Choice For Management Research Articles

Exploratory Cost-Utility Analysis of a 37-Gene Panel Versus Usual Care to Guide Therapy for Patients with Intermediate-Risk Myeloid Malignancies.

Genomic risk stratification methods for myeloid malignancies have moved beyond conventional karyotyping and single gene approaches to better define disease behaviour. Next-generation sequencing has been established as the new standard-of-care tool to accurately define prognosis at diagnosis and guide therapy decisions. We aimed to determine the economic value of a 37-gene panel test for informing subsequent care for patients with intermediate-risk myeloid malignancies. We performed an exploratory cost-utility analysis of a 37-gene panel test to inform stem cell transplantation therapy in patients with myeloid malignancies in Queensland, Australia. Clinician surveys provided data on management choice with and without genomics information while both published and individual-level data were used for healthcare costs, quality of life, relapse rates and survival data. We used a decision-analytic cohort model with Markov chains and 5000 simulations to derive the incremental cost per quality-adjusted life year (QALY) gained. Scenario, one-way and probabilistic sensitivity analyses were undertaken to test input variation on the stability of the main findings. Over 10 years, the model predicted mean costs of AU$125,561 for the panel testing strategy and AU$117,045 for usual care, indicating an incremental cost of AU$8516 for panel testing. The corresponding mean QALYs were 4.52 for panel testing and 4.46 for usual care, producing a cost of AU$153,854 per QALY gained. In the Australian system, the likelihood that panel testing would be cost effective was <1 % and would have a more favourable cost-effective profile at a willingness-to-pay of AU$140,000 per QALY gained. Driven by small gains in survival and relapse rates following therapies, genomic panel sequencing for myeloid malignancies in people with intermediate-risk disease is unlikely to be cost effective in Australia.

BS O06 - Management of Leaks post Bariatric Surgery: Recent Experience from a Tertiary Bariatric Surgery Referral Unit

Abstract Background Bariatric surgery has been consistently demonstrated to provide effective long-term sustained weight loss and remission of several life-threatening conditions. The most common bariatric procedures undertaken globally include laparoscopic sleeve gastrectomy (SG) and gastric bypass2. These procedures are safe and have low associated mortality rates [0.05% SG, 0.09% single anastomosis gastric bypass (SAGB) and Roux-en-Y (RNYGB)]3. However, complications including staple line and anastomotic leaks can occur in up to 3% of patients and are associated with significant morbidity, thus requiring prompt identification and treatment4. Our study aims to analyse management of these leaks and establish an algorithm for our centre. Method This was a retrospective study of consecutive patients who experienced post-bariatric surgery leak between 2018 to 2024, in a regional tertiary bariatric surgery referral unit in the UK, serving a population of 5 million. The study included patients who underwent bariatric surgery in the UK or abroad (SG, RNYGB and SAGB), both primary and revision cases, and were subsequently diagnosed with post-operative leak. Patients were initially managed in our facility or referred to our centre for ongoing management of leak from other centres. Demographics, time to presentation, hospital length of stay (LOS), diagnostic investigations performed, and management approaches were analysed. Results 22 patients (8 bypasses, 14 sleeves) were included. Mean time to presentation from index surgery was 19.6 days and mean LOS was 43.6 days. Initial management included conservative (3), endo-vacuum therapy (EVT) (4), stent (1), surgical (14) [9 laparoscopy and 5 laparotomy]. Surgical management comprised 7 T-tube insertions, 1 Foley catheter, 2 primary repairs, 2 EVTs, 1 washout and drain, and 1 stoma formation. Three patients required no further intervention, six needed different management approaches and three required re-operations. 7 patients were readmitted following discharge. Resolution of leak was achieved in all cases. There was no 90-day mortality. Conclusion Management of postoperative leak following bariatric surgery is a complex issue, requiring early identification, adequate drainage and control of sepsis, and maintenance of nutrition. Successful management requires a proactive and aggressive approach, including early clinical suspicion. Access to a range of interventions to support a dynamic approach to management is critical. The sequence and choice of management of leaks should be individualised according to each patient’s clinical presentation and investigation findings. A combination of different management approaches is often required for successful treatment of leak. Multicentre studies are needed to move closer to a consensus on managing bariatric leaks.

Exome Sequencing in Fetuses With Bilateral Renal Agenesis Identified on Second Trimester Ultrasound: ASingle Referral Center Experience.

To determine the exome sequencing results in fetuses with bilateral renal agenesis (BRA). This was a retrospective study of 14 cases with BRA diagnosed on second trimester anatomy ultrasound. All cases underwent invasive prenatal diagnosis. Genetic investigations were performed by chromosomal microarray analysis and trio exome sequencing. Clinical and laboratory data were collected and reviewed for these cases, including maternal demographics, prenatal sonographic findings, molecular sequencing results, and pregnancy outcomes. Pathogenic and likely pathogenic variants in three genes (FRAS1, PBX1, and KMT2D) were detected by exome sequencing in 6 (6/14) cases. One gene (FRAS1) is inherited in an autosomal recessive (AR) manner and two (PBX1and KMT2D) are autosomal dominant (AD); both AD variants were de novo. Only the FRAS1 variants were detected in more than one case. Variants in five cases were believed to be the cause of BRA, and the variants detected in PBX1 and KMT2D were likely the cause of fetal phenotype suggesting that the two genes can present with BRA. The yield of exome sequencing in our series is one third (4/12) after excluding two families with a previous family history. Fraser syndrome, resulting from FRAS1 variants, is the most common cause of genetic BRA identified in this specific cohort. The determination of genetic etiology will be valuable in the possible choices for pregnancy management and risk assessment of recurrence in future pregnancies.

Survey of Flemish Poultry Farmers on How Birds Fit for Transport to the Slaughterhouse Are Selected, Caught, and Crated and Their Opinions Regarding the Pre-Transport Process

The pre-transport phase induces stress, fear, and injury in poultry, but management choices greatly influence this. Pre-transport practices for spent hens and broilers in Flanders (Belgium) were studied. Poultry farmers (31 of 156 layers and 48 of 203 broiler farmers completed the survey) were surveyed on the selection of unfit chickens, catching and crating, and farmer opinion. A minority of farmers made a specific selection of chickens unfit for transport prior to catching (layers 25%: 5.1 ± 5.9 h, broilers 39%: 6.8 ± 7.0 h). More layer (69%) than broiler farmers (19%) withdrew feed too early (EU regulations stipulate max. 12 h before expected slaughter time). Layer farmers withdrew water earlier than broiler farmers (47.9 ± 51.1 min vs. 20.6 ± 23.3 min). More broiler than layer farmers believed that the container type affects the birds’ welfare (48% vs. 27%; p &lt; 0.05). On broiler farms, mechanical catching was preferred for catchers’ well-being, while upright catching was considered better for animal welfare than catching more than three chickens by one/two legs, wings, or mechanically. Poultry farmers should be sensitized about the need for additional selection before catching, including clear guidelines about judging which birds are fit for transport.

The recursive impact in the multivariate probit model: An application on farmers’ decisions for opting risk management strategies

AbstractThis study investigates the determinants of farmers’ risk management decisions in Khyber‐Pakhtunkhwa, Pakistan, using a recursive multivariate probit (RMVP) model. Employing data from 382 farmers collected through a multistage sampling process, the study compares the RMVP with the traditional multivariate probit (MVP) model, demonstrating the superior performance of the RMVP in capturing complex decision‐making patterns. Our rigorous statistical analysis demonstrates the significant impact of endogenous covariates on farmers’ risk management choices, revealing complementarity or substitutability among strategies. The study contributes to the literature by providing empirical evidence on the effectiveness of the RMVP model for understanding smallholder farmers’ risk management behavior and offering insights for policymakers to support resilient agricultural systems.

Perioperative Application of Point-of-care Test for Blood Viscoelasticity: A Good Choice for Coagulation Management

Point-of-care test (POCT) of blood viscoelasticity can reflect the coagulation status of patients accurately and timely. POCT can be used to monitor the effect of preoperative antithrombotic drugs on coagulation function, which will inform the selection of appropriate surgical timing. It can also be applied to analyze the reasons of intraoperative bleeding and guide the transfusion of blood products. Also, it is useful to assess the risk of postoperative thromboembolism and hint the need for prophylactic anticoagulation. This article mainly introduces the principles and clinical application of several frequently used POCTs for blood viscoelasticity, with a focus on their role in special types of diseases in which coagulation function changes significantly, such as cardiac disease, trauma, pathological obstetrics, and liver disease. Furthermore, we describe the role of microparticle in coagulation, which is a novel potential biomarker for diagnosing thrombotic disorders and possesses potential to be applied in POCTs of blood viscoelasticity.

Position statement of Polish Cardiac Society experts on cardiomyopathy.

Cardiomyopathies (CMs) are a very broad group of diseases, including genetically determined and acquired, and their classification is based on phenotypic characteristics. There is always a need to search for the etiology (often also to try to identify the genetic cause), which may determine the appropriate choice of clinical management. The geographical distribution of genetic variants varies as does the prevalence across populations, ethnic groups, regions, and countries. The most reliable data on the distribution of individual genetic variants come from developed countries. The phenotypic classification includes 5 main types of CM, i.e., dilated CM, hypertrophic, restrictive, arrhythmogenic right ventricular CM, and non-dilated left ventricular (LV) CM. Individual CMs are characterized by a variety of causes and different phenotypic pictures, which affect their presentation, diagnosis, and response to treatment. Within each type of CM, there are both familial and sporadic (acquired) forms. The complex presentation of CM, as well as the limited availability of screening and diagnostic tests, causes CMs to be diagnosed late, often at an advanced stage of the disease. Therapeutic management of CM is strictly determined by its type and clinical picture. Diagnostics include the assessment of symptoms, the results of imaging and genetic tests, as well as morphological, functional, and often histological assessment. This allows for personalized and dedicated clinical management. To optimize thediagnosis, treatment, and care of patients with CMs, an individualized, expert, systemic, coordinated, and often multidisciplinary structure of care is necessary. Hence, it is important to create multidisciplinary teams for CM management. We present examples of existing systemic solutions for the care of CM patients in Europe (France and Spain). Not all of these options are available to patients in our country. This article presents issues related to CM and may be the basis for developing a diagnostic and therapeutic model allowing for earlier detection of CM in Polish patients and their effective treatment.

Associations Between Testing and Treatment Pathways in a Case of Pediatric Nonlesional Epilepsy: A Census Survey of NAEC Center Directors.

Epilepsy surgery is vital in managing of children with drug-resistant epilepsy. Noninvasive and invasive testing modalities allow for evaluation and treatment of children with drug-resistant epilepsy. Evidence-based algorithms for this process do not exist. This study examines expert response to a vignette of pediatric nonlesional epilepsy to assess associations in evaluation and treatment choices. We analyzed annual report data and an epilepsy practice survey reported in 2020 from 135 pediatric epilepsy center directors in the United States. Characteristics of centers along with noninvasive and invasive testing and surgical treatment strategies were collected. Multivariable logistic regression modeling was performed. The response rate was 100% with 135 responses included in the analyses. Most used noninvasive testing modalities included Neuropsychology evaluation (90%), interictal brain fluorodeoxyglucose-positron emission tomography (85%), and functional magnetic resonance imaging (MRI) (72%) with nearly half obtaining genetic testing. Choosing functional MRI was associated with stereo electroencephalography (EEG) (P = .025) and selecting Wada with subdural grid/strips (P = .038). Directors from pediatric-only centers were more likely to choose stereo EEG as opposed to combined centers (P = .042). Laser interstitial thermal therapy was almost 7 times as likely to be chosen as a treatment modality compared with open resection in dedicated pediatric centers (OR 6.96, P = .002). In a vignette of nonlesional childhood drug-resistant epilepsy, epilepsy center directors' patterns of noninvasive testing, invasive testing, and treatment were examined. Management choices were associated with pediatric versus combined pediatric/adult center characteristics. Expert opinions demonstrated equipoise in evaluation and management of children with drug-resistant epilepsy and the need for evidence-based management strategies.

Beyond one size fits all: Probing patient choices in gestational diabetes management, from screening to postpartum

Beyond one size fits all: Probing patient choices in gestational diabetes management, from screening to postpartum

Which landscape do you prefer? The role of emotions on choices for landscape management

Landscape preferences refer to the subjective likes and dislikes people have regarding various types of landscapes. However, the specific role that emotions play in this question and their impact on influencing choices for landscape is still poorly studied. To address this gap, we hypothesise that landscapes evoke emotions and we explore whether they have a role in shaping landscape preferences. Using 109 semi-structured interviews we captured the diversity of emotions on different landscapes in SE Spain, employing a random parameter logit model to explain how emotions could influence the probability of choosing a landscape. Results revealed that different landscapes were perceived as preferred, with specific emotions associated with them. Results also showed that two main factors significantly influenced landscape preference choices: specific positive emotions and distinct landscape typologies. These insights may contribute to reframe human-nature relationships in landscape management, considering emotional bonds and human behaviour as important aspects for guiding conservation policies.

Anesthetic management of laparoscopically assisted fetoscopic surgery to correct spina bifida

Introduction. The growing incidence of intrauterine pathology in the fetus at the present stage dictates the need to develop and improve intrauterine surgical correction of defects in the fetus. Myelomeningocele (SPINA BIFIDA) is the most common and severe neural tube defect in the fetus, the severity of the neurological deficit is determined by the level of location and extent of the anomaly. By uniting doctors of various specialties (obstetricians-gynecologists, neonatologists, surgeons, anesthesiologists-resuscitators), the Clinic of the St. Petersburg State Pediatric Medical University effectively introduces methods of prenatal surgery.The objective was to demonstrate by clinical example the experience of successful fetoscopic correction of myeloneningocele to reduce maternal risks and injuries, to reduce risks aimed at protecting the tissues of the spinal cord of the fetus, as well as to reduce the need for postpartum correction of the defect in the fetus, to improve prognosis and risks of subsequent disability.Materials and methods. The article presents the first successful experience of minimally invasive laparoscopic correction of myelomeningocele in the fetus with the participation of the multidisciplinary team and the features of anesthesiological support of the method.Conclusion. Laparoscopic access, together with the optimal choice of anesthetic management in fetal surgery, allows not only to successfully correct the defect in myelomeningocele in the fetus, but also to significantly minimize and reduce the risks of injury to the mother, and also reduces the need for postpartum surgical treatment and reduce disability. Accumulation and improvement of experience, a multidisciplinary approach is the key to successful correction of intrauterine fetal pathology.

Intelligent solar light electric vehicle moving in hot regions under a hybrid power source strategy

Solar Light Electric Vehicles (ISLEV) have recently gained increasing attention as a promising solution for sustainable transportation. In hot regions, such as the BECHAR region in southwest Algeria, where temperatures can exceed 50 °C, the challenge of maintaining high performance standards while coping with challenging environmental conditions is critical. To address this challenge, this study proposes an intelligent hybrid power source strategy comprising SUN Power solar PV and lithium-ion battery supercapacitors. To optimize the vehicle's performance, a feedforward neural network FF-NN is employed, which regulates the power flow between the hybrid sources. The proposed system's efficiency and effectiveness are assessed through simulations, which reveal its robustness in coping with challenging environmental conditions while maintaining high performance standards. The results show that the proposed system holds con-siderable potential for sustainable and efficient transportation in hot regions and can have broad applications in diverse sectors. Future industrial vehicle designs must incorporate the choice of hybrid power management into their planning process to ensure the efficient use of energy and optimize the vehicle's performance.

Parental Management Choices and Discordant Ultrasound Findings in Referrals for Fetal Spina Bifida.

The severity of spina bifida aperta can be assessed prenatally by ultrasound. Morphological findings assist parents in choosing between management options. We aimed to document those management choices since the introduction of fetal surgery, and compare initial ultrasound findings prior to referral to findings in a fetal surgery center. Single center cohort study of 245 consecutive fetuses with a second-trimester diagnosis of SBA. Data included nature of referral (for assessment or for surgery), condition-specific findings on ultrasound, and further management. We compared the reported findings on the initial ultrasound to ours for the presence of hindbrain herniation, lesion level, ventricular width, kyphosis, leg movement, and club feet. Seventy-two percent (n=177) of fetuses met the eligibility criteria for surgery; in 60% (n=106) parents opted for fetal surgery. Of 136 patients specifically referred for surgery, 27 were ineligible (20%). Of the others, 93 proceeded with surgery. In up to 28% (n=30) of surgery referrals, eligibility criteria such as lesion level (n=30, 28%) or leg movement (72%, n=78) as severity indicators were not reported. Fetal surgery uptake was high in patients referred for surgery. Second assessment in a fetal surgery center often reveals additional relevant information.

A STUDY ON WORKING WOMEN’S FINANCIAL DECISIONS IN BANGALORE NORTH

This study investigates the financial decision-making patterns of working women in Bangalore North, focusing on the factors that influence their personal finance management and investment choices. Through a combination of surveys and interviews, the research explores the impact of demographic variables such as age, education, income level, and marital status on financial decisions. It also examines the role of societal expectations, family responsibilities, and financial literacy in shaping their ability to make informed financial choices. The findings highlight both the progress and the challenges that working women face in achieving financial independence. Despite an increasing number of women participating in the workforce, many still encounter barriers to effective financial planning, including limited access to tailored financial products and a lack of comprehensive financial education. The study concludes by recommending policies and initiatives that aim to empower working women, enhance their financial literacy, and support their pursuit of financial autonomy. KEY-WORDS: Societal Expectations, Family Responsibilities, Financial Independence, Financial Planning, Demographic Factors, Empowerment, Gender and Finance, Workforce Participation

Financial decision dynamics: Environmental, social, and governance factors and managerial choices in emerging markets

This study examines the linkage between the ESG performance of firms and managerial decision-making. It uses 8 years of ESG performance data of 110 Indian firms collected from the Thomson Reuters database. The study finds that high ESG performance mitigates a firm’s cost of debt more than equity cost. Furthermore, increases in ESG performance are associated with higher capital expenditures, lower investment cash flow sensitivity, higher cash holdings, and lesser payout of increased cash flows to shareholders. The findings are in sync with the Slack resources view, suggesting that the requirement of financial Slack for ESG-related innovations and risk-bearing is large and impacts the major managerial decisions of firms. While the effects of environmental and social performance on these decisions are similar to that of the composite ESG performance, governance performance shows an independent impact on the payout decisions of firms. The Granger Causality test reveals a bi-directional association between debt issues and ESG performance. The main results obtained from the multiple panel regressions are robust to additional tests involving lead-lag analysis. The overall findings of this study highlight the importance of ESG performance screening in the managerial decision-making process of investors who would not like to risk growth potential for a short-term increase in dividends.

Comparison of Patients with and without Predicted Surgical Indication between Clusters of Adult Spine Deformity (ASD) Patients.

Multicentric, retrospective analysis of prospectively collected data. To utilize machine-learning (ML) for clustering and management prediction (conservative vs. operative) in surgically treated adult spine deformity (ASD) patients, and to compare the attainment of the Minimum Clinically Important Difference (MCID) between predicted surgical and conservative patients. Management choice in ASD is complex. ML can identity patient clusters and predicted treatment, but it is unclear whether patients treated according to the prediction also show better clinical outcomes. ASD patients (2-year follow-up) were divided into groups using k-means clustering. Management choice was predicted among operated patients in each cluster. The MCID for the Oswestry Disability Index (ODI) and the Scoliosis Research Society-22 (SRS-22) was calculated and compared between patients with and without surgical prediction. In Cluster 1 (idiopathic scoliosis, n=675, 150 surgeries), 57% of patients had a conservative prediction. Of these, 52% and 49% achieved MCID for ODI and SRS-22, respectively, compared to 68% and 75% for those with surgical predictions (OR=2 and 3.1, respectively).In Cluster 2 (moderate sagittal imbalance, n=561, 200 surgeries), 12% had a conservative prediction. Of these, 29% and 46% achieved MCID for ODI and SRS-22, respectively, compared to 47% and 56% for those with surgical predictions.In Cluster 3 (significant sagittal imbalance, n=537, 197 surgeries), 17% had a conservative prediction. Of these, 12% and 15% achieved MCID for ODI and SRS-22, respectively, compared to 37% and 45% for those with surgical predictions (OR=4.2 and 4.5, respectively). Patients with a concordant surgical prediction and management had higher odds of achieving the MCID, indicating a good correlation between prediction and clinical outcomes. In Cluster 3, the low percentage of patients with conservative prediction achieving the MCID suggests that machine learning could well identify patients with poor clinical outcomes.

Response of Hydroponic Tomato Yield and Yield-correlated Morphological Characteristics to Constant or Growth Stage-based Nutrient Management Strategies

In the United States, the annual revenue attributable to tomato production is $1 billion. However, tomato production can cause negative environmental impacts, such as water pollution, often in the form of eutrophication-causing nutrient pollution. Hydroponic production can decrease excess nutrient leaching; however, optimization of nutrient management and cultivar choices could further decrease excess nutrient discharges. The objectives of this study were as follows: to evaluate and compare the responses of tomato growth characteristics, yield, and yield components to two nutrient management regimes (varying nutrient solution concentrations by growth stage and the use of a constant nutrient solution concentration from transplant to termination), and to analyze the effects of growth habits among six cultivars (Big Beef, Cherokee Purple, Heatmaster, Legend, Mountain Fresh Plus, and Tropic) on tomato yield and yield-correlated morphological characteristics. The nutrient management strategies were applied to tomato plants, and data regarding yield and related morphological characteristics were obtained. Data were analyzed using SAS PROC GLM. An analysis revealed no significant difference in the total fruit weight/plant between nutrient management regimes (P = 0.05); however, the mean fruit weight (164.26 g) and diameter (71.70 mm) were significantly greater (P &lt; 0.0001) for plants that received the constant concentration nutrient regime. Indeterminate plants had a significantly greater (P &lt; 0.0001) mean fruit weight (192.76 g) and mean fruit diameter (76.42 mm). Among cultivars, Big Beef had a significantly greater (P &lt; 0.05) total fruit weight/plant (9.25 kg). Applying a constant nutrient concentration to indeterminate cultivars, particularly Big Beef and Cherokee Purple, improved the factors analyzed and could decrease negative environmental impacts while increasing profits of the producers.

Monitoring the rewilding of the Brazilian Atlantic Forest on tree and mammal diversity: From a biodiversity hotspot to a biodiversity hopespot

The implementation of rewilding initiatives is crucial for biodiversity recovery, particularly in biodiversity hotspots such as the Brazilian Atlantic Forest. Long-term monitoring of rewilding initiatives is critical for assessing progress and informing management choices. This study assesses the efficiency of different reforestation practices for biodiversity recovery, including passive restoration, active reforestation with different native seedlings, and plantations of exotic species. We applied an ecosystem approach to estimate the tree and mammal diversity, collected through forest plots and camera traps. We selected differently managed areas and included the oldest forest patches as reference points for the assessment of biodiversity; a naturally disturbed montane forest in the area was included as a control category for the disturbance analysis. Moreover, we investigated the influence of ecological variables, such as biodiversity, aboveground biomass, and altitude, on rewilding processes. Our results suggest that Eucalyptus plantations, a simplified ecosystem made up of monocultures of exotic species, support lower biodiversity. On the contrary, active reforestation with different native species resulted in an ecological status comparable to naturally regrown secondary forests. We show that active reforestation can reduce the time required for rewilding. We also found a positive correlation between tree and mammal species richness. These results underscore the importance and potential of responsible restoration efforts in recovering local biodiversity, contributing to the vision of a future where the Brazilian Atlantic Forest can be acknowledged not only as a biodiversity hotspot but also as a “hopespot.”

A-162 Identifying Patients With Poor Outcomes in Mycosis Fungoides & Sezary syndrome For Improved Management Choices

A-162 Identifying Patients With Poor Outcomes in Mycosis Fungoides & Sezary syndrome For Improved Management Choices

Why continue social concertation, not lobby?: Strategic choices of labor, management, and government through social learning

Why continue social concertation, not lobby?: Strategic choices of labor, management, and government through social learning