Preemptive Approach Research Articles

Similar Goals, Divergent Paths: Exploring Approaches Towards Hepatitis C Treatment Protocols in Heart Transplantation.

Heart transplantation from hepatitis C positive donors is on the rise, yet there exists divergence in approaches to managing recipients of these organs. Practices range from prophylactic treatment of recipients prior to transplantation to delayed treatment following the detection of viremia, with no established consensus on the optimal approach. An online survey was conducted among the heart transplant centers in the United States of America and Canada from January 2023 to February 2024. The survey gathered comprehensive information from the institutions regarding direct antiviral (DAA) therapies used, timing and duration of DAA, frequency of viral load testing, adverse effects, virological response and immunosuppressive therapy modifications. The treatment pathways were categorized based on the timing of treatment initiation into prophylactic, preemptive, or reactive approaches. Analysis was restricted to US adult transplant programs that had an HCV transplant protocol and performed at least one HCV NAT positive transplant. The SRTR database was queried for total heart transplants using HCV NAT positive donors. Of 122 heart transplant programs, 35 (28.7%) institutions responded. 689 heart transplants (49.1%) using HCV NAT positive donors were captured across institutions. Among 30 US institutions performing adult heart transplantation with HCV NAT positive donor hearts, 5 (16.7%) used prophylactic, 9 (30%) preemptive, and 16 (53.3%) reactive treatment pathways. Most employed pan-genotype DAA therapies for a median of 12 weeks. Significant heterogeneity existed in treatment and monitoring protocols. Practice patterns for management of HCV NAT positive donor hearts vary significantly. Establishing registries and Randomized Control Trials for these patients is crucial for guiding future practices.

Right ventricular electrophysiology and arrhythmias in adults with congenital heart disease: scientific basis for management.

Right ventricular (RV) dysfunction and arrhythmias are major concerns in adults with congenital heart disease (CHD). The relationship between RV dysfunction and arrhythmogenesis is bidirectional, with structural and electrical remodeling contributing to arrhythmia development and, conversely, arrhythmias exacerbating RV failure. In addition to an RV in the standard subpulmonary position failing as a result of pressure and/or volume overload, other phenotypes associated with RV dysfunction in CHD include transposition of the great arteries with a systemic (subaortic) RV and univentricular hearts with a predominant RV morphology. The RV is better suited for low-pressure workloads. When it supports the systemic circulation, it undergoes remodeling changes that promote arrhythmias, which can provoke a cycle of worsening dysfunction and arrhythmogenesis. Arrhythmias can worsen RV dysfunction by impairing hemodynamic stability, reducing cardiac output, provoking dyssynchrony, and inducing tachycardia-induced cardiomyopathy. Cellular mechanisms, including myocardial fibrosis, dysregulation of ion channels, and abnormal gap junction function, are central to this process, facilitating both reentrant and triggered arrhythmias. Conduction disturbances, whether inherent or caused by fibrosis or pacing, compound these effects, aggravating both RV dysfunction and arrhythmia perpetuation. Management strategies must be comprehensive and include pre-emptive approaches to minimize arrhythmias, alongside early detection. Individualized therapies may include catheter ablation and cardiac implantable electronic devices, with treatment tailored to the specific RV phenotype and arrhythmia type. This review emphasizes the importance of personalized interventions to prevent the vicious cycle of RV dysfunction and arrhythmias in CHD. Further research is essential to optimize therapeutic strategies and address care-limiting knowledge gaps.

P-2311. Logical Versus Absolute Lymphocyte Count-guided Preemptive Therapy for CMV Prevention in Solid Organ Transplant Recipients: A Randomized Controlled Trial

Abstract Background A preemptive approach using plasma CMV DNA load monitoring is recommended among CMV-seropositive (R+) solid organ transplant recipients (SOTr). Lately, absolute lymphocyte count (ALC) has been proposed as a surrogate marker to predict CMV infection in SOTr. We hypothesized that a preemptive approach guided by immune assessment, using low ALC, could effectively prevent CMV infection, akin to the proposed routine preemptive therapy. We aimed to assess the efficacy of logical preemptive therapy (LOG) versus ALC-guided preemptive therapy for CMV infection in CMVR+ SOTr, along with cost-effectiveness. Methods A 1:1 open-labeled randomized controlled trial was conducted at a single transplant center from February to November 2023. All adult CMVR+ SOTr not receiving anti-thymocyte globulin were randomly assigned to two groups: the LOG Group, where patients underwent plasma CMV DNA load testing every 4 weeks for 12 weeks after transplantation, and the ALC group, where the quantity of CMV DNA load was initiated when the ALC was < 1,000 cells/mm3. Patients were then followed for 6 months after SOT to compare the occurrence of CMV infection and the CMV DNA load testing-related cost. Results A total of 98 eligible SOTr were included and assigned into two groups, 49 patients each. They all underwent kidney transplantation (KT) with a mean+SD age of 46+11 years old; 66.3% were male. Demographic data between the two groups were comparable. Twenty-five (25.5%) participants developed CMV infection within 6 months after KT. CMV infection was comparably observed in 13 (26.5%) participants in the LOG group vs. 12 (24.5%) participants in the ALC group, p=0.82. Of those, there were no significant differences in terms of asymptomatic CMV infection, CMV disease, and clinically significant CMV infection (p=NS, all). The total cost of plasma CMV DNA load testing (68 USD per test) was significantly lower in the ALC group compared to the LOG group (2,320 vs.10,014 USD, p< 0.01), respectively. Conclusion Immune-guided preemptive therapy directed by low ALC appears to be effective in preventing early CMV infection after SOT. A simple and universally available ALC test could potentially be used as a personalized and cost-effective marker to initiate preemptive therapy in moderate-risk CMVR+ SOTr. TCTR20220720007. Disclosures All Authors: No reported disclosures

Evaluation of Antifungal Treatment Strategies in Febrile Neutropenic Episodes of High-Risk Hematologic Malignancies: A Single Center Retrospective Study

Background Febrile neutropenic patients are at high risk for developing invasive fungal infection (IFI). Currently, two treatment strategies, empiric and preemptive, are used in febrile neutropenic patients with IFI. This study aimed to evaluate empirical and preemptive treatment strategies in patients with high-risk hematologic malignancies. Methods We retrospectively analyzed 402 febrile neutropenic attacks in 281 patients with hematological malignancies hospitalized in a university hospital hematology clinic. Between June 2006 and January 2009, 154 febrile neutropenic episodes of 104 patients who met the study eligibility criteria were included. Patients who received antibiotic and antifungal treatment for febrile neutropenia were retrospectively recorded. Patients treated with empiric and preemptive approaches were identified and compared with statistical methods. Results Antifungal treatment was initiated as empiric treatment in 62 (40%), preemptive therapy in 55 (36%) (subgroups; 45 [29%] possible-IFI and 10 [7%] probable-IFI), and 37 (24%) for secondary prophylaxis. In terms of length of hospitalization and all-cause mortality, no statistically significant results were found when patients receiving empiric and preemptive treatment were compared. (p>0.05). Conclusion In patients with high-risk hematologic malignancies, even if empiric treatment is initiated, a dynamic approach that can be summarized as persistently trying to obtain evidence by using ancillary diagnostic tools and early termination of therapy in unnecessary cases seems appropriate.

Regulation of Forest Police’ Authorities in Enforcing Illegal Logging Law in Mount Ciremai National Park

This study aims to understand the regulation of illegal logging in Indonesia as well as to analyze the implementation of forest police authorities in combating illegal logging in Mount Ciremai National Park. This study applied a juridical-empirical approach which involves literature study and field research in which the primary, secondary, and tertiary data were collected through observation and interviews. The results indicated that illegal logging is governed in Articles 12, 19, 82, 83, and 87 of Law No. 18 of 2013 on the Prevention and Eradication of Forest Destruction, and the forest police authorities are regulated in Article 51 paragraph (2) of Law No. 41 of 1999 on Forestry and Article 4 paragraph (2) of the Regulation of the Minister of Forestry of the Republic of Indonesia No. P.75/Menhut-II/2014 on Forest Police, which serve as the regulatory framework for forest police in addressing illegal logging in Mount Ciremai National Park. In carrying his/her authorities, the forest police applies 3 (three) approaches, namely Preemptive, Preventive, and Repressive. Hence, it can be concluded that illegal logging is governed in Law No. 18 of 2013 on the Prevention and Eradication of Forest Destruction, and the implementation of forest police authorities in combating illegal logging is carried out through preemptive, preventive, and repressive approach. Finally, it is suggested that law enforcement officials must be consistent and firm in taking action against illegal logging to create a deterrent effect, and the improvement of facilities and infrastructure is urgently needed

The Preemptive Approach of Ulama in Aceh to Eradicating Corruption

Corruption in Aceh has become a serious issue, with its corruption rates over the past decade being above average compared to other provinces in Sumatra and nationally. Efforts to eradicate corruption do not solely rely on law enforcement agencies but also require the participationof various parties, including religious leaders. Thestudy aimedto analyze the perspectives and participationof ulama (scholars) in Aceh in combating corruption. It employedan empirical legal research method with a sociological anthropological approach. The results of this study indicated that corruption in Aceh wasa complex issue that requires a holistic approach and cross-sector collaboration. Ulama plays an important role in eradicating corruption through preaching and religious education that instills the values of amar ma’ruf nahi munkar (enjoining what is good and forbidding what is wrong).However,their involvement is limited to the general public without direct access to policymaking. Effective efforts require synergy between ulama, law enforcement, the government, and society to create a corruption-free culture.

Unboxing Common Internet Video Genres and Their Coverage in LCGFT

A possible gap in the coverage of internet videos by the Library of Congress Genre/Form Terms (LCGFT) is explored through an analysis of a random sample of 500 YouTube videos. Almost all of a brief list of popular internet video genres were identifiable through the videos’ metadata and/or their content, confirming the genres’ prevalence. Of the confirmed 28 genres, only 10 were covered accurately by LCGFT. Representatives of some of the others could nevertheless be readily found in OCLC WorldCat. A preemptive approach to adding internet video genres to LCGFT is suggested.

Prophylactic vs preemptive strategy for the prevention of CMV disease in solid organ transplant recipients: systematic review and meta-analysis of randomized controlled trials.

Cytomegalovirus (CMV) is associated with significant morbidity and mortality among solid organ transplant (SOT) recipients. Strategies for CMV prevention include universal prophylaxis or preemptive approach. We aimed to evaluate the optimal approach. We performed a systematic review and meta-analysis of randomized controlled trials comparing prophylaxis versus preemptive therapy for CMV in SOT. The primary outcome was CMV disease. Subgroup analysis of outcomes in D+ R- patients was performed. Nine trials have met inclusion criteria, five of them included kidney transplant recipients, all compared val/ganciclovir universal prophylaxis versus preemptive approach. Universal prophylaxis resulted in lower probability of CMV infection (relative risk [RR] 0.44, 95% confidence interval [CI] 0.33-0.58), yet the impact on CMV disease was insignificant (RR 0.54, 95% CI 0.24-1.23), in neither SOT recipients in general nor among D+R- subgroup (RR 0.93, 95% CI 0.37-2.32). Late-onset CMV disease rates were lower with preemptive approach. Sensitivity analysis according to allocation concealment and blinding showed similar results for CMV disease. No significant differences were demonstrated for the outcomes of mortality, bacterial or fungal infection or graft related outcomes. Acute kidney injury was significantly more common with prophylaxis (RR 1.79, 95% CI 1.12-2.89). Preemptive approach is a reasonable approach for CMV prevention in SOT recipients, if feasible. Strategies for combining the preemptive with prophylaxis strategies, as well as immune monitoring, should be investigated.

Clinical insights into Invasive Aspergillosis in Mexican children with cancer

Abstract Background In the last years Invasive Aspergillosis (IA) has become the most frequent invasive fungal infection (IFI) affecting children with hematological malignancies. This complication results in the delay of cancer treatment and/or poor prognosis mainly due to late diagnosis and late start of antifungal treatment. Therefore, antifungal prophylaxis and preemptive approaches have been proposed for these patients based on risk factors and local epidemiological data. For this reason, we performed a unicenter, descriptive and prospective study to determine the frequency and clinical course of IA in hospitalized cancer patients with fever and neutropenia. Methods we included events of fever and neutropenia of hospitalized patients with cancer and either with persistent febrile neutropenia (PFN: fever for >96h with total neutrophil count of <500cells/mm3) or profound prolonged neutropenia (PPN: total neutrophil count of <500cells/mm3 for >7 days). Informed consent was requested prior inclusion and follow up of these events was performed with weekly measurement of serum galactomannan antigen (until the recovery of neutrophil count), lung computed tomography (CT) and/or sinus and/or central nervous system (CNS) imaging, depending on clinical findings, and if feasible bronchoscopy to obtain bronchioalveolar lavage (BAL) samples. Clinical and laboratory data were obtained; with this information diagnosis of IA was classified as possible, probable, and proven, according to the EORTC/MSG guidelines. This protocol was approved by the hospital’s research and ethics committees (INP 041/2021). For data analysis categorical variables were presented as frequencies and numerical variables as median and range. Statistical analysis was made with X2 and U Mann Whitney tests. Results Seventy events were included, 14 (20%) had IA diagnosis; 2 possible, 11 probable and 1 proved. Median of age was 10.2y (5.5 – 17) and 64.3% were male. Acute lymphoblastic leukemia was the main oncologic diagnosis (71.4%), 35.7% during induction phase; followed by acute myeloblastic leukemia (21.4%). 92.9% of events with IA presented as PFN (p=0.001) with a fever duration of 3.5 days (1-8) (p=0.004). Pulmonary disease was evident in all events with IA, two had disseminated infection. In 5/14 events serum galactomannan antigen was positive in the first measurement. Only 8 events underwent bronchoscopy: BAL was positive in 6 and 4 had positive culture with Aspergillus spp. Lung CT scan showed different findings, lobar/segmental consolidation and nodule with halo sign were the most common; 85.7% of cases presented with more than one radiological sign (p=0.003). Voriconazole monotherapy was given to 78.5% of IA cases and 21.4% required combined antifungal therapy (added caspofungine or liposomal amphotericin B) due to disseminated disease or severe clinical course. Intensive care admission resulted with statistical significance for the events with diagnosis of IA (64.3% p= 0.019). Within the IA events survival at 60 days was of 78.6%. Conclusion Frequency of IA was high among our high risk cancer patients. This study demonstrates the importance of a complete work up for invasive fungal infection in high-risk patients with persistent febrile neutropenia. The information obtained is of great use for the implementation of pre-emptive approaches and antifungal prophylaxis in this patient population.

Toxoplasma qPCR kinetics to guide pre-emptive treatment of toxoplasmosis after allogeneic hematopoietic stem cell transplantation.

Recent ECIL-guidelines recommend a quantitative PCR (qPCR) guided pre-emptive treatment approach to toxoplasmosis in seropositive recipients of allogeneic hematopoietic cell transplantation (allo-HCT). While qPCR might serve as a sensitive tool for early Toxoplasma detection, its role in treatment follow-up remains unknown. We analyzed the qPCR kinetics of allo-HCT recipients experiencing either Toxoplasma infection (TI, n=71) or disease (TD, n=14) in relation to different parameters. We included 85 patients with available qPCR values expressed as quantitative cycle (Cq) from four large hematological centers from 2009 to 2023, and kinetic analysis was performed in a selection of 74 patients screened at least weekly with blood qPCR. Day 0 (D0) was the day of anti-Toxoplasma treatment start or (when untreated) day of diagnosis. Time to qPCR negativity was inversely proportional to the Cq value at D0 (p=0.0063). Not reaching negativity at D10 was associated with a significantly higher mortality at D30 (p=0.023). Patients with a high D0-parasitic load and patients with TD showed slower clearance (p<0.001, p=0.032). Time to negativity was not significantly different for patients started on prophylactic vs curative doses as first-line treatment regimen (p=0.16). This study underscores the predictive value of qPCR kinetics monitoring in allo-HCT patients with toxoplasmosis. With the aforementioned risk factors, clinicians can identify patients at high-risk for worse outcome. Our results support to consider a therapeutic change or reinforcement if the parasitic load does not decrease after 10 days, supplementing existing clinical guidelines.

The Security of SSH Protocol Public Key Sharing in the Post-Quantum Era

The security of traditional cryptographic schemes is based on mathematical puzzles that cannot be cracked by current computers. However, the rapid development of quantum computers has the potential to greatly reduce the time and resources required to crack these encryption schemes. Although true quantum supremacy may still be years away, it is imperative to adopt anti-quantum algorithms proactively. This preemptive approach aims to thwart "catch first, decrypt later" attacks, wherein attackers intercept and store encrypted data with the intent of decrypting it once quantum computing becomes sufficiently advanced. This threat is particularly critical for protocols like Secure Shell (SSH), which is widely used for secure communication over unsecured networks. In this paper, we propose an innovative approach to enhance the security of public-key distribution within the SSH protocol. Our method integrates quantum-resistant algorithms to ensure that even with the advent of quantum computing, the confidentiality and integrity of SSH sessions are maintained. We emphasize the importance of using cryptographic protocols that operate over open channels, which, while not necessarily confidential, must be authenticated to prevent tampering. In such scenarios, attackers may be able to intercept and even extract information, but they should not be able to alter the data.

Microservices Deployment Strategies: Navigating Challenges with Kubernetes and Serverless Architectures

This paper aims at exploring the effects of performance tuning on concerns such as reliability and uptime with respect to the three current architectures: cloud, on-premise, and hybrid models. This paper shows that performance tuning does enhance system stability and availability based on comparative data on CPU load, memory consumption, disk I/O operations, network delays, application response time, and system failure rates. Employing both quantitative and qualitative data, the study compares features taken from real-world system logs and information obtained from expert interviews indicating that tuning brings about balanced resource distribution as well as ensures faster data processing free from system constraints. The results presented prove that performance tuning positively affects the availability of the system and lowers the failure rates significantly after tuning. This work underscores the need for pre-emptive approach to performance calibration as a means of guaranteeing the systems availabilities and reliability where systems integration is complex and distributed across several nodes. The conclusions help those organizations striving for improvements of the systems in their concern areas for better performances and less failures in a world where competition and operations demands are growing.

Preemptive Approach to Plerixafor Use Is Optimal in Patients With Relapsed/Refractory Germ Cell Tumors Undergoing Peripheral Blood Hematopoietic Stem Cell Collection: Effect on Collection Days, Yields, and Cost.

Evidence describing the use of plerixafor in the off-label population of relapsed/refractory germ cell tumors (GCT) is limited. Weaim to describe the effect of rescue versus preemptive plerixafor use on apheresis collection days, collection yields, and cost. We retrospectively collected data on 77 consecutive patients (at least 15 years of age) with GCT who underwent peripheral blood stem cell (PBSC) collection for autologous stem cell transplant between January 1, 2020 and May 1, 2022. Depending on insurance approval, plerixafor was given either as "rescue" (after a first apheresis collection of < 5 × 106 CD34+ cells/kg) or as "preemptive" on Day 4 of granulocyte-colony stimulating factor (G-CSF) prior to the first apheresis collection, if the Day 4 peripheral blood CD34+ count was < 40 cells/μL. A total of 66% of patients who received preemptive plerixafor completed collection in 1 day, similar to good mobilizers who only needed G-CSF (71%, p = 0.366). In contrast, all poor mobilizers in the rescue group required at least 2 days of collection and had lower CD34+ cell yields than the preemptive group (7.15 vs. 9.81 × 106/kg, p = 0.0055). A cost analysis revealed that preemptive plerixafor may save approximately $7000 per patient compared with a rescue approach. Preemptive plerixafor in GCT patients undergoing PBSC collection allows relatively poor mobilizers to collect in fewer days and with lower overall cost. Fewer apheresis procedures result in less risk to the patient, increased patient satisfaction, and the ability to schedule more patients within the constraints of staffing.

Machine learning-driven predictions and interventions for cardiovascular occlusions.

Cardiovascular diseases remain a leading cause of global morbidity and mortality, with heart attacks and strokes representing significant health challenges. The accurate, early diagnosis and management of these conditions are paramount in improving patient outcomes. The specific disease, cardiovascular occlusions, has been chosen for the study due to the significant impact it has on public health. Cardiovascular diseases are a leading cause of mortality globally, and occlusions, which are blockages in the blood vessels, are a critical factor contributing to these conditions. By focusing on cardiovascular occlusions, the study aims to leverage machine learning to improve the prediction and management of these events, potentially helping to reduce the incidence of heart attacks, strokes, and other related health issues. The use of machine learning in this context offers the promise of developing more accurate and timely interventions, thus improving patient outcomes. We analyze diverse datasets to assess the efficacy of various machine learning algorithms in predicting heart attacks and strokes, comparing their performance to pinpoint the most accurate and reliable models. Additionally, we classify individuals by their predicted risk levels and examine key features that correlate with the incidence of cardiovascular events. The PyCaret machine learning library's Classification Module was key in developing predictive models which were evaluated with stratified cross-validation for reliable performance estimates. Our findings suggest that machine learning can significantly improve the prediction accuracy for heart attacks and strokes, facilitating earlier and more precise interventions. We also discuss the integration of machine learning models into clinical practice, addressing potential challenges and the need for healthcare professionals to interpret and apply these predictions effectively. The use of machine learning for risk stratification and the identification of modifiable factors may empower preemptive approaches to cardiovascular care, ultimately aiming to reduce the occurrence of life-threatening events and improve long-term patient health trajectories.

Genomic Data Fusion using Paillier Cryptosystem

The proposed work performs secure data fusion using homomorphic encryption, specifically the Paillier cryptosystem. The Paillier cryptosystem allows computation to be performed on encrypted data without decrypting it first, thus ensuring the privacy and security of the computation. The experiment measures the algorithm's performance based on execution time, memory usage, security, accuracy, and scalability. The data-level Paillier cryptosystem approach is generally slower than the feature-level fusion method due to its more complex operations and computations. Scalability is limited by the time required for encryption, homomorphic addition, and decryption. Improving scalability can be achieved by parallelizing the encryption and decryption steps, optimizing the homomorphic addition algorithm, or using more efficient cryptographic primitives. The article compares the performance of the Paillier cryptosystem with differential privacy in terms of their advantages and disadvantages. By adopting a preemptive approach to data fusion security, healthcare organizations can minimize the risk of data breaches and protect patient privacy. Data fusion security is an important factor when dealing with medical records. In the field of medical records, data fusion refers to the method of combining multiple sources of data into a distinct record. This can include data from electronic health records (EHRs), medical imaging devices, wearable devices, and other sources. There are several security considerations that must be addressed when fusing data from multiple sources.

Does secondary adrenal insufficiency require supplementation prior to oral surgery procedures? An update

Adrenal insufficiency (AI) is linked to a rare medical emergency, acute AI, or adrenal crisis (AC), which can occur following stressful events, like infection or surgery. A commonly overlooked form of secondary AI occurs when individuals take exogenous glucocorticoids for extended periods of time, resulting in hypoactivity of the adrenal glands. Many patients take glucocorticoids to treat conditions like asthma, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, or dermatitis. These patients may be prone to secondary AI, which may go undetected, increasing their risk of facing a medical emergency. Our aim is to review the literature on current guidelines for corticosteroid supplementation for patients at risk of AC; and assess the risk of developing AI in patients taking exogenous glucocorticoids and whether the current supplementation guidelines require modifications. Current recommendations from the Addison’s disease self-help group and Miller suggest steroid supplementation for dental procedures only for patients with primary AI. However, they do not recommend supplementation for patients with secondary or tertiary adrenal insufficiency. The drawbacks of short-term supplementation of glucocorticoids in patients at risk of secondary AI, for stressful dental procedures is negligible. Adverse effects of glucocorticoid use are typically seen after prolonged usage. Thus, steroid supplementation before dental procedures should be considered, customized based on identified risk factors and the stress associated with the procedure, as a pragmatic and preemptive approach to reduce the risk of AC. Moreover, this review highlights the need for updated guidance on supplementing patients at risk of secondary AI

VLR-BPP: An intelligent virtual location replacement based bilateral privacy-preserving architecture for edge cloud systems

VLR-BPP: An intelligent virtual location replacement based bilateral privacy-preserving architecture for edge cloud systems

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.

PROACTIVE RISK IDENTIFICATION IN THE CHANGING AUTOMOTIVE INDUSTRY: A COMPREHENSIVE FRAMEWORK

Advancements in technology, shifts in consumer preferences, and revised regulations are all propelling rapid growth in the automotive industry. Traditional approaches to risk management are insufficient when confronted with the emerging risks presented by this transition. Adopting a proactive approach to detecting hazards is essential for successfully navigating this constantly evolving world. The present work presents a comprehensive framework for the proactive identification and management of risks within the ever-changing automotive sector. The essay commences with providing an overview of the industry's historical context and current advancements, followed by an analysis of the inadequacy of conventional risk management methods facing emerging risks. Furthermore, it proposes a complete framework specifically tailored to tackle the unique challenges faced by the automotive sector. Implementing a comprehensive approach to risk management, this framework integrates assessments of technology, markets, legislation, cybersecurity, and supply chain vulnerabilities. The analysis proceeds to discuss potential issues associated with implementing this methodology and offers remedies to overcome them. In order to enhance their decision-making and resilience in the face of industry-wide complexity, stakeholders in the automobile sector might adopt a pre-emptive approach to risk management. This study contributes to our knowledge of proactive risk management strategies and enhances our understanding of future risk identification in the automobile industry. Methodology: By employing this approach, these enterprises can enhance their ability to make well-informed judgements on their risk management plans. The technique facilitates the identification of critical vulnerabilities, therefore enabling the implementation of preventive measures to mitigate the effects of specific risks on net income. Moreover, the model possesses the capability to undertake data analysis from multiple companies within the same industry, thereby offering potential insights that can be extrapolated to other similar organisations. This has the potential to result in enhanced risk management strategies within India's automobile industry.

Immune Thrombotic Thrombocytopenic Purpura: Pathophysiology, Diagnosis, Therapy and Open Issues.

Immune thrombotic thrombocytopenic purpura (iTTP) is a life-threatening thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, thrombocytopenia, and ischemic end-organ injury due to microvascular platelet-rich thrombi. iTTP pathophysiology is based on a severe ADAMTS13 deficiency, the specific von Willebrand factor (vWF)-cleaving protease, due to anti-ADAMTS13 autoantibodies. Early diagnosis and treatment reduce the mortality. Frontline therapy includes daily plasma exchange (PEX) with fresh frozen plasma replacement and immunosuppression with corticosteroids. Caplacizumab has recently been added to frontline therapy. Caplacizumab is a nanobody that binds to the A1 domain of vWF, blocking the interaction of ultra-large vWF multimers with the platelet and thereby preventing the formation of platelet-rich thrombi. Caplacizumab reduces mortality due to ischemic events, refractoriness, and exacerbations after PEX discontinuation. Until now, the criteria for response to treatment mainly took into account the normalization of platelet count and discontinuation of PEX; with the use of caplacizumab leading to rapid normalization of platelet count, it has been necessary to redefine the response criteria, taking into account also the underlying autoimmune disease. Monitoring of ADAMTS13 activity is important to identify cases with a low value of activity (<10IU/L), requiring the optimization of immunosuppressive therapy with the addition of Rituximab. Rituximab is effective in patients with refractory disease or relapsing disease. Currently, the use of Rituximab has expanded, both in frontline treatment and during follow-up, as a pre-emptive approach. Some patients do not achieve ADAMTS13 remission following the acute phase despite steroids and rituximab treatment, requiring an individualized immunosuppressive approach to prevent clinical relapse. In iTTP, there is an increased risk of venous thrombotic events (VTEs) as well as arterial thrombotic events, and most occur after platelet normalization. Until now, there has been no consensus on the use of pharmacological thromboprophylaxis in patients on caplacizumab because the drug is known to increase bleeding risk.