Preemptive Management Research Articles

Correlative study to assess the predictive power of the ICOS HF calculator in the prediction of development of HER-2 antagonist induced cardiac dysfunction in a single center in Saudi Arabia in 2023

Abstract Background Over the past 3 decades, there has been a significant increase in cancer survivors supported by the major advances in cancer therapies. However, most of those therapies are cardio-toxic. In 2022, the European Society of cardiology had published, for the first time, a clinical guideline that describes how to manage this cohort of patients, and endorsed the utilization of a risk calculator to predictor likelihood of development of cancer therapy cardiac dysfunction (CRTCD). We did retrospective review of all consecutive patients that have received Trstuzumab (HER-2 antagonist) in the year 2023 in a single tertiary cardiac center. We assessed their demographics and co-morbidities, incidence of CRTCD, evaluated their ICOS-HF score and looked for any CRTCD in this cohort to assess whether the calculated stratification correlated with development of CRTCD. The objective is to assess the utilization of this tool in our patient population. Methods 369 unique individuals were identified from the hospital databas that had received HER-2 antagonists. Basic patient demographics were extracted from the information system along with their clinical, laboratory, and echocardiographic data. Their risk profiles were stratified using the ICOS-HF calculator. Follow up echocardiogrphic studies were reviewed to assess the incidence of CRTCD in patients receiving HER-2 antagonists and the correlation between the risk strata using the ICOS-HF and actual development of CRTCD. Results The average age was 53+/- 11 years. 96.8% were females. At baseline, 20% were diabetic, 26.8% were hypertensive, 10.8% were dyslipidemic, 1.9% had prior cardiomyopathy or heart failure, 1.3% had IHD, 1.1% were smoker, 33.3% were obese, and 3.8% had CKD. Overall, in the year 2023, the incidence of HER-2 induced cardiac dysfunction was 10.6%. At baseline, using the ICOS-HF calculator, 57.9% were stratified as low risk, 21% as moderate risk 14.6% as high risk, and 6.5% as very high risk. Approximately 5% of the patients with low to moderate risk developed CRTCD, which rose to 18.5% in the high risk, and significantly rose to 58% in the very high risk population. Conclusion The risk stratification using the ICOS-HF calculator in consecutive patients receiving Trastuzumab correlated directly with the likelihood of developing CRTCD. 58% of all of the patients in the very high risk category developed CRTCD. This retrospective analysis validates the use of this tool in our patient population and will aid in the identification of patients that would require to have a more aggressive preemptive management, especially in the high and very high risk population using a multidisciplinary cardio-oncology team to optimize their surveillance and reduce their likelihood of cardiac dysfunction.

Impact of atrial fibrillation on progression of tricuspid regurgitation in patients undergoing transcatheter aortic valve replacement

Abstract Background Recent advancements in interventional cardiology have spurred growing interest in atrial tricuspid regurgitation (TR) as a potential therapeutic target. Atrial TR, a form of secondary TR, arises from the dilatation and dysfunction of the right atrium, frequently seen in the context of atrial fibrillation (AF). While the concept is increasingly recognized, the natural history of TR in relation to AF remains incompletely understood. Purpose This study aims to elucidate the impact of AF on the progression of TR in patients undergoing transcatheter aortic valve replacement (TAVR). Methods Utilizing data from a comprehensive single-center TAVR registry, this study included patients who underwent TAVR between 2016 and 2023, excluding those with severe TR post-TAVR. Subjects were categorized based on the presence or absence of paroxysmal or persistent/permanent AF/atrial flutter (AFL). The study employed the cumulative incidence function to depict the progression to severe TR, considering all-cause mortality as a competing risk. Results Among 981 eligible patients, 169 (17.2%) presented with AF/AFL, with 57 (5.8%) having persistent/permanent and 112 (11.4%) paroxysmal forms. Patients with AF/AFL had a higher surgical risk, a higher prevalence of significant mitral regurgitation and TR, and a lower left ventricular ejection fraction. The median follow-up period was 366 days, with an interquartile range from 36 to 1079 days. Over a 5-year period, 11.7% of patients with AF/AFL experienced progression to severe TR, with 14.2% in those with persistent/permanent AF/AFL and 10.6% in those with paroxysmal AF/AFL, compared to merely 0.8% in patients without AF/AFL (sub-distribution HR: 7.60, 95%CI: 2.86-20.0; P<0.001) (Figure 1). Multivariable Fine-Gray regression analysis showed that AF/AFL was associated with the progression of TR by at least one grade, independently of the TR grade post-TAVR and other echocardiographic parameters (sub-distribution HR: 1.38, 95% CI: 1.06-1.78; p=0.015). Other factors associated with progression included the TR grade post-TAVR (sub-distribution HR: 1.20, 95% CI: 1.05-1.38; p=0.009) and the presence of a permanent pacemaker (sub-distribution HR: 1.53, 95% CI: 1.18-1.71; p=0.001) (Figure 2). Conclusions The presence of AF/AFL significantly increases the risk of developing severe TR in the long-term following TAVR, underscoring the need for vigilant monitoring and potentially preemptive management strategies in this patient cohort.

Activity Concentration of Natural Radionuclides in Surface Sediments of Major River Watersheds in Korea and Assessment of Radiological Hazards

The assessment of potential radiation hazards in accumulated sediments in aquatic ecosystems is vital for the management and disposal of sediments. Furthermore, preemptive management of radionuclides in terrestrial ecosystems is critical for marine ecosystem conservation. We analyzed the activity concentrations of natural radionuclides (226Ra,232Th, 238U, and 40K) in the surface sediments of major river watersheds in Korea and evaluated the radiation hazards stemming from these activity concentrations. The mean activity concentrations of 226Ra and 238U were lower than the global average, whereas those of 232Th and 40K were higher. The mean values of radium equivalent activity, external hazard index, and internal hazard index calculated from these activity concentrations did not exceed the recommended maximum values. The mean values of absorbed gamma dose rate in air and annual outdoor effective dose rate (AEDRout) were higher than the global average by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) but remarkably lower than the recommended and background values by the International Commission on Radiological Protection (ICRP) and the Korea Institute of Nuclear Safety (KINS). The contribution of 40K and 232Th to the AEDRout mean value was predominant. In conclusion, the surface sediments of major river watersheds in Korea are associated with negligible radiation hazards. These findings provide fundamental data for the management and treatment of sediments in terrestrial and marine ecosystems.

A Review of the Concurrent Incidence and Evidence for Dysphagia and Constipation in Acute Stroke Patients

Abstract Background Dysphagia post-acute stroke is a commonly reported complication. It can effect up to 80% of the post stroke population (Banda et al., 2022). Constipation is a well-recognised complication in all hospital admissions. The cause of which is thought of as multifactorial, change in diet and fluid intake, reduced mobility, change in routine etc. A scoping review has found that despite both conditions being prevalent in a stroke population, their concurrent incidence has not been studied or reported. Methods A scoping literature review was carried out to investigate the incidence of these conditions concurrently in stroke. Databases used were CINAHL, EMBASE and MEDLINE. Inclusion criteria for the review included 1) Stroke population over 18 years 2) published in English 3) any measure taken of constipation. Opinion pieces and non-peer reviewed papers were excluded. An audit of our current inpatient cohort on the stroke unit was also carried out to identify if these concurrent conditions are being documented and acted upon. Results The literature review resulted in an empty review. There was no clearly defined literature that reported on the concurrent incidence of dysphagia and constipation in an acute stroke population. The supportive audit on the ward included 29 patients on the inpatient acute stroke unit. 2 of 29 had documented constipation, while 21 of 29 (72%) patients were prescribed laxatives. 15 of 29 (51.7%) had been commenced on a modified diet by speech and language therapy secondary to dysphagia. Conclusion Dysphagia and constipation have been identified as common post stroke complications. 72% of the inpatient cohort have been commenced on laxatives, this indicates the recognition and pre-emptive management off this prevalent complication. Dysphagia was documented in over 50% of patients. Continued research needs to be carried out on the concurrent incidence and management of these post stroke complications.

On the calibration and improvement of human mobility models in intercity transportation system

As one of the research highlights of physics-level modelling, human mobility has generated numerous universal laws over the past decades. However, the majority of research has concentrated on the intracity networks, leaving the intercity mobility systems with insufficient attention despite its increasingly crucial role in the development of urban agglomerations. Related research gaps further extend to the limited understanding of spatiotemporal heterogeneity in intercity human mobility. To bridge these gaps, our study systematically validated and improved the modelling framework of intercity mobility flows utilizing real-world data sources. Specifically, building upon the nationwide Location-based Services (LBS) datasets in China, the applicability of classic human mobility models, including gravity model and intervening opportunities-class models, was extensively explored in the intercity domain by developing fitting models that incorporated multi-class urban attributes. Then, we contributed to proposing improved models that consider the diverse attraction effect of the origin and potential destinations. Moreover, our research scope was expanded to incorporate spatiotemporal heterogeneity through model comparisons among various city sets during both regular period and holiday. The findings suggested that our improved models effectively enhance the modelling accuracy while strengthening the explanatory power. They especially demonstrate a balanced performance even when handling datasets with spatiotemporal heterogeneity. Consequently, this study provides valuable insights into understanding intercity human mobility from the intrinsic mechanism of opportunity attraction. Our models hold practical significance in accurately modelling intercity mobility flows utilizing observable urban attributes and spatial layouts, further providing effective tools for preemptive traffic management.

Islamic Banks Stability in Indonesia: Assesing the Role of Islamicity Performance Amidst the Pandemic Challenges

Research Originality: Islamicity performance reflects adherence to Sharia principles, which are fundamental to Islamic banking operations. Research that emphasizes the contribution of Islamicity performance to the stability of Islamic bank requires additional studies.Research Objectives: This research examines the influence of banks’ internal factors, Islamicity performance, and macroeconomic factors on the Islamic bank stability amidst the pandemic challenges using financial intermediation theory.Research Methods:A random effects test was performed on a balanced panel data covering the period of 2017.1-2023.3 on 10 Islamic banks continuously publishing quarterly financial reports.Empirical Results: Credit risk and eficiency affect stability. Higher expenses enhance stability during pandemic. Reserves for uncollectible debt reduce stability. Islamicity performance in profit-sharing financing may reduce stability. Economic growth and inflation negatively affect stability pre-pandemic. Interest rate and dummy variables have positive effects.Implications: These findings imply the significance of preemptive risk management, cost-effective operations, prudent reserves allocation, and regulatory compliance to enhance stability in Islamic bank across varying economic circumstances.JEL Classification: E4, G21, B22How to Cite:Amaroh, S., Masykuroh, E., Husnurrosyidah., & Ali, M., (2024). Islamic Banks Stability in Indonesia: Assesing the Role of Islamicity Performance Amidst the Pandemic Challenges. Etikonomi, 23(2), 317 – 332. https://doi.org/10.15408/etk.v23i2.37269.

New insights into mycotoxin risk management through fungal population genetics and genomics.

Mycotoxin contamination of food and feed is a major global concern. Chronic or acute dietary exposure to contaminated food and feed can negatively affect both human and animal health. Contamination occurs through plant infection by toxigenic fungi, primarily Aspergillus and Fusarium spp., either before or after harvest. Despite the application of various management strategies, controlling these pathogens remains a major challenge primarily because of their ability to adapt to environmental changes and selection pressures. Understanding the genetic structure of plant pathogen populations is pivotal for gaining new insights into their biology and epidemiology, as well as for understanding the mechanisms behind their adaptability. Such deeper understanding is crucial for developing effective and preemptive management strategies tailored to the evolving nature of pathogenic populations. This review focuses on the population-level variations within the two most economically significant toxigenic fungal genera according to space, host, and pathogenicity. Outcomes in terms of migration patterns, gene flow within populations, mating abilities, and the potential for host jumps are examined. We also discuss effective yet often underutilized applications of population genetics and genomics to address practical challenges in the epidemiology and disease control of toxigenic fungi.

Forecasting the architecture billings index (ABI) using machine learning predictive models

PurposeThis research aims to forecast the ABI as a leading indicator of U.S. construction activities, applying multivariate machine learning predictive models over different horizons and utilizing the nonlinear and long-term dependencies between the ABI and macroeconomic and construction market variables. To assess the applicability of the machine learning models, six multivariate machine learning predictive models were developed considering the relationships between the ABI and other construction market and macroeconomic variables. The forecasting performances of the developed predictive models were evaluated in different forecasting scenarios, such as short-term, medium-term, and long-term horizons comparable to the actual timelines of construction projects.Design/methodology/approachThe architecture billings index (ABI) as a macroeconomic indicator is published monthly by the American Institute of Architects (AIA) to evaluate business conditions and track construction market movements. The current research developed multivariate machine learning models to forecast ABI data for different time horizons. Different macroeconomic and construction market variables, including Gross Domestic Product (GDP), Total Nonresidential Construction Spending, Project Inquiries, and Design Contracts data were considered for predicting future ABI values. The forecasting accuracies of the machine learning models were validated and compared using the short-term (one-year-ahead), medium-term (three-year-ahead), and long-term (five-year-ahead) ABI testing datasets.FindingsThe experimental results show that Long Short Term Memory (LSTM) provides the highest accuracy among the machine learning and traditional time-series forecasting models such as Vector Error Correction Model (VECM) or seasonal ARIMA in forecasting the ABIs over all the forecasting horizons. This is because of the strengths of LSTM for forecasting temporal time series by solving vanishing or exploding gradient problems and learning long-term dependencies in sequential ABI time series. The findings of this research highlight the applicability of machine learning predictive models for forecasting the ABI as a leading indicator of construction activities, business conditions, and market movements.Practical implicationsThe architecture, engineering, and construction (AEC) industry practitioners, investment groups, media outlets, and business leaders refer to ABI as a macroeconomic indicator to evaluate business conditions and track construction market movements. It is crucial to forecast the ABI accurately for strategic planning and preemptive risk management in fluctuating AEC business cycles. For example, cost estimators and engineers who forecast the ABI to predict future demand for architectural services and construction activities can prepare and price their bids more strategically to avoid a bid loss or profit loss.Originality/valueThe ABI data have been forecasted and modeled using linear time series models. However, linear time series models often fail to capture nonlinear patterns, interactions, and dependencies among variables, which can be handled by machine learning models in a more flexible manner. Despite the strength of machine learning models to capture nonlinear patterns and relationships between variables, the applicability and forecasting performance of multivariate machine learning models have not been investigated for ABI forecasting problems. This research first attempted to forecast ABI data for different time horizons using multivariate machine learning predictive models using different macroeconomic and construction market variables.

Toward a more pre-emptive approach to managing work emotions and emotional labor

PurposeTo propound a broadened perspective on emotional labor management by exploring mitigatory approaches that could be pre-emptively deployed prior to actual episodic experiences of emotional dissonance and their associated negative consequences (e.g. burnout). At present, the management of emotional labor appears to skew toward reactive measures, such as deploying employee assistance programs (EAPs) to assist overwhelmed employees in coping better with their emotional demands, reducing job-related emotional demands or a combination of both.Design/methodology/approachIntricate processes of emotion emergence and established literature on emotion regulation are considered. By conceptualizing emotion emergence as a process entailing situation, attention, appraisal and response, current efforts can be seen as primarily acting upon the late stages of this process. General emotion regulation strategies that act upon more upstream processes are then considered and applied to the specific context of emotional labor.FindingsPre-emptive steps could be taken from the early stages of job selection as well as personnel selection and assessment through systematic and concerted efforts in identifying job-related emotional demands (e.g. specific display rules, frequency and intensity). Formal job descriptions could then reflect these demands to better facilitate self-selection processes. Additionally, considering these identified parameters as personnel selection and assessment criteria could further enhance person-job fit in terms of emotional congruency. For current hires, pre-emptive steps could also be taken to subliminally modulate their emotional emergence trajectory toward more job-congruent emotions. Collectively, these steps may facilitate the pre-emptive reduction of emotionally dissonant work episodes and bear substantive potential to be deployed synergistically with current, more reactive measures.Originality/valueThis paper offers a broadened perspective on emotional labor management. Through considering intricate processes of emotion emergence and established literature on emotion regulation, a pre-emptive perspective toward managing work emotions and emotional labor is propounded. It is believed that the synergistic incorporation of these pre-emptive management approaches with current strategies (e.g. reducing emotional demands, EAPs, etc.) would holistically allow for greater amelioration of this debilitating issue. Finally, it is hoped that this paper could serve as a primer for future research and discourses to be conducted, such that our arsenal available for combating emotional labor could be substantively expanded to holistically target all stages of the emotion emergence process.

Preemptive airway management planning: A retrospective evaluation of the pediatric difficult airway consultation service.

The pediatric Difficult Airway Consultation Service (pDACS) was created in 2017 to identify patients with potentially difficult airways and create airway management plans prior to airway management. Consults were either nurse-initiated, physician-initiated, or both nurse-and-physician-initiated and were examined for demographic and clinical factors. If a child had difficult airway risk factors, a consult note with airway management recommendations was completed. We included 419 consults from the 4-year study period for analysis. Sixty-one patients had chronic tracheostomies in place and thus, were analyzed separately. Of the remaining 358 consults, 50% (n = 179) were nurse-initiated, 30.2% (n = 108) physician-initiated, and 19.8% (n = 71) nurse-and-physician-initiated consults. Differences in observed frequency of airway edema (difference, 6.3%; 95%CI 0.1%-12.5%; p = .04), cleft lip/palate (difference, 8.1%; 95%CI 0.07%-16.3%, p = .04), craniofacial abnormalities (difference, 12.3%; 95%CI 1.9%-22.7%, p = .02), and trauma/burn (difference, 6.5%; 95%CI 0.09%-12.8%, p = .04) were calculated. Observed frequencies were higher in physician-initiated compared to nurse-initiated consults. Airway edema was also more prevalent in dual nurse-and-physician-initiated consults (difference, 8.7%; 95%CI 1.6%-15.8%; p = .01). Physician-initiated consults were associated with a greater proportion of high-risk difficult airways than nurse-initiated consults (difference, 26.7%; 95%CI 14.0%-39.4%, p < .001). Approximately 41.9% of patients at high-risk for having a difficult airway were identified by nurse-screening only. Using bag-valve-mask was often the primary ventilation recommendation (89.3%, n = 108) and supraglottic airway placement was the most common tertiary plan (74.2%, n = 83). Direct laryngoscopy (47.1%, n = 65) and videolaryngoscopy (40.6%, n = 56) were the most recommended modes of intubation. Three patients with airway emergencies had previously documented airway management plans and were successfully intubated without complications following the primary intubation technique recommended in their consult note. In our study, nurse-screening identified patients at high-risk for a difficult airway that would likely not have been identified prior to initiation of a screening protocol. Furthermore, airway management plans outlined prior to an emergent difficult airway event may increase first-attempt success at securing the difficult airway, reducing morbidity and mortality.

Agricultural Drought-Triggering for Anticipatory Action in Papua New Guinea

Throughout its history, Papua New Guinea (PNG) has faced recurrent agricultural droughts, imposing considerable strain on both livelihoods and the economy. Particularly severe droughts have been associated with El Niño climate patterns. During these episodes, PNG becomes especially vulnerable to extended periods of aridity and diminished precipitation. Historically, humanitarian assistance for these events has primarily focused on responding to emergencies after an agricultural drought has been declared and communities have already been impacted. Here, we developed a proactive agricultural drought-triggering method for anticipatory action (AA) in PNG to offer a more sustainable and cost-effective approach to address this hazard. Our AA uses weather forecasts and risk data to identify and implement mitigative actions before a disaster occurs. The research details a step-by-step guide from early warning to action implemented by the Food and Agricultural Organization of the United Nations and the Government of Papua New Guinea. This preemptive disaster risk management initiative integrates a combined drought index (CDI) with specific thresholds and tailored anticipatory actions based on crop calendars. Moreover, the developed CDI provides a 3-month lead time for implementing AA to reduce the impact of the agricultural drought. During the El Niño-induced drought event that began in 2023, the CDI was tested and the AA was piloted for the first time.

Diagnosis and management of sarcopenia

Background: Sarcopenia refers to the progressive and generalized loss of skeletal muscle mass, strength, and function and is associated with falls, fractures, hospitalization, and even mortality. Owing to rapid population aging, the prevalence of sarcopenia is expected to increase, and this condition is increasingly gaining attention as an important topic in research and clinical settings. This review focuses on the diagnosis, pathophysiology, and management of sarcopenia.Current Concepts: Diagnosis of sarcopenia can be confirmed based on low muscle mass accompanied by low muscle strength, or low physical performance. The European Working Group on Sarcopenia in Older People and the Asian Working Group for Sarcopenia guidelines are commonly used in clinical practice. Intrinsic factors associated with skeletal muscles, such as inflammation, anabolic resistance, mitochondria, and neuromuscular junctions, combined with extrinsic factors associated with the systemic environment, including decreased endocrine function, malnutrition, and immobilization all play a role in impaired muscle anabolism, muscle atrophy, and weakness. Currently, the Food and Drug Administration has not approved any specific medications for treatment of sarcopenia. Therefore, non-pharmacological interventions such as aerobic, resistance, and combined exercise and appropriate nutrition (protein and essential amino acids) are important for prevention and treatment of sarcopenia.Discussion and Conclusion: Sarcopenia is a manageable target for improvement of overall health outcomes. Exercise and nutrition are essential components of nonpharmacological management of sarcopenia. Future studies are needed to identify early diagnostic biomarkers and pharmacologic targets and to develop consistent pre-emptive management strategies and sensitive measures to predict effectiveness of sarcopenia management and treatment response.

Evaluation of activated sludge settling characteristics from microscopy images with deep convolutional neural networks and transfer learning

Timely assessment and prediction of changes in microbial compositions leading to activated sludge settling problems, such as filamentous bulking (FB), can reduce water resource recovery facilities (WRRFs) upsets, operational challenges, and negative environmental impacts. This study presents a computer vision approach to assess activated sludge-settling characteristics based on Microscopy Images (MIs). We utilize MIs to train deep convolutional neural networks (CNN) using transfer learning to investigate the morphological properties of flocs and filaments. The methodology was tested on the offline MI dataset collected over two years at a full-scale industrial WRRF in Belgium. Various CNN architectures were tested, including Inception v3, ResNet18, ResNet152, ConvNeXt-nano, and ConvNeXt-S. The sludge volume index (SVI) was used as the final prediction variable, but the method can be easily adjusted to predict any other settling metric of choice. The best-performing CNN, ConvNeXt-nano, could predict SVI values with MAE (37.51 ± 4.02), MTD (11.65 ± 1.94), MAPE (0.18 ± 0.02), and R2 (0.75 ± 0.05). The model was tested in real-life FB events, where it identified early indicators of bulking by predictive surges in SVI values. We used an explainable AI technique, Eigen-CAM, to discover key morphological indicators of sludge bulking transitions. The findings highlight the SVI multimodality issue, where SVI readings as a unidimensional metric could not capture delicate shifts from good to poor sludge settling, while the model detected these subtle changes. The key morphological attributes of threshold conditions leading to FB were identified, which can provide actionable insight for preemptive WRRF management.

INTEGRATİON OF ARTİFİCİAL INTELLİGENCE (AI) İN TASK MANAGEMENT SYSTEMS

The incorporation of artificial intelligence (AI) into task management systems has become a disruptive force in today's fast-paced work environments, changing how teams plan, prioritize, and complete tasks. This trend is best illustrated by platforms such as Trello, Monday.com, and Asana, which use AI technology to streamline project workflows, automate tedious chores, and offer insightful recommendations. These systems enable users to improve decision-making, expedite procedures, and increase productivity using AI-driven capabilities like predictive analytics, automated task assignment, and smart suggestions. Through the utilization of natural language processing (NLP) and data visualization tools, these systems facilitate data-driven insights, preemptive risk management, and intuitive interaction. The incorporation of AI in task management signifies a paradigm change towards more intelligent, cooperative work practices, as companies depend more and more on AI to enhance human talents and boost productivity. This article addresses the consequences of this technological advancement for the nature of work in the future, presents real-world examples of AI-powered features in popular platforms, and examines the many advantages of integrating AI into task management. Keywords: task management, artificial intelligence, task management systems, integration of AI, automated task assignment, Natural Language Processing (NLP).

Optimizing patient outcomes: the impact of multimodal preemptive analgesia in video-assisted thoracoscopic lobectomy.

The aim of this study was to evaluate the efficacy of a multimodal preemptive analgesia management approach, specifically incorporating ultrasound-guided thoracic paravertebral block (UG-TPVB) in conjunction with intravenous analgesia, after video-assisted thoracoscopic (VATS) lobectomy under the guidance of enhanced recovery after surgery. A total of 690 patients who underwent VATS lobectomy between October 2021 and March 2022 were divided into the UG-TPVB group (group T, n = 345) and the control group (group C, n = 345). Patients in group T received UG-TPVB prior to the induction of general anaesthesia, while group C did not undergo nerve block. A comparison was conducted between the 2 groups regarding various indicators, including postoperative sedation, static/dynamic numeric rating scale scores, intraoperative fentanyl consumption, duration of mechanical ventilation/anaesthesia recovery/hospitalization, postoperative complications and other relevant factors. The static/dynamic numeric rating scale scores of group T were lower than those of group C after surgery. Intraoperative fentanyl consumption in group T (0.384 ± 0.095 mg) was lower than that in group C (0.465 ± 0.053 mg). The duration of mechanical ventilation, anaesthesia recovery and hospitalization were significantly shorter in group T compared to group C. Patient satisfaction rate in group T (70.1%) was higher than that in group C (53.6%). All differences were statistically significant (P < 0.05). The multimodal preemptive analgesia management strategy effectively reduces postoperative pain, decreases opioid consumption and promotes faster recovery in patients undergoing VATS lobectomy.

Towards Intercity Mobility System – Insights into the Spatial Interaction Gravity Model and Determination Approach

The current development of urban agglomeration greatly promotes the intercity connection and elevates the significance of intercity mobility system. However, intercity mobility often exhibits extreme spatiotemporal imbalances due to the diverse urban characteristics. This poses a huge challenge for traffic management and reveals the necessity on understanding the urban attractiveness for intercity mobility, which is represented as spatial interaction gravity in this study. While recent works have explored relevant aspects, they failed to provide insights into temporal variations in spatial interaction gravity or capture the determining factors from multiple perspectives. To fill this gap, this study proposed a two-phase framework to measure the urban spatial interaction gravity and developed determination approaches utilising the large-scale location-based services (LBS) dataset. Specifically, the inverse gravity model was adopted for the measure within multiple urban agglomerations and city sets during weekdays, weekends and holidays. Then, we developed the fitting equations of spatial interaction gravity by incorporating the correlated features associated with social, economic, network accessibility and land use. The findings present spatial interaction gravity across different periods and substantiate the distinct determination effects of features, with a high fitting accuracy. They provide promising supports for the intercity mobility prediction and pre-emptive traffic management.

Spatiotemporal patterns of groundwater over South Korea

Understanding the large-scale spatiotemporal pattern of multi-depth groundwater levels is critical to develop water management plans and policies for sustainable ecological and social prosperity, which are still lacking. Here, we investigate three major spatiotemporal modes of groundwater levels from ∼200 groundwater monitoring stations over the southern Korean Peninsula (2009–2020), using the Cyclostationary empirical orthogonal function analysis. The first two major modes are associated with the seasonality of recharge and discharge and groundwater use during the 2016/17 drought, which explained half of the total variance. The third major mode indicated a decreasing trend of deep groundwater levels over the western Korean Peninsula, where key administrative and authority offices have been relocated via balanced national land development policies. Furthermore, at least three million Koreans over this region likely experience groundwater depletion by the 2080s. Observational evidence of emerging groundwater depletion suggests a window of opportunity for pre-emptive groundwater management plans.

Unscheduled health care interactions in patients with multiple myeloma receiving T-cell redirection therapies

AbstractOutcomes for patients with relapsed/refractory multiple myeloma (R/RMM) have dramatically improved after the development and now growing utilization of B-cell maturation antigen–targeted chimeric antigen receptor (CAR) T-cell therapy and bispecific antibody (BsAb) therapy. However, health care utilization as a quality-of-life metric in these growing populations has not been thoroughly evaluated. We performed a retrospective cohort study evaluating the frequency and cause of unscheduled health care interactions (UHIs) among patients with R/RMM responding to B-cell maturation antigen–targeted BsAb and CAR T-cell therapies (N = 46). This included the analysis of remote UHIs including calls to physicians’ offices and messages sent through an online patient portal. Our results showed that nearly all patients with R/RMM (89%) receiving these therapies required a UHI during the first 125 days of treatment, with a mean of 3.7 UHIs per patient. Patients with R/RMM responding to BsAbs were significantly more likely to remotely contact their physicians’ offices (1.8-fold increase; P = .038) or visit an urgent care center (more than threefold increase; P = .012) than patients with R/RMM responding to CAR T-cell therapies. This was largely due to increased reports of mild upper respiratory tract infections in BsAb patients. Our results underscore the need to develop preemptive management strategies for commonly reported symptoms that patients with R/RMM experience while receiving CAR T-cell or BsAb therapies. This preemptive management may significantly reduce unnecessary health care utilization in this vulnerable patient population.

Conceptual framework for effective communication strategies in high-risk industries: Insights from the energy sector

This concept paper explores the conceptual framework for developing and implementing communication strategies tailored to the unique challenges of high-risk environments. Drawing insights from the energy sector, the paper identifies the importance of clear communication, stakeholder engagement, and proactive risk management. By establishing a robust conceptual framework, organizations can enhance safety, mitigate risks, and improve overall performance. Effective communication strategies are paramount in high-risk industries, particularly in the energy sector, where safety and operational efficiency are non-negotiable. This paper delves into the intricacies of crafting and executing communication strategies that address the specific challenges prevalent in such environments. Leveraging insights gleaned from the energy sector, it underscores the pivotal role of lucid communication, active stakeholder engagement, and preemptive risk management. Through the establishment of a sturdy conceptual framework, organizations stand to bolster safety protocols, mitigate potential risks, and elevate their overall performance. In high-risk industries like energy, effective communication serves as the linchpin that binds together various operational facets, ensuring seamless coordination and alignment with overarching objectives. Amidst the complex operational dynamics characteristic of the energy sector, clarity in communication emerges as a foundational element for averting potential hazards and facilitating smooth operations. This paper navigates through the nuances of communication strategies tailored to high-risk environments, advocating for a strategic approach that not only disseminates information but also fosters understanding and accountability across all levels of the organization. Drawing from experiences within the energy sector, it becomes evident that effective communication transcends mere transmission of messages; it embodies a holistic approach that encompasses proactive engagement with stakeholders and meticulous risk assessment. In the energy sector, stakeholders encompass a diverse spectrum ranging from employees and regulatory bodies to local communities and environmental advocates. Effective communication entails not only disseminating information but also soliciting feedback, fostering transparency, and nurturing trust among stakeholders. By fostering open channels of communication, organizations can cultivate a culture of collaboration, thereby enhancing operational efficiency and engendering stakeholder buy-in for initiatives aimed at risk mitigation and sustainability.

Comparing apples and pears: Linking capitals and capacities to assess the resilience of commercial farming operations

CONTEXTAs the concept of social-ecological resilience gains increasing policy attention, there is growing demand for approaches that operationalise it. Amongst these demands is the need to empirically assess absorptive, adaptive and transformative capacities that underpin resilience to better understand the ways in which social-ecological systems can navigate change and uncertainty. OBJECTIVEWe explore the application of a capitals approach for assessing resilience capacities, using an example of deciduous fruit farming operations in the Western Cape region of South Africa. METHODSSemi-structured interviews were conducted, thematically coded, and analysed using causal loop diagrams and co-occurrence analyses to identify changes experienced by farming operations, their responses to these changes, and the effects of both on capital resources. We then apply the criteria developed for the classification of resilience capacities. RESULTS AND CONCLUSIONSA variety of changes affect farming operations at multiple points across the value chain, and have effects across capital resources. Most significant to farmers are changes which impact the amount of water available and the cashflow they require to sustain their operations. The most common responses employed by farmers consisted of activities which either increase the availability of an affected resource, or decrease its demand in order to maintain the same functions (adaptive capacity). In fewer cases, farming operations were able to absorb the depletion of their capital resources due to pre-emptive management (absorptive capacity). In similarly few cases, the potential or realised resource deficiencies caused by changes were either corrected or decoupled from the farming operation through structural reorganisation towards a different or additional function and types of output being delivered (transformative capacity). Evidence of changes being anticipated prior to their onset were also identified, leading to responses which are used in conjunction with the preceding three capacities. SIGNIFICANCEOur findings suggest that the criteria we developed for classifying resilience capacities offer a useful means of operationalising resilience. In particular, the approach we pilot in this paper enables the application of a systems perspective to identify interactions between changes and responses, which broadens the options for identifying management strategies and interventions. The approach we propose can be used to identify key leverage points to strengthen the capacities of vulnerable farmers. Further work is required to integrate consideration of cross-scale effects of farm-scale resilience strategies on the broader social-ecological system.