Complex Management Research Articles

Dural perforation and life-threatening central nervous system complications associated with septic arthritis of the lumbar facet joint: illustrative case.

Septic arthritis of the lumbar facet joint (SALFJ) is a rare condition that can lead to serious complications. The authors present an uncommon case in which SALFJ resulted in bacterial meningitis (BM) with hydrocephalus and pyogenic ventriculitis, causing a disturbance of consciousness. Reports describing perforation of the dura mater by an epidural abscess are rare, and the present case offers valuable insights into the management of complex and severe complications arising from SALFJ. A 54-year-old woman presented with impaired consciousness and paraplegia. The patient was eventually diagnosed with SALFJ at the left L3-4 facet joint complicated by BM, hydrocephalus, pyogenic ventriculitis, and acute transverse myelitis. Surgery confirmed a dural perforation, enabling direct invasion of the abscess into the central nervous system (CNS). Surgical interventions, including debridement, dural reconstruction, and local antibiotic perfusion, along with systemic antibiotics, significantly improved the patient's condition. This case highlights the potential for an epidural abscess of the SALFJ to directly perforate the dura mater, causing severe CNS complications. This emphasizes the importance of prompt diagnosis and appropriate surgical intervention in managing such complex cases. Timely lumbar surgery, combined with targeted antibiotic therapy, can be life-saving in this rare but critical scenario. https://thejns.org/doi/10.3171/CASE24621.

Using High‐Resolution Fisheries Data to Identify Spatial Patterns in Retained Catch Compositions for Mixed Fisheries

ABSTRACTMixed fisheries exploit fish stocks that are heterogeneously distributed in space using gears that are not species selective. This poses a challenge for management as catch limits for less productive stocks constrain catches of more productive stocks leading to losses in yield and economic value. Decoupling catches of stocks caught together in mixed fisheries could increase potential yields and may be achieved through changes in spatial fishing patterns. This study identifies fine‐scale spatial patterns of retained catches for the UK otter trawlers in UK waters by combining vessel monitoring system positional information and logbook data on retained catches. Spatially contiguous units were identified through a combination of Principal Components Analysis and spatial clustering. Our results show a complex spatial structure in the fish assemblage which differs across UK sea areas, with greater similarity between the Northern North Sea and West of Scotland compared to other sea areas. Through simulation, we highlight how fine‐scale spatially resolved fisheries data can identify areas where choke risks from catches of low‐quota, low‐productivity species associated with target species can be reduced. This underscores the value of fine‐scale data for enhancing efficiency and sustainability in mixed fisheries. Wider benefits from the use of fine‐scale data include the ability to identify consistent spatial métier definitions for use in modelling technical interactions. Ultimately, our study informs strategies and approaches that decouple catches of low‐quota, low‐productivity species caught together in mixed fisheries, improving sustainability and the conservation of living resources under complex management challenges.

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients, this study examines the strain these conditions impose on healthcare systems at a local level, focusing on a pilot program. Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes. If proven effective, this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients. AIM To evaluate the effectiveness of the high complexity unit (HCU) in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care. METHODS The study employed a descriptive longitudinal approach, analyzing data from the Basic Minimum Data Set (BMDS) to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge. RESULTS The study employed a descriptive longitudinal approach, analyzing data from the BMDS to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge. CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach. The coordinated care provided by the HCU results in improved patient outcomes, reduced unnecessary hospitalizations, and better management of patient complexity. The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction, reinforcing its value as a model of care to be replicated.

Case—Diagnostic Pitfalls with Concurrent Posterior Urethral Valves and Duodenal Atresia

Background/Objectives: This case study presents the complex management of a neonate with concurrent posterior urethral valves (PUV) and duodenal atresia (DA), highlighting diagnostic challenges due to overlapping and atypical imaging findings. Methods: A retrospective chart review was performed with a focus on pre- and postnatal imaging and clinical findings throughout the patient’s course of care. Results: A 32-week gestational referral revealed polyhydramnios, a double-bubble sign, and hydronephrosis. DA-associated polyhydramnios masked the expected oligohydramnios and other in utero sonographic signs of PUV, complicating prenatal diagnosis. Postnatally, early urethral stenting for DA repair obscured typical PUV imaging. PUV diagnosis was confirmed by cystoscopy on day 73. Conclusions: We emphasize the importance of multidisciplinary care and appreciating diagnostic uncertainties in neonates with concurrent obstructive uropathy and intestinal obstruction.

Effect of β-blocker on clinical outcomes in patients with traumatic brain injury: a retrospective propensity-matched study

BackgroundTraumatic brain injury (TBI) represents a significant public health challenge due to its complex management. β-blockers may offer neuroprotective benefits, but their impact on TBI outcomes remains unclear. This study aims to evaluate the effect of β-blocker use on clinical outcomes in TBI patients.MethodsThis retrospective cohort study included adult TBI patients, categorized into β-blocker and non-β-blocker groups. Propensity score matching (PSM) was utilized to balance baseline characteristics. Mortality was assessed through the application of multivariable Cox regression models and Kaplan–Meier survival curves. Subgroup analyses examined the consistency of the results.ResultsA total of 1,516 patients were included in the study, with 750 receiving β-blocker therapy and 766 not receiving it. After PSM, 473 pairs of patients were matched. The analysis indicated that β-blockers significantly reduce 28-day mortality (HR 0.43, 95% CI: 0.31–0.60, P < 0.001). However, patients receiving β-blocker had considerably longer hospital stays (7.89 days vs. 5.45 days, P < 0.001) and ICU stays (2.94 days vs. 2.33 days, P < 0.001).Conclusionβ-blocker therapy is associated with improved short-term outcomes in patients with TBI, particularly in those with mild (GCS 13–15) and severe (GCS 3–8) TBI. However, no significant benefit was observed in patients with moderate TBI (GCS 9–12). This therapy may also prolong hospital and ICU stays.

P1241 Identification and characterization of patients with Crohn's disease and complex perianal fistulas using Natural Language Processing and machine learning: INTUITION-CPF Study.

Abstract Background Crohn’s disease (CD) is an inflammatory condition that can cause perianal fistulas (mostly complex), affecting 26-35% of CD patients. There is no gold-standard treatment for perianal disease, leading to significant unmet needs. This study uses Artificial Intelligence (AI) to analyze electronic medical records (EMRs) to identify and characterize CD patients with complex perianal fistulas (CPF). It offers an overview of patient characteristics, treatment patterns, and CPF incidence in CD patients attending inflammatory bowel disease units in Spain. Methods INTUITION-CPF is a national, multicenter, retrospective study. EMRs of patients with CD, diagnosed or not with CPF (overall CD population) from January 2015-December 2021, were reviewed and processed using an AI analysis based on machine learning and Natural Language Processing (NLP). There were two phases in the study. Phase 1: NLP-identified patients with CD+CPF were manually validated to assess sensitivity and specificity; and Phase 2: characteristics, treatments and visits to departments were analysed in eligible patients with CD+/-CPF. Here, we present results from the phase 2. Results A total of 2,182 patients with CD were identified. Median age (range) was 51 years (21-105). 263 patients (12%) suffered from CPF, of which 70% experienced pain, 48% active (suppurative) disease, and 28% perianal abscesses. The estimated annual incidence of CPF among CD patients was 1.6%. Patients with CD+CPF had more medical treatments (91%) compared to overall CD patients (74%). Proportion of patients receiving biologics was near double for CD+CPF compared to overall CD patients (41% vs 21%) with infliximab the most frequently used (26%) (Table 1). 13% of the overall CD population had ≥1 surgery, compared with 36% of patients with CD+CPF. The main surgeries in patients with CD+CPF included seton placement (14%), advancement flap surgery (FLAP) (16%) and ostomy (13%) (Table 1). Hospitalisation (≥24h) was required for 49% of overall CD patients vs 64% of those with CPF. Gastroenterology (73%) was the most frequently visited department, followed by surgery (31%) and emergency departments (27%) (Figure 1). Conclusion This study demonstrates that CD patients with CPF require more complex and multidisciplinary management, including more biological treatments and surgeries, and exhibit higher hospitalization and emergency visit rates compared to overall CD patients.Inconsistencies with the existing literature highlight the opportunity to further enhance NLP techniques to achieve more accurate outcomes.

N13 Development of an interactive vaccination guide for Canadian Inflammatory Bowel Diseases nurses to use with immunosuppressed patients with IBD: Insights into the process & practical applications

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic, immune-mediated condition requiring complex management, often with immunosuppressive therapies. These therapies increase infection risk, making vaccination vital. Given the complexities of immunosuppressive therapies and vaccine considerations, IBD nurses need support to provide vaccination-related guidance to patients. The Canadian IBD Nurses (CANIBD) group developed an interactive vaccination guide to support IBD nurses in this role and shares the process, lessons learned, and practical applications. Methods The interactive vaccination guide, developed by CANIBD and infectious disease specialists, is a web-based resource hosted by Crohn’s and Colitis Canada (https://canibdvaccination.ca/). With greater access to technological resources, such as computers-on-wheels and electronic tablets, the paper-based format became under-utilized. Transitioned to an interactive web-based format in 2024, the guide was redesigned to optimize usability. The development process involved a scoping review of updates in vaccination, including COVID-19 vaccination guidelines. This review was conducted by 2 IBD nurse practitioners and 2 infectious disease specialists in pediatric and adult care. The CANIBD board members approved a budget for web development after reviewing a business proposal. The project took 12 months to complete, involving multiple virtual meetings among collaborators and web designers. Results The vaccination guide includes updated content on: 1) identifying immunocompromised patients; 2) live vaccines; 3) inactivated vaccines; 4) COVID-19 vaccines; 5) travel vaccines; and 6) vaccinations for family members of immunocompromised patients. Designed for ease of use, the guide enables IBD nurses to provide timely, real-time vaccination support to patients and families. It ensures appropriate and comprehensive care plans for immunocompromised patients and is regularly updated as new data emerges. Conclusion The vaccination guide has proven valuable for IBD care. Its interactive, question-based design simplifies vaccination recommendations, supporting patients and families in staying protected. By incorporating the latest vaccine updates and addressing family vaccination needs, the guide reduces infection risk, enhances patient care, and reinforces CANIBD’s commitment to advocacy and healthcare collaboration. Future plans include evaluating the guide’s usability and expanding its reach to other healthcare providers, such as physicians and pharmacists.

TRACKING MAP UNTUK MONITORING GANGGUAN JTR PADA NH FUSE GARDU DISTRIBUSI

This research develops an IoT-based fault monitoring system for Low Voltage (LV) Networks using a tracking map on NH fuses, aiming to improve response time efficiency and fault detection accuracy. The system integrates sensors with a web-based platform to monitor and visualize fault locations in real-time. Test results indicate that the system is capable of detecting faults with high accuracy, with detection errors as low as 0% to 0.32%. The response time for fault detection ranges from 0.5 to 1 second, significantly faster than conventional methods. As a result, fault recovery time can be accelerated by 30-40%, potentially enhancing the reliability of the power supply. Additionally, the use of IoT technology allows more efficient monitoring and quicker response to faults, enabling faster repair processes and minimizing downtime. Although the system demonstrates promising results, the study also identifies areas for further development, particularly in integrating it with more complex distribution management systems and enhancing data analytics. Overall, the proposed system offers an innovative solution for mitigating faults in LV networks, improving reliability, and increasing operational efficiency in power distribution systems

Antifungal susceptibility, clinical findings, and biofilm resistance of Fusarium species causing keratitis: a challenge for disease control.

Fusarium keratitis (FK) is an important clinical condition that can lead to blindness and eye loss, and is most commonly caused by the Fusarium solani species complex (FSSC). This study evaluated the susceptibility of planktonic cells and biofilms of FSSC (n = 7) and non-FSSC (n = 7) isolates obtained from patients with keratitis from a semi-arid tropical region to amphotericin B (AMB), natamycin (NAT), voriconazole (VRZ), efinaconazole (EFZ), and luliconazole (LCZ). Analysis of clinical data showed that trauma was the most common risk factor for FK patients. Disease onset was longer in non-FSSC group (3-30 days) than in the FSSC group (3-7 days). FSSC strains were less susceptible to AMB and VRZ than non-FSSC strains (p < 0.05). Susceptibility to NAT, LCZ and EFZ was similar between isolates of FSSC and non-FSSC groups. Overall, patients infected with non-FSSC showed a better response to antifungal treatment. Corneal transplantation was more common in patients infected with FSSC (3/7) than in those infected with non-FSSC (1/7). Mature biofilms showed a poor response to antifungal treatment. Patients infected with Fusarium strains capable of forming antifungal tolerant biofilms had more complex therapeutic management, requiring two antifungals and/or corneal transplantation (p < 0.05). This study highlights the importance of mycological diagnosis and the antifungal susceptibility testing in the clinical management of FK. The ability of Fusarium to form antifungal tolerant biofilms poses a challenge to clinicians and urges the development of new antibiofilm therapeutics.

Innovative Strategies in the Management of Hypoplastic Left Heart Syndrome: A Multidisciplinary and Translational Approach

Background: Hypoplastic Left Heart Syndrome (HLHS) represents one of the most severe congenital cardiac malformations, characterized by underdevelopment of left-sided heart structures, necessitating a complex surgical and medical management strategy. Despite advancements in staged palliation and neonatal care, outcomes remain suboptimal for a significant subset of patients. Recent progress in molecular biology, regenerative medicine, and surgical innovations offers novel approaches that may transform the clinical trajectory of these patients. Objectives: This article explores emerging strategies for HLHS management, including stem cell therapy, tissue engineering, genomic medicine, hybrid procedures, and long-term monitoring protocols facilitated by artificial intelligence (AI). Methods: A comprehensive review of contemporary literature was conducted, focusing on the translational application of novel therapies and their integration into current staged palliation frameworks. Results: Early-stage studies demonstrate promise for stem cell therapies and myocardial regeneration in improving ventricular function. Advances in 3D printing and bioengineering have facilitated patient-specific surgical planning and the development of biocompatible grafts. Furthermore, AI-driven algorithms provide personalized risk assessment and optimized perioperative management strategies. Conclusions: The integration of multidisciplinary and translational approaches offers an opportunity to redefine HLHS management, potentially improving survival and quality of life for affected individuals. However, further clinical trials and international collaboration are essential to establish these novel therapies as standard of care.

Evaluation of a content-based image retrieval system for radiologists in high-resolution CT of interstitial lung diseases

BackgroundThis retrospective study aims to evaluate the impact of a content-based image retrieval (CBIR) application on diagnostic accuracy and confidence in interstitial lung disease (ILD) assessment using high-resolution computed tomography CT (HRCT).MethodsTwenty-eight patients with verified pattern-based ILD diagnoses were split into two equal datasets (1 and 2). The images were assessed by two radiology residents (3rd and 5th year) and one expert radiologist in four sessions. Dataset 1 was used for sessions A and C, assessing diagnostic accuracy and confidence with mandatory and without CBIR software. Dataset 2 was used for sessions B and D with optional CBIR use, assessing time spending and frequency of CBIR usage. Accuracy was assessed on the CT pattern level, comparing readers’ diagnoses with reference diagnoses and CBIR results with region-of-interest (ROI) patterns.ResultsDiagnostic accuracy and confidence of readers showed an increasing trend with CBIR use compared to no CBIR use (53.6% versus 35.7% and 50.0% versus 32.2%, respectively). Time for reading significantly decreased in both datasets (A versus C: 104 s versus 54 s, p < 0.001; B versus D: 88.5 s versus 70 s, p = 0.009), whereas time for research increased with CBIR software use (A versus C: 31 s versus 81 s, p = 0.040). CBIR results showed a high pattern-based accuracy of overall 73.4%. Comparison between readers indicates a slightly higher accuracy of CBIR results when more than one ROI was used as input (77.7% versus 70.1%).ConclusionCBIR software improves in-training radiologist diagnostic accuracy and confidence while reducing interpretation time in ILD assessment.Relevance statementContent-based image retrieval software improves the assessment of interstitial lung diseases (ILD) in high-resolution CT, especially for radiology residents, by increasing diagnostic accuracy and confidence while reducing interpretation time. This can provide educational benefits and more time-efficient management of complex cases.Key PointsA content-based image retrieval (CBIR) software improves diagnostic accuracy and confidence for in-training radiologists for interstitial lung disease (ILD) assessment on computed tomography (CT).A CBIR application provides condensed information about similar HRCT cases reducing time for ILD assessment.CBIR algorithms benefit from the input of multiple regions of interest per ILD case.Graphical

Forecast modeling of the dynamics of main resources and construction of a simulation system for managing the activities of the regional energy system of the Samara region

Regional energy systems are complex dynamic systems that operate in conditions of constant changes in the external environment. In this regard, the task of developing complex management decisions and conducting a systemic analysis of the efficiency of its activities arises. To solve this problem, it is necessary to improve the mathematical models of the dynamics of capital, labor and fuel resources, since they have the greatest impact on the energy output of the energy system. The paper analyzes existing methods of mathematical description of the dynamics of basic resources and their shortcomings. The paper considers covariance-stationary models of time series in the form of difference equations with a deterministic polynomial trend. The paper presents the results of mathematical modeling of the dynamics of capital, labor and fuel resources based on statistical data on the activities of the energy system of the Samara Region, published in the annual reports of regional ministries and energy companies, and conducts a statistical analysis of them. Based on a comparative analysis of mathematical models, the most effective models of the dynamics of capital, labor and fuel resources with the best predictive qualities were selected. Also, in the work, a single-loop simulation model of the energy system management system was constructed by forming investments for the renewal of capital resources and the structure of the decision support system (DSS) was developed, allowing the formation of mathematically sound management decisions.

A Comprehensive Analysis of Fibromyalgia and the Role of the Endogenous Opioid System.

Fibromyalgia represents a chronic pain disorder characterized by musculoskeletal pain, fatigue, and cognitive impairments. The exact mechanisms underlying fibromyalgia remain undefined; as a result, diagnosis and treatment present considerable challenges. On the other hand, the endogenous opioid system is believed to regulate pain intensity and emotional responses; hence, it might be expected to play a key role in the enhanced sensitivity experienced by fibromyalgia patients. One explanation for the emergence of disrupted pain modulation in individuals with fibromyalgia is a significant reduction in opioid receptor activity or an imbalance in the levels of endogenous opioid peptides. Further research is essential to clarify the complex details of the mechanisms underlying this abnormality. This complexity arises from the notion that an improved understanding could contribute to the development of innovative therapeutic strategies aimed at targeting the endogenous opioid system in the context of fibromyalgia. Although progress is being made, a complete understanding of these complexities remains a significant challenge. This paradigm has the potential to revolutionize the complex management of fibromyalgia, although its implementation may experience challenges. The effectiveness of this approach depends on multiple factors, but the implications could be profound. Despite the challenges involved in this transformation, the potential for improving patient care is considerable, as this condition has long been inadequately treated.

Economic potential in the management of real estate from non-core assets of the Russian aircraft building complex: Analysis and assessment of the resource base

The paper analyzes the structure and overview of real estate object location in the non-core assets of the enterprises of the aircraft industry on the example of The United Aircraft Corporation (Russia). The study aims to identify the economic benefits in the management of non-core assets. In particular, some qualitative and quantitative features of the asset structure were determined. Using the cartographic method, a high concentration of assets in some regions of Russia was noted, which is visually represented in the form of geographical maps. In the context of identifying trends in the property complex management, the entire resource base of the Russian aircraft industry was assessed. Some of the trends were found to be related to geographical, historical peculiarities as well as to human resources. The data posted on the official website of United Aircraft Corporation PJSC were used for the study. The results and some conclusions of this work can further serve as a more detailed analysis of the composition of the aircraft industry assets. Moreover, in order to form a management strategy for the resource base in terms of excess non-core assets, it is possible to assess the dependence of the asset structure on the enterprise type and the volume of manufactured products, its cost as an indicator of qualitative characteristics, as well as to determine correlations and average sufficiency to cover the needs of civil and aerospace aviation.

Digitalization of land management in the agroindustrial complex: institutional aspect

Digitalization of land management in the agroindustrial complex: institutional aspect

The Impact of Financial Innovations on the Amplification of Financial Crises

A financial crisis arises when the value of financial assets or markets rapidly declines, often leading to panic, liquidity shortages, and the collapse of the banking systems. In modern financial systems, financial innovations such as mortgage-backed securities (MBS), credit default swaps (CDS), and high-frequency trading have emerged as key drivers of both market efficiency and systemic instability. These innovations can amplify financial crises by increasing leverage, introducing complexity, and precipitating abrupt market shocks. This paper examines how specific financial innovations, particularly derivatives like MBS and CDS, contributed to the amplification of the 2007-2008 financial crisis. The study uses a case study approach to analyze the crisis and evaluate both the advantages and disadvantages associated with these financial innovations. The conclusion underscores the necessity for stronger regulation and oversight of financial innovations since unchecked complexity, excessive leverage, and inadequate risk management can precipitate to systemic collapse. Transparent markets, robust risk management practices, and prudent regulation are indispensable in averting and preventing future crises. This research highlights the critical role that financial innovations play in both driving and mitigating financial crises. By analyzing the 2007-2008 American Financial Crisis, the paper provides insights into how these innovations, while offering potential benefits, can also introduce significant risks when improperly regulated. The findings emphasize the necessity of balanced oversight to ensure innovation does not compromise systemic stability.

Ageing, clinical complexity, and exercise therapy: a multidimensional approach.

Ageing is a multidimensional concept related to the progressive decline in physiological functions. The decrease of physical autonomy due to the ageing process leads to frailty, which in turn is associated with disability and comorbidity. Ageing represents the primary risk factor for chronic degenerative diseases, especially involving cardiovascular, metabolic, respiratory, and osteoarticular systems, determining the decrease in activities and quality of daily life. Regular physical activity can significantly reduce the risk of chronic degenerative diseases, moderate or severe functional limitations, and premature death in older adults. In light of the relationship between ageing, sedentary lifestyle, disability, comorbidity, and physical activity, a clear need emerges within the health system. Better control on the territory of pathologies related to ageing with the management of clinical and care complexity, multidimensional and multi-professional evaluation of the elderly complex and fragile patient, also through the definition of specific outpatient packages for pathology that allow the simplification of the evaluation process. There is a need for integration between local services, hospitals, and social assistance services. Aim of this review is to highlight the importance of the multidimensional approach is essential to be able to classify the complex elderly patient according to a multi-professional vision aimed at evaluating comorbidities and frailties, including sarcopenia, nutritional deficits, functional capacity, and planning a personalized and monitored motor training program, to improve motor, metabolic, cardiovascular and respiratory functions. In addition, developing an integrated hospital-community-care services management program to follow up with patients post-care is crucial.

From darkness to light: Reversible bitemporal hemianopia

Aims/Purpose: The purpose of this case study is to describe the diagnostic process, surgical treatment, and subsequent recovery in a patient who was being monitored for strabismus due to previous thyroid orbitopathy. This case aims to underscore the importance of early diagnosis and timely surgical intervention in the resolution of visual impairments associated with pituitary adenomas.Methods: A 53‐year‐old female, under follow‐up for strabismus due to previous thyroid orbitopathy, was noted to have limitations in certain eye movements and diplopia during a routine consultation. Suspecting an exacerbation of orbitopathy, a computed tomography (CT) scan was ordered. The CT revealed a sellar and suprasellar mass, an incidentaloma not seen in a CT performed five years earlier. Visual field testing was then conducted, revealing bitemporal hemianopia. Further evaluation with magnetic resonance imaging (MRI) was performed to better characterize the lesion. The patient was subsequently scheduled for transsphenoidal surgery to excise the tumor.Results: The patient underwent successful transsphenoidal resection of the pituitary adenoma. Postoperative assessments, including regular visual field testing and MRI scans, indicated a gradual but complete restoration of the visual fields over a three‐month period. Follow‐up showed no recurrence of the tumor, and the patient remained free of visual symptoms.Conclusions: This case illustrates that bitemporal hemianopia caused by pituitary adenomas can be effectively reversed through surgical intervention. Early identification and prompt surgical treatment are essential to prevent permanent visual deficits and ensure full recovery of visual function. This case also highlights the importance of a multidisciplinary approach in the management of complex neuro‐ophthalmological conditions.

From darkness to light: Reversible bitemporal hemianopia

Aims/Purpose: The purpose of this case study is to describe the diagnostic process, surgical treatment, and subsequent recovery in a patient who was being monitored for strabismus due to previous thyroid orbitopathy. This case aims to underscore the importance of early diagnosis and timely surgical intervention in the resolution of visual impairments associated with pituitary adenomas.Methods: A 53‐year‐old female, under follow‐up for strabismus due to previous thyroid orbitopathy, was noted to have limitations in certain eye movements and diplopia during a routine consultation. Suspecting an exacerbation of orbitopathy, a computed tomography (CT) scan was ordered. The CT revealed a sellar and suprasellar mass, an incidentaloma not seen in a CT performed five years earlier. Visual field testing was then conducted, revealing bitemporal hemianopia. Further evaluation with magnetic resonance imaging (MRI) was performed to better characterize the lesion. The patient was subsequently scheduled for transsphenoidal surgery to excise the tumor.Results: The patient underwent successful transsphenoidal resection of the pituitary adenoma. Postoperative assessments, including regular visual field testing and MRI scans, indicated a gradual but complete restoration of the visual fields over a three‐month period. Follow‐up showed no recurrence of the tumor, and the patient remained free of visual symptoms.Conclusions: This case illustrates that bitemporal hemianopia caused by pituitary adenomas can be effectively reversed through surgical intervention. Early identification and prompt surgical treatment are essential to prevent permanent visual deficits and ensure full recovery of visual function. This case also highlights the importance of a multidisciplinary approach in the management of complex neuro‐ophthalmological conditions.

Machine Learning Prediction of Tritium‐Helium Groundwater Ages in the Central Valley, California, USA

AbstractGroundwater ages provides insight into recharge rates, flow velocities, and vulnerability to contaminants. The ability to predict groundwater ages based on more accessible parameters via Machine Learning (ML) would advance our ability to guide sustainable management of groundwater resources. In this study, ML models were trained and tested on a large data set of tritium concentrations and tritium‐helium groundwater ages from the California Central Valley, a large groundwater basin with complex land use, irrigation, and water management practices. The ML models were trained on 63 features, including location, well construction information, landscape characteristics, and climate variables, water chemistry, and stable isotopes. The Bagging regressor method can accurately classify (F1‐score = 0.91) groundwater samples as either modern or pre‐modern whereas the accuracy of the ML prediction of continuous tritium‐helium groundwater ages is limited and explains only of the variability in this data set. In general, ML groundwater age prediction relies mostly on features related to (a) the source of groundwater recharge, (b) contaminant history, (c) aquifer materials, (d) well construction, and (e) geochemical reactions along flow paths.