Management Mode Research Articles

China’s marine eco-environment law enforcement from the perspective of the responsibility system: Dilemmas and solutions

As the final link in promoting the construction of marine ecological civilization, the marine eco-environment law enforcement is crucial to realize the Chinese-style modernization which concerns the harmonious coexistence of humans and nature. This study examined the current state of the responsibility system of China’s marine eco-environment law enforcement through legal doctrinal analysis. Three deficiencies that are hindering the improvement of the effectiveness and efficiency of China’s marine eco-environment law enforcement were identified. Firstly, at central level, the allocation of law enforcement powers fails to reflect the principle of integrated land-sea management. There is also insufficient coordination between marine environmental law enforcement and marine resources law enforcement. Secondly, at local level, there is a lack of cross-departmental and cross-regional law enforcement collaboration mechanisms. Thirdly, regarding central-local relations, the allocation of law enforcement powers and resources is unreasonable, and there are conflicts in the management modes of law enforcement agencies. To enhance the effectiveness and efficiency of China’s marine eco-environment law enforcement, it is necessary to: (i) coordinate central law enforcement powers among different maritime-related administrations based on the principle of integrated land-sea management, and the principle of environment-resources integration; (ii) establish cross-departmental and cross-regional law enforcement collaboration mechanisms; (iii) and appropriately allocate marine eco-environment law enforcement powers between the central and local maritime-related administrations.

Research on the Strategy of Film and Television Operation Management Mode

At this stage, with the rapid development of the film industry, more and more film and television works have emerged, mainly films, TV series, and online dramas. The film industry is an important part of the cultural industry of various countries. Analysing the operation mechanism of the film production management model will help the prosperity and development of the film industry. The research is mainly about the operation and management mode of the film and television industry. It uses the methods of searching for literature, searching on the Internet, and finally summarises the steps and strategies of film and television operation. The operation steps of film and television mainly include four links: shooting, production, distribution, and screening. Each link is quite important and needs to be carefully arranged and operated, with a strong team and psychological quality to deal with various emergencies. It must invest much money and energy in every step to complete perfect work and create profits in the final release. The operation of film and television is still advancing and will continue to develop new models and update strategies to meet the development of the times.

Internet Technology for Efficiency and Resilience in Ocean Transportation Supply Chain Management: A Case Study of China Ocean Shipping Group

With the global maritime transport industry has faced many challenges in recent years, such as market volatility, environmental requirements and technological upgrading. The wide application of Internet technology has changed the management mode of the marine shipping industry and brought new opportunities for its development. Taking China Ocean Shipping Group as a case study, this study aims to explore the use of Internet technology to solve the problems faced by the ocean shipping supply chain and to discuss the importance of Internet technology in the ocean shipping supply chain, its areas of application, and the changes it may bring. Currently, the main problems faced by the marine transport supply chain include human resource costs, logistics information technology level, port and route selection, and shipping market uncertainty, which seriously affect the efficiency and flexibility of marine transport and operating costs. This study discusses Internet technologies to solve practical problems and specific supply chain management measures, including supply chain efficiency, flexibility and operating costs.

Ansurethral Removal of Vesical Fungal Bezoar Using Ho:YAG LASER—A Case Report

Fungal bezoars are extremely rare in the urinary bladder, and there is limited literature regarding the modality of management. We report a case, where the piecemeal removal of a vesical fungal bezoar was performed using Ho:YAG LASER. A 60-year-old man presented with lower urinary tract symptoms and on evaluation was diagnosed with vesical calculus. On cystoscopy, a white-colored, smooth contoured ball was identified in the bladder. The effective endourological modalities for the removal of fungal bezoar require mention in the literature. This case report demonstrates the possibility and efficiency of Ho:YAG LASER in the endourological retrieval of fungal bezoar in the bladder. The rarity of the diagnosis results in difficulty in prompt management.

Postoperative Opioid Administration and Prescription Practices Following Hysterectomy in Two Tertiary Care Centres: A Comparative Cohort Study between Canada and Austria.

Background: In light of the opioid epidemic, opioid-prescribing modalities for postoperative pain management have been discussed controversially and show a wide variation across geographic regions. The aim of this study was to compare postoperative pain treatment regimes. Methods: We performed a matched cohort study of women undergoing hysterectomy in Austria (n = 200) and Canada (n = 200). We aimed to compare perioperative opioid medications, converted to morphine equivalent dose (MED) and doses of non-opioid analgesic (NOA) within the first 24 h after hysterectomy, and opioid prescriptions at discharge between the two cohorts. Results: The total MED received intraoperatively, in the post-anaesthesia care unit (PACU) and during the first 24 h after surgery, was similar in both cohorts (145.59 vs. 137.87; p = 0.17). Women in the Austrian cohort received a higher MED intraoperatively compared to the Canadian cohort (117.24 vs. 79.62; p < 0.001) but a lower MED in the PACU (25.96 vs. 30.42; p = 0.04). The primary outcome, MED within 24 h in the postoperative ward, was markedly lower in the Austrian compared to the Canadian cohort (2.36 vs. 27.98; p < 0.001). In a regression analysis, only the variables "Country" and "mode of hysterectomy" affected this outcome. A total of 98.5% in the Canadian cohort were given an opioid prescription at discharge vs. 0% in the Austrian cohort. Conclusions: Our analysis reveals marked differences between Austria and Canada regarding pain management practices following elective hysterectomy; the significantly higher intraoperative and significantly lower postoperative MED administration in the Austrian cohort compared to the Canadian cohort seems to be significantly affected by each country's cultural attitudes towards pain management; this may have significant public health consequences and warrants further research.

Подзаконное регулирование предпринимательской деятельности в механизме обеспечения текущего равновесия экономической системы

The state economic policy is built on the basis of the set goals determined in accordance with the constitutional principles of the economic system. Maintaining a course towards achieving an equilibrium of the economic system, the state uses various tools. The system of constitutional principles of the economic system is reflected in the mechanism for ensuring its strategic equilibrium. However, attention should be paid to the functioning of the current equilibrium mechanism, which is an operational control tool. The article analyzes the possibilities of ensuring the equilibrium of the economic system by by-law regulation. It was concluded that in the ordinary mode of management, and especially in the event of extraordinary situations, it is by-law regulation that becomes the basis for maneuvering by the state in maintaining the equilibrium of the economic system.

A prospective study of total hip arthroplasty for failed proximal femur fracture fixation

Background: Proximal femur fractures have been widely studied and there are several well-accepted management modalities for the same such as PFN A2, IMIL nails, and DHS. Despite several management options we do encounter significant failure rates which could be due to several factors such as post-operative time rehabilitate patients related comorbidity and differences in surgical techniques. Aim of the study was to assess the outcomes of total hip arthroplasty (THA) after failed surgical management in proximal femur fractures Methods: The 50 patients who underwent surgical management for proximal femur fractures at any given point in time and presented with non-union or malunion and inability to bear weight affecting their activities of daily living assessed with Harris hip score were enrolled in a prospective cohort study during 2015 and 2022 after obtaining IRB approval. All these patients underwent surgical management for proximal femur fractures within 3 weeks of sustaining a fracture. Results: A strong statistically significant difference is seen with pain, functional gait, functional activity, range of movement and total score in post-operative group of patients in comparison to patients of pre-operative group. THA had excellent outcomes in 42 patients (85.71%) of the study group. About 6 (14.29%) patients of the study group had good outcome. 2 patients that lost to follow up were removed from the study. Conclusions: THA is an effective procedure for failed proximal femur fracture fixation patients despite the challenges such as distorted anatomy of femoral head, poor bone quality, longer operative times, larger amounts of blood loss, high rates of intra-operativities and post operative complications.

Simple-Challenging-Difficult (SCD) Difficulty Classification for Vertical Bone Augmentation.

To propose a new difficulty classification for vertical bone augmentation (VBA) based on different defect morphologies. VBA procedures for dental implant placement present significant biological and technical challenges. Among the various techniques, guided bone regeneration (GBR) provides an optimal balance between the anticipated bone gain and the likelihood of postoperative complications. Understanding the specific configuration of defects and adjacent bone peaks is essential for tailoring treatment strategies and improving outcomes. The proposed Simple-Challenging-Difficult (SCD) difficulty classification was based on defect morphology (V-shaped, U-shaped, VV-shaped), including defect size (Height: < 5 mm, 5-8 mm, and > 8 mm), proximity of neighboring bony walls (Width: < 10 mm, 10-20 mm, and > 20 mm), as well as predictability of treatment outcomes. The proposed difficulty classification for VBA serves as a guide for selecting the most appropriate GBR treatment modality and sequence for safe and predictable management of VBA in implant therapy. In addition, when determining the preferred treatment, it is again essential to consider site-specific and patient-related factors alongside the clinician's surgical experience and skill. Identifying defect patterns and bone peak structures is crucial, and the proposed classification assists in decision-making in VBA treatment.

Acute Achilles Tendon Ruptures: An Update on Current Management Strategies

Acute rupture of the Achilles tendon is a frequently encountered injury that occurs most commonly in people who participate in recreational athletics into their thirties and forties. For many years, the injury has been treated either nonsurgically or surgically using a standard open approach. More recently, a variety of new surgical techniques have emerged in the literature aiming to improve surgical outcomes while decreasing the potential complications associated with standard open repair. Nonsurgical treatment plans using early weight bearing and accelerated functional rehabilitation have also proven to be excellent management options. Achilles rupture treatment plans can include the use of orthobiologics, such as platelet-rich plasma, with mixed results. Accelerated functional rehabilitation protocols have shown to improve patient outcomes, whether used in conjunction with surgery or nonsurgical management modalities, and reduce the disparity between the injured tendon and the native Achilles.

ChatGPT as a psychotherapist for anxiety disorders: An empirical study with anxiety patients.

Purpose: this study aims to investigate the role of ChatGPT as a psychotherapist for anxiety disorders, examining its effectiveness, acceptability, and potential benefits among individuals with anxiety disorders. Methods: a quasi-experimental design was adopted, involving a 4-week intervention where participants used ChatGPT as a therapeutic tool. The study included outpatients aged above 18 years from public hospitals in Saudi Arabia. A total of 399 participants completed a survey questionnaire that focused on their experiences with AI-based psychotherapy (six items), perceptions of ChatGPT (four items), and its role in different therapy modalities for anxiety management (seven items). Measures were taken to ensure the validity and reliability of responses by using Cronbach's alpha reliability testing (> 0.7), including the use of a translated and verified questionnaire. Results: majority received prior therapy (89.6%), reporting severe anxiety symptoms (36.1%). ChatGPT was widely used and perceived as accurate by 91.2% of users. Concerns included privacy (67.2%) and ethics (64.9%). Statistically significant differences (p < .05) in perceptions of ChatGPT for anxiety disorders were observed. While urban residents generally rated ChatGPT more positively, females consistently reported higher levels of trustworthiness, effectiveness, and coherence in guidance compared to males. Conclusion: ChatGPT has the potential to complement traditional psychotherapeutic approaches and enhance access to quality mental health care.

5141 Metastatic Adrenocortical Carcinoma

Abstract Disclosure: N. Anwaar: None. Adrenocortical carcinomas are rare and frequently aggressive tumors that may be functional (hormone secreting) and cause Cushing's syndrome and/or virilization or nonfunctional and present as an abdominal mass or as an incidental finding. We report a case of a 72-year-old lady who was presented to the ER with chest pain and elevated blood pressure. CTA was performed to evaluate for aortic dissection, which incidentally found a 5.0 x 3.7 cm right-sided adrenal mass. 1 mg overnight dexamethasone suppression study showed non-suppression of cortisol. The ACTH was suppressed, consistent with the autonomous production of cortisol from the adrenal gland. CT abdomen with adrenal protocol showed an indeterminate suspicious 5.1 x 3.9 cm right-sided adrenal mass. She underwent an adrenalectomy and the final pathology showed adrenocortical carcinoma. Postoperatively she was treated with adjuvant radiotherapy and chemotherapy. A few years later, she developed metastatic lesions and overt Cushing syndrome. She was started on pembrolizumab, which was later discontinued due to poor response and then placed on mitotane. The metastatic disease progressed, and the patient was transitioned to hospice care. Due to tumor’s rarity, the understanding and experience of management modalities are limited. New treatment options may be available in the coming years. Presentation: 6/1/2024

Pathogenesis and Management Modalities of Typhoid Perforation: A Review of Literature

Pathogenesis and Management Modalities of Typhoid Perforation: A Review of Literature

Is pancreatic adenosquamous carcinoma (PASC) a surgical disease? A large healthcare system review

IntroductionPancreatic cancer represents an increasing cause of cancer-related deaths. Pancreatic adenosquamous carcinoma (PASC) is a rare subtype of pancreas cancer. Optimal treatment is not well-defined. This review aims to provide a detailed analysis of the natural history, management, and outcomes of the patients with PASC within a single large healthcare system. Materials and methodsA large healthcare database was used to retrospectively identify all patients with histological diagnosis of PASC from 2010 to 2020. The cohort was evaluated as a whole and according to the following management modalities: operative, non-metastatic non-operative, and patients with metastatic disease. Abstracted data included patient characteristics, oncologic characteristics at presentation, and details of surgical and non-surgical treatment. ResultsIn total, 60 patients with PASC were identified. All patients had confirmed histopathological diagnosis of PASC. Mean age at the time of diagnosis was 70.9 years, and 28 patients were male (46.7 %). Most patients presented with pancreas head tumors (60 %). Thirty-four patients presented with non-metastatic disease (56.6 %). The operative group consisted of 17 patients (28.3 %). Most patients received adjuvant systemic therapy (70.6 %). Majority of patients experienced recurrence (76.5 %), with median time to recurrence at 6.5 months. Median overall survival in the operative group was 19.1 months. Seventeen patients with non-metastatic disease (28.3 %) did not undergo resection. Median overall survival of this cohort was 3.3 months. Systemic chemotherapy was used in 8 patients. Approximately half of patients with non-metastatic disease (9/17) did not receive any treatment due to rapid physical deterioration or poor functional status at baseline. Median survival for the non-treatment group was 1.7 months. At presentation, 26 patients (43.3 %) had metastatic disease. Most common site of metastasis was the liver. Median survival for patients with metastatic disease was 3.1 months. DiscussionPASC is a distinct entity from glandular PDAC, and it appears to be a more aggressive disease process. Complete resection confers survival benefit but is not curative. Furthermore, few patients undergo surgery, even with seemingly resectable disease. Systemic therapy administration is limited in many patients due to physiologic decline. Dismal clinical course and poor survival is universal among all patients who do not undergo any treatment modality, regardless of metastatic status. Globally grim prognosis appears to be due early systemic effects, disease progression and lack of effective systemic therapy. ConclusionsPASC remains a poorly understood cancer and portends particularly poor prognosis. It is associated with a rapid clinical decline, poor response to systemic therapy, early recurrence, and poor overall survival. However, ability to treat with surgery and chemotherapy may best prolong survival. SynopsisPancreatic adenosquamous carcinoma (PASC) is a rare subtype of pancreatic cancer. In this study, we evaluated 60 patients with PASC. PASC is a systemic disease characterized by rapid clinical decline, poor response to systemic therapy, early recurrence, and poor survival. Despite resection or systemic therapy, patients succumb rapidly.

Risk Management in Production using Quality Risk Approach and FMEA

Abstract: The production process of 600ml AQUA at PT Tirta Investama (AQUA) Pandaan faces significant risks, including non-compliance with standards in bottle density, incorrect packaging labels, unreadable bottle codes, box failures, and barcode rework. These issues pose challenges in maintaining product quality and operational efficiency. Specific Background: With 247 bottles failing density standards and 18 packaging errors occurring daily, effective risk management is crucial. Knowledge Gap: Previous studies have not integrated Quality Risk Management (QRM) and Failure Mode Effect and Criticality Analysis (FMECA) to address production risks in the context of AQUA's operations. Aims: This study aims to identify the highest critical risk points and propose mitigation strategies. Results: Utilizing QRM and FMECA, 42 risks were identified, categorized into 20 acceptable, 21 tolerable, and 1 unacceptable risk, specifically related to pallets stuck on conveyors due to substandard quality. Novelty: The application of these integrated methodologies provides a systematic approach to identifying and mitigating risks in the production process, highlighting the necessity for in-depth inspections by logistics and machine operators. Implications: The findings underscore the importance of rigorous quality control and proactive risk management in manufacturing to enhance product quality and minimize operational disruptions, thus ensuring customer satisfaction and competitiveness in the market. Highlights: Effective risk management is crucial to ensure product quality and operational efficiency. Integration of QRM and FMECA identifies critical risk points in the production process. Regular inspections and quality control can significantly reduce unacceptable risks. Keywords: Risk Management, Production Process, QRM, FMECA, AQUA

Photodynamic Therapy for Oral Squamous Cell Carcinoma: Current Status, Challenges, and Prospects.

Oral squamous cell carcinoma (OSCC) is the most prevalent and deadly malignancy of the head and neck. The standard treatments for OSCC are surgery, radiotherapy, and chemoradiotherapy, which can cause severe cosmetic and functional damage to the oral cavity and impair the patients' quality of life. Photodynamic therapy (PDT) is a promising alternative that uses light-activated photosensitizers to induce selective phototoxicity and necrosis in the target tissues. PDT has several advantages over conventional treatments, such as minimal invasion, low side effects, high selectivity and preservation of the oral function and appearance. This review explores the principles, mechanisms, and current applications of PDT for OSCC. We address the challenges, such as the depth of light penetration and tissue hypoxia, and underscore the progressive innovations in photosensitizer enhancement, nanotechnological integration, and precision therapy. The exploration of biomarkers for refining patient selection and tailoring individualized treatment regimens is also undertaken. PDT holds promise as a secure and efficacious modality for OSCC management. Nonetheless, additional investigation is imperative to refine treatment protocols and validate sustained therapeutic success.

Digital traffic state analysis for urban regions considering complex multi-directional flow changes

In this research, a digital analytical model based on three-flow full-cycle state macroscopic fundamental diagram (MFD) with observable different perimeter control management and flow loading modes has been proposed on the basis of real network and peak hour traffic flow loading scenarios in Rostov-on-Don. It is known that the aim of digital management of urban intelligent traffic is to ultimately optimize the overall state of multi-area traffic operation in the city. The goal of this research was to provide a strong basis to establish digital management strategies for intelligent transport, determine the change trends of steady-state equilibrium of regional traffic flow and their effects on full-cycle states of traffic flow under various peripheral control management strategies and traffic loading patterns. Simulation results confirmed that with the evolution of traffic state, stricter peripheral control management always results in a wider attraction area ultimately giving rise to steady-state equilibrium of traffic flow.

Aloe vera as a new treatment modality for management of chemotherapy-induced oral mucositis in patients with acute leukemia: A review article

Aloe vera as a new treatment modality for management of chemotherapy-induced oral mucositis in patients with acute leukemia: A review article

Sharp-pointed Foreign Body Ingestion in a Child: A Unique Case Report and Literature Review

Abstract: Accidental foreign body ingestion is commonly encountered in clinical practice, especially among children.Concern arises especially when the ingested foreign body is a sharp object due to the risk of perforation, mucosal injury, and impaction in the gut. Of inadvertently ingested foreign bodies, 10%–20% require endoscopic removal and &lt;1% require open surgical intervention.Endoscopic management, though popular, still remains difficult due to the inaccessibility of certain points in the bowel. Here, we describe a 7-year-old male child who presented to us on March 31, 2024, with a history of accidental ingestion of an iron nail 2 days prior. Although colonoscopic retrieval was the first mode of management undertaken on the basis of impaction in the distal ileum, the same was not successful. Eventually, the child was placed on conservative management and the nail was passed per rectally spontaneously on defecation after 3 days of observation.

Improving NSAID Safety: The Role of Transdermal Ketoprofen in the Management of Musculoskeletal Pain and Inflammation

Pain and inflammation affect patients both acutely and chronically across all patient demographics. Often, the medications which are used to target musculoskeletal conditions are poorly tolerated due to various contraindications, drug interactions, and troublesome adverse events. The investigation and development of localized, externally applied NSAIDs is on the rise among researchers and pharmaceutical manufacturers, but research is still inefficient in determining the role in therapy of transdermal analgesics and anti-inflammatories. Compounding Pharmacies and FDA 503b Outsourcing Facilities aid in this critical endeavor through endogenous compounding and manufacturing (respectively) of transdermal analgesic formulations. This review summarizes the currently available data supporting the implementation of transdermal ketoprofen preparations in the management of musculoskeletal pain and inflammation. Externally applied NSAIDs are crucial in the development of pain management modalities which reduce the risk of numerous complications, including drug-drug interactions, conflicting comorbidities, and harmful systemic adverse events.

The Therapeutic Potential of Transdermal Gabapentin in the Symptomatic Management of Chronic Neuropathy

Standard pharmacotherapeutic options in the management of neuropathic pain are often poorly tolerated due to various contraindications, drug interactions, and troublesome adverse events. The investigation and pharmaceutical development of localized anti-neuropathic options is increasing among researchers and manufacturers, but results have not yet determined the role in therapy of transdermal/locally acting analgesics, anti-neuropathics, and anti-inflammatories. Compounding Pharmacies and FDA 503b Outsourcing Facilities aid in this critical endeavor through endogenous compounding and manufacturing (respectively) of transdermal analgesic formulations. This review summarizes the currently available clinical data supporting the implementation of transdermal gabapentin preparations in the management of chronic neuropathic symptoms. Transdermally applied analgesic, anti-inflammatory, and anti-neuropathic preparations are crucial in the development of pain management modalities which reduce the risk of numerous well-known complications, including drug-drug interactions, conflicting patient comorbidities, and CNS depressant effects. The adjunctive treatment of neuropathy with a transdermal analgesic/antispasmodic preparation remains under-investigated, and the role of these preparations in the management of chronic neuropathic pain remains unclear.