25.2%), and low (17%). Adherence rates were as follows: 1% poor, 2.8% low, 22.6% partial, 26.5% good, and 47% high. A positive correlation was found between knowledge and adherence (r = 0.47, p < 0.001). Major barriers to adherence included affordability (43.4%) and unavailability of medications (36.2%). While 82.3% of participants had a history of controlled hypertension, only 58.4% remained controlled at their most recent measurement, with 41.6% presenting uncontrolled blood pressure, highlighting challenges in sustained hypertension management. Improved adherence was associated with higher income, better education, and controlled blood pressure.ConclusionHigher hypertension knowledge was significantly associated with better adherence and improved blood pressure control. However, sustained control remains a challenge, as 41.6% of participants had uncontrolled hypertension at their last measurement. Addressing economic barriers and medication shortages through targeted interventions is essential for improving long-term hypertension management in conflict settings.

Is source data verification a valid tool to improve data quality of tumour documentation data? A critical assessment.

Accurate documentation of tumours presents significant opportunities for advancing cancer research and improving patient care, yet it also poses challenges for healthcare management. This study aimed to assess the effectiveness and resource implications of source data verification (SDV) in enhancing the quality of tumour documentation data, focusing on accuracy, completeness and correctness. Using tumour documentation data from a large German University Hospital, an SDV was conducted by an external audit group (group RE), comparing the data initially documented by the centre's tumour documentalists (group TD) to available source documents for the years 2016-2020. The analysis set comprised 240 cases, with exemplary data fields strategically selected across various organ entities and other tumour features. Identified errors were cross-validated by a third group (group CO). Visualisations depicted error frequencies by diagnosis year and organ entity. Potential errors were identified, providing feedback to the tumour documentation unit. However, uncertainties in error identification raised questions about the efficacy of SDV. While effective in identifying errors, SDV faced challenges due to ambiguous source data and potential bias from external auditors, as well as being deemed uneconomical. The study suggests SDVs suitability for small sample validation but questions its scalability for large datasets.Implications for health information management:Alternative methods, such as data exchange interfaces to subsystems or plausibility checks, are recommended for enhancing data quality. This study emphasises the need to explore alternatives for improving data quality in tumour documentation.

Urban green spaces and flood disaster management: toward sustainable urban design

This paper explores how rapid urbanization and frequent extreme rainfall affect urban flood risk, highlighting that stormwater management challenges worsen due to increased impervious surfaces, altered urban hydrological cycles, and damaged natural retention systems. This paper, grounded in sustainable urban design principles, underscores the significance of green infrastructure for bolstering urban flood resilience. Urban green spaces not only reduce surface runoff through natural storage and infiltration but also improve water quality, regulate urban microclimate, and enhance biodiversity. Furthermore, this paper examines the application of green infrastructure in stormwater management, drawing inspiration from international success stories such as the Amsterdam Canal Network, Singapore’s ABC Waters Program, and Kazan’s “Resilient Belt” project. The study suggests that an integrated “blue-green-gray” strategy, which combines natural ecosystems with engineered facilities, should be adopted to optimize stormwater management efficiency. Despite the significant advantages of green infrastructure, there are still challenges in scaling up the application, connecting decentralized green spaces, and integrating real-time monitoring systems for dynamic regulation. Future research should focus on the synergistic effects of green infrastructure at different urban scales and explore a balanced path between urban expansion and ecological sustainability.

An Approach to Thermal Management and Performance Throttling for Federated Computation on a Low-Cost 3D ESP32-S3 Package Stack

The rise of 3D heterogeneous packaging holds promise for increased performance in applications such as AI by bringing compute and memory modules into close proximity. This increased performance comes with increased thermal management challenges. This research explores the use of thermal sensing and load throttling combined with federated computation to manage localized internal heating in a multi-3D chip package. The overall concept is that individual chiplets may heat at different rates due to operational and geometric factors. Shifting computational loads from hot to cooler chiplets can prevent local overheating while maintaining overall computational output. This concept is verified with experiments in a low-cost test vehicle. The test vehicle mimics a 3D chiplet stack with a tightly stacked assembly of SoC devices. These devices can sense and report internal temperature and dynamically adjust frequency. The configuration is for ESP32-S3 microcontrollers to work on a federated computational task, while reporting internal temperature to a host controller. The tight packing of processors causes temperatures to rise, with those internal to the stack rising more quickly than external ones. With real-time temperature monitoring, when the temperatures exceed a threshold, the AI system reduces the processor frequency, i.e., throttles the processor, to save power and dynamically shifts part of the workload to other ESP32-S3s with lower temperatures. This approach maximizes overall efficiency while maintaining thermal safety without compromising computational power. Experimental results with up to six processors confirm the validity of the concept.

Burden and Outcomes of Severe Lower Respiratory Tract Infections with Unknown Etiology: A Retrospective Observational Study on Epidemiological Trends Over an 8-Year Period (2016-2024).

Severe lower respiratory tract infections often require hospitalization, but a significant proportion lack microbiological diagnosis, leading to challenges in management. This study aimed to compare clinical outcomes of S-LRTIs with unknown versus known bacteria or viral etiology in Lombardy, Italy. A retrospective study analyzed respiratory infection-related hospitalizations in Lombardy over 8years (2016-2024) using patient discharge charts. Patients were categorized into four groups: bacterial, viral (non-COVID-19), COVID-19-related, and unknown etiology. Outcomes included length of stay, intensive care unit admissions, and intra-hospital mortality. Temporal, seasonal, and age-specific trends were evaluated. Among 683,741 hospitalizations, 338,211 (49.5%) were of unknown etiology, showing a 12.3% intra-hospital mortality rate (41,627 deaths) and 4.0% intensive care unit admission rate (13,625 admissions). COVID-19-related hospitalizations had the highest intra-hospital mortality rate (22.0%, 36,446 deaths in 165,605 COVID-19-related hospitalizations) and number of intensive care unit admissions (14,725 admissions, 8.9% of COVID-19-related hospitalizations), while viral non-COVID-19 hospitalizations showed the lowest intra-hospital mortality rate (3.2%, 1114 deaths in 34,769 viral-non-COVID-19 hospitalizations) and shortest length of stay (11.9days). Hospitalizations with unknown etiology were more common in minors (42,190 episodes, 57.6% of total in < 18years) and elderly (358,534 episodes, 56.2% of total in > 75years), especially during warm seasons. Post-pandemic years saw increased bacterial and viral hospitalizations alongside a reduced proportion of those without an unknown etiology. Respiratory infection-related hospitalizations with unknown etiology are associated with distinct seasonal and demographic patterns, and poorer outcomes compared to viral non-COVID-19 hospitalizations. COVID-19 reshaped S-LRTI epidemiology and diagnostic approaches, highlighting the need for comprehensive pathogen panels and tailored management strategies, while promoting their expanded use. Future research should integrate detailed clinical data to improve understanding and outcomes of severe respiratory infections, especially in vulnerable populations.