Optimal Management Research Articles

DAHEAN: A Danish nationwide study ensuring quality assurance through real-world data for suspected hereditary anemia patients

BackgroundHereditary anemias are a group of genetic diseases prevalent worldwide and pose a significant health burden on patients and societies. The clinical phenotype of hereditary anemias varies from compensated hemolysis to life-threatening anemia. They can be roughly categorized into three broad categories: hemoglobinopathies, membranopathies, and enzymopathies. Traditional therapeutic approaches like blood transfusions, iron chelation, and splenectomy are witnessing a paradigm shift with the advent of targeted treatments. However, access to these treatments remains limited due to lacking or imprecise diagnoses. The primary objective of the study is to establish accurate diagnoses for patients with hereditary anemias, enabling optimal management. As a secondary objective, the study aims to enhance our diagnostic capabilities.ResultsThe DAHEAN study is a nationwide cohort study that collects advanced phenotypic and genotypic data from patients suspected of having hereditary anemias from all pediatric and hematological departments in Denmark. The study deliberates monthly by a multidisciplinary anemia board involving experts from across Denmark. So far, fifty-seven patients have been thoroughly evaluated, and several have been given diagnoses not before seen in Denmark.ConclusionsThe DAHEAN study and infrastructure harness recent advancements in diagnostic tools to offer precise diagnoses and improved management strategies for patients with hereditary anemias.

The Practical Management of Rhinitis in Athletes.

Exercise-induced rhinitis (EIR) is a poorly understood condition that can have a massive impact within elite sport. This was epitomized in 2019 when British cyclist and Tour de France winner Chris Froome lost control of his bike at 37 mph while wiping his nose, resulting in an admission to intensive care. We aim to produce a comprehensive resource to guide the assessment and management of rhinitis in athletes. Rhinitis is a common condition which can be broadly divided into allergic rhinitis (AR) and non-AR (NAR), a subset of which is known as vasomotor rhinitis. Exercise-induced rhinitis is an important but understudied subcategory of NAR. The pathophysiology of the disease is broadly believed to be an imbalance of the sympathetic and parasympathetic nervous systems, leading to symptoms of watery rhinorrhea, nasal congestion, and paroxysmal sneezing. Up to 50% of people suffer from some degree of EIR, which impedes their nasal breathing and affects performance. The assessment of the athlete with rhinitis requires consideration of both allergic and vasomotor contributions to ensure optimal management is introduced. There is no clear guidance for the management of EIR, with uncertainty regarding the most effective pharmaceuticals and optimizing the timing of treatment to enable peak performance. N/A. N/A. N/A. N/A. Based on expert clinical experience in a busy ear, nose, and throat center and a systematic review of current literature, this article proposes a step-wise, incremental approach to the management of EIR symptoms. In an industry where marginal gains give athletes a competitive edge, optimal management of EIR is crucial.

Enhanced hybrid energy storage system combining battery and supercapacitor to extend nanosatellite lifespan

The power limitations of nanosatellites, particularly during peak demand periods such as data transmission and maneuvering, hinder their operational capabilities. Traditional Electrical Power Subsystems relying solely on batteries face challenges in delivering the necessary power density and maintaining battery life, especially during eclipses. This study proposes an innovative Hybrid Energy Storage System for a 3U nanosatellite, integrating high-energy-density batteries with high-power-density supercapacitors, using an active parallel hybrid topology with two bidirectional converters and an optimal power management strategy. Using MATLAB and Simulink models, the study optimizes the Hybrid Energy Storage System by focusing on minimizing the capacity rate and depth of discharge to extend battery life. Simulation results show a 53.42% reduction in depth of discharge compared to a battery-only system, indicating a significant extension of battery life. Additionally, the proposed system allows for a minimal 2.08% increase in overall mass while maintaining enhanced performance. This research fills a critical gap in the literature by exploring active Hybrid Energy Storage System topologies for spacecraft applications, beyond the traditional passive and semi-active configurations. The innovative power management strategy ensures efficient energy utilization, significantly enhancing the reliability and efficiency of nanosatellite missions. The findings offer a practical solution to improve mission performance and extend the operational lifespan of nanosatellites, paving the way for more robust and capable small satellite deployments.

AutistiCare: A One-Stop Centre for Parents With Autism Spectrum Disorder Children In Perlis

Individuals with Autism Spectrum Disorder (ASD) typically struggle with social communication and interaction, psychomotor, activity daily living, cognitive, as well as behavioural and intention issues. It is difficult for parents and carers of children with ASD to manage their difficulties, particularly at home and at school. This going to be worst if the parents or carers are not well-equipped with related knowledge on the ASD management. The COVID-19 pandemic situation that spread the world in 2020 has caused significant mental health challenges for parents, such as anxiety and depression, as a result of additional challenges in coping with their children in everyday life, in which the usual therapies that they received at the therapy centre must be completed at home. As a result, supporting them in managing this problem is critical to improving their psychological well-being as a continual attempt from the therapy centre to home. Society nowadays is adapted to the use of the technologies because of COVID-19 phenomena. Strong evidence suggests that online intervention is equally important with a face-to-face approach that has positive effects to autistic children and provides psychological support for the parents. However, there is a gap on the digital intervention platform according to the needs of parents for ASD management especially in Perlis society. Therefore, the purpose of this project is to invent a telehealth platform, characterized as the delivery of healthcare to patients and caregivers via the Internet. The proposed system is AutistiCare targeting parents with ASD children in Perlis that will be developed through a web-based system. The system includes various intervention modules, such as online communities, including online consultations between experts and parents, psychological support through forums, psychoeducation delivered via learning materials such as videos or modules, and service-related postings such as advertisements for ASD programs or seminars. It is envisaged at the end, the system is equipped with optimal ASD management content to support parents with autistic children in Perlis. In addition, it can be a platform to seek knowledge and assistance from the expert remotely.

Minimally invasive, maximally impactful: minimally invasive glaucoma surgery and the changing glaucoma landscape.

The advent of minimally invasive glaucoma surgery (MIGS) procedures has ushered in a new era of interventional glaucoma. MIGS has expanded the treatment options for surgeons necessitating a rethinking of the optimal management strategy for patients with glaucoma. There are several new MIGS devices and procedures available to glaucoma surgeons. With several options available, patient selection is crucial to maximize the utility of MIGS in the context of traditional glaucoma surgery. A management algorithm is presented based on our practice pattern to help guide decision-making for glaucoma surgeons. Although we encourage surgeons to continue to broaden their toolkit, we emphasize the continued importance of teaching the next-generation traditional glaucoma surgery in the MIGS era. Future prospective studies are warranted to elucidate the optimal treatment strategy for patients with glaucoma.

Subcutaneous endoscopic surgery for plicating divarication of recti and epigastric hernia repair in a child.

Epigastric hernia with divarication of recti is uncommon in children, and the aetiology remains incompletely understood - as does the optimal management strategy - whether to repair epigastric hernia alone or both defects. We present an innovative technique utilising subcutaneous endoscopic surgery to address both epigastric hernia and divarication in children. Our approach yields excellent cosmetic outcomes, avoids the need for a larger laparotomy scar and mitigates the risks associated with the transperitoneal laparoscopic approach. It is a viable option with all the advantages of minimally invasive surgery for repairing epigastric hernia and divarication of recti in symptomatic cases, particularly when the aetiology is uncertain and multiple defects are anticipated. Its use may be extrapolated to isolated diastasis recti as working in subcutaneous space involves lesser risk with excellent cosmesis.

Sequential optimal experimental design for vapor-liquid equilibrium modeling

We propose a general methodology of sequential locally optimal design of experiments for explicit or implicit nonlinear models, as they abound in chemical engineering and, in particular, in vapor-liquid equilibrium modeling. As a sequential design method, our method iteratively alternates between performing experiments, updating parameter estimates, and computing new experiments. Specifically, our sequential design method computes a whole batch of new experiments in each iteration and this batch of new experiments is designed in a two-stage locally optimal manner. In essence, this means that in every iteration the combined information content of the newly proposed experiments and of the already performed experiments is maximized. In order to solve these two-stage locally optimal design problems, a recent and efficient adaptive discretization algorithm is used. We demonstrate the benefits of the proposed methodology on the example of the parameter estimation for the non-random two-liquid model for narrow azeotropic vapor-liquid equilibria. As it turns out, our sequential optimal design method requires substantially fewer experiments than traditional factorial design to achieve the same model precision and prediction quality. Consequently, our method can contribute to a substantially reduced experimental effort in vapor-liquid equilibrium modeling and beyond.

Total neoadjuvant treatment for anal adenocarcinoma with inguinal lymph node metastasis: A case report

BackgroundMetastasis of anal adenocarcinoma to inguinal lymph nodes is a rare occurrence and published literature on the optimal management strategy for these patients is limited. Case presentationWe present a case where the use of total neoadjuvant therapy (long course concurrent chemoradiotherapy followed by chemotherapy alone), surgical resection of primary anal disease and selective inguinal lymph nodes is dissection was used to treat a male in his sixties with anal adenocarcinoma with inguinal lymph node metastasis. This was a novel approach in our centre where the management of rectal adenocarcinoma was extrapolated to treat anal adenocarcinoma. ConclusionThere is no clear guideline for management of anal adenocarcinoma with metastasis to inguinal lymph nodes. This case offers an approach for future patients with similar pathology that appears feasible in the short term 1 year follow up.

Propensity score matched comparison of transperitoneal laparoscopic ureterolithotomy and percutaneous nephrolithotomy for management of large impacted proximal ureteral stones with long-term follow-up.

Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4g/dL vs. 1.5 ± 0.7g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates.

Neonatal Riga-Fede disease: A systematic review of 84 cases collected over 120 years

Background: Traumatic ulceration of the tongue due to congenital teeth is known as Riga-Fede disease (RFD). The literature on RFD consists largely of anecdotal case reports, thereby lacking valid clinical recommendations. While managing a newborn with RFD complicated by Ludwig’s angina, this knowledge gap was recognized. Therefore, this systematic review was conducted to gain insight into the optimal management and the possible complications of RFD. Methods: A literature search was conducted using PubMed, Google Scholar, and Science Direct, supplemented with African Journals Online, Indmed, and manual searches. Papers published between 1900 and July 2023 in any language were retrieved. Neonates with natal or neonatal teeth and ulceration of the oral mucosa were included. Papers with incomplete data and review articles were excluded. Results: A total of 84 newborns with RFD from 62 published reports (including the case reported herein) were analyzed. Most of the reports were from the Indian subcontinent, and the frequency of reporting has increased since the year 2000. Tongue ulceration in all cases was due to mandibular incisors. There was no significant difference in the median duration of healing between the tooth extraction group (14 days) and the conservative management group (18 days). There was only a very weak positive correlation between the duration of symptoms and healing time, which was statistically insignificant. Conclusion: Healing of mucosal ulcers in RFD is often protracted and does not appear to be influenced by the duration of symptoms or by the modality of treatment. Extraction of the offending teeth is more common (75% of cases) than conservative management, such as grinding (ameloplasty) or resin capping of teeth. RFD is mostly a benign disorder; however, serious complications such as meningitis, Ludwig’s angina, and soft tissue abscesses can rarely occur with Staphylococcus aureus infections.

Stochastic Optimal Strategies and Management of Electric Vehicles and Microgrids

This study combines the Nash–Cournot competition model and the stochastic optimization model to examine the impact of electric vehicle (EV) quantity fluctuations on microgrid operations, aiming to optimize energy usage in a competitive electricity market. Integrating distributed energy resources and bidirectional charging, microgrids offer a novel approach for energy optimization, aiding in renewable energy generation, peak demand management, and emission reduction. Empirical evidence highlights benefits in Taiwan’s electricity market and net-zero emissions target by 2050, with a case study demonstrating enhanced local renewable energy generation due to EVs and microgrid integration. As the number of EVs increases, electricity sales from microgrids decline, but electricity purchases remain stable. The degree of electricity liberalization also influences the supply and demand dynamics of the electricity market. Microgrids selling electricity only to the main grid increases total power consumption by 65.55 million MWh, reducing the market share of the state-owned utility (Taipower). Conversely, allowing retailers to purchase from microgrids increases total consumption by 30.87 million MWh with a slight market share decrease for Taipower. This study contributes to providing an adaptable and flexible general model for future studies to modify and expand based on different scenarios and variables to shape energy and environmental policies.

Stevens–Johnson syndrome-toxic epidermal necrolysis overlap in a patient taking quetiapine and famotidine: a case report

BackgroundStevens–Johnson syndrome-toxic epidermal necrolysis (SJS-TNE) overlap is a rare skin disorder characterized by erythema, blisters, extensive exfoliation, epidermal detachment, the involvement of multiple mucosae, and positive Nikolsky’s sign. SJS-TEN has a high mortality rate. Our case involves a rare occurrence of drug-induced Stevens–Johnson syndrome-toxic epidermal necrolysis overlap with a delayed onset in the setting of quetiapine and famotidine therapy.Case presentationAn 82-year-old Taiwanese female was admitted to our hospital for decreased urine output, generalized edema, and multiple skin blisters and bedsores. With further spread of the lesions, multiple ruptured bullae with shallow erosions on the face, trunk, and limbs and mucosal involvement affected 20% of the total body surface area. Nikolsky’s sign was positive. A diagnosis of Steven–Johnson syndrome was highly suspected. One month prior, she had started famotidine and quetiapine. Intravenous methylprednisolone treatment was initiated, which ameliorated the skin lesions after 3 days. However, new lesions developed after only 1 day of methylprednisolone tapering. The patient died 12 days after admission.ConclusionStevens–Johnson syndrome-toxic epidermal necrolysis is a rare skin disorder. Although it is mainly acute and has a high mortality rate, delayed onset can still occur. Quetiapine and famotidine are generally safe and effective for treating geriatric and gastrointestinal problems, but rare drug hypersensitivity reactions can lead to debilitating consequences. Therefore, increased clinical awareness and the initiation of supportive care are imperative. Optimal management guidelines are still lacking, and confirmation of developed guidelines through randomized controlled trials is needed. Collaboration for better management strategies is warranted.

Economic and risk based optimal energy management of a multi-carrier energy system with water electrolyzing and steam methane reform technologies for hydrogen production

This paper proposes stochastic programming to optimal economic scheduling problems of a sustainable integrated energy system with renewable resources including power, natural gas, and hydrogen carriers. Hydrogen is considered a byproduct of electrical power and natural gas carriers using water electrolysis and steam methane reform process technologies. The main objective is to minimize the operation and emission costs while addressing uncertainties of electric/heating/cooling demands, electricity price, and renewable generation using scenario-based stochastic programming. To achieve a risk-hedging strategy, downside risk constraints are involved to minimize the risky scenarios portfolio. The whole problem is modeled as mixed-integer linear programming in GAMS optimization software. The analysis revealed that the expected operation cost without DRC is $ 577.52 and the expected risk-in-cost value for risky scenarios is $ 470.7. However, a conservative decision for reaching zero risk is costly and increases the expected cost up to $ 2901.1, which is not economically viable. A modest decision-making strategy compromises the cost and risk values where for decreasing the risk-in-cost to $ 288.7 (36.8%), the expected cost increased by to $1010.39 (75.95%). Moreover, the risk-averse decision-maker lowers the power sold to the grid, increases the use of water electrolyzing instead of the SMR process to reduce the environmental charges, and tries to increase flexibility with the help of hydrogen and battery storage.

Influence of Participatory Stakeholders Involvement Interventions on Performance of Commercial State Corporations in Kenya

Organizations worldwide face obstacles that hinder their ability to achieve long-term goals in change management in an optimal and sustainable manner. Failing to embrace change renders managers irrelevant in the competitive market. The success of any organization relies on the support of stakeholders. By considering the interests of various stakeholders, organizations can improve their performance. This study aimed to investigate the relationship between engaging stakeholders in the decision-making process and the success of state-owned businesses in Kenya. The researchers used a cross-sectional survey methodology and selected a sample of forty-eight commercial state enterprises through stratified random sampling. The study involved a total of one hundred and forty-four participants, including CEOs, Finance Managers, and HR Managers from each company. Survey forms were distributed to the participants in their respective institutions with the assistance of research aides to collect data. The collected data was analyzed using SPSS version 24 and Microsoft Excel. Regression models were used, and standard F and t tests were conducted for hypothesis testing. The research examined stakeholder involvement and support in three aspects: involvement in the change process, fostering positive relationships between different groups, and support from stakeholders. Factor analysis was applied to five factors. The majority of respondents agreed that involvement in the change process and support from stakeholders have a significant impact on participatory stakeholder involvement interventions. The findings revealed a significant positive relationship between involvement in the change process and performance, as well as between support from stakeholders and performance. The correlation coefficients were 0.502 and 0.580 respectively, with p-values of 0.000. The regression coefficients for participatory stakeholder involvement interventions were statistically significant at a 5% level of significance, with a coefficient of 0.632 and a p-value of 0.000. This indicates that the null hypothesis was rejected, supporting the alternative hypothesis that participatory stakeholder involvement interventions have an impact on the performance of commercial state corporations in Kenya. The research concluded that engaging stakeholders in decision-making, especially involving them in the change process and receiving their support, is closely linked to the performance of commercial state-owned companies in Kenya. Involvement in the change process showed a beneficial and direct connection with performance, while support from stakeholders also indicated a favorable association with performance. This research highlights the importance of stakeholder involvement interventions in implementing change initiatives in commercial state corporations in Kenya. It is crucial for these corporations to seek support from stakeholders when involving them in their operations, as the study revealed that stakeholder support significantly enhances organizational performance.

Risk Factors and Drug Therapy Monitoring in CKD Patients (Chronic Kidney Disease)

Chronic Kidney Disease (CKD) is a global health problem that affects millions of people, characterized by a progressive decline in kidney function. This study aims to determine Drug Related Problems (DRPs) in the treatment management of CKD (Chronic Kidney Disease) patients. This study used the literature review method. The research results from the collected literature will be summarized and presented in the form of descriptive analysis. Researchers will conduct literature searches through online sites such as Google Scholar, PubMed, ResearchGate, Elsevier, and NCBI. The keywords used are “CKD risk factors” and “drug therapy for CKD patients”. The results of the search for relevant literature will be collected and selected according to the inclusion criteria. The research results from the collected literature will be presented in the form of a descriptive table. The table will include information such as author, year of publication, article title, and summary of the study results. The prevalence of drug-related problems (DRP) in CKD patients ranges from 12% to 87%. Commonly found problems include ineffective treatment, inappropriate drug selection, and drug dosing issues. Regular drug monitoring and dose adjustment are essential to reduce adverse drug reactions and improve patient outcomes. Effective drug therapy management and patient education are essential to improve the quality of care and life of CKD patients. In conclusion, this study emphasizes the importance of identifying and addressing drug-related problems (DRPs) to improve treatment effectiveness in CKD patients. Close drug monitoring and comprehensive patient education are key components in the optimal management of CKD.

Treatment adjustment in biologic therapies for moderate-to-severe plaque psoriasis: a German retrospective chart review (TABU).

Flexible biologic therapy dosing regimens in psoriasis management are common, but data from routine care in Germany are scarce. This study evaluated treatment adjustments for biologic therapies commonly prescribed in Germany. Charts for up to 100 consecutive patients treated at 29centers were reviewed. Data were extracted for adults (aged 18-65years) with moderate-to-severe plaque psoriasis treated with adalimumab, guselkumab, ixekizumab, secukinumab, or ustekinumab for ≥36weeks. The primary endpoint was time to first treatment adjustment. Secondary endpoints included frequency of and reasons for treatment adjustments. Time to treatment adjustment was analyzed using Kaplan-Meier methods. Among 982 patients, 297 treatment adjustments in 240 (24.4%) patients were identified. The mean (median; interquartile range) time to first treatment adjustment (n=223) was 8.4 (4.0; 2.0-12.0) months (secukinumab: 14.1 [10.0; 4.0-21.0], adalimumab: 11.0 [7.0; 3.0-14.5], ustekinumab: 11.0 [6.0; 2.0-16.0], ixekizumab: 5.8 [3.0; 2.0-8.5], guselkumab: 5.1 [3.0; 2.0-7.0]). The most frequent adjustment type was starting concomitant treatment(s) (10.4% of patients); insufficient skin effectiveness was the most frequent reason for adjustment. Biological treatment adjustments are frequent in moderate-to-severe psoriasis; flexible dosing regimens would support optimal management.

SPLANDID — Optimal Sizing, PLacement, And management of centralized aNd DIstributed shareD battery energy storage systems in residential communities: Application to smart grids

This paper introduces SPLANDID, a novel techno-economic methodology for the optimal sizing, placement, and management of shared Battery Energy Storage Systems (BESSs) in residential communities that minimizes both capital and operational costs, along with energy losses within the community. To address the installation of two types of shared BESSs (i.e., single centralized BESS, multiple distributed BESSs), our methodology offers two distinct approaches: one optimizes the centralized BESS, while the other focuses on optimizing distributed BESSs. We formulate each approach as a constrained optimization problem and solve it using the particle swarm optimization (PSO) algorithm. To validate our methodology, we use real consumption and production patterns collected from households in a residential community in the United Kingdom (UK). We propose and compare three scenarios (i.e., no BESS installation, single BESS installation, and multiple BESSs installation) using various numerical metrics, such as total energy losses and total costs. Simulation results underscore the effectiveness of BESS installation, demonstrating an impressive 82.24% reduction in total costs compared to the benchmark scenario without BESS. Moreover, the installation of multiple distributed BESSs outperforms a single centralized BESS, reducing total costs and energy losses by 17.4% and 49.4%, respectively. Furthermore, the distributed installation proves efficient by decreasing the required storage capacity by 11.82% in contrast to the centralized approach. Compared to the large existing body of literature, this study contributes on several fronts. First, it explores the feasibility of installing multiple distributed shared BESSs in residential communities, departing from the dominant single centralized shared BESS installation in existing studies. The results obtained with this alternative installation strategy are highly promising from several perspectives. Secondly, our methodology is uniquely designed to base planning on actual batteries available on the market, enhancing its practical applicability in real-life scenarios. This approach contrasts with studies that often propose optimal sizes without considering the constraints imposed by the capabilities of existing batteries.

Association between glucose levels and all-cause mortality in cancer survivors: findings from NHANES 1999–2018

BackgroundHyperglycemia is a rapidly increasing risk factor for cancer mortality worldwide. However, the dose‒response relationship between glucose levels and all-cause mortality in cancer survivors is still uncertain.MethodsWe enrolled 4,491 cancer survivors (weighted population 19,465,739) from the 1999–2019 National Health and Nutrition Examination Survey (NHANES). Cancer survivors were defined based on the question of whether they had ever been diagnosed with cancer by a doctor or a health professional. Hemoglobin A1c (HbA1c) was selected in this study as a stable marker of glucose level. Mortality was ascertained by linkage to National Death Index records until December 31, 2019. Cox proportional hazard, Kaplan‒Meier survival curves and Restricted cubic spline regression models were used to evaluate the associations between HbA1c and all-cause mortality risk in cancer survivors.ResultsIn NHANES, after adjusting for confounders, HbA1c had an independent nonlinear association with increased all-cause mortality in cancer survivors (nonlinear P value < 0.05). The threshold value for HbA1c was 5.4%, and the HRs (95% CI) below and above the threshold value were 0.917 (0.856,0.983) and 1.026 (1.010,1.043), respectively. Similar associations were found between fasting glucose and all-cause mortality in cancer survivors, and the threshold value was 5.7 mmol/L.ConclusionsHbA1c was nonlinearly associated with all-cause mortality in cancer survivors, and the critical value of HbA1c in decreased mortality was 5.4%, suggesting optimal glucose management in cancer survivors may be a key to preventing premature death in cancer survivors.

State-of-the-Art Review for the American Journal of Hypertension Cardio-Rheumatology insights into hypertension: Intersection of inflammation, arteries, and heart.

There is an increased prevalence of atherosclerotic cardiovascular disease (ASCVD) in patients with inflammatory rheumatic diseases (IRD) including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, and systemic sclerosis. The mechanism for development of ASCVD in these conditions has been linked not only to a higher prevalence and undertreatment of traditional cardiovascular (CV) risk factors, but importantly to chronic inflammation and a dysregulated immune system which contribute to impaired endothelial and microvascular function, factors that may contribute to accelerated atherosclerosis. Accurate ASCVD risk stratification and optimal risk management remains challenging in this population with many barriers that include lack of validated risk calculators, the remitting and relapsing nature of underlying disease, deleterious effect of medications used to manage rheumatic diseases, multimorbidity, decreased mobility due to joint pain, and lack of clarity about who bears the responsibility of performing CV risk assessment and management (rheumatologist vs primary care provider vs cardiologist). Despite recent advances in this field, there remains significant gaps in knowledge regarding the best diagnostic and management approach. The evolving field of Cardio-Rheumatology focuses on optimization of cardiovascular care and research in this patient population through collaboration and coordination of care between rheumatologists, cardiologists, radiologists, and primary care providers. This review aims to provide an overview of current state of knowledge about ASCVD risk stratification in patients with IRD, contributing factors including effect of medications, and review of the current recommendations for cardiovascular risk management in patients with inflammatory disease with a focus on hypertension as a key risk factor.

Using green hydrogen as the supplementary fuel for a scheme of power/fresh water production: An application of AI for optimal energy management and emission reduction

The primary objective of the current research is to speed up the shift towards a carbon-neutral economy and reduce our reliance on fossil fuels by developing a novel, highly efficient, environmentally friendly, and economically feasible multi-generation system based on solar-biomass hybridization. The essential element of this concept involves the introduction of green hydrogen into the combustion chamber, aiming to enhance the quality of the incineration products and facilitate the implementation of a waste-to-power Rankine cycle. The practicality of the suggested model is compared with a system that does not incorporate hydrogen injection. As a part of artificial intelligence, a neural network model integrated with the grey wolf optimizer is applied to ascertain the most optimal energy conversion/management condition with reduced computational time. The results show that the injection of additional hydrogen exhibits superior performance compared to the base system from all facets. The optimization achieves higher exergy efficiency and drinkable water production of 8.7 % and 27.9 kg/s while reducing the total cost and emission index of 13.7 $/h and 410.7 kg/GWh. The results indicate that the combustion chamber and steam generator are the poorest parts in terms of exergy under ideal conditions. Potential future directions of this work are to explore alternate techniques for generating hydrogen and perform regional evaluations to comprehend the accessibility and fluctuation of biomass and solar resources in various geographical areas.