Management Plan Research Articles

Optimasi Ukuran Lot Persediaan dalam Model Integrasi Single Vendor dan Single Buyer dengan Mempertimbangkan Kekurangan Buyer

<p><strong>The supply chain is the main factor influencing the production process in achieving goals. This research develops a model to determine the optimal production lot size in the supply chain system between vendors and buyers by considering the inventory shortage at the buyer. Minimizing the combined inventory cost is the goal of optimizing the production lot size by developing an integration model to determine the optimal lot size. The proposed model uses a periodic delivery method from the vendor to the buyer and allows for inventory shortages at the buyer. An iterative algorithm is applied to find the optimal lot size and minimum integrated inventory cost. The results showed that the initial model with n=1 resulted in a total cost of 2252 and an optimal production size (Q*) of 457. The proposed model reduces the total cost to 1605 with an optimal production size (Q*) of 737. Sensitivity analysis showed that an increase in the frequency of deliveries to vendors and vendor set-up costs contributed to a rise in total cost, while an increase in vendor storage costs led to a decrease in production lot size. This research can improve the efficiency of production planning and inventory management in the supply chain.</strong></p><p><strong><em>Keywords</em></strong> - <em>Inventory, Shortages, Single Buyer</em><em>, Single Vendor.</em></p>

A geographic-semantic context-aware urban commuting flow prediction model using graph neural network

Urban commuting flow prediction is crucial for urban planning, transportation optimization, and supply chain management. Traditional models and machine learning solutions often fall short in capturing the complex dynamics of urban mobility, overlooking factors like spatial correlation and human mobility patterns. Recent deep learning advancements have shown promise by integrating spatial correlation through incorporating geographical adjacency. However, this approach may not fully capture spatial correlation, particularly the semantic adjacency effect of zones connected via public transportation lines, such as metro networks—a novel dimension overlooked in prior research. The metro station serves as a major transit hub, attracting passengers from various origins and destinations and correlating the flow between the connected zones and other zones within the metro network. Devising an optimized model to encapsulate these spatial correlations is another crucial area of research where scientists are actively seeking the most effective solutions. We propose a novel sequential hybrid approach leveraging graph-based learning, focusing on the underexplored impact of metro networks on commuting flow prediction. Our model integrates two types of adjacency—geographic and semantic—using Graph Convolutional Networks (GCNs) to embed geographic correlations among proximate zones and Graph Attention Networks (GATs) to incorporate semantic adjacency defined by metro line connectivity. Furthermore, our approach innovatively incorporates features directly from online maps, eliminating reliance on third-party resources and enhancing scalability and efficiency. We validate our model using real-world datasets from Montreal, Canada, comprising travel surveys and GPS trajectory types, totaling nearly 900,000 trip records. Through evaluation using established performance metrics such as MAE, RMSE, MAPE, and CPC, we demonstrate significant improvement in predictive accuracy compared to existing state-of-the-art models. Our research has practical implications for urban planning and infrastructure development, aiding policymakers and urban planners in analyzing the impact of new urban infrastructure on commuting flow dynamics and facilitating informed decisions regarding transportation and infrastructure planning.

Effects of habitat fragmentation on ecosystem services and their trade-offs in Southwest China: A multi-perspective analysis

Exploring the relationships between habitat fragmentation on ecosystem services (ESs) is important for ecological conservation and spatial pattern optimisation. However, analyzing the influence of different habitat fragmentation processes on ESs and their trade-offs from a multiple perspective is still relatively lacking. Therefore, taking Southwest (SW) China as an example, this paper evaluated the dynamics and trade-off relationship of four main types of ESs (i.e., carbon storage (CS), grain production (GP), water retention (WR), soil retention (SR)) during 2000–2020, and analyzed the effects of four habitat fragmentation processes (i.e., decreasing habitat area, increasing habitat density, increasing habitat shape complexity and decreasing habitat cohesion) on ESs and their trade-offs by using geographically and temporally weighted regression model. The results showed that ESs showed a deterioration trend during 2000–2020, with GP, WR, CS, SR, and total ecosystem services (TES) declined by 66.45 %, 54.33 %, 41.68 %, 76.25 % and 65.83 %, respectively. The GP-SR, GP-CS and GP-WR pairs exhibited trade-offs, while other ES types pairs exhibited synergies with each other. Increasing habitat density and increasing in habitat shape complexity were the two strongest fragmentation processes influencing ESs and their trade-offs. The effects of various habitat fragmentation processes on ESs and their trade-offs have obvious spatial heterogeneity. With changes in terrain relief, proportion of karst area, habitat quality, and urbanization level, the association of habitat fragmentation-ESs and habitat fragmentation-ESs trade-offs existed different sensitivities. The results can provide effective guidance for landscape planning and ecosystem management in the SW.

Physical, chemical and biological treatment of textile wastewater for removal of dyes and heavy metals

The water consumption by textile industries is millions of gallons per day. Discharge of untreated wastewater causes environmental, health, and aquatic life problems. This study aims to remove the dyes and heavy metals in textile wastewater by three different methods. In physical treatment, adsorption includes rice husk and sawdust and coagulation includes lime and alum, in chemical treatment AOPs and biological treatment Pistia stratiotes and Eichhornia crassipes macrophytes were utilized. Results showed that the maximum removal efficiency of azo dyes AY-17, AY-36, DY-4, DR-28, EBT, AB-1 was 35 %, 87 %, 89 %, 95 %, 94 %, 78 % and basic dyes MV-10B, BG-4, BB-9 was 80 %, 76 %, 94 % and reactive dyes RO-4, RO-16 and RB-5 was 89 %, 78 %, 95 % after physical treatment. The maximum removal efficiency of heavy metal Cu was detected 28.46 % with alum compared to other materials used in the physical treatment. The maximum removal efficiency of azo dyes AY-17, AY-36, DY-4, DR-28, EBT, AB-1 was 74 %, 91 %, 94 %, 88 %, 89 %, 92 % and basic dyes MV-10B, BG-4, BB-9 was 89 %, 87 %, 94 % and reactive dyes RO-4, RO-16 and RB-5 was 82 %, 68 %, 86 % after chemical treatment. H2O2/O3 and ozonation yielded a maximum removal efficiency of 31.35 % and 26.36 %, respectively, for Cu metal after chemical treatment. The maximum removal efficiency of azo dyes AY-17, AY-36, DY-4, DR-28, EBT, AB-1 was 62 %, 78 %, 80 %, 92 %, 89 %, 69 % and basic dyes MV-10B, BG-4, BB-9 was 90 %, 80 %, 80 % and reactive dyes RO-4, RO-16 and RB-5 was 90 %, 84 %, 62 % after biological treatment on dilutions. The maximum removal efficiency of Zn was 69.4 %, 53.5 %, and 61.7 % with Eichhornia crassipes, Pistia stratiotes, Pistia stratiotes + Eichhornia crassipes respectively. Overall, the biological treatment showed the best results for the removal of dyes and heavy metals so for this reason, this technique could be integrated into the industrial management plan for treating wastewater.

Sleep-disordered breathing diagnosis: a comprehensive audit of home sleep testing in real clinical settings.

This study aimed to investigate the indications and outcomes of Home Sleep Testing (HST) for patients with suspected obstructive sleep apnea (OSA), aligning with guidelines set forth by the American Academy of Sleep Medicine and the European Sleep Research Society. Specifically, we aimed to audit whether validated type 3 polygraphy could effectively ensure patient care while optimizing resource utilization. A retrospective analysis was conducted on data from patients undergoing type 3 polygraphy for suspected OSA in a tertiary referral hospital between January 2022 and December 2022. Demographic, clinical, and management data were collected. The efficacy of HST in guiding management plans was evaluated, with outcomes categorized as effective or ineffective based on subsequent need for in-laboratory polysomnography. While 85% of patients received a reliable diagnosis, 44.4% of them still required subsequent polysomnography, primarily due to adherence to funding regulations, rather than clinical need for further testing. Factors impacting the efficacy of HST included patient age, severity of apnea, and referral by a certified sleep specialist physician. Our study highlighted the potential of type 3 polygraphy, as a valuable tool for diagnosing OSA in an outpatient setting. However, having the result interpreted by a certified sleep specialist doctor was not enough. To streamline the care pathway, the referral for polygraphy had also to be made by a trained specialist. Challenges related to funding regulations, patient demographics and physician training stress the need for optimized diagnostic pathways to improve patient care and resource utilization.

Unlocking sustainability in China's small-scale fisheries: A case study of livelihood analysis in the Bohai Region

Small-scale fisheries (SSF) are a vital component of the global fisheries sector, significantly contributing to food security, livelihoods, and cultural heritage. In China, the SSF sub-sector is substantial, yet it is often overshadowed by large-scale fisheries (LSF), resulting in limited understanding and targeted management measures for SSF. This study uses the Sustainable Livelihoods Framework (SLF) to compare the livelihoods of SSF and LSF in China's Bohai Region, aiming to identify the sustainability challenges faced by SSF and explore potential improvement pathways. The results indicate that the overall livelihood assets of SSF are significantly lower than those of LSF. The failure to differentiate between these two sub-sectors in fisheries management may exacerbate this disparity, further marginalizing SSF. We recommend that China undertake immediate fisheries reforms and outreach efforts aimed at promoting the sustainability of SSF communities. Key strategies include strengthening property rights governance, establishing inclusive decision-making processes for SSF fishers, providing preferential policies and financial support for the most vulnerable SSF actors, and incorporating considerations of SSF's role within the broader socio-ecological system and its interactions with other components into management. Additionally, we suggest the development of a separate management plan for SSF to address their unique needs. This study enhances the understanding of China's SSFs, supports the implementation of SSF Guidelines in China, and offers insights into global SSF management.

Pain Self-Management in Individuals With Chronic Musculoskeletal Pain During Lebanon's Overlapping Crises

ObjectivesWith Lebanon facing multiple crises simultaneously, it is important to understand how Lebanese adults with chronic musculoskeletal pain (CMP) are self-managing their pain amidst challenging circumstances. This study aimed to describe the pain self-management strategies Lebanese adults with CMP are using, as measured by the Arthritis Pain Self-Management Inventory (APSI), and to determine how helpful they perceive these strategies to be for pain relief. A secondary aim was to translate, culturally adapt, and validate the APSI in Lebanese adults with CMP. MethodsA descriptive design was used and a convenience sample of 154 Lebanese adults with CMP completed the Arabic version of the APSI and self-report measures of pain intensity and sociodemographic and clinical characteristics. ResultsThe APSI demonstrated acceptable content and cultural validity in Lebanese adults with CMP. Self-directed arthritis education was the strategy used by the largest number of participants, although it was perceived as the second least helpful for pain relief. The second and third most common strategies used were rest/relaxation, warm baths, and maintaining a healthy weight. The most helpful strategy was maintaining a healthy weight, followed by watching religious television, music therapy, and the use of braces or splints. ConclusionsLebanese adults with CMP should actively participate in their pain management plan and be educated on the various strategies they could use to effectively self-manage their pain.

Applying cultural perspective in Indonesia municipal solid waste management process towards a grounded climate concept and action: A mini-review of opportunities and challenges.

This mini-review emphasises the role of municipal solid waste (MSW) as the biggest contributor to climate change, as well as the need for more grounded climate action. The UN Framework Convention on Climate Change (UNFCCC) 2023 Synthesis Report by the co-facilitators on the technical dialogue Key Finding 3 of applying the 'whole-of-society' approach in this article is interpreted as a cultural approach in MSW management planning and implementation process. Using anthropological critiques of development, the cultural approach is frequently considered an obstacle or a justification for a project's failure rather than an important aspect of the people being developed. Therefore, the goal of this mini-review is to showcase the findings and explore the practical application of UNFCCC Key Finding 3, emphasising its importance in every phase of the solid waste management process for climate action. This mini-review argues that applying a cultural perspective presents both opportunities and challenges. More importantly, without careful acknowledgement and consideration, opportunities can become challenges, if not vice versa. The discussion section explores the ways in which religious and economic conditions might offer a contextual understanding and effective techniques for managing MSW at the local level. To apply Key Finding 3 in practice, academia needs to move away from generality and embrace multiple 'modernities', while practitioners also need to include cultural perspectives to complement scientific knowledge.

SHORT INTRODUCTION ON PRESENT DESIGN AND TRENDS REGARDING

This paper covers some aspects regarding present technology used in large crude oil carriers design and operation, as well as requirements regarding energy management on board. Obviously, due to complexity of such subject, there cannot be an exhaustive presentation. It is intended as a mere starting point for further discussion and research regarding possibilities to improve vessel’s general energy efficiency, including ways of using non-conventional and renewable energy, with due regard to specific trading routes involving large oil tankers. Some practical figures achieved typically on a Very Large Crude Oil Carriers engaged in international voyages are presented. A brief explanation on Energy Efficiency Index (EEI) and Carbon Conversion Factors (CF), as accepted by IMO, is also included. Work may be continued with further theoretical research in energy efficiency improvement on board such vessels. The article is structured in five parts: Introduction, Main Particulars of Large Tankers, Oil Tankers Outfitting, Energy Management Plan and Conclusion.

Interaction behavior between hydraulic fractures and interface in coal-rock complex rock layer: Experimental study and application exploration

To achieve long-term and efficient gas extraction in soft, low-permeability coal seams, this study conducted hydraulic fracturing experiments on coal-rock complexes under true triaxial conditions. The pattern of hydraulic fractures (HFs) was reconstructed based on the fractal dimension concept. The results indicate that the tendency of the complex rock layers to initiate fractures toward the coal weakens the trend of increasing fracture initiation pressure with rising geostress. When HFs interact with the interface, the extension pressure significantly decreases. With the lateral pressure coefficient decreasing, HFs tend to extend toward the coal and be captured by the interface, transitioning from a single-wing to a double-wing shape and approaching a symmetrical conjugate state. Only when the vertical principal stress is sufficiently large can HFs separate from the interface. Based on the derived distribution function of induced stress in the coal-rock matrix around the HFs, the displacement conditions of the coal, rock, and interface were examined. The interaction process of rock layer HFs and the interface was divided into three stages: deflection, capture, and separation. The applicability of this study to high-gas soft coal seams was discussed, and a gas management plan involving roof fracturing and full-period extraction was proposed, with the aim of providing a theoretical foundation for the co-extraction and efficient utilization of coal and gas in mines.

Comparative Study of Waste Management and Sampling Practices in Latvia and Estonia

Abstract The study focuses on waste management and sampling practices carried out in two large Baltic cities: Riga (Latvia) and Tartu (Estonia). Even though waste collection schemes are not at the same centralisation level in the two municipalities, certain similarities can be observed in waste collection, management and sampling processes. Governed by provisions of Council Directive 1999/31/EC of 26 April 1999 on the landfill of waste, general national waste treatment legislation, and the national waste management plans, waste management practices in Latvia and Estonia are moving towards minimalisation of waste landfilling and maximalisation of waste inclusion into various recycling practices (use in waste biodegradation cells, bioreactors, different waste recycling facilities, in developing modern waste management supporting infrastructure, etc.). Therefore, waste management in two countries can be partly characterised as a vital element of emerging circular economy activities aimed at minimising landfill deposition of waste, hence, a more effective and permanent approach to sustainable waste management problems, on the one hand, and maximising the diversified use of waste in different branches of economy, hence, larger economic and social benefits.

Megabenthic Diversity Patterns on a Seamount in the Philippine Sea: Implications for Conservation Planning on the Kyushu-Palau Ridge.

The oligotrophic tropical western Pacific region is characterized by a high density of seamounts, with the Kyushu-Palau Ridge (KPR) being the longest seamount chain here. Effective spatial management plans for seamount ecosystems necessitate an understanding of distribution patterns and key environmental factors influencing benthic communities. However, knowledge regarding deep-sea biodiversity patterns over intricate topography remains limited. In this study, we investigated a seamount with a water depth of 522 m at the summit located in the southern section of KPR. Survey transects were conducted from 522 m to 4059 m. By analyzing video-recorded data obtained by a human-occupied vehicle (HOV) during dives and environmental variables derived from bathymetry, distinct assemblages were identified through noise clustering. α- and β-diversity patterns within the seamount megabenthic community were analyzed across the depth gradient, along with investigation of their environmental drivers. A total of 10,596 megafauna individuals were documented, categorized into 88 morphospecies and statistically separated into six distinct community clusters using noise clustering analysis. Species abundance and richness were highest within the 700-800 m water depth range, declining notably beyond 2100 m, indicating a critical threshold for habitat classification in this region. The β-diversity of megabenthic communities was high (0.836). Although β-diversity patterns along the depth gradient were mostly dominated by differences in species richness, the contribution of species replacement increased with depth, becoming dominant at depths greater than 3000 m. Depth emerged as the primary driver of spatial variation in community structure, while near-bottom current velocity, topographic parameters (bathymetric position index, slope), and substrate type also influenced the formation of microhabitats. The study highlights the depth gradients, thresholds, and other intricate environmental factors shaping the spatial heterogeneity of these communities. It provides valuable insights for the future development of effective survey and conservation strategies for benthic biodiversity on the KPR.

Factors associated with Ontario dairy producers' management and care of down dairy cattle.

The objective of this study was to better understand current management practices for down cows in Ontario, Canada, and to identify factors associated with the adoption of acceptable practices. An online survey was distributed to all dairy producers in Ontario, Canada (n = 3,367) and was available from November 2020 to March 2021, inclusive. Dairy producers were identified through their provincial dairy organization and contacted via email, and the survey was also promoted via social media. The survey was comprised of 134 questions, 31 of which were related to down cow management. Descriptive statistics were evaluated, and 2 logistic regression models were generated using Stata 17, exploring factors associated with 1) relocating down cows with hip lifters and 2) assisting cows to stand within an hour after discovering a down cow. A total of 226 producers responded (7.4%). Participants were predominantly male (68%), farm owners (78%), and 30-39 years old (29%). Producers reported relocating down cows with a boat or sled (32.6%), front-end loader bucket (31.4%), hip lifters (28.0%), or 'other' (with a text box to further describe) (8.0%). The median time to relocating a down cow after identifying her was 1 h (range 0 - 17h). Farms that relocated a down cow sooner after identifying her as down, were more likely to use appropriate methods to move the cow. However, we also found that farms that provided feed and water sooner to down cows, were more likely to use an inappropriate method (hip lifters) to move her. Farms that used hip lifters to move cows had higher odds of assisting a cow to stand within an hour following the discovery of recumbency. Additionally, producers who waited longer to relocate a down cow were less likely to assist the cow to stand within one hour of finding them down. Research has identified effective management practices for down cows, yet there remains a gap in understanding the implementation and the decision-making process of producers. Data from this study will be helpful in designing future research that further explores the barriers and motivations of producers when implementing evidence-based management plans to care for down dairy cows and may help inform current industry extension efforts.

Decoding prognosis: Unraveling physicians' responses in electronic treatment plans.

230 Background: Communicating prognosis to cancer patients is a critical aspect of shared decision making in healthcare. Practices in The US Oncology Network (The Network) use an electronic version of a treatment plan based on the Institute of Medicine (IOM) care management plan for patients receiving cancer treatment. Physicians document in their own words the prognosis section of the treatment plan. This study seeks to better understand the responses provided by physicians in the prognosis section. Methods: We evaluated word frequency analysis using FreqDist library, conducted sentiment analyses using the Natural Language Toolkit (NLTK) Sentiment Intensity Analyzer, and performed thematic analyses using Latent Dirichlet Allocation library on a random sample of 35,000 treatment plans developed in 2023 for practices in The Network. Results: 32% of the responses were 5 words or less, with 3.8% single word responses. Words like “excellent, good, fair, poor, guarded” or a combination thereof were commonly used to describe the prognosis. 26% of responses were ≥12 words in length, and generally were personalized to the patient’s disease, treatment, and/or contained situation specific narratives. Responses <12 words generally contained templated phrases, or minimally customized responses. 38% of the responses contained a numerical value, representing either a percentage probability of survival, chance of response to treatment, or a quantification of time (months, years). Thematic analyses conducted on responses ≥12 words revealed that the predominant theme focused on survival represented in different ways, followed by response to therapy, probability of recurrence or relapse, and disease control. Sentiment analyses revealed that 60.6% of responses denoted a negative sentiment. 71.7% of responses ≤5 words in length had a negative sentiment, compared to 58.3% of responses ≥12 words in length. Conclusions: This study reveals that prognosis responses from physicians used on treatment plans shared with patients are very diverse. The manner in which prognosis is presented to patients can greatly influence their understanding, engagement, and involvement in making treatment decisions. To optimize shared decision making in cancer care, healthcare providers must strive to effectively communicate prognosis by using clear and empathetic language, ensuring patient comprehension, and tailoring the information to individual patient needs and preferences. The data set has high potential for further study to better understand the role and impact of written treatment plans to help physicians refine this documentation for better patient understanding.

DEVELOPMENT STRATEGIES FOR BACKPACKER TOURISM DEVELOPMENT IN KOTA KINABALU, SABAH, MALAYSIA

This study investigates the development strategies aimed at enhancing backpacker tourism in Kota Kinabalu, Sabah, with a focus on social, environmental, and economic dimensions. This study uses quantitative methods through the distribution of questionnaires to study the behaviour and opinions of backpackers in Kota Kinabalu. This study focuses on respondents at backpacker accommodation and tourist destinations in Kota Kinabalu. A total of 228 backpackers participated in this study. These strategies encompass social development, environmental development, and economic development, and encompass initiatives such as community engagement, environmental conservation, and collaboration with local businesses. Achieving a balance between economic growth and social and environmental sustainability is crucial in maximizing the potential of backpacker tourism. Successful implementation of these strategies necessitates the active involvement of various stakeholders, including government agencies, local communities, and the tourism industry. Integrating these strategies into destination management plans will elevate the backpacker tourism experience and facilitate sustainable growth. Further research and collaboration among stakeholders are imperative to effectively implement these strategies and harness the opportunities presented by backpacker tourism in the region.

Surface-derived groundwater contamination in Gulu District, Uganda: Chemical and microbial tracers

Groundwater is consumed by over 2 billion people globally, though it can be impacted by microbial and chemical contamination in both rural and (peri-)urban areas. This issue is particularly pertinent in regions like East Africa, where rapid urbanisation has strained local infrastructure, including water and sanitation systems. We use selected tracers of human and animal waste to assess the quality of community drinking sources with regards to surface-derived groundwater inputs and to compare urban versus rural water quality, under the rapidly developing urban area of Gulu, Northern Uganda. Specifically, we examine bulk and fluorescent dissolved organic matter (DOM), microorganisms (total coliforms, E.coli) and inorganic tracers of anthropogenic waste (NO3−, SO42−, Cl/Br) from various sources: boreholes (12–76 m depth; n = 90), protected springs (n = 11) and municipal taps (n = 4). Our results show that NO3− and SO42− were elevated in groundwater sources in the Gulu city urban area and the Cl/Br ratio was elevated in springs, compared to concentrations in the more rural Aswa and Omoro County area (p < 0.05). Interestingly, human and animal waste indicators E.coli and Tryp:FA (the ratio of tryptophan-like to fulvic-like fluorescence) displayed no significant difference between rural and urban settings (p > 0.05), though total coliforms were significantly higher in rural boreholes (p < 0.05). The presence of a pollution source, pollution carrier and a breakdown of a sanitary barrier at the borehole, as spot-checked by a visual sanitary risk assessment, was significantly associated with groundwater E.coli abundances. Evidence suggests monitoring and mitigation should be improved for all water types in Gulu District to meet WHO and Uganda Standard guidelines for potable water. This study offers valuable insights for water management planning and risk assessment of community water sources particularly in the context of East Africa and similar settings.

Therapeutic implications of etiology-specific diagnosis of early-onset developmental and epileptic encephalopathies (EO-DEEs): A nationwide Turkish cohort study

ObjectiveTo evaluate the etiology-specific diagnosis of early-onset developmental epileptic encephalopathies (EO-DEEs) in a nationwide Turkish cohort to determine the implications for therapeutic management. MethodsThe cohort comprised 1450 patients who underwent EO-DEE. The utility of genetic testing was assessed with respect to the initial phases of next generation sequencing (NGS) (2005–2013) and the current NGS era (2014–2022). A predefined four-stepwise diagnostic model was evaluated using cost-effectiveness analysis. The diagnostic and potential therapeutic yields of the genetic tests were subsequently determined. ResultsGene-related EO-DEEs were identified in 48.3% (n=701) of the cohort: non-structural genetic (62.6%), metabolic genetic (15.1%), and structural genetic (14.1%). The most common nonstructural genetic variants were SCN1A (n=132, 18.8%), CDKL5 (n=30, 4.2%), STXBP1 (n=21, 2.9%), KCNQ2 (n=21, 2.9%), and PCDH19 (n=17, 2.4%). The rate of ultra-rare variants (< 0.5%) was higher in the NGS era (52%) than that in the initial phase (36%). The potential therapeutic yields with precision therapy and antiseizure drug modification were defined in 34.5% and 56.2% in genetic-EO-DEEs, respectively. The diagnostic model provided an etiology-specific diagnosis at a rate of 78.7%: structural (nongenetic) (31.4%), genetic (38.5%), metabolic (6.1%), and immune-infectious (2.8%). Based on a cost-effectiveness analysis, the presented diagnostic model indicated the early implementation of whole-exome sequencing for EO-DEEs. SignificanceIn the present cohort, the higher rate (48.3%) of gene-related EO-DEE diagnoses in the NGS era provides a potential therapeutic management plan for more patients.

Evaluation of treatment-related problems in hemodialysis patients in Egypt: a prospective observational study

BackgroundHemodialysis (HD) patients often have multiple comorbidities, leading to care from various prescribers and a complex medication regimen. Patients on HD are particularly vulnerable to treatment-related problems (TRPs). This study aimed to evaluate the impact of the lack of clinical pharmacy services on HD care by assessing the types and frequencies of TRPs encountered in HD units.Patients and methodsThis was a prospective observational study. Data were collected from medical records and medication reconciliation of HD patients attending to a large Hospital specialized in Nephrology and Urology at the Minia region in Egypt. The frequencies and percentages of demographic data were calculated. Standard multiple regression analysis was conducted to assess predictors of TRPs.ResultsA total of 103 patients were included. The mean age was 47.6 ± 15.1 years; patients had been on HD for 5.95 ± 5.04 years, had 2.47 ± 0.57 comorbidities and took 7.02 ± 1.35 different medications. Within the included patients, 121 TRPs were identified. The most common TRPs were the need for more frequent monitoring, followed by inappropriate dose/dosing frequency and the need for additional therapy (33.9%, 26.2%, and 15.5%, respectively). We did not identify any predictors of TRP in this study.ConclusionIn the Minia HD population of Egypt, TRPs affected 75% of the patients. Therefore, involving clinical pharmacy services to tailor the optimal management plan for each patient is crucial to reduce the frequency of TRPs in this vulnerable patient population.

Sediment evaluation indices point to cadmium and selenium contamination: A simultaneous analysis of potentially toxic elements in the water and sediment along the upper and middle Awash River, Ethiopia

This study presents a simultaneous analysis of potentially toxic elements (PTEs) in the water and sediment of the upper and middle Awash River for the first time. We used standard field and laboratory procedures, sediment assessment indices and guidelines, and multivariate statistical methods to analyze PTEs and assess their possible sources. Water and sediment samples were collected from nine sampling sites, and PTEs were analyzed using the Inductively Coupled Plasma Optical Emission Spectrometer. The PTEs concentrations arranged in descending order in water were Fe>Mn>B>Zn>Cr>Ni>Pb>Cu, ranging between 4.14 ± 2.093 mg L 1 and 0.074 ± 0.016 mg L 1. The level of PTEs in the sediment varied between 24,493.6 ± 16,640.3 mg kg-1 and 0.4 ± 0.2 mg kg-1 and follows the order: Fe>Mn>Cr>Zn>Pb>Ni>B>Se>Co>Cu>Cd>Hg>As. The river-mouth of the upper Awash had the highest concentrations of Mn, Ni, Cr, and Cu in water and Fe, Mn, Cr, Ni, Pb, Co, Se, Cu, Cd, and AS in the sediment. Contamination factor, enrichment factor, and geo-accumulation index showed a very high level of contamination of Se and Cd. The ecological risk index, Nemerow pollution index, and pollution load index also indicated a high ecological risk and pollution by PTEs in the river. The levels of Fe, Pb, Ni, Mn, B, and Cr in the water surpassed Ethiopian/WHO's drinking water guidelines, while the levels of Cd, Hg, and Cr in the sediment exceeded Canadian/Ontario's probable/severe effect levels. This study revealed the presence of ecological degradation at the downstream sites of the upper and middle Awash. The most likely sources of contaminants were identified as small-scale agricultural pollution, residential and commercial waste from towns like Addis Ababa, Merti, and Metehara, and the inflow of Lake Beseka. We recommend an integrated management plan for the Awash River to ensure sustainable use of the water, guarantee the well-being of wildlife, and reduce public health risks.

The challenge of harvesting common sole (Solea solea) in highly selective trawl fisheries

Common sole (Solea solea) is an economically important species in several European trawl fisheries, yet little is known about the size selective properties of codends used in bottom trawl fisheries targeting sole. This study presents results from a sea trial conducted in the inner Danish waters where common sole is fished in a seasonal trawl fishery using a 90 mm diamond mesh codend with a mandatory large mesh escape panel. To improve understanding of the selectivity in this gear, we in addition tested a plain 90 mm diamond mesh codend without an escape panel. This combination of codend mesh size and large mesh escape panel is part of an ambitious management plan aimed at eliminating bycatch of cod (Gadus morhua) in trawl fisheries in the inner Danish waters. In the fishery for common sole, we found a severe mismatch between gear regulations and minimum conservation reference size of the target species. The outcome is a highly inefficient fishery in which only 22 % (CI: 18–27 %) by weight of the marketable sole is retained in the 90 mm diamond mesh codend. Further, we estimated that 25 % (CI: 16–35 %) of the sole entering the codend would contact the mandatory escape panel and escape, resulting in a total loss of 83 % (CI: 79–87 %) of marketable sole through the mandatory gear. The inefficiency in this fishery demonstrates the need for other means than gear specifications to regulate this type of fishery.