Optimal Management Strategy Research Articles

Consensus guidelines for the management of primary supra-tentorial intraventricular tumour for low- and middle-income countries.

Almost any primary or metastatic brain tumour can manifest in intraventricular (IV) locations. These tumours may either originate within the ventricular system or extend into the IV space through growth. Such neoplasms represent a broad spectrum, with supratentorial IV tumours forming a heterogeneous group. This group includes primary ependymal tumours, central neurocytomas, choroid plexus tumours, and notably, meningiomas, as well as a variety of non-neoplastic, benign, glial, and metastatic lesions that can secondarily invade the IV compartment. Often presenting with nonspecific symptoms, these tumours can lead to delayed medical attention. The diversity in potential diagnoses, combined with their deep and complex locations, poses significant management challenges. This paper aims to delineate optimal management strategies, underscoring the importance of multidisciplinary care, especially in settings with limited resources, to effectively navigate the complexities associated with treating intraventricular brain tumours.

Open reduction and internal fixation using suture anchors for an isolated lesser tuberosity fracture: description of technique and a case report

Isolated fractures of the lesser tuberosity (LT) of the humerus are uncommon and pose diagnostic challenges. This case study explores a distinctive treatment for a displaced and angulated LT fracture in a 27-year-old female skier. Emphasizing open reduction and internal fixation with suture anchors, the study addresses the scarcity of consensus on optimal treatments and the difficulties in accurate diagnosis. The successful application of suture anchors highlights their potential advantages, including biodegradability, improved vascularity, optimized intraoperative workflow without the need for fluoroscopy, and minimized risk of collateral bone damage. This case underscores the importance of surgical intervention for preventing long-term functional impairments in displaced LT fractures and advocates for considering alternative surgical techniques. By contributing insights into the rationale and advantages of using suture anchors, this study aims to enrich the discourse on optimal management strategies for these rare fractures, potentially informing future treatment decisions.

Energy optimization management of microgrid using improved soft actor-critic algorithm

To tackle the challenges associated with variability and uncertainty in distributed power generation, as well as the complexities of solving high-dimensional energy management mathematical models in mi-crogrid energy optimization, a microgrid energy optimization management method is proposed based on an improved soft actor-critic algorithm. In the proposed method, the improved soft actor-critic algorithm employs an entropy-based objective function to encourage target exploration without assigning signifi-cantly higher probabilities to any part of the action space, which can simplify the analysis process of distributed power generation variability and uncertainty while effectively mitigating the convergence fragility issues in solving the high-dimensional mathematical model of microgrid energy management. The effectiveness of the proposed method is validated through a case study analysis of microgrid energy op-timization management. The results revealed an increase of 51.20%, 52.38%, 13.43%, 16.50%, 58.26%, and 36.33% in the total profits of a microgrid compared with the Deep Q-network algorithm, the state-action-reward-state-action algorithm, the proximal policy optimization algorithm, the ant-colony based algorithm, a microgrid energy optimization management strategy based on the genetic algorithm and the fuzzy inference system, and the theoretical retailer stragety, respectively. Additionally, com-pared with other methods and strategies, the proposed method can learn more optimal microgrid energy management behaviors and anticipate fluctuations in electricity prices and demand.

Joint optimization of load balancing and resource allocation in cloud environment using optimal container management strategy

SummaryDue to the high performance of cloud computing‐based microservices, a wide range of industries and fields rely on them. In a containerized cloud, traditional resource management strategies are typically used to allocate and migrate virtual machines. A major problem for cloud service providers is resource allocation for containers, which directly affects system performance and resource consumption. In this paper, we propose a joint optimization of load balancing and resource allocation in the cloud using an optimal container management strategy. We aim to enhance scheduling efficiency and reduce costs by improving the container's schedule requested digitally by users. An improved backtracking search optimization (IBSO) algorithm is used to allocate resources between end‐users/IoT devices and the cloud under the consideration of service‐level agreements. Mechanic quantum recurrent neural networks (MQ‐RNNs) are designed to allocate, consolidate, and migrate containers in cloud environments. The various simulation measures used to validate the proposed strategy are energy consumption, number of active servers, number of interruptions, total cost, runtime, and statistical measures.

Current management of acute Stanford type A aortic dissection complicated with mesenteric malperfusion

The management of acute type A aortic dissection (aTAAD) with mesenteric malperfusion (MMP) is quite challenging as it is often associated with high mortality and poor outcomes, and an optimal treatment strategy is lack of consensus for this critically ill condition. Emergent open surgical repair of the ascending aorta is a life-saving operation and remains the standard of care for aTAAD with MMP, but is associated with a high rate of mortality. In recent years, reperfusion of superior mesenteric artery (SMA) by endovascular repair as the first treatment strategy in the treatment of aTAAD with MMP has been concerned and reported. Only endovascular repair and conservative medical treatment are also introduced in few cases with poor outcomes. There are many urgent issues that need to be addressed in current strategies. The optimal management strategies remain controversial, and further investigation and research are needed. These issues were addressed in this article.

Clinical, epidemiological, and therapeutic hallmarks of pyoderma gangrenosum: a case series of 35 patients.

Over the past few decades, advances in medical research and diagnostic tools have shed light on some aspects of pyoderma gangrenosum (PG). Nevertheless, the multifactorial etiology, pathogenesis, and optimal management strategies for PG need to be further investigated. To address these knowledge gaps and contribute to a better understanding of this complex dermatological disorder, we collected epidemiological, clinical, and therapeutic aspects of a case series of PG patients occurring in our department over the past 10 years. We performed a single-centered, retrospective, observational study analyzing all cases with a diagnosis of PG observed at the Dermatology clinic of the Fondazione Policlinico A. Gemelli IRCCS Catholic Universityfrom January 1, 2013, to January 1, 2023. For each case, we retrieved demographic data, the presence of other skin and systemic conditions, and the histopathological and clinical characteristics of PG, such as clinical variant, number of lesions, disease localization, previous therapy, response to treatment, and occurrence of relapse. We included 35 patients, 22 females and 13 males with a mean age of 40.0 years. Twenty patients (57.1%) had multiple localizations of disease, and the most commonly involved site was the lower limbs (85.7%). The lesions were mainly associated with inflammatory bowel diseases (51.4%) and hidradenitis suppurativa (37.1%). Clinical resolution with complete re-epithelialization was achieved in 25 patients (71.4%) with an average time of 20.8 months. On average, patients who underwent therapy with biological drugs had better outcomes. PG is a severe, rare, and pleomorphic disease associated with a broad spectrum of conditions. Corticosteroids remain the primary first-line approach for severe forms, but using biological immunosuppressants is promising.

Comparison of clinical and radiological outcomes for the anterior and medial approaches to open reduction in the treatment of bilateral developmental dysplasia of the hip: a systematic review protocol.

Developmental dysplasia of the hip (DDH) affects 1-3% of newborns and 20% of cases are bilateral. The optimal surgical management strategy for patients with bilateral DDH who fail bracing, closed reduction or present too late for these methods to be used is unclear. There are proponents of both medial approach open reduction (MAOR) and anterior approach open reduction (AOR); however, there is little evidence to inform this debate. We will perform a systematic review designed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol. We will search the medical and scientific databases including the grey and difficult to locate literature. The Medical Subject Headings "developmental dysplasia of the hip", "congenital dysplasia of the hip", "congenital hip dislocation", "developmental hip dislocation", and their abbreviations, "DDH" and "CDH" will be used, along with the qualifier "bilateral". Reviewers will independently screen records for inclusion and then independently extract dataon study design, population characteristics, details of operative intervention and outcomes from the selected records. Data will be synthesised and a meta-analysis performed if possible. If not possible we will analyse data according to Systematic Review without Meta-Analysis guidance. All studies will be assessed for risk of bias. For each outcome measure a summary of findings will be presented in a table with the overall quality of the recommendation assessed using the Grading of Recommendations Assessment Development and Evaluation approach. The decision to perform MAOR or AOR in patients with bilateral DDH who have failed conservative management is not well informed by the current literature. High-quality, comparative studies are exceptionally challenging to perform for this patient population and likely to be extremely uncommon. A systematic review provides the best opportunity to deliver the highest possible quality of evidence for bilateral DDH surgical management. The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO ID CRD42022362325).

Optimal investment strategy for asset-liability management with a defaultable bond under stochastic default intensity

This paper studies a continuous-time asset-liability management problem with a defaultable bond under stochastic interest rates and stochastic default intensity. Specifically, an asset-liability manager is allowed to invest in a cash, a treasury bond, a defaultable bond and a stock. Using the stochastic control scheme and partial differential equation approach, we derive closed-form expressions for optimal investment strategies and corresponding value functions under the power and exponential utility functions. In addition, we also provide numerical experiments to illustrate the impact of relevant parameters in the default process and recovery rate on the optimal asset allocation strategy.

Optimal Adaptive Fractional Order Integral Sliding Mode Controller-Energy Management Strategy for Electric Vehicles Based on Bald Eagle Search Algorithm

This research presents an optimal energy management system (EMS) for a lithium-ion battery-supercapacitor hybrid storage system used to power an electric vehicle. The storage systems are connected in parallel to the DC bus by bidirectional DC-DC converters and feed a synchronous reluctance motor through an inverter. The proposed energy management strategy is built on the idea to take full benefits of two combined methods: the bald eagle search algorithm and fractional order integral sliding mode control. To evaluate the effectiveness of the suggested optimal energy management strategy, an urban dynamometer driving schedule (UDDS) driving cycle is considered. The obtained results are compared to a classical fractional order integral sliding mode control-based energy management strategy in terms of voltage ripples, overshoots, and battery final state of charge. The ultimate results approve the ability of the proposed energy management system to enhance the power quality and enhance battery power consumption at the same time. Comprehensive processor-in-the-loop (PIL) cosimulations were conducted on the electric vehicle using the C2000 launchxl-f28379d digital signal processing (DSP) board to assess the practicability and effectiveness of the proposed EMS.

Analyzing Factors That Affect Korean B2B Companies’ Sustainable Performance

This study empirically examines factors that can influence the sustainable corporate performance of Korean business-to-business (B2B) companies with the help of unique survey data. Factors such as technological capability, the chief executive officer (CEO)’s risk-taking propensity, B2B seller skill, and key account management (KAM) are analyzed to clarify their impact on sustainable financial and non-financial performance. In particular, given that environment, society, and governance (ESG) reporting has recently been widely recognized as an important evaluation factor for companies, we look at the mediating effects of ESG management on sustainable business performance. The results show that the CEO’s risk-taking propensity and B2B seller skill significantly impact the company’s sustainable financial performance, while technological capability and the CEO’s risk-taking propensity significantly impact sustainable non-financial performance. The fact that a CEO’s risk-taking propensity affects both sustainable financial and non-financial performance indicates the importance of entrepreneurial competency in the sustainability of the company. Furthermore, the findings reveal that ESG management plays a crucial role in sustainable corporate performance. The mediating role of ESG management allows technological capability, B2B seller skill, and KAM to influence sustainable financial performance significantly. Likewise, all of the explanatory factors contribute to the company’s sustainable non-financial performance through ESG management. The findings are important for both practitioners and scholars because they emphasize the need to establish an optimal ESG management strategy for corporate survival and sustainability. Furthermore, this study underscores that ESG management should be implemented by all organizational members, from CEOs to employees. Future research will include more comprehensive samples and analyze various strategic factors not covered in this study to derive effective ways by which companies can increase their performance and sustainability. We will also explore the factors that contribute to good ESG management practices.

Comparison of postoperative analgesia and side effects in pediatric laparoscopic surgery with morphine and nalbuphine

There is currently no consensus on the optimal perioperative pain management strategy involving specific opioids. This study aims to compare the postoperative analgesia, the associated side effects between nalbuphine and morphine in children undergoing laparoscopic surgery. One hundred ninety children were randomly assigned to nalbuphine (0.2mg/kg) or morphine (0.2mg/kg). Nalbuphine's analgesic effect was non-inferior to morphine, with similar total rescue analgesic consumption during PACU stay (0.03± 0.05mg vs. 0.04± 0.06mg, p>0.05). Nalbuphine group had a lower incidence of respiratory depression (RR ≤ 10/min) (4.8% vs. 38.6%, p<0.001), PONV (2.4% vs. 18.1%, p= 0.002), and pruritus (0% vs. 16.9%, p<0.001) than morphine. Additionally, nalbuphine showed a shorter laryngeal mask airway removal time (13.9 [12.7, 15.1]) compared with morphine (17.0 [15.1, 18.9], p= 0.011). Nalbuphine provides equipotent analgesia with significantly lower incidences of respiratory depression, PONV, and pruritus compared with morphine in pediatric laparoscopic surgery.

Experimental CIGS technology performance under low concentration photovoltaic conditions

This research study assesses the influence of the concentration factor on two different PV technologies: c-Si and CIGS, to analyze the feasibility of utilizing CIGS thin-film technology in Low Concentration Photovoltaic conditions. Additionally, the importance of the encapsulation design is explored to determine the optimum thermal management strategy. The initial phase involves an analysis of the thermal performance of two types of commercial photovoltaic module and explores the enhancement of temperature management in CIGS photovoltaics modules by substituting the rear glass backsheet with an aluminum sheet to reduce the operating temperature of the prototype. Subsequently, various prototypes are fabricated, incorporating CIGS and silicon technologies, and different encapsulation designs: tedlar, glass and aluminum backsheets. The analysis reveals that comparing performance under 2.2× and 1× concentration conditions, CIGS technology exhibits the higher performance at 2.2×, making it a more promising choice for LCPV systems. While CIGS technology boasts an intrinsic advantage because of its open circuit voltage temperature coefficient, its performance enhancement under LCPV conditions is further amplified through the optimization of the backsheet to improve the thermal management.

Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches.

Anterior capsular contraction syndrome (ACCS) is a challenging complication that can occur following phacoemulsification cataract surgery. Characterized by capsular bag wrinkling, intraocular lens (IOL) decentration and tilt, ACCS can have negative effects on visual outcomes and patient satisfaction. This review aims to investigate the pathogenesis, clinical course, influencing factors, and intervention approaches for ACCS after cataract surgery. By understanding the underlying mechanisms and identifying factors that contribute to ACCS, surgeons can enhance their ability to predict and manage this complication. Various intervention strategies are discussed, highlighting their importance in reducing complications and improving surgical outcomes. However, further research is needed to determine optimal prevention and management strategies through long-term follow-up and comparative analyses. Advancements in this field will ultimately lead to improved visual outcomes and optimized cataract surgery for patients.

Left Main Coronary Artery Disease: A Contemporary Review of Diagnosis and Management.

Significant left main coronary artery disease is a very high-risk subgroup of coronary artery disease that is a crucial indicator of heightened morbidity and mortality rates. Despite its clinical significance, uncertainties persist regarding the optimal management strategy for patients, particularly given its phenotypic variations. Existing evidence-based guidelines offer insights into revascularization options, yet questions remain regarding long-term prognoses and clinical outcomes when comparing percutaneous coronary intervention to coronary artery bypass grafting. This comprehensive review aims to provide an in-depth analysis of contemporary strategies for the diagnosis, assessment, and treatment of left main coronary artery disease. By synthesizing current literature and addressing the evolving landscape of revascularization modalities, this review seeks to contribute valuable insights for clinicians and researchers grappling with the complexities of managing left main coronary artery disease.

Spread management priorities to limit emerald ash borer (Agrilus planipennis) impacts on United States street trees

AbstractThe invasive emerald ash borer (Agrilus planipennis) causes damage to street trees which is estimated to reach US$ 900 million over the next 30 years. Although millions of dollars are spent annually to control this species, spatiotemporal management plans are often based on rules of thumb that ignore future pest dispersal. Here, we reveal an optimal management strategy to protect urban trees in North America from A. planipennis. To achieve this, we embedded a pest dispersal model within a mixed integer programming framework. We discovered that optimized strategies consistently outperformed those based on rules of thumb, potentially resulting in the protection of an additional nearly 1 million street trees and savings of $ 629 million. Critically, the best management strategies always relied on quarantines and biological control (constituting 98–99% and 1–2% of the project budget, respectively), in contrast with current practices, where federal spending has been diverted to biological control. Our findings serve to inform future pest control efforts and can help protect many more trees from this invasive species.

Updated Markov Model to Determine Optimal Management Strategy for Patients with Paraesophageal Hernia and Symptoms, Cameron Ulcer, or Comorbid Conditions.

The current paradigm of watchful waiting (WW) in people 65 years or older with an asymptomatic paraesophageal hernia (PEH) is based on a now 20-year-old Markov analysis. Recently, we have shown that elective laparoscopic hernia repair (ELHR) provides an increase in life-years (L-Ys) compared with WW in most healthy patients aged 40 to 90 years. However, elderly patients often have comorbid conditions and may have complications from their PEH such as Cameron lesions. The aim of this study was to determine the optimal strategy, ELHR or WW, in these patients. A Markov model with updated variables was used to compare L-Ys gained with ELHR vs WW in hypothetical people with any type of PEH and symptoms, Cameron lesions, and/or comorbid conditions. In men and women aged 40 to 90 years with PEH-related symptoms and/or Cameron lesions, ELHR led to an increase in L-Ys over WW. The presence of comorbid conditions impacted life expectancy overall, but ELHR remained the preferred approach in all but 90-year-old patients with symptoms but no Cameron lesions. Using a Markov model with updated values for key variables associated with management options for patients with a PEH, we showed that life expectancy was improved with ELHR in most men and women aged 40 to 90 years, particularly in the presence of symptoms and/or Cameron lesions. Comorbid conditions increase the risk for surgery, but ELHR remained the preferred strategy in the majority of symptomatic patients. This model can be used to provide individualized management guidance for patients with a PEH.

Wastewater irrigation and Trichoderma colonization in tomato plants: effects on plant traits, antioxidant activity, and performance of the insect pest Macrosiphum euphorbiae

The scarcity of freshwater for agriculture in many regions has led to the application of sewage and saline water for irrigation. Irrigation with non-conventional water sources could become a non-harmful process for plant cultivation, and the effects of their use on crops should be monitored in order to develop optimal management strategies. One possibility to overcome potential barriers is to use biostimulants such as Trichoderma spp. fungi. Tomato is a crop of great economic importance in the world. This study investigated the joint effects of Trichoderma afroharzianum T-22 on tomato plants irrigated with simulated unconventional waters. The experiment consisted of a control and three water treatments. In the control, the plants were watered with distilled water. The three water treatments were obtained by using an irrigation water added with nitrogen, a wastewater effluent, and a mixed groundwater-wastewater effluents. Potted tomato plants (variety Bobcat) were grown in a controlled growth chamber. Antioxidant activity, susceptibility to the aphids Macrosiphum euphorbiae, and tomato plant growth parameters were estimated. Trichoderma afroharzianum T-22 had a positive effect on plant growth and antioxidant defenses when plants were irrigated with distilled water. Instead, no significant morphological effects induced by T. afroharzianum T-22 on plants were observed when unconventional water was used for irrigation. However, inoculation with T. afroharzianum T-22 activated a stress response that made the colonized plants more susceptible to aphid development and increased their fecundity and longevity. Thanks to this study, it may be possible for the first time to open a new discussion on the practical possibility of using reclaimed wastewater for crop irrigation with the addition of a growth-promoting fungal symbiont.

Flight-Path Optimization for a Hybrid-Electric Aircraft

Abstract This study aims to illustrate a sequence that optimizes the flight-path trajectory for a hybrid-electric aircraft at mission level, in addition to identifying the respective optimum power management strategy. An in-house framework for hybrid-electric propulsion system modeling is utilized. A hybrid-electric commuter aircraft serves as a virtual test-bench. Vectorized calculations, decision variable count, and optimization algorithms are considered for reducing the computational time of the framework. Performance improvements are evaluated for the aircraft's design mission profile. Total energy consumption is set as the objective function. Emphasis lies on minimizing the average value and standard deviation of the energy consumption and timeframe metrics. The best performing application decreases computational time by two orders of magnitude, while retaining equal accuracy and consistency as the original model. It is employed for creating a dataset for training an artificial neural network (ANN) against random mission patterns. The trained network is integrated into a surrogate model. The latter part of the analysis evaluates optimized mission profile characteristics with respect to energy consumption, against a benchmark flight-path. The combined optimization process decreases the multihour-scale timeframe by two orders of magnitude to a 3-min sequence. Using the novel framework, a 12% average energy consumption benefit is calculated for short, medium, and long regional missions, against equivalent benchmark profiles.

Pedigree analysis in the mhorr gazelle (Nanger dama mhorr): Genetic variability evolution of the captive population.

Breeding programs have an essential role in the recovery of threatened populations through optimal genetic management and mating strategies. The dama gazelle (Nanger dama) is a North African ungulate listed as critically endangered. The mhorr subspecies is extinct in the wild and currently survives thanks to the creation in 1971 of an ex situ breeding program. The aim of the present study was to assess the evolution of genetic variability in this mhorr gazelle captive population, as well as the mating strategy used in two reference populations studied (Almeria and Europe). The entire pedigree, with 2739 animals, was analyzed to measure demographic characters, pedigree completeness level, probability of gene origin, level of relatedness and genetic structure of the population. The population size has been progressively increasing, with up to 264 individuals alive in Europe at the time of the study. The average number of equivalent complete generations was 5.55. The effective number of founders and ancestors was both 3, and the founder genome equivalent was 1.99. The genetic contributions of the four main ancestors were unbalanced. The average values of inbreeding and average relatedness for the whole pedigree were, respectively, 28.34% and 50.14%. The effective population size was 8.7 by individual increase in inbreeding and 9.8 by individual increase in coancestry. F-statistics evidenced a very small level of population subdivision (F ST = 0.033370). The mating strategy used, based on the minimum coancestry of the individuals, has minimized the losses of genetic variability and helped to balance the genetic contributions between ancestors. The strategy also avoided large subdivisions within the population and the appearance of new bottlenecks. This study shows how pedigree analysis can both be used to determine the genetic variability of the population and to assess the influence of the mating strategy used in the breeding program on such variability.

Annual review of clinical research on extracorporeal life support in 2023

The clinical research in the field of extracorporeal life support (ECLS) in 2023 has focused on the efficacy of veno-arterial extracorporeal membrane oxygenation (ECMO) in patients with infarct-related cardiogenic shock. Additionally, the research also explored the efficacy of prone positioning during veno-venous ECMO, transfusion strategies, and the impact of obesity on outcomes. Awake veno-venous ECMO has shown novel therapeutic potential, but its optimal practice methods and management strategies remain to be determined. In in-hospital cardiac arrest patients, extracorporeal cardiopulmonary resuscitation has demonstrated higher survival rates and better neurological recovery compared to conventional cardiopulmonary resuscitation. The effectiveness of extracorporeal carbon dioxide removal varies among patients with different types of respiratory failure. Future research should focus on optimizing the application strategies and process management of ECLS technologies, investigating personalized therapy, and studying how to improve long-term rehabilitation and quality of life for survivors.