Preferred Management Research Articles

Gallstone Ileus as an Infrequent Cause of Bowel Obstruction: A Review of Small Cohort.

Introduction Gallstone ileus is an uncommon cause of small bowel obstruction; it is a rare complication of calculus chronic cholecystitis which leads to cholecystoenteric fistula and impaction of gallstone in the gastrointestinal tract leading to mechanical bowel obstruction. Our aim is to report the natural history and management of this rare condition in a teaching hospital. Materials and methods It is a retrospective study, where 10 years of data related to the management of intestinal obstruction secondary to gallstone ileus was collected. The cohort included 10 patients, whose demographic data, clinical findings, and management outcomes were evaluated. Results Majority of patients were female (90%, n=9) with a median of 83 years (range 61-96) although 90% of the population were above 70 years. Presenting complaints were mostly pain and vomiting. The onset of symptoms was between two and seven days.The site of obstruction was mostly the ileum (n=9) with the exception of one case in the sigmoid proximal to a benign stricture, and the size of the stone ranged from 2.5 to 4 cm. Moreover, most of the patients had a previous history of gallstone (n=7) with one post-cholecystectomy status. The laboratory investigations in 50% of patients had deranged liver function test (LFT) and acute kidney injury (AKI), and 60% had raised inflammatory markers, namely, white blood cells (WBC) and C-reactive protein (CRP). Intervention as enterolithotomy was the preferred approach (n=8 (two laparoscopic, six open surgery)), and two patients were managed conservatively. The mean postoperative length of stay was 10 days in the open approach and five days in the laparoscopic approach, respectively. Conclusions Elderly female patients are more prone to have gallstone ileus particularly with a past medical history of gallstones, and the preferred management option is enterolithotomy which could be open or laparoscopic depending on the expertise of the surgeon.

Preservation of neurologic function in the setting of penetrating-knife spinal cord injury with dural involvement and concurrent lung injury

Introduction Penetrating spinal cord injuries present unique clinical scenarios with high variability in presentation and management. These injuries are rare, accounting for 0.8% of annual penetrating spine injuries in the United States, with knives being the most common penetrating object. Retention of the knife blade further complicates management, with greater risk of infection and progressive neurologic injury. Given the rarity and variability of such injuries, preferred management for penetrating-knife spinal cord injuries (PKSCI), especially those with retained knife blades, remains contested. Furthermore, the management of PKSCI with concurrent lung injury is poorly described within the literature. Case Report Here we discuss a unique case of a neurologically intact adult male who suffered a large lower thoracic PKSCI with complete dural transection and lung involvement. The patient arrived with the blade in situ while maintaining full neurologic function. Emergent imaging revealed the blade trajectory passing through the T8 lamina exiting the spinal canal at the costovertebral junction with involvement of the lung parenchyma and associated pneumorrhachis and pneumothorax. The patient was brought to the operating room where the blade was removed under direct visualization, the dura was repaired, and pneumothorax was stabilized. Conclusion We describe in this case the choice of imaging, method of blade removal, cerebrospinal fluid leak management, dural repair, and concurrent lung injury management that afforded a favorable, ASIA class E outcome with complete preservation of neurologic function.

Predictive analytics support for complex chronic medical conditions: An experience-based co-design study of physician managers’ needs and preferences

PurposeThe literature suggests predictive technology applications in health care would benefit from physician and manager input during design and development. The aim was to explore the needs and preferences of physician managers regarding the role of predictive analytics in decision support for patients with the highly complex yet common combination of multiple chronic conditions of cardiovascular (Heart) and kidney (Nephrology) diseases and diabetes (HND). MethodsThis qualitative study employed an experience-based co-design model comprised of three data gathering phases: 1. Patient mapping through non-participant observations informed by process mining of electronic health records data, 2. Semi-structured experience-based interviews, and 3. A co-design workshop. Data collection was conducted with physician managers working at or collaborating with the HND center, Danderyd University Hospital (DSAB), in Stockholm, Sweden. HND center is an integrated practice unit offering comprehensive person-centered multidisciplinary care to stabilize disease progression, reduce visits, and develop treatment strategies that enables a transition to primary care. ResultsInterview and workshop data described a complex challenge due to the interaction of underlying pathophysiologies and the subsequent need for multiple care givers that hindered care continuity. The HND center partly met this challenge by coordinating care through multiple interprofessional and interdisciplinary shared decision-making interfaces. The large patient datasets were difficult to operationalize in daily practice due to data entry and retrieval issues. Predictive analytics was seen as a potentially effective approach to support decision-making, calculate risks, and improve resource utilization, especially in the context of complex chronic care, and the HND center a good place for pilot testing and development. Simplicity of visual interfaces, a better understanding of the algorithms by the health care professionals, and the need to address professional concerns, were identified as key factors to increase adoption and facilitate implementation. ConclusionsThe HND center serves as a comprehensive integrated practice unit that integrates different medical disciplinary perspectives in a person-centered care process to address the needs of patients with multiple complex comorbidities. Therefore, piloting predictive technologies at the same time with a high potential for improving care represents an extreme, demanding, and complex case. The study findings show that health care professionals’ involvement in the design of predictive technologies right from the outset can facilitate the implementation and adoption of such technologies, as well as enhance their predictive effectiveness and performance. Simplicity in the design of predictive technologies and better understanding of the concept and interpretation of the algorithms may result in implementation of predictive technologies in health care. Institutional efforts are needed to enhance collaboration among the health care professionals and IT professionals for effective development, implementation, and adoption of predictive analytics in health care.

Speaking with one voice? Individual preferences and managers’ personal communication style

AbstractWe examine whether and to what extent the personal communication of corporate information by individual managers is affected by their personal preferences for impression management. Using earnings conference calls as a setting in which to observe individual managers’ personal communication and controlling for firm‐specific and manager‐specific factors, we document that the communication style of managers who sell corporate stock shortly after the call is significantly more optimistic than that of the nonselling manager who participates in the same call. The effect is more pronounced in the less scripted and more flexible question and answer section and is more likely to emerge from Chief Financial Officer (CFO) than from Chief Executive Officer (CEO) communications. Taken together, our findings suggest that differences in individual communication styles are not only affected by personality and career backgrounds of individual managers but rather can also emerge from managers’ conscious or unconscious preferences for impression management.

A Layered Employee Recruitment Model and Strategy Considering Value Fitness

Based on the status and role of employees at different levels in the enterprise, a hierarchical employee recruitment model (3C model) and corresponding strategies based on the perspective of values are proposed. For enterprises, rather than striving to influence and change their employees' values, it is better to choose employees who align with the company's values during recruitment. Senior managers are the leaders and leaders of enterprises, and their value orientation in business management is closely related to the long-term development of the enterprise. When recruiting, emphasis should be placed on the compatibility of values, consciously forming heterogeneity in the management values of senior team members, and improving the effectiveness of team operation; Middle level managers are the backbone of the enterprise, playing an important role in connecting the past and the future. When recruiting, emphasis should be placed on consistency of values, and their value assessment standards can be determined based on the 3V model, with appropriate consideration given to the widely recognized life values of middle level managers; Grassroots employees are the specific executors of work, and recruitment should focus on the competence of values. Enterprise values can be integrated into the competency model of the position, and comprehensive consideration should be given to specific job characteristics. The hierarchical employee recruitment strategy based on the perspective of values provides a new perspective and method for the recruitment and selection of employees from a more detailed perspective.

Nonlinear Internal Control System in Business

The purpose of the written study is to study the relationship between the qualifications of the CFO and the nonlinear system of the firm’s internal control system. We used three indicators of the competence of the CFO: financial education, accounting, seniority, and education. Using the model of Kazakhstan companies registered on the stock exchange in 2023. In the methodology of the internal control system, in which stimuli cause a reverse response, the internal control system should be recognized as a nonlinear approach that can have a high impact if it has little impact. The results of this study show a negative relationship between the financial, accounting experience of a CFO and work experience under a nonlinear system of internal control, which indicates that firms with high-quality CFO are facing a nonlinear internal control system in business. A business management team with a large number of employees is associated with an effective internal control system. In addition, the political preferences of senior management directly and indirectly affect the quality of financial statements through the internal control system. Several reliability tests confirm our main results. The results show that a capable CFO can effectively implement a suitable subsystem. The results of the study of a nonlinear system of internal control in business, in terms of improving individual elements of internal control in companies, can be used by members of audit firms.

The evolution of non-financial report quality and visual content: information asymmetry and strategic signalling: a cross-cultural perspective

AbstractThe increasing stakeholders’ scrutiny requires firms to communicate their non-financial performance to signal their commitment to sustainability. Building on the intention-based view and signalling, legitimacy and institutional theories, this study investigates whether corporate efforts to reduce information asymmetry and enhance their legitimacy led to higher quality and more transparent non-financial reporting practices. This study analyses reports from German, UK and Chinese companies over 14 years. It carries out quantitative and qualitative analysis of textual and visual content to evaluate disclosure density and accuracy of non-financial reports. The findings show limited progress in terms of the density and accuracy of the information disclosed by businesses since 2005. Also, they reveal cultural specificities in the reporting and approach to corporate social responsibility, along with a tendency to “create an appearance of legitimacy” by organisations. This study adds to the literature by studying the use of visual elements in non-financial reports. Moreover, it calls for strict policies and guidelines for the reporting of environmental and social issues by organisations. In particular, the inappropriate use of visual contents, the failure to provide quantitative information and managerial orientations show the need for completeness, transparency, and balance of information in reporting guidelines and regulations. The lack of authenticity and quality of the reports jeopardises the very purpose of non-financial reporting eroding trust in the system by all relevant social and economic stakeholders.

Carbon emissions and abnormal cash holdings

AbstractWe find that companies that emit high levels of carbon tend to have lower abnormal cash holdings. We have run a battery of endogeneity tests to ensure the robustness of our findings. Our further analysis revealed that weaker internal governance, higher information asymmetry and CEO overconfidence contribute to the heterogeneity of the results. Additionally, we notice that polluting firms prefer to spend more on capital investments while allocating less toward dividends and R&D activities. Our results are consistent with agency theory, indicating that managerial preference for suboptimal investment and/or avoidance of external disciplining might contribute to lower abnormal cash holdings.

Architectural design space exploration of complex engineered systems with management constraints and preferences

During the architectural design phase, the decisions made have a crucial impact on developing complex systems. These decisions often limit the performance bounds and steer subsequent research directions. However, the multitude of architectural components and intricate interrelationships cause component combination explosion. Additionally, the diverse requirements of different stakeholders add complexity to determining the weight of indicators, posing challenges to complex system architecture generation and trade-off. This paper proposes a method for exploring the architectural design space in complex systems realisation, which aims to resolve issues related to the formal representation of architectures, selection within the architectural design space, and trade-offs. Firstly, the architectural design space is represented by formulating and mathematically describing a morphological matrix. Then, the construction of the Constraint Satisfaction Problem model aims to achieve a reduction in the scale of the design space. Moreover, through the evolutionary algorithm, the Pareto front is identified. Weight sensitivity analysis and the improved Technique for Order Preference by Similarity to the Ideal Solution method are combined to assist designers in finding a satisfactory architecture from the design space with many combinations. Finally, the proposed method is verified by the design of the launch vehicle’s primary and secondary separation system.

Genealogy of Green Mining in Europe and Asia

The green mining concept is a consequence of the world’s commitment to realizing sustainable economic development. This aims to maintain the availability of natural resources in the future by minimizing environmental and social damage due to mining. This article aims to explain the genealogy of green mining in Europe and Asia, as well as conditions encourage the formation of green mining regulations. This is important, considering that Indonesia has abundant natural resources and is committed to accelerating green economybased downstream programs. It is hoped that this study can become a preference for natural resource management, especially mining, that prioritizes sustainability. Our research used literature studies starting from searching, collecting, evaluating and analyzing relevant sources according to the research topic. We found that there were differences in the background to the emergence of the concept of green mining in Europe and Asia. Green mining in Europe stems from public awareness of climate change due to environmentally unfriendly mining processes. So, this awareness gives birth to environmentally friendly policies in the mining process. Meanwhile, in Asia, the emergence of green mining is caused by international policies that pressure countries in Asia both politically and economically to implement green mining. This shows that green mining is related to the geopolitical and geoeconomic spectrum.

78 Empowering Patients with Congenital Heart Disease: Insights into Serious Video Game Preferences

OBJECTIVES/GOALS: Serious video games are designed for skill-building and are increasingly being used for healthcare interventions with adolescents and young adults (AYAs). The study goal was to identify AYAs’ preferred game features, by demographic groups, to inform the development of a game to improve AYA’s engagement in their congenital heart disease (CHD) care. METHODS/STUDY POPULATION: Pediatric patients, 12-18 years old, completed surveys at a routine CHD care visit. Participants rated their likelihood of using games to learn CHD management skills (5-point Likert) and preferences for ten game features commonly used, such as: personalization (make your own avatar) and levels (unlock new, advanced stages as you do better). Participants selected one of three response options: 1=would make me less interested in the game, 2=doesn’t matter, 3=would make me more interested in the game. Descriptives and frequencies assessed interest in different game features. Chi-square tests were used to identify potential differences in game feature preferences by gender identity, age group (early/mid-adolescence vs. late adolescence), and race and ethnicity. RESULTS/ANTICIPATED RESULTS: Of 83 participants who completed surveys, the mean age was 15 years old (12-18; SD=1.73), 55% were male, 79% were Non-Hispanic White, and 70% were interested in video games for gaining CHD management skills. The top-rated game features were: levels (78%; unlock advanced stages), conflict (74%; face challenges), personalization (70%; create avatar), and story (70%; journey-based). The three lowest-ranked features were: time (29%; restricted time to complete challenge), competition (47%; score/play against others), strategy (53%; plan to reach goal). No significant differences in game feature preferences were found by demographic characteristics. DISCUSSION/SIGNIFICANCE: Most AYAs with CHD were interested in games, offering a promising avenue for future healthcare interventions. Given no significantly different preferences by demographics, the game may not require tailoring game features for certain groups. However, additional research with diverse participants is needed to fully inform game development.

The Pendulum: The Need to Develop a Safe, Effective, and Equitable Management Strategy for Opioids in Cancer Patients.

The opioid epidemic has caused major morbidity and mortality to Americans. Although there are multiple sources of this staggering issue, one inciting factor has been the use of opioids to manage pain. Although recent efforts have changed care pathways for patients with chronic pain, the first-line management of cancer pain remains opioids. Despite this, there is very little evidence and no guidelines/regulations to assist in the management of these patients. Although the literature suggests a number of current barriers to identifying and managing the challenges (such as the preferred management of patients with opioid use disorder (OUD), the optimal approach to taperering, or approaches to disparities), there are no concrete strategies for providers to manage these circumstances. Investing in further research utilizing the national opioid settlement funding, exploring the equity gaps using community based participatory research and community health worker models, and increasing provider education pathways are all potential approaches to improving this issue. These solutions could help identify and address some of the gaps that affect cancer patients taking opioids for pain.

Psychological distances to climate change and public preferences for biodiversity-augmenting attributes in family-owned production forests

Understanding public perceptions on how management can help adapt forests to climate change is fundamental to the design of socially-acceptable policies. A binary discrete choice experiment in Norway and Sweden was conducted to elicit public preferences for biodiversity-augmenting changes in three forest management attributes (set-aside, proportion of uneven-aged tree stands, and number and type of tree species) compared to typical status quo conditions in family-owned production forests. Importantly, how self-constructed psychological (spatial, social, temporal and hypothetical) distances to climate change were associated with management preferences was investigated. Following integrated choice and latent variable modeling approaches to account for their latency, our econometric results show that closer psychological distances to climate change were associated with increased support for biodiversity-augmenting changes in management attributes from status quo conditions of family-owned production forests. On average, the Norwegian public preferred larger set-asides and introducing one more broadleaved species, while the Swedish public favored changes in all attributes. The highest utility was derived from increasing set-aside areas from the status quo (5%) to 10% and 20% in both countries with respective average WTP of about 10 to 11 EUR/month in Norway, and approximately 10 to 14 EUR/month in Sweden. Findings point to universal acceptability of increasing set-aside areas in both nations, and public approval for uneven-aged and mixed forest management in Sweden.

The utility of performance review systems: A total quality management perspective

AbstractScholars and practitioners alike have argued that performance review is prone to destructive effects and negative outcomes in progressive work organizations with a total quality management (TQM) orientation. Despite its pervasive use and significant consequences at individual, team, and organizational levels across contemporary workplaces, it has remained inadequately explored for its current operational systems and their role in helping employees achieve job mastery and enabling organizations to attain desired quality outcomes. To address this lacuna, this study aims to explore how performance review systems can align with continuous quality improvement in contemporary workplaces that espouse a culture of continuous learning and quality improvement. Given the exploratory and broad scope of the research, it adopts a multiple case study design which offers benefits both in terms of process and outcomes. The findings are indicative of two different performance review systems with very different implications for managing employees and achieving quality outcomes in line with TQM: tactical system with a focus on employee obedience to rigid top‐down control system for achieving conformance quality measures, and a dynamic system with a focus on employee ownership of the quality process for achieving desired quality.

Risk-Conditioned Reinforcement Learning: A Generalized Approach for Adapting to Varying Risk Measures

In application domains requiring mission-critical decision making, such as finance and robotics, the optimal policy derived by reinforcement learning (RL) often hinges on a preference for risk management. Yet, the dynamic nature of risk measures poses considerable challenges to achieving generalization and adaptation of risk-sensitive policies in the context of RL. In this paper, we propose a risk-conditioned RL model that enables rapid policy adaptation to varying risk measures via a unified risk representation, the Weighted Value-at-Risk (WV@R). To sample risk measures that avoid undue optimism, we construct a risk proposal network employing a conditional adversarial auto-encoder and a normalizing flow. This network establishes coherent representations for risk measures, preserving the continuity in terms of the Wasserstein distance on the risk measures. The normalizing flow is used to support non-crossing quantile regression that obtains valid samples for risk measures, and it is also applied to the agent’s critic to ascertain the preservation of monotonicity in quantile estimations. Through experiments with locomotion, finance, and self-driving scenarios, we show that our model is capable of adapting to a range of risk measures, achieving comparable performance to the baseline models individually trained for each measure. Our model often outperforms the baselines, especially in the cases when exploration is required during training but risk-aversion is favored during evaluation.

Patient Preferences for Lifestyle Management in a Multi-site Randomized Lifestyle Trial for Remission of the Metabolic Syndrome.

Randomized behavioral clinical trials are the gold standard for evaluating efficacy of a behavioral treatment. However, because participants are generally unblinded to treatment, preference for a specific treatment option can lead to biased results and/or reduced treatment efficacy. The purpose was to describe the relative frequency and correlates of existence of a preference and patient preference for either an in-person group-based or a remote self-directed, lifestyle treatment prior to randomization to one of these treatments. The Enhanced Lifestyles for Metabolic Syndrome (ELM) trial is a multi-site behavioral clinical trial that compares efficacy of a group-based vs. a self-directed approach to lifestyle change on 2-year remission of the metabolic syndrome. Prior to randomization, participants were asked whether they had a preference for a particular treatment and, if so, which approach they preferred. Baseline data were used for a series of logistic regression models to determine behavioral correlates of treatment preference, independent of socioeconomic factors. Of the 331 participants, 131 (39.6%) had no preference for either treatment. Among the 200 with a preference, 56 (28.0%) preferred the self-directed program. Strength of a pre-existing habit of eating vegetables on most days was an independent correlate of no preference (adjusted OR, 1.27; 95% CI, 1.01-1.61; p = 0.03) and preference for a self-directed program (adjusted OR, 1.55; 95% CI, 1.09-2.22; p =0.01). A pre-existing habit of eating vegetables was associated with no preference and preference for a less intensive lifestyle treatment. Post-treatment follow-up of the trial results will determine if concordance between preference and treatment assignment influences outcomes.

Collaborative optimization model and algorithm for airport capacity and traffic flow allocation.

How to efficiently utilize the existing airport capacity without physical expansion and considerable economic inputs to meet air traffic needs is one of the important tasks of air traffic management. To improve the efficiency of capacity utilization, it is necessary to find the actual airport capacity properly. In this work, taking Shuangliu International Airport as an example, a methodology for capacity estimation is proposed that combines the empirical method with an analytical approach that uses historical performance data from the airport to construct a capacity envelope to approximate the airport's actual capacity to the greatest extent, establishes a collaborative optimization model that reflects the inherent relations between airport capacity and arrival and departure traffic demand, adopts an improved optimization algorithm to solve the model, and generates an optimal flight allocation scheme. Priority ratio is introduced to dynamically adjust management preferences for arrival and departure traffic demand to further reveal the synergy mechanism between departure and arrival traffic flow demand and the airport capacity. The result shows that the Flight On-time Performance rate is lifted by 6% in the case study which proves the feasibility of the proposed method, demonstrating its value for maximizing airport capacity and traffic flow demand without requiring expansions on airport scales.

Characterizing clinical patterns of physical therapy activities for post-stroke spasticity in stroke rehabilitation: looking into the "Black Box".

Physical therapy is considered to be an adjunctive therapy for the management of post-stroke spasticity. The insight of this study is to observe the current clinical practices of rehabilitation for post-stroke spasticity. For this purpose, an observational cross-sectional study was conducted. Data was collected by a standardized therapy documentation form for spasticity management. Fifty physiotherapists filled out that form. Almost all of them used subjective measures (modified Ashworth scale) for spasticity assessment and functional independence measure for level of independence. Readings were taken in the first, second, and third blocks of six-hour duration. Results showed that 42 (83.5%) physiotherapists measured spasticity at the initial session, while 47(94.6%) reported various multiple rehabilitation treatment preferences for spasticity management. Disparities exist in therapeutic management for post-stroke spasticity throughout rehabilitation which are mainly based on physiotherapists' clinical expertise. However, a better understanding of current trends in physical therapy clinical practices will assist in tailoring strategies to upgrade management for post-stroke spasticity.

Strictureplasty may lead to increased preference in the surgical management of Crohn's disease: a case-matched study.

Resection and strictureplasty are the two surgical modalities used in the management of Crohn's disease (CD). The objective of this study was to compare morbidity and clinical recurrence between patients who underwent strictureplasty and patients who underwent resection. Patients with CD who underwent strictureplasty between January 2012 and December 2022 were enrolled. The patients were well matched with patients who underwent resection without strictureplasty. Patient- and disease-specific characteristics, postoperative morbidity, and clinical recurrence were also analyzed. A total of 118 patients who underwent a total of 192 strictureplasties were well matched to 118 patients who underwent resection. The strictureplasty group exhibited significantly less blood loss (30ml versus 50ml, p < 0.001) and stoma creation (2.5% versus 16.9%, p < 0.001). No significant difference was found regarding postoperative complications or length of postoperative stay. At the end of the follow-up, the overall rate of clinical recurrence was 39.4%, and no difference was observed between the two groups. Postoperative prophylactic use of biologics (odds ratio= 0.2, p < 0.001) was the only protective factor against recurrence. Strictureplasty does not increase the risk of complications or recurrence compared with resection. It represents a viable alternative to resection in selected patients, and as such, it should have a broader scope of indications and greater acceptance among surgeons.

LANGUAGE AND INFORMATION SPACE IN THE CONTEXT OF UKRAINIAN LEGISLATION: SOCIOLINGUISTIC ASPECTS

The article focuses on the functioning of the language and information space as a marker of the state and on the choice of the language of information. The relationship between language and information is taking on new forms in the context of globalization and the intensive development of information dissemination. The information society is formed in the system of legislative, quantitative and qualitative dimensions of the language and information environment. The author outlines the prognostic prospects of the impact of the language and information space on the dynamics of the language situation, attitudes towards language and information security in general. A promising goal of the study is to determine the parameters of the language and information space as a sociolinguistic concept. The key issues of the relationship between language and information from the point of view of sociolinguistics are the choice of the language of information and the possibilities of this choice, the balance of the legislative and regulatory framework on language and information issues, and the orientation of language management in the information space. The variability of language-information relations in this context is traced in terms of national, community and individual information needs. Language-information relations in the parameters of language choice and the principles of current legislation are measured by sociolinguistic categories such as language power, language consciousness, communicative convenience, language rights, language strategies, etc. The spread and power of languages is usually related to their communicative and demographic characteristics. In the context of the study, we also talk about the information power of a language as an indicator of the language’s presence in the information space. The importance of the influence of language policy and language planning on the formation of the language and information space of the state is emphasized. Considerable attention is paid to the problems of choosing the language of information in the context of information security.