Paradigm Shift Research Articles

From Cogs to Connectivity: Fintech and the Industrial Revolution of Finance

This article provides an in-depth analysis of the profound impact that financial technology (Fintech) has had on the financing landscape for small and micro enterprises in China. Drawing from the insights of numerous reputable institutions and research findings, it underscores the pivotal role played by Fintech in facilitating the digital transformation of these enterprises. This transformative role encompasses a paradigm shift in credit delivery methods, heightened credit efficiency, and reduced default risks. Furthermore, the article delves into how Fintech actively fosters financial inclusion, leading to positive reforms within the financial market and enhancing the delivery of financial services. Nevertheless, the discussion does not shy away from addressing the potential technological and legal risks that accompany the rapid development of Fintech, particularly the challenges pertaining to network security and regulatory oversight. In essence, Fintech has injected newfound dynamism into China's financial sector while introducing a spectrum of prospective risks. With ongoing technological advancements and regulatory enhancements, Fintech is poised to sustain its pivotal role in China's financial landscape, propelling innovation and advancing financial services.

The initiation of a migraine associated with a specific gene responsible for regulating immune function: Hypothesis

Migraine, recognized as a pervasive global health concern, is ranked the third leading cause of disability. It continues to pose significant challenges attributable to the lack of a definitive etiology and absence of universally efficacious treatment modalities. Despite extensive research and diverse treatment approaches, such as the use of CGRP antagonists, the outcomes have not consistently met expectations. Given this context, our hypothesis introduces a novel viewpoint by suggesting potential associations between migraine and deviations in immunological irregularities, specifically emphasizing the role of FOXP3. The theory posits that mutations in FOXP3 may play a central role in the migraine puzzle, implicating Treg cells and cytokines in the pathophysiology. Supporting evidence includes observed changes in T cell subsets and cytokines in patients with migraine, highlighting the intricate interplay between genetics and immune functions. To substantiate this, the author suggests employing assays targeting immune cells, autoantibodies, and specific genetic variations, and investigating B-cell activating factors and inflammatory markers during different migraine phases. This proposed connection aligns with the observed associations between autoimmune conditions and migraine, indicating shared genetic factors. Understanding the intricate relationship between genetics and immune function in migraine could offer insights into the origin of the condition and guide personalized treatment strategies, potentially marking a paradigm shift in migraine management.

Cardiovascular Dynamics in HIV: The Influence of Adrenal Function and Nutritional Status.

This interdisciplinary review explores the intricate nexus between HIV infection, nutrition, adrenal gland function, and cardiovascular health, highlighting a critical aspect of HIV management often overlooked in current literature. With the advent of antiretroviral therapy, the life expectancy of people living with HIV has dramatically improved, transforming HIV into a manageable chronic condition. However, this success brings forth new challenges, notably an increased risk of cardiovascular diseases among people living with HIV. We examine the normal physiology of the adrenal gland, including its role in mineral metabolism, a crucial facet of nutrition. We discuss the evolution of knowledge tying adrenal pathology to cardiovascular disease. We explore the impact of HIV on adrenal gland findings from a gross pathology perspective, as well as the clinical impact of adrenal insufficiency in HIV. The review further elucidates the role of nutrition in this context, considering the double burden of undernutrition and obesity prevalent in regions heavily affected by HIV. By aggregating findings from longitudinal studies and recent clinical trials, the review presents compelling evidence of increased cardiovascular disease among people living with HIV compared with people without HIV. It highlights the critical role of the adrenal glands in regulating nutrient metabolism and its implications for cardiovascular health, drawing attention to the potential for dietary interventions and targeted therapies to mitigate these risks. This review urges a paradigm shift in the management of HIV, advocating for a holistic approach that incorporates nutritional assessment and interventions into routine HIV care to address the complex interplay between HIV, adrenal function, and cardiovascular health. Through this lens, we offer insights into novel therapeutic strategies aimed at reducing cardiovascular risk in people living with HIV, contributing to the ongoing efforts to enhance the quality of life and longevity in this population.

Analyzing Translated Research Methods Books in Social And Educational Sciences from English to Turkish: Exploring the Reasons for Translation Through Even-Zohar’s Poly-System Theory

In the last century, a paradigm shift in the scientific field has transformed our perspective on issues and events, our ability to discern cause-and-effect relationships, and our approach to them. This shift has led to radical changes in the scientific field and has accelerated the development of social and educational sciences, enabling such methods to become more prevalent than quantitative ones in the social and educational sciences. As a result, qualitative and mixed method approaches have increasingly replaced quantitative methods, giving rise to various new fields within the social sciences and providing diverse research opportunities. This evolution in research methods has also led to the proliferation of books on research methodologies in these fields. To reach a global audience, these books are predominantly written in English as the Lingua Franca and later translated into national languages if needed, or they are initially written in the native languages of the authors. The choice of translated books can be influenced by the preferences of researchers or translators, gaps in the national literature, the juvenile and unsettled nature of the national literature experiencing significant changes, or their unfamiliarity with current literary innovations. This article examines the justifications provided by translators and translation editors for translating books on research methods in social and educational sciences from English into Turkish within the framework of themes regarding the formation of poly-system theory, as coined by Itamar Even-Zohar as a functionalist pioneer in translation studies, newly emerging in social sciences in the last century. The content analysis, a qualitative research design for document analysis, was utilized in the research through using criterion sampling and maximum diversity, by selecting the prefaces of the translated versions of 20 research methods books by different authors and publishing houses between 2013 and 2022 and exclusively focusing on social sciences and educational sciences. Examining translators’ and editor’s statements deductively through the themes from the poly-system theory, we concluded that there are gaps and turning points in this field both in the national literature and in the world literature, that the relevant literature is not yet settled and trying to become primary and canonized via translated books, resulting in an increasing interest in the field.

A Paradigm Shift in Obesity Care.

Treatments are available and improving.

Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions.

Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.

Navigating the Digital Frontier: Exploring the Landscape of Digital Finance in the United States

Driven by technology innovation and digital change, the US financial environment is going through a significant transition. The exceptional accessibility and simplicity of digital finance—which encompasses fintech, bitcoin, and mobile banking—benefits both consumers and businesses. However, regulatory frameworks, consumer behavior, and cybersecurity risks come along with this paradigm shift. Through the integration of contemporary literature studies and empirical data, this study aims to present a comprehensive picture of the digital financial landscape in the United States. We evaluate the revolutionary impact of digital technologies on financial services, client preferences, emerging risks like decentralized finance (DeFi) and cybersecurity vulnerabilities, and regulatory innovations and limits using a systematic evaluation approach. Our findings underscore the multifaceted nature of digital banking and point to important trends, drivers, and stakeholder implications. We suggest enhancing regulatory coordination, fostering financial education and awareness, putting robust cybersecurity measures in place, supporting regulatory innovation, fortifying consumer protection measures, and keeping an eye on and responding to emerging risks to address the opportunities and challenges that have been identified. By putting these suggestions into practice, regulators, legislators, and business stakeholders will be able to handle the complexities of the digital banking ecosystem and fully utilize its potential to promote innovation, financial inclusion, and economic growth.

Sensory synergy and energy dynamics: unveiling the performance drivers of Chinese hotel frontline employees

ABSTRACT This study explores the relationship between sensory experiences and the energy levels of Chinese hotel frontline employees, examining the pathways through which their resource energy is activated and the underlying mechanisms. Specifically, it looks at how frontline employees in Asian hotels promote work integration through relational and collective energy. Set within the Asian hospitality sector, this research highlights the Asian paradigms – service philosophies and management styles embedded in Asian culture and values – that have made an impact on the global hospitality industry. Interviews with 35 hotel employees resulted in 35 narrative structure maps, revealing that sensory synergy and compensation can activate an interactive dynamic mechanism, facilitating the ongoing activation of energy in their daily tasks. This process advances the five critical nodes of energy activation at work. The study significantly contributes by focusing on the individual and collective values of frontline employees as they navigate and adapt to shifts in the Asian paradigm. It reveals the internal mechanism that regulates the integration and optimisation of hotel frontline employees’ energy, providing insights into improving employee well-being and performance in the hospitality industry.

Revolutionizing Organizational Decision-Making for Banking Sector: A Machine Learning Approach with CNNs in Business Intelligence and Management

This research investigates the transformative impact of deep learning, particularly Convolutional Neural Networks (CNNs) such as VGG16, ResNet50, and InceptionV3, on organizational management and business intelligence within the banking sector. Employing a comprehensive methodology, the study emphasizes the crucial role of high-quality datasets in harnessing deep learning for improved decision-making. Results reveal the superior performance of CNN models over traditional algorithms, with CNN (VGG16) achieving an impressive accuracy rate of 90%. These findings underscore the potential of deep learning in extracting valuable insights from complex data, presenting a paradigm shift in optimizing various banking processes. The article concludes by highlighting the importance of investing in infrastructure and expertise for successful CNN integration, while also addressing ethical and privacy considerations. This research contributes to the evolving discourse on deep learning applications in organizational management, offering valuable insights for banks navigating the challenges of the global market.

Ecosystem Approach in Agrivoltaic Parks Design

The approach to strategic landscape design faces today two challenges: a) the reduction of biodiversity loss b) the mitigation of the negative impact that anthropic activities have on ecosystems. As these are subject to a continuous transformation process, it is essential that the design methodology considers its underlying properties. Hence, arises the need of a profound paradigm shift: integrate better the human landscape into the natural one. To achieve this goal, it is necessary to understand first landscape dynamics as well as the mechanisms that facilitate its resilience and functionality in ecological terms. This is possible thanks to the strategic framework of the Ecological Infrastructure. The landscape proposal must evaluate then the sequence of actions to be carried out, the measures necessary for the improvement of the recognised systems, and its possible evolution over time. Then, according to the Sustainable Development Goals (SDGs), agreed by the EU 2030 biodiversity strategies, the proposal must demonstrate: How biodiversity will improve and how it will be preserved - How ecological processes linked to biodiversity will be upgraded - How cultural and social processes linked to the site will be enhanced - How agricultural and energy production will increase land efficiency - How disturbances will be modulated and controlled. This methodology carried out in Spain aims to demonstrate that the implementation of agrivoltaic fields create an optimal synergy to ensure food security and mitigate the effects of climate change, but also provide the chance to make the landscape more sustainable, efficient, and beautiful.

River flow in the near future: a global perspective in the context of a high-emission climate change scenario

Abstract. There is high confidence that global warming intensifies all components of the global water cycle. This work investigates the possible effects of global warming on river flows worldwide in the coming decades. We conducted 18 global hydrological simulations to assess how river flows are projected to change in the near future (2015–2050) compared to the recent past (1950–2014). The simulations are forced by runoff from the High Resolution Model Intercomparison Project (HighResMIP) CMIP6 global climate models (GCMs), which assume a high-emission scenario for the projections. The assessment includes estimating the signal-to-noise (S/N) ratio and the time of emergence (ToE) of all the rivers in the world. Consistently with the water cycle intensification, the hydrological simulations project a clear positive global river discharge trend from ∼2000 that emerges beyond the levels of natural variability and becomes “unfamiliar” by 2017 and “unusual” by 2033. Simulations agree that the climate change signal is dominated by strong increases in the flows of rivers originating in central Africa and South Asia and those discharging into the Arctic Ocean, partially compensated for by the reduced flow projected for Patagonian rivers. The potential implications of such changes may include more frequent floods in central African and South Asian rivers, driven by the projected magnification of the annual cycles with unprecedented peaks, a freshening of the Arctic Ocean from extra freshwater release, and limited water availability in Patagonia given the projected drier conditions of its rivers. This underscores the critical need for a paradigm shift in prioritizing water-related concerns amidst the challenges of global warming.

Unraveling the Complexity of DNA Radiation Damage Using DNA Nanotechnology.

Radiation cancer therapies use different ionizing radiation qualities that damage DNA molecules in tumor cells by a yet not completely understood plethora of mechanisms and processes. While the direct action of the radiation is significant, the byproducts of the water radiolysis, mainly secondary low-energy electrons (LEEs, <20 eV) and reactive oxygen species (ROS), can also efficiently cause DNA damage, in terms of DNA strand breakage or DNA interstrand cross-linking. As a result, these types of DNA damage evolve into mutations hindering DNA replication, leading to cancer cell death. Concomitant chemo-radiotherapy explores the addition of radiosensitizing therapeutics commonly targeting DNA, such as platinum derivatives and halogenated nucleosides, to enhance the harmful effects of ionizing radiation on the DNA molecule. Further complicating the landscape of DNA damage are secondary structures such as G-quadruplexes occurring in telomeric DNA. These structures protect DNA from radiation damage, rendering them as promising targets for new and more selective cancer radiation treatments, rather than targeting linear DNA. However, despite extensive research, there is no single paradigm approach to understanding the mysterious way in which ionizing radiation causes DNA damage. This is due to the multidisciplinary nature of the field of research, which deals with multiple levels of biological organization, from the molecular building blocks of life toward cells and organisms, as well as with complex multiscale radiation-induced effects. Also, intrinsic DNA features, such as DNA topology and specific oligonucleotide sequences, strongly influence its response to damage from ionizing radiation. In this Account, we present our studies focused on the absolute quantification of photon- and low-energy electron-induced DNA damage in strategically selected target DNA sequences. Our methodology involves using DNA origami nanostructures, specifically the Rothemund triangle, as a platform to expose DNA sequences to either low-energy electrons or vacuum-ultraviolet (VUV, <15 eV) photons and subsequent atomic force microscopy (AFM) analysis. Through this approach, the effects of the DNA sequence, incorporation of halogenated radiosensitizers, DNA topology, and the radiation quality on radiation-induced DNA strand breakage have been systematically assessed and correlated with fundamental photon- and electron-driven mechanisms underlying DNA radiation damage. At lower energies, these mechanisms include dissociative electron attachment (DEA), where electrons attach to DNA molecules causing strand breaks, and dissociative photoexcitation of DNA. Additionally, further dissociative processes such as photoionization and electron impact contribute to the complex cascade of DNA damage events induced by ionizing radiation. We expect that emerging DNA origami-based approaches will lead to a paradigm shift in research fields associated with DNA damage and suggest future directions, which can foster the development of technological applications in nanomedicine, e.g., optimized cancer treatments or the molecular design of optimized radiosensitizing therapeutics.

Prospects and Challenges of ELT at a Glance

English has been utilized for more than 150 years as the primary language of instruction, evaluation system, and subject matter to be taught and learned, or both, covering a broad variety of subjects from early childhood to higher education (Khadka, 2022). This paper uses the qualitative method, relying on secondary sources of data. An overview of teaching English in Nepal is provided in this article. It makes an effort to investigate how teaching and learning languages are situational. The study aims to discuss Nepal's ELT paradigm shift along with societal inequality and disparity, which lead to difficulties in English language instruction in Nepal. How an English language education practitioner would address those challenges is covered in the paper's conclusion.

#1491 Management of immune thrombotic thrombocytopenic purpura without therapeutic plasma exchange

Abstract Background and Aims Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening autoimmune disorder caused by ADAMTS13 deficiency. The anti-VWF nanobody Caplacizumab is approved for iTTP treatment, reducing the need for therapeutic plasma exchange (TPE) and improving platelet recovery and survival. This study evaluates the treatment of acute iTTP with caplacizumab and immunosuppression, but without TPE, in comparison to the conventional management with TPE, caplacizumab and immunosuppression. Method All patients in this study were identified from the Austrian Thrombotic Microangiopathy Registry (ATMAR) and the German REACT-2020 TTP registry (ClinicalTrials.gov identifier: NCT04985318). A total of 42 acute iTTP episodes in 41 patients were managed with a treatment regimen aimed at avoiding first-line TPE if the platelet count increased after the first dose of 10 mg caplacizumab, and the patient's condition and organ function remained stable (TPE-free cohort). This treatment modification was implemented based on shared decision making. An extensive efficacy and safety analysis of this approach was performed, in comparison with a control group of 59 iTTP patients, receiving frontline caplacizumab treatment with TPE and immunosuppression (TPE cohort). The main outcome was time to platelet count normalization. Secondary outcomes included clinical response, exacerbation, refractoriness, and iTTP-related deaths. Results The primary outcome parameter, time to platelet count normalization, was not significantly different between TPE-free and TPE-based management (Kaplan-Meier estimator and log-rank test, Table 1 and Fig. 1). The median time to platelet count normalization was 3 days in the TPE-free cohort and 4 days in the TPE cohort. There were no significant differences in clinical response, exacerbations, refractoriness, or iTTP-related deaths. For evaluation of the short-term treatment response, both cohorts were assessed for the time to platelet count doubling. The median time to platelet count doubling was 1 day in both cohorts. Four patients in the TPE-free cohort did not immediately respond to the first caplacizumab injection and subsequently underwent TPE, after a maximum monitoring period of 40 hours. In these patients, TPE was initiated at a median of 1.5 days after the first caplacizumab dose, and TPE was performed for a median of 4.5 days. This delayed platelet response could be attributed to concomitant diseases and factors, e.g. active HIV and hepatitis B virus coinfection, active CMV infection, concomitant antiplatelet antibodies in association with an ovarian teratoma, and multiple platelet transfusions before the correct diagnosis. During overall follow-up, complications were observed in 11 patients (26.2%) in the TPE-free group and 16 patients (27.1%) in the TPE group, excluding complications of iTTP that were evaluated as outcome parameters. Serious complications occurred in 4 patients (6.8%) from the TPE cohort while on TPE, including severe systemic anaphylactic reactions with severe hypotension, generalized seizure and supraventricular tachycardia. Bleeding complications were reported without a significant difference between groups. Conclusion For the first time since the introduction of TPE in the early 1990s, the results of our study systematically challenge the absolute need for TPE and suggest a paradigm shift in acute iTTP management. In detail, our treatment approach was successfully implemented in 38 of 42 acute iTTP episodes (90.5%). We observed no significant difference in the time to platelet count normalization between patients with iTTP treated with and without TPE. The analysis of key secondary outcomes did not reveal significant differences in the proportion of patients who achieved a clinical response or experienced exacerbations, refractoriness, or TTP-related deaths. In conclusion, Caplacizumab and immunosuppression, without TPE, rapidly controlled microvascular thrombosis and achieved a sustained clinical response in iTTP.

Scientific Discovery at the Press of a Button: Navigating Emerging Cloud Laboratory Technology

AbstractThe “cloud lab,” an automated laboratory that allows researchers to program and conduct physical experiments remotely, represents a paradigm shift in scientific practice. This shift from wet‐lab research as a primarily manual enterprise to one more akin to programming bears incredible promise by democratizing a completely new level of automation and its advantages to the scientific community. Moreover, they provide a foundation on which automated science driven by artificial intelligence (A.I.) can be built upon and thereby resolve limitations in scope and accessibility that current systems face. With a focus on DNA nanotechnology, the authors have had the opportunity to explore and apply the cloud lab to active research. This perspective delves into the future potential of cloud labs in accelerating scientific research and broadening access to automation. The challenges associated with the technology in its current state are further explored, including difficulties in experimental troubleshooting, the limited applicability of its parallelization in an academic setting, as well as the potential reduction in experimental flexibility associated with the approach.

Systematic Review of Utilized Ports in Laparoscopic Cholecystectomy: Pushing the Boundaries.

Surgical procedures have undergone a paradigm shift in the last 3 decades, with minimally invasive surgery becoming standard of care for a number of surgeries, including the treatment of benign gallbladder diseases. By providing a thorough and impartial summary of the earlier published systematic reviews, the current systematic review is the first to present comparison results. This review illustrates the data of intraoperative and postoperative results of each laparoscopic cholecystectomy technique. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was meticulously followed to conduct the present systematic review. MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, and Web of Science were searched for eligible publications, and a total of 14 systematic reviews were included. A newly developed extraction table was utilized to obtain the predefined parameters from eligible systematic reviews, including operative time, conversion rate, estimated blood loss, bile leak, length of hospital stay, postoperative pain, and cosmetic results. All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) software, version 26.0. The analysis of dichotomous results was summarized using relative risks and 95% confidence intervals (95% CI), and continuous results were summarized using mean differences and 95% CIs. The proportions were compared using a single proportion z-test. The analysis of our primary and secondary outcomes revealed a statistically significant improvement in aesthetic results after single-incision laparoscopic cholecystectomy (SILC) in comparison to the multiport approach of laparoscopic cholecystectomy. This, however, is accompanied by extended operative timing and subsequently, prolonged exposure to anesthesia. Patients should be carefully selected for SILC to minimize technical difficulties and prevent complications both intraoperatively and shortly after the procedure. This trial is registered with CRD42023392037.

Impact of Indian Accounting Standards (IND AS) on Financial Statements

The adoption and implementation of accounting standards play a pivotal role in shaping the financial reporting landscape of a country, influencing how businesses communicate their financial performance and position to stakeholders. In the case of India, the transition from Generally Accepted Accounting Principles (GAAP) to Indian Accounting Standards (Ind-AS) marked a significant paradigm shift in the accounting framework. The move was aimed at aligning Indian accounting practices with global standards, fostering transparency, comparability, and international investment. Historically, India had been following its own set of accounting standards, which sometimes diverged from international norms, leading to challenges in cross-border financial analysis and investment decisions. Recognizing the need for convergence with International Financial Reporting Standards (IFRS), the Ministry of Corporate Affairs (MCA) in India mandated the adoption of Ind-AS for certain classes of companies, primarily listed entities and large unlisted companies. The adoption of Ind-AS was a phased process, with the first set of companies transitioning in the financial year 2016-17. The primary objective was to enhance the quality and reliability of financial reporting, making it more comparable and relevant on a global scale. Ind-AS aimed to bring about consistency in accounting treatments, disclosures, and presentation of financial statements, fostering a more transparent and investor-friendly environment. One of the key motivations behind the shift to Ind-AS was to facilitate easier access to global capital markets for Indian companies. By adhering to internationally recognized accounting standards, Indian businesses sought to attract foreign investment and broaden their investor base. This move was particularly crucial as India aimed to position itself as a global economic player, attracting multinational corporations and fostering cross-border investments. The implementation of Ind-AS introduced changes in various aspects of financial reporting, affecting balance sheets, income statements, and disclosure practices. Companies faced the challenge of adapting to new measurement criteria, recognition principles, and disclosure requirements. The impact of these changes extended beyond mere compliance; it influenced how companies assessed their assets, liabilities, and overall financial performance. Additionally, the adoption of Ind-AS prompted companies to reevaluate their internal control mechanisms, financial policies, and governance structures. The transition required a robust framework for training and educating financial professionals, auditors, and other stakeholders to ensure a smooth and accurate implementation of the new standards.

Virtual Digital Metaverse Chartered Accountant

A globally renowned financial expert that oversees customers' budgets, audits, taxes, and company strategy is a chartered accountant. You can work for companies, the government, or private citizens as a CA Assisting clients with money management and offering professional financial advice are your duties. For the accounting sector, the emergence of virtual reality (VR) and the metaverse offers an exciting opportunity. Modern technologies like blockchain, artificial intelligence (AI), and data analytics, which come together to form a virtual environment that reimagines the function of the accountant, are the foundation of this paradigm shift. Virtual Digital Metaverse Chartered Accountant is what we're working on. By using artificial intelligence (AI), one may automate repetitive processes related to financial reporting, taxation, predictive analytics, business intelligence, and automation of regular tasks. Chartered accountants are becoming increasingly important to the growth and recovery of the Indian economy. They guarantee honest, ethical trade and commercial practices, support the smooth operation of businesses and organizations, and apply their financial know-how to different economic and financial initiatives aimed at improving the country. They are therefore crucial to boosting the economy. Forecasting the budget, tax audits, creating monthly financial reports, capital planning, tax planning, and other duties are all part of the CA's job description. Additionally, since the GST was implemented, their function has grown stronger and more significant

Towards Sustainable Urban Futures: Integrating a Novel Grey Multi-Criteria Decision Making Model for Optimal Pedestrian Walkway Site Selection

Today, urban development faces complex global challenges that require new approaches to influence its practices and policies. By prioritizing sustainability, mobility, and community resilience, we are moving towards a holistic approach that protects the well-being of residents and the environment. In this dynamic urban design environment, finding ways to identify pedestrian-friendly spaces and create safe, efficient, and sustainable urban environments is a major challenge, and it requires research that seeks to optimize this choice, especially in terms of integrating numerical modeling methods and a wide range of measurement tasks. This research is concerned with optimizing pedestrian accessibility, which directly contributes to reducing environmental impact, improving non-motorized transport, and reducing traffic congestion. It integrates a novel, mixed multi-criteria decision-making (MCDM) model that benefits from the use of Grey’s theory. This research’s purpose goes beyond addressing cities’ immediate challenges; it seeks to contribute to a broader understanding of sustainable urban planning. This study represents a pioneering effort to identify the challenges of optimal site selection for pedestrian walkways. By using a multi-criteria decision-making approach based on mathematical modelling and facility engineering, this effort addresses gaps in the current understanding of site selection criteria and aims to lead a paradigm shift toward a sustainable, efficient, and inclusive urban environment. The results show that the updated RANCOM-PIV greyscale is quite robust and reliable, when comparing the final results of the PIV greyscale and the MARCOS greyscale.

#487 Treating chronic kidney disease in Danish primary care: results from the observational ATLAS study

Abstract Background and Aims Little is known about the clinical characteristics and medical treatment of individuals with chronic Kidney Disease (CKD) in primary care clinics, including uptake of cardio-renoprotective treatments like renin-angiotensin-system inhibitors (RASi) and sodium glucose co-transporter 2 inhibitors (SGLT2i). Therefore, the aim of this study were to describe the clinical characteristics, comorbidity, and medical treatment in the primary care population with decreased estimated glomerular filtration rate (eGFR) and albuminuria. Additionally, to examine the awareness and habits of primary care physicians (PCP) in regard to CKD and treatment patterns in this high-risk patient population. Method An observational study of current CKD prevalence, treatment patterns and comorbidities in primary care based on patient record data, Data was drawn from 128/211 randomly invited primary care clinics throughout Denmark. A computerized selection identified 12 random individuals with CKD per clinic with ≥2 measurements of eGFR &amp;lt;60 mL/min/1.73 m2 or UACR &amp;gt;30 mg/g within two years. Pre-specified data collected from individual electronic health records included demographics, clinical variables, comorbidities, and relevant prescribed medications. Our analyses was strengthened by 125/128 PCP completing a questionnaire with responses regarding diagnosis, management and treatment of impaired kidney function in a real-world, primary care setting. Results Of the identified CKD study population (N = 1497), 80% had hypertension, 32% diabetes (DM), 13% heart failure (HF), 59% no DM/HF. RASi were prescribed to 65%, statins to 56%, SGTL2is to 14%, and MRAs to 8% of all individuals. Treatment patterns differed between individuals with varying comorbidities, e.g., RASi usage was higher in DM (76%) or HF (74%) vs. no DM/HF (58%), as was statin usage (76% in DM vs. 45% in no DM/HF). SGTL2i usage in CKD without DM/HF was low. Questionnaire results showed that most PCPs identified CKD using threshold eGFR &amp;lt;60 mL/min/1.73 m2 (62%) or UACR &amp;gt;30 mg/g (58%) and 62% reported initiating treatment to retard kidney function decline. 53% of PCPs reported using SGLT2is as second-line treatment for CKD. 38% of PCPs often spoke to patients with an eGFR &amp;lt;60 mL/min/1.73 m2 as having CKD, whilst 38% reported rarely doing so and 19% never did so. The voluntary nature of PCP study participation (accepting an invitation to participate) may have generated bias towards those with an interest in CKD. Conclusion Despite good PCP awareness and wish to use relevant guidelines, a gap exists in implementation of cardio-renoprotective treatment, especially in individuals without DM or HF. Data from both patient files and questionnaires emphasizes a need for clear recommendations to PCPs to optimize early cardio-renal protection in individuals with CKD. Applying the same systematic screening as in individuals with DM to non-diabetic populations could offer a paradigm shift for the identification, diagnosis and monitoring of CKD. Boehringer Ingelheim supported this study, but had no role in the design, analysis or interpretation of the results.