Preemptive Strategies Research Articles

Organ donation messages and psychological reactance: examining preemptive and postscript mitigation strategies coupled with restoration scripts

Organ donation messages and psychological reactance: examining preemptive and postscript mitigation strategies coupled with restoration scripts

PHM-Based Modeling for Cyberattack Classifier Performance

This research implements Prognostics and Health Management (PHM) using multiple linear regression and multivariate time series models to monitor and predict when the performance of a Machine Learning-based cyberattack classifier might degrade to an unacceptable level, enabling preemptive maintenance strategies.

Phase IV adaptive randomised clinical trials evaluating efficacy and cost-efficacy of pre-emptive pharmacogenetic genotyping strategies in the Spanish National Health System: iPHARMGx Master Protocol and PREVESTATGx nested clinical trial

IntroductionGenetic variations impact drug response, driving the need for personalised medicine through pre-emptive pharmacogenetic testing. However, the adoption of pre-emptive pharmacogenetic testing for commonly prescribed drugs, such as statins, outside...

Timeline and outcomes of viral and fungal infections after Chimeric Antigen Receptor (CAR) T-cell therapy: A large database analysis

ObjectivesThis large database analysis aims to describe the incidence, timeline, and risk factors for viral and fungal infections after chimeric antigen receptor (CAR) T-cell therapy. MethodsWe queried a global research network database, TriNetX, for patients who received CAR T-cell therapy, who were identified and followed for the development of viral and fungal infections. Baseline demographic, oncologic history, laboratory data and medication histories were collected. We evaluated risk factors for respiratory viral infections (RVI), herpesvirus, fungal infections and mortality using Cox regression. ResultsA total of 2,256 patients who received CAR T-cell therapy were included, 1,867 (82.7%) were CD19-targeted and 400 (17.7%) were BCMA-targeted. Following CAR T-cell infusion, RVI were the most prevalent (23.3%) with a median onset of 160 days (IQR 52-348 days), while herpesvirus and fungal infections were less frequent, occurring in 13.6% and 11.4% of cases with median onsets of 71 (IQR 18-252) and 73 days (IQR 14-236 days), respectively. On multivariable Cox regression, independent predictors of RVI included acute lymphoblastic leukemia (ALL, HR 1.61), prior hematopoietic cell transplant (HCT, HR 1.29), cytokine release syndrome (CRS, HR 1.41), hemophagocytic lymphohistiocytosis (HLH, HR 1.96), and glucocorticoids (HR 3.37). Prior HCT (HR 2.00), hypogammaglobulinemia (HR 1.51), immune-effector cell-associated neurotoxicity syndrome (ICANS, HR 1.52), and HLH (HR 1.99) were associated with a higher risk of herpesviruses. Independent predictors of fungal infections included prior HCT (HR 1.59), CRS (HR 1.58) and hypogammaglobulinemia (HR 1.40). Idecabtagene vicleucel was associated with a lower risk of herpesvirus and fungal infections (HR 0.39 and 0.44, respectively). ConclusionsIn a large cohort of CAR T-cell therapy recipients, respiratory viral infections were the most common but occurred later, while herpesvirus and fungal infections were less frequent but occurred earlier. Prospective studies investigating prophylaxis and pre-emptive monitoring strategies are needed in this population.

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.

Peran Patroli Perintis Presisi dalam Mencegah Terjadinya Tawuran di Wilayah Hukum Polda Metro Jaya

The phenomenon of brawls in the DKI Jakarta area is increasing due to environmental, economic, and population density factors in the region. The literature references that form the main basis of this research are situational crime prevention theory, iceberg theory, social conflict theory, youth identity theory, as well as the concepts of community policing, and precision inspector patrols. This research uses qualitative methods with data collection techniques of interviews and document studies. The results showed that the role of the Precision Inspector Patrol in preventing fighting in the jurisdiction of Polda Metro Jaya is to ensure that patrols and general guards can run smoothly, be responsible for each assignment, training, and supervision of patrol teams in other units, be the front guard to carry out various preventive and responsive efforts, conduct routine patrols, respond to reports from the public, and maintain the situation in the jurisdiction of Polda Metro Jaya to remain conducive and under control. Through this role, the strategies that can be carried out by the Metro Jaya Police Precision Inspector Patrol Team in preventing fighting crimes are preemptive, preventive, and repressive strategies that are investigative in nature. The community policing policy model in an effort to maximise the implementation of the Precision Pioneer Patrol to prevent horizontal conflicts in the Polda Metro Jaya jurisdiction can be realised through several management stages which include communication and synergy, cooperation, handling, and performance evaluation. Thanks to this, the Precision Pioneer Patrol has been able to reduce the number of horizontal conflicts that occur in the Polda Metro Jaya jurisdiction. The suggestions are for the Precision Pioneer Patrol Team to increase the frequency of patrols at night in the red and yellow zones, for future researchers to apply GIS as an early detection map of conflict-prone areas, and for cooperation partners to expand the scope of programme implementation P2TP2A Unit, PPA Unit, and FKDM to provide an understanding of the importance of Precision Pioneer Patrol in preventing horizontal conflicts.

Real-world evaluation of CYP2C19 guided antiplatelet therapy in patients undergoing intracranial aneurysm repair.

Aim: To evaluate the feasibility and impact of using CYP2C19 genotype to guide selection of antiplatelet therapy in patients undergoing intracranial aneurysm treatment with a flow diversion stent in a real-world clinical setting.Patients & methods: A single-center, retrospective, observational cohort study was conducted in 112 patients undergoing intracranial aneurysm repair with flow-diversion stenting from 2014 to2021. Data were abstracted from health records. The frequency of clopidogrel or alternative therapy (ticagrelor or prasugrel) use was compared across CYP2C19 status (intermediate or poor metabolizer [IM/PM] vs. normal, rapid, or ultrarapid metabolizer [NM/RM/UM]).Results: In the study population, CYP2C19 genotype testing was performed on 110 (98.2%) patients; of these, 106 (97.2%) had results available prior to the stent procedure and 28 (25.5%) were IM/PMs. Alternative therapy was used more frequently in IM/PMs compared with NM/RM/UMs (57.1 vs. 8.5%, respectively, p<0.0001). The frequency of thromboembolic events over 12months did not significantly differ across clopidogrel-treated IM/PMs, clopidogrel-treated NM/RM/UMs and patients on alternative therapy (p=0.352); although, event numbers were low.Conclusion: A pre-emptive CYP2C19 genotyping strategy to guide antiplatelet therapy selection in intracranial aneurysm repair patients is feasible in a real-world clinical setting. Larger studies are needed to assess the impact on clinical outcomes.

Sequential living donor liver transplantation after liver resection optimizes outcomes for patients with high-risk hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seqLDLT) after LR as a strategy for HCC patients with high-risk of recurrence. MethodsWe analyzed data from 27 adult patients who underwent seqLDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS). ResultsAmong 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqLDLT. Five patients (19%) underwent LDLT following LR as a downstaging strategy while the rest received seqLDLT as a preemptive strategy. The median age was 53.5 years with 85% males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0% and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors > 5 cm (19%), and a total tumor diameter > 10 cm (7%). ConclusionsSeqLDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seqLDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.

A multi-center, double-blind, placebo-controlled, randomized, parallel-group, non-inferiority study to compare the efficacy of goal-directed tranexamic acid administration based on viscoelastic test versus preemptive tranexamic acid administration on postoperative bleeding in cardiovascular surgery (GDT trial)

BackgroundTranexamic acid (TXA) effectively attenuates hyperfibrinolysis and preemptive administration has been employed to reduce bleeding and blood transfusions in various surgical settings. However, TXA administration could be associated with adverse effects, such as seizures and thromboembolic risks. While patients with fibrinolysis shutdown showed greater thromboembolic complications and mortality, TXA administration may aggravate the degree of shutdown in these patients.Selective TXA administration based on the results of rotational thromboelastometry (ROTEM) would be non-inferior to preemptive TXA administration in reducing postoperative bleeding and beneficial in reducing its risks in patients undergoing cardiovascular surgery.MethodsThis non-inferiority, randomized, double-blind, placebo-controlled, multicenter trial will be performed in 3 tertiary university hospitals from August 2023 to March 2025. Seven hundred sixty-four patients undergoing cardiovascular surgery will be randomly allocated to get TXA as a preemptive (Group-P) or goal-directed strategy (Group-GDT) in each institution (with a 1:1 allocation ratio). After anesthesia induction, TXA (10 mg/kg and 2 mg/kg/h) and a placebo are administered after anesthesia induction in Group-P and Group-GDT, respectively. ROTEM tests are performed immediately before weaning from CPB and at the considerable bleeding post-CPB period. After getting the test results, a placebo is administered in Group-P (regardless of the test results). In Group-GDT, placebo or TXA is administered according to the results: placebo is administered if the amplitude at 10 min (A10-EXTEM) is ≥ 40 mm and lysis within 60 min (LI60-EXTEM) of EXTEM assay is ≥ 85%, or TXA (20 mg/kg) is administered if A10-EXTEM is < 40 mm or LI60-EXTEM is < 85%. The primary outcome is inter-group comparisons of postoperative bleeding (for 24 h). The secondary measures include comparisons of perioperative blood transfusion, coagulation profiles, reoperation, thromboembolic complications, seizures, in-hospital mortality, fibrinolysis phenotypes, and hospital costs.DiscussionThe absence of inter-group differences in postoperative bleeding would support the selective strategy’s non-inferiority in reducing postoperative bleeding in these patients. The possible reduction in thromboembolic risks, seizures, and fibrinolysis shutdown in Group-GDT would support its superiority in reducing TXA-induced adverse events and the cost of their management.Trial registrationThis trial was registered at ClinicalTrials.gov with the registration number NCT05806346 on March 28, 2023.Trial status: recruiting.Issue date: 2023 March 28 (by Tae-Yop Kim, MD, PhD).The trial was registered in the clinical registration on March 28, 2023 (ClinicalTrials.gov, NCT05806346) and revised to the latest version of its protocol (version no. 8, August 26, 2024) approved by the institutional review boards (IRBs) of all 3 university hospitals (Konkuk University Medical Center, 2023–07-005–001, Asan Medical Center, 2023–0248, and Samsung Medical Center, SMC 2023–06-048–002). Its recruitment was started on August 1, 2023, and will be completed on December 31, 2024.Protocol amendment number: 08 (protocol version 08, August 26, 2024).Revision chronology:2023 March 28:Original.2023 April 10:Amendment No 01. The primary reason for the amendment is the modification of Arms (adding one arm for sub-group analyses) and Interventions, Outcome Measures, Study Design, Study Description, Study Status, Eligibility, and Study Identification.2023 May 03:Amendment No 02. The primary reason for the amendment is to modify the Outcome Measures and update the study status.2023 July 06:Amendment No 03. The primary reason for amendment is to update the chronological study status.2023 July 07:Amendment No 04. The primary reason for the amendment is the modification of study information (the treatment category was changed to diagnostic, and Phase 4 was changed to not applicable) and a chronological update on the study status.2023 September 12:Amendment No 06. The primary reason for the amendment is a chronological update in the study status and the inclusion of additional information regarding contacts/locations and oversight.2023 December 29:Amendment No 07. The primary reason for the amendment is to modify the outcome measures (including detailed information on outcome measures, addition of extra secondary measures, and chronological updates in study status).2024 August 26:Amendment No 08. The primary reason for the amendment is to add detailed descriptions regarding data handling and the names and roles of the participating institutions and to update the chronological process of the trial.

I assume others are influenced by health misinformation on social media: examining the underlying process of intentions to combat health misinformation

PurposeThe mounting health misinformation on social media triggers heated discussions about how to address it. Anchored by the influence of presumed influence (IPI) model, this study investigates the underlying process of intentions to combat health misinformation. Specifically, we analyzed how presumed exposure of others and presumed influence on others affect intentions to practice pre-emptive and reactive misinformation countering strategies.Design/methodology/approachCovariance-based structural equation modeling based on survey data from 690 Chinese participants was performed using the “lavaan” package in R to examine the proposed mechanism.FindingsPersonal attention to health information on social media is positively associated with presumed others’ attention to the same information, which, in turn, is related to an increased perception of health misinformation’s influence on others. The presumed influence is further positively tied to two pre-emptive countermeasures (i.e. support for media literacy interventions and institutional verification intention) and one reactive countermeasure (i.e. misinformation correction intention). However, the relationship between presumed influence and support for governmental restrictions, as another reactive countering method, is not significant.Originality/valueThis study supplements the misinformation countering literature by examining IPI’s tenability in explaining why individuals engage in combating misinformation. Both pre-emptive and reactive strategies were considered, enabling a panoramic view of the motivators of misinformation countering compared to previous studies. Our findings also inform the necessity of adopting a context-specific perspective and crafting other-oriented messages to motivate users’ initiative in implementing corrective actions.

A predictive model for stunting among children under the age of three.

In light of the global effort to eradicate stunting in childhood, the objective of this research endeavor was to assess the prevalence of stunting and associated factors, simultaneously construct and validate a risk prediction model for stunting among children under the age of three in Shenzhen, China. Using the stratified random sampling method, we selected 9,581 children under the age of three for research and analysis. The dataset underwent a random allocation into training and validation sets, adhering to a 8:2 split ratio. Within the training set, a combined approach of LASSO regression analysis and binary logistic regression analysis was implemented to identify and select the predictive variables for the model. Subsequently, model construction was conducted in the training set, encompassing model evaluation, visualization, and internal validation procedures. Finally, to assess the model's generalizability, external validation was performed using the validation set. A total of 684 (7.14%) had phenotypes of stunt. Utilizing a combined approach of LASSO regression and logistic regression, key predictors of stunting among children under three years of age were identified, including sex, age in months, mother's education, father's age, birth order, feeding patterns, delivery mode, average daily parent-child reading time, average time spent in child-parent interactions, and average daily outdoor time. These variables were subsequently employed to develop a comprehensive prediction model for childhood stunting. A nomogram model was constructed based on these factors, demonstrating excellent consistency and accuracy. Calibration curves validated the agreement between the nomogram predictions and actual observations. Furthermore, ROC and DCA analyses indicated the strong predictive performance of the nomograms. The developed model for forecasting stunt risk, which integrates a spectrum of variables. This analytical framework presents actionable intelligence to medical professionals, laying down a foundational framework and a pivot for the conception and execution of preemptive strategies and therapeutic interventions.

Safety and Efficacy of a Preemptive Mycophenolate Mofetil Dose Reduction Strategy in Kidney Transplant Recipients.

There are no high-quality data to guide long-term mycophenolate mofetil (MMF) dosing in kidney transplant recipients (KTRs) to balance the long-term risks of allograft rejection with that of infections and malignancy. At our center, KTRs are managed with either a "preemptive" dose reduction strategy, where the MMF dose is reduced after the first year before the development of adverse events, or with a "reactive" dosing strategy, where they are maintained on the same MMF dose and only reduced if they develop an adverse event. We hypothesized that a preemptive MMF dosing strategy after the first year of transplantation is associated with decreased infections without increasing alloimmune complications. We conducted a retrospective cohort study of all KTRs receiving MMF from January 1, 2015, to December 31, 2020. The primary outcome was the incidence of infections requiring hospitalization. One hundred forty-two KTRs met the inclusion criteria, of whom 44 (31%) were in the preemptive group and 98 (69%) were in the reactive group. The median follow-up was 4 y (interquartile range, 3.8-4.0). Multivariable analysis showed that a preemptive MMF dose reduction strategy was associated with a lower risk of infections requiring hospitalization (adjusted hazard ratio = 0.39; 95% confidence interval, 0.16-0.92). There was no difference in graft loss, rejection, or estimated glomerular filtration rate slope. Preemptive MMF dose reduction in KTRs may be an effective strategy to prevent infections without increasing the risk of allograft rejection. Randomized clinical trials are needed to confirm these findings.

P.025: Is a complete viral load suppression required to reduce the risk of cytomegalovirus recurrence in kidney transplant recipients using the preemptive strategy?

P.025: Is a complete viral load suppression required to reduce the risk of cytomegalovirus recurrence in kidney transplant recipients using the preemptive strategy?

Mitigating adversarial cascades in large graph environments

A significant amount of society’s infrastructure can be modeled using graph structures, from electric and communication grids, to traffic networks, to social networks. Each of these domains are also susceptible to unwanted cascades, whether this be overloaded devices in the power grid or the reach of a social media post containing misinformation. The potential harm of a cascade is compounded when considering a malicious attack by an adversary that is intended to maximize the cascade impact. However, by exploiting knowledge of the cascading dynamics, targets with the largest cascading impact can be preemptively prioritized for defense, and the damage an adversary can inflict can be mitigated. While game theory provides tools for finding an optimal preemptive defense strategy, existing methods struggle to scale to the context of large graph environments because of the combinatorial explosion of possible actions with the size of the graph. Data-driven deep learning approaches can fill this gap, but they demand a large amount of data that is often costly to obtain. We propose a novel data generation approach for the cascading failure security problem that uses counterfactual data augmentation and a sub-game data querying strategy to generate both high quality and a high quantity of training data. We demonstrate that our data generation approach creates up to an order of magnitude more data than naïve querying with double the efficiency. We also introduce a deep learning model based embedding node pairs, and train it on our generated data, showing that it effectively defends from cascades on graphs as large as 1000 nodes. Our deep learning approach achieves a closer approximation to the Nash Equilibrium than existing heuristic methods, for graphs where the ground-truth equilibrium can be calculated.

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.

Competitive kill-and-restart and preemptive strategies for non-clairvoyant scheduling

AbstractWe study kill-and-restart and preemptive strategies for the fundamental scheduling problem of minimizing the sum of weighted completion times on a single machine in the non-clairvoyant setting. First, we show a lower bound of 3 for any deterministic non-clairvoyant kill-and-restart strategy. Then, we give for any $$b &gt; 1$$ b &gt; 1 a tight analysis for the natural b-scaling kill-and-restart strategy as well as for a randomized variant of it. In particular, we show a competitive ratio of $$(1+3\sqrt{3})\approx 6.197$$ ( 1 + 3 3 ) ≈ 6.197 for the deterministic and of $$\approx 3.032$$ ≈ 3.032 for the randomized strategy, by making use of the largest eigenvalue of a Toeplitz matrix. In addition, we show that the preemptive Weighted Shortest Elapsed Time First (WSETF) rule is 2-competitive when jobs are released online, matching the lower bound for the unit weight case with trivial release dates for any non-clairvoyant algorithm. Using this result as well as the competitiveness of round-robin for multiple machines, we prove performance guarantees smaller than 10 for adaptions of the b-scaling strategy to online release dates and unweighted jobs on identical parallel machines.

Associations between acute and chronic graft-versus-host disease

AbstractChronic graft-versus-host disease (GVHD) is 1 of the major complications after allogeneic hematopoietic cell transplantation (allo-HCT). Although various risk factors for chronic GVHD have been reported, limited data are available regarding the impact of acute GVHD on chronic GVHD. We examined the association between acute and chronic GVHD using a Japanese registry data set. The landmark point was set at day 100 after allo-HCT, and patients who died or relapsed before the landmark point were excluded. In total, 14 618 and 6135 patients who underwent allo-HCT with bone marrow or peripheral blood (BM/PB) and with umbilical cord blood (UCB), respectively, were analyzed. In the BM/PB cohort, the risk for chronic GVHD that requires systemic steroids increased with each increase in acute GVHD grade from 0 to 2 (grade 0 vs 1 [hazard ratio (HR), 1.32; 95% confidence interval (CI), 1.19-1.46; P < .001]; grade 1 vs 2 [HR, 1.41; 95% CI, 1.28-1.56; P < .001]), but the risk was similar between acute GVHD grade 2 and grade 3 to 4 (HR, 1.02; 95% CI, 0.91-1.15; P = 1.0). These findings were confirmed in the UCB cohort. We further observed that the risk for severe chronic GVHD increased with each increment in the grade of acute GVHD, even between acute GVHD grade 2 and grade 3 to (grade 2 vs 3-4: HR, 1.70; 95% CI, 1.12-2.58; P = .025). In conclusion, the preceding profiles of acute GVHD should help to stratify the risk for chronic GVHD and its severity, which might be useful for the development of risk-adopted preemptive strategies for chronic GVHD.

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.

Navigating challenges in the management of Dactylopius opuntiae (Cockerell): Transitioning from ’introduction biological control’ to a preemptive strategy of artificial seeding of a natural enemy

The invasion of false carmine cochineal Dactylopius opuntiae (Cockerell) (Hemiptera; Dactylopiidae) in the Mediterranean region presents a serious threat to cactus pear cultivation. The cochineal was first identified in Israel in 2013, and it soon became clear that biological control is the only long-term solution to protect the cactus pear Opuntia ficus-indica. Releases of the introduced predatory beetle Hyperaspis trifurcata Schaeffer (Coleoptera; Coccinellidae) began in 2016, demonstrating high efficacy and leading to a decline in cochineal populations and plant survival. While H. trifurcata can autonomously reach new cochineal hotspots, it often arrives too late to prevent substantial damage to cactus pear. Human intervention is therefore necessary to expedite the predator’s establishment in new infested sites. To facilitate the spread of the beetle, we consider two approaches: transferring beetle seeding stocks from northern locations through a volunteer network organized by the research team, and applying the ’predator – prey dual introduction’ concept to preemptively mitigate new hotspots expected to emerge as the cochineal spreads southward via winds or birds. These activities have led to a major decrease in the rate of spread of the cochineal population in the East Mediterranean, and in the damage that it inflicts to cactus pear hedgerows. Implementing a similar approach in North Africa can prevent or slow the spread of the cochineal to the northern coast of the central Mediterranean and avoid the heavy damage experienced in Morocco.

Artificial Intelligence in Anesthesiology: Field of Dreams or Fire Swamp? Preemptive Strategies for Optimizing Our Inevitable Future.

Artificial Intelligence in Anesthesiology: Field of Dreams or Fire Swamp? Preemptive Strategies for Optimizing Our Inevitable Future.