Management Procedures Research Articles

Research on Urban Traffic Flows Prediction Model Based on Deep Learning

Abstract. Vehicle accumulation in urban regions is a significant complication, giving rise to monetary and sustainability-related concerns. The most important procedure for effective traffic management is the precise forecasting of traffic flow. This study leverages Long Short-Term Memory (LSTM) networks to predict traffic volume on Interstate-94 (I-94) in the US, using hourly traffic and weather data from 2012 to 2018, which was normalized using Min-Max scaling, and the LSTM model was trained on 80% of the data, with the remaining 20% used for testing. Evaluation of the model was conducted using performance indicators such as Mean Absolute Error (MAE) and Root Mean Square Error (RMSE). Showing its strong forecasting ability, evidenced by its low MAE and RMSE, which highlight the model's high accuracy, and forecast the traffic flow under varying conditions. This study highlights the effectiveness of LSTM networks for traffic prediction, offering a significant tool for the management of the metropolitan areas. Upcoming studies might prioritize on real-time implementation and integrating additional data sources to further enhance prediction accuracy.

Climate-readiness of fishery management procedures with application to the southeast US Atlantic

Abstract Global climate change threatens the assumption of stationarity inherent in many fisheries management decisions. This heightens the importance of developing management strategies that are robust to future uncertainty. Management strategy evaluation (MSE) is a framework in which management procedures (MPs) can be developed and tested using closed-loop simulation. We explored the performance of various model-based and empirical MPs with nonstationary future projections for three commercially and recreationally important fish stocks in the southeast US Atlantic. Using openMSE, we tested candidate MP performance across projections designed to emulate plausible future conditions, including regime shifts, nonstationarity, and observation error shifts in the survey index. Candidate MP performance was primarily measured based on its ability to maintain a healthy stock biomass. Results of this MSE demonstrate that several empirical MPs may be better able to adapt to regime shifts and nonstationary dynamics compared to traditional model-based MPs that employ full age-structured stock assessments, though empirical MPs struggle to maintain stock biomass when facing artificial index observation error shifts. Relative performance of model-based versus empirical MPs varied by stock and climate-change scenario. These findings highlight the value that adaptive MPs may hold for climate-ready fisheries management.

Common sports-related nerve injuries seen by the electrodiagnostic medical consultant.

The high physiologic demands of sports create dynamic stress on joints, soft tissues, and nerves which may lead to injuries in the athlete. Electrodiagnostic (EDx) assessment is essential to identify the correct diagnosis, localization, and prognosis, to guide management of sports-related neuropathies. A comprehensive review was performed to provide the EDx medical consultant with a practical approach to the common peripheral nerve disorders seen in athletes. Sports-related neuropathies reviewed include transient traumatic irritation of the brachial plexus and/or cervical nerve roots ("Burners and stingers,") suprascapular and axillary neuropathies, ulnar neuropathy at the elbow (UNE) in throwers, ulnar neuropathy at the hand/wrist in cyclists, multi-ligamentous knee injury, and foot/ankle neuropathies including tarsal tunnel syndrome. A thorough understanding of peripheral anatomy, possible entrapment sites, mechanisms of injury, and key physical examination findings is essential for correct diagnosis. EDx assessments beyond routine studies are generally required for sports-related neuropathy, which may not necessarily follow typical entrapment patterns. Adjunct diagnostic imaging, such as point-of-care ultrasound and magnetic resonance imaging, are helpful tools to identify associated musculoskeletal pathology such as compressive cysts or nerve entrapment, which may be amenable to interventional or surgical treatment. When no clear reversible structural pathology exists, management of sports-related neuropathy is athlete-specific and generally multi-modal, involving a combination of physical rehabilitation techniques to address muscle imbalances, load management, protective equipment, and interventional pain procedures.

An Algerian Soil-Living Streptomyces alboflavus Strain as Source of Antifungal Compounds for the Management of the Pea Pathogen Fusarium oxysporum f. sp. pisi

Fusarium wilt caused by Fusarium oxysporum f. sp. pisi (Fop) poses significant threats to pea cultivation worldwide. Controlling this disease is mainly achieved through the integration of various disease management procedures, among which biological control has proven to be a safe and effective approach. This study aims to extract and identify antifungal secondary metabolites from Streptomyces alboflavus KRO3 strain and assess their effectiveness in inhibiting the in vitro growth of Fop. This bacterial strain exerts in vitro antagonistic activity against Fop, achieving highly significant inhibition over one week. The ethyl acetate extract, obtained from its ISP2 agar medium culture, also exhibited strong antifungal activity, maintaining an inhibition rate of approximately 90% at concentrations up to 250 µg/plug compared to the control. Thus, the organic extract has been fractionated using chromatographic techniques and its bioguided purification allowed us to isolate the main bioactive compound. This latter was identified as metacycloprodigiosin using nuclear magnetic resonance (NMR) spectroscopy, electrospray ionization mass spectrometry (ESI-MS), and specific optical rotation data. Metacycloprodigiosin demonstrates dose-dependent inhibitory activity against the phytopathogen with an effective concentration of 125 µg/plug. The other secondary metabolites present in the ethyl acetate extract were also identified by gas chromatography–mass spectrometry (GC-MS) and nuclear magnetic resonance (NMR). This study highlighted the potential of S. alboflavus KRO3 strain and its antimicrobial compounds for the management of the pea pathogen Fusarium oxysporum f. sp. pisi.

Liquidity Management Practices and Financial Performance of Microfinance Banks in Nairobi City County, Kenya

Microfinance banks are financial institutions that provide loans, insurance, saving platforms and other financial products to various individuals. Thus, these institutions require sufficient liquid assets to enable them to meet their routine financial obligations. However, in Kenya, microfinance banks have been recording a declining trend regarding their financial performance over time, leading to grave concerns. Thus, this study aimed to assess cash management practices and their effect on Nairobi City County’s MFB's financial performance. The analysis and elucidation of the literature was facilitated by the examination of the Keynesian Liquidity theory. A descriptive research design with a regression analysis model was embraced in determining the predictor variable’s impact on the explained variable. Data review guide was then utilized to gather secondary data, which was obtained from the CBK and covered the years 2017 to 2022. According to the study, operational cash flow management and cash management significantly and favorably impacted the financial performance of Kenyan microfinance institutions. Nonetheless, the financial performance of Kenya's microfinance institutions was significantly impacted negatively by operational efficiency management. As per the study's findings, microfinance banks in Kenya carry out cash budget preparation, bank reconciliation, cash inflow and outflow recording, cash expense payment, and cash surplus investment. As a result, they manage their funds carefully. Furthermore, the stability and functioning of the financial system depend heavily on efficient cash flow management. It entails keeping an eye on money coming in from investments, sales, and outside funding sources as well as tracking money going out to pay for bills, obligations, and loan repayments. Microfinance banks are able to balance inflows and outflows, lower the risk of liquidity crises, and take advantage of growth possibilities by managing cash flow well. This allows microfinance institutions to make well-informed choices regarding debt management, expansion strategies, and investments—all of which are essential for overall financial success. To maximize the beneficial effects on financial performance, the study recommends adhering to the statutory minimum liquidity ratio. Since excessive liquidity and illiquidity reduce the institutions' profitability, microfinance banks should implement effective cash management procedures.

Efficient High Heating Value estimation using Latin Hypercube Sampling and Artificial Neural Network-based approach.

To maximize energy recovery in waste-to-energy (WTE) systems, the High Heating Value (HHV) of municipal solid waste (MSW) must be accurately estimated. To forecast the HHV of MSW, this study proposes a unique method that combines an Artificial Neural Network (ANN) model with Latin Hypercube Sampling (LHS), with a focus on Solan City, Himachal Pradesh, India. In the present study, the elemental characteristics of waste have been used to deal with uncertainty and to find the suitable parameters responsible for the HHV of the MSW. Initially, Latin Hypercube Sampling (LHS) has been used to deal with uncertainty in the elemental composition of MSW, which includes carbon (C), hydrogen (H), nitrogen (N), sulfur (S), and oxygen (O) content. This elemental composition has been used as input parameters to the ANN model for predicting the HHV of MSW. The network 5-28-5-1 offered a minimum MAPE value of 2.18%, MSE, RMSE and R2 values are 0.012, 0.107 and 0.767, respectively. Thereafter, a synaptic weight approach was used to find the most significant parameters responsible for HHV in MSW. It was observed that carbon is the most suitable parameter for HHV of MSW. By dealing with the uncertainty in MSW characteristics, the integration of LHS strengthens the robustness of the model. The results offer an accurate and economical approach for HHV estimation, which will be useful for improving the MSW management and WTE conversion procedures.

Prediction of the impact of tobacco waste hydrothermal products on compost microbial growth using hyperspectral imaging combined with machine learning

The insufficient understanding of the impact of hydrothermal products on the growth characteristics of compost microorganisms presents a significant challenge to the broader implementation of hydrothermal coupled composting for tobacco waste. Traditional biochemical detection methods are labor-intensive and time-consuming, highlighting the need for faster and more accurate alternatives. This study investigated the effects of hydrothermal treatment on tobacco straw products and their influence on compost microorganism growth, using hyperspectral imaging (HSI) technology and machine learning algorithms. Sixty-one tobacco straw samples were analyzed with a hyperspectral camera, and image processing was used to extract average spectra from regions of interest (ROI). Hierarchical cluster analysis (HCA) and principal component analysis (PCA) were applied to assess four key variables: nicotine content, total humic acid content, Penicillium chrysogenum H/C ratio, and Bacillus subtilis OD600 ratio. The effects of hydrothermal treatment on compost were classified as promoting, inhibiting, or neutral regarding microbial growth. The Competitive Adaptive Reweighted Sampling (CARS) method identified the most influential wavelengths in the 900-1700 nm spectral range. The Random Forest (RF) model outperformed SVM, KNN, and XGBoost models in predicting microbial growth responses, achieving Rc = 0.957, RMSE = 3.584. Key wavelengths were identified at 1096 nm, 1101 nm, 1163 nm, 1335 nm, and 1421 nm. The results indicate that hyperspectral imaging combined with machine learning can accurately predict changes in the chemical composition of tobacco straws and their effects on microbial activity. This method provides an innovative and effective means of improving the resource usage of tobacco straws in composting, enhancing sustainable waste management procedures.

Preparing the ground for bespoke nursing training in advanced renal cell carcinoma care (RCC4Nurses): An international prospective study

ObjectivesNurses require specialist knowledge and skills to effectively support an increasing population of people affected by advanced renal cell cancer (aRCC). RCC4Nurses was a three-phase project that aimed to develop bespoke training in aRCC for nurses in Europe. Phase 1 examined pre-existing educational programs in kidney cancer, then developed a curriculum of core education topics in aRCC care to suit generalist and specialist nurses’ education needs. MethodsPhase 1 employed a prospective design that involved two parts. Part 1 was a scoping review of educational programs developed for multidisciplinary health professionals in kidney cancer/RCC. Findings of Part 1 formed the basis for Part 2, which was a three-round Delphi study that involved experts by personal experience or profession in aRCC, who rated the importance of a range of education topics and education methods for inclusion in the developing RCC4Nurses. ResultsThe scoping review identified eight education programs via two published reports and six online resources. Existing programs had limitations in accessibility, recency and target professional groups; none of them was developed specifically for nurses. Program content was primarily focused on diagnostic, treatment and management procedures in kidney cancer. Fourteen educational topics were derived from the review and evaluated during Round 1 of the Delphi by 47 experts. By Round 3, 17 topics had iteratively reached consensus for inclusion within RCC4Nurses. Experts showed preference to problem-solving and clinical-scenario learning methods, but not reflective practice learning. ConclusionsGiven the dearth of up-to-date, evidence-based training for nurses in aRCC, we have prepared the ground to develop a bespoke training course in this area of practice. Implications for Nursing PracticeThe RCC4Nurses project will offer accessible, state-of-the-art education to registered nurses in Europe to help enhance nursing competency in aRCC and enhance the standard of care provided to people affected by aRCC.

Survey about target temperature and thermal management in intensive care for severe thermal trauma in burn centres of Germany, Austria and Switzerland

Burn trauma induces hypermetabolism and alters thermoregulation resulting in elevated body temperature. Because patients with burns are prone to heat loss and hypothermia, maintaining physiologic body temperature is important. However, optimal target temperature is widely unknown because thermoregulation of burn trauma has mainly been studied in the last century when treatment concepts differed from current one. The aim of this study was to investigate current thermal management of burn treatment and to investigate the discrepancies between classical concepts of thermoregulation in burn trauma and current practice of temperature management.A paper-based survey was conducted in burn centres in Germany, Austria and German-speaking Switzerland. Participants were asked for expected temperatures, temperature goals and thermal management of severely burned patients. Results were evaluated for adults and children.37 of 38 approached burn centres participated in this survey. 59% expected that adults with burn trauma would develop hyperthermia (>37.5°C) but only 27% expected hyperthermia in children (>38°C). The average target body temperature was 37.1°C for adults and 36.9°C for children. Adults below 35.7°C and children below 36.0°C were supposed to be hypothermic. Temperatures above 38.8°C in adults and 38.7°C in children raised suspicion for sepsis. Antipyretic treatment was assumed to be justified at temperatures above 39.1°C in adults and 38.5°C in children. Although the most common warmth protective method was to increase ambient temperature, 89% of all participants felt their wellbeing was affected by an increased ambient temperature and 68% were concerned about temperature related negative effects. Although 57% of the responding centres had established a standard operating procedure for thermal management, only 41% considered the available literature to be very relevant in daily practice and 89% criticized the lack of guidelines.Limit- and target-temperatures in European burn centres are heterogeneous. Classic concepts of thermal management in burn care are not generally adopted. A majority of the centers expresses the need for specific guidelines. The basis for this should be multicentre clinical trials on temperature management in burn trauma.

Functional ecology of plant communities as a guide for vegetation management

Plant functional traits determine how individual plants cope with varying environmental conditions, and extensive literature supports their role in influencing ecosystem properties. The study of plant functional traits could help the prediction of species responses to disturbances and environmental change, thus providing invaluable knowledge to refine conservation strategies of species and vegetation. However, applications of functional ecology for vegetation management are still underrepresented.The articles in this Special Issue of FLORA offer cutting-edge insights on the variation of plant traits and ecological strategies in response to environmental drivers, such as anthropogenic disturbance, climate and land use change. The results demonstrate how trait-based approaches can be used for the prediction of climate and land use change impacts on vulnerable sets of species or on biogeochemical cycles, reinforcing the concept that functional plant ecology can help identify the most effective procedures for vegetation management, such as the choice of mowing intensity in grasslands or planning vegetation recovery after wildfires.Our knowledge of plant trait coordination at the community level is still undefined, especially concerning the integration of above- and belowground traits. This represents a missed opportunity for vegetation management, especially considering that a complete understanding of the dynamics of the entire ecosystem is crucial for complete understanding of ecosystem properties. Since plant functional traits can represent a straightforward tool for monitoring changes in ecosystem structure and functions, their use could support vegetation monitoring as required by different programs of nature conservation. It would be useful to embrace a perspective that integrates plant traits with systematic conservation planning, ensuring effective and sustainable conservation efforts.

Utilization management and physician burnout.

This study was designed to assess physician experiences with utilization management and burnout and investigate whether they are linked. We conducted an electronic survey with items related to demographics, profession, utilization management, burnout, and potential policy solutions. The survey was sent to 7222 physicians working in outpatient settings who were recruited from a large, opt-in database. Outcome measures were responses to categorical and Likert-style survey items related to demographics, utilization management, burnout, and potential policy solutions. Of 7222 requests sent, 501 physicians completed the survey and were included in the final data set (77% men; mean [SD] age, 57 [9.8] years; mean [SD] years in practice, 24 [8.9]). Of these, 200 were general practitioners and 301 were nonhospital specialists. Physicians indicated that utilization management procedures for prior authorization (81%), step therapy (79%), and nonmedical switching (69%) were major or significant barriers to their clinical and patient care. More than half (52%) reported spending 6 to 21 or more hours per week on paperwork related to health insurance utilization management, 67% had experienced burnout at some point in their careers, and 64% indicated that utilization management had been a contributing factor to feelings of burnout, with an additional 8% citing it as the main factor. Physicians favored streamlining prior authorization practice (77%), requiring step therapy to be based on science (73%), and ensuring that peer-to-peer reviews are done by qualified medical experts (67%). These findings indicate that utilization management has a detrimental impact on physicians and patient care and contributes to physician burnout.

ПОДХОДЫ К ОСУЩЕСТВЛЕНИЮ РИСК-МЕНЕДЖМЕНТА В УСЛОВИЯХ НЕОПРЕДЕЛЕННОЙ И ТУРБУЛЕНТНОЙ ВНЕШНЕЙ СРЕДЫ (НА ПРИМЕРЕ ЗЕРНОВОГО ПРОИЗВОДСТВА)

In the modern Russian socio-economic system, there is an objective increase in uncertainty and turbulence, which requires adequate management responses. In connection with the sanctions pressure, in agriculture the strategy of reducing the risks of import dependence is becoming a stimulating factor for development. The study was conducted on the example of grain production development, which has some specifics from the standpoint of management and, in particular, risk management. The purpose of the study is to generalize approaches to risk management in an uncertain and turbulent external environment and to develop on this basis a risk distribution scheme between management entities in the risk management system adapted to the specifics of grain production. It is shown that the increase in the values of economic indicators of grain production is influenced by natural and climatic conditions, they determine the quality of grain products, costs and the complex of applied agrotechnological measures. In addition to the observed "standard" variability of natural and climatic conditions, the study also identifies extreme risk events that require forecasting and consideration when managing grain production. Also, risks in the considered sphere are caused by diversity and interdependence of such factors as natural and climatic, soil, technological, economic, social, legal, etc. In their mutual interweaving, these factors determine annual fluctuations of economic indicators (yield, gross harvest, sown area) in grain production in Russia. As a result of the study, it was established that risk management procedures in the sphere of grain production should be carried out according to the hierarchical principle with the allocation of at least two levels: the coordinating level - the executive level. Based on this idea, an industry structural and functional model of risk management at various levels of decision-making has been developed. This model has the property of dualism: some levels are simultaneously coordinating, offering strategic solutions to lower levels, and executive - for higher structures. Implementation of the developed model in the practice of risk management in grain production will increase its sustainability and predictability.

THE IMPACT OF INTERNAL AUDIT ON THE EFFECTIVENESS OF BANKING RISK MANAGEMENT (APPLIED STUDY ON A SAMPLE OF IRAQI BANKS)

In light of the scientific and technical progress in all aspects of life, banks need a control and auditing system to protect them from the risks they are exposed to as a result of their diverse financial dealings, to reduce or avoid losses and maintain and support banks to carry out their work in a way that enables them to achieve a competitive advantage. The problem is embodied in the extent of the contribution of internal auditing in how to manage banking risks and demonstrate their effectiveness in banks. It aims to stand on the reality of internal auditing and the extent of its application in Iraqi banks, with the importance of identifying the functions of internal auditing in auditing, evaluating and following up on the efficiency and effectiveness of risk management procedures based on the risk-based auditing approach. In addition to the commitment to applying the standards, principles and guidelines issued by the Institute of Internal Auditors or issued by the International Organization for Banking Supervision that govern the performance of the internal auditor and help him identify obstacles and find solutions to support and succeed in risk management in the two banks. The research sample used the questionnaire in the practical aspect to show the effectiveness of internal auditing in managing banking risks and to come up with a number of recommendations, the most important of which are: Continuing work to enhance and develop the skills and knowledge of internal auditors by holding training courses on how to deal with banking risk management to enable them to perform their work effectively, and for banking institutions to support the components of the independence of the internal auditor to perform his work efficiently.

ПОДХОДЫ К ОСУЩЕСТВЛЕНИЮ РИСК-МЕНЕДЖМЕНТА В УСЛОВИЯХ НЕОПРЕДЕЛЕННОЙ И ТУРБУЛЕНТНОЙ ВНЕШНЕЙ СРЕДЫ (НА ПРИМЕРЕ ЗЕРНОВОГО ПРОИЗВОДСТВА)

In the modern Russian socio-economic system, there is an objective increase in uncertainty and turbulence, which requires adequate management responses. In connection with the sanctions pressure, in agriculture the strategy of reducing the risks of import dependence is becoming a stimulating factor for development. The study was conducted on the example of grain production development, which has some specifics from the standpoint of management and, in particular, risk management. The purpose of the study is to generalize approaches to risk management in an uncertain and turbulent external environment and to develop on this basis a risk distribution scheme between management entities in the risk management system adapted to the specifics of grain production. It is shown that the increase in the values of economic indicators of grain production is influenced by natural and climatic conditions, they determine the quality of grain products, costs and the complex of applied agrotechnological measures. In addition to the observed "standard" variability of natural and climatic conditions, the study also identifies extreme risk events that require forecasting and consideration when managing grain production. Also, risks in the considered sphere are caused by diversity and interdependence of such factors as natural and climatic, soil, technological, economic, social, legal, etc. In their mutual interweaving, these factors determine annual fluctuations of economic indicators (yield, gross harvest, sown area) in grain production in Russia. As a result of the study, it was established that risk management procedures in the sphere of grain production should be carried out according to the hierarchical principle with the allocation of at least two levels: the coordinating level - the executive level. Based on this idea, an industry structural and functional model of risk management at various levels of decision-making has been developed. This model has the property of dualism: some levels are simultaneously coordinating, offering strategic solutions to lower levels, and executive - for higher structures. Implementation of the developed model in the practice of risk management in grain production will increase its sustainability and predictability.

THE MEDIATING ROLE OF EARNINGS MANAGEMENT IN THE RELATIONSHIP BETWEEN THE FIRM LIFE CYCLE AND THE COST OF EQUITY: EVIDENCE FROM BANKS IN IRAQ

The present study seeks to examine the interaction among three separate variables. The initial variable relates to the organization's life cycle and financial attributes. The second variable pertains to the procedures of firm management that influence performance and financial condition, as demonstrated by earnings management. Investors manage the impact of the previous two factors by weighing the risks and potential gains, which the corporation terms as "the cost of equity." We utilized these variables to analyze 15 Iraqi commercial banks that have been listed on the Iraq Stock Exchange for 10 years, equivalent to 150 observations.Our quantitative assessment of the study variables, conducted using models from the relevant literature, has yielded significant findings. We have uncovered a direct correlation between the life cycle and earnings management, indicating a beneficial association. Moreover, we have revealed that each factor exerts a unique and favourable influence on the cost of equity. The correlation between the life cycle and earnings management has led to an increase in the favourable influence of earnings management on the cost of equity. Conversely, the life cycle now has an inverse impact on the cost of equity, with the cost of equity being mainly influenced by the maturity stage. These findings have important implications for stock market traders, as they guide them to direct their investments towards banks that offer higher returns relative to the level of risk, considering the age group and the administration's approach to managing announced profits. This study's implications for stock market traders are significant, as it provides them with valuable insights for making informed investment decisions. It also serves as a guide for future studies in this field.

Effects of Silver Diamine Fluoride and Potassium Iodide Solutions on the Anti-Caries Properties, Surface Hardness, and Bond Strength of Resin Modified Glass Ionomer in Dentin

This study evaluated the effects of silver diamine fluoride (SDF) and potassium iodide (PI) on carious dentin. The antibacterial efficacy, surface hardness, and bond strength of resin-modified glass ionomer cement (RMGI) were assessed. Dentin specimens were prepared and subjected to artificial caries formation. The antibacterial effect of SDF/PI was compared to sodium fluoride varnish using Streptococcus mutans colony counts. Surface microhardness was measured using the Vickers hardness test. Shear bond strength of RMGI to treated surfaces was evaluated after thermocycling. Results showed that SDF/PI had superior antibacterial effects compared to NaF varnish. Surface hardness significantly increased one week after SDF/PI application. While SDF/PI treatment did not immediately affect RMGI bond strength to carious dentin, delayed bonding after one week significantly improved bond strength. These findings suggest that SDF/PI is effective in arresting caries and enhancing remineralization of carious dentin. The study also indicates that delaying restoration placement for one week after SDF/PI application may be beneficial for improving bond strength. This research provides valuable insights into the clinical application of SDF/PI for caries management and subsequent restorative procedures.

A qualitative investigation of crisis cafés in England: their role, implementation, and accessibility

BackgroundCrisis cafés (also known as crisis sanctuaries or havens) are community-based services which support people in mental health crises, aiming to provide an informal, non-clinical and accessible setting. This model is increasingly popular in the UK; however, we are aware of no peer-reviewed literature focused on this model. We aimed to investigate the aims of crisis cafés, how they operate in practice and the factors that affect access to these services and implementation of the intended model.MethodsA qualitative approach was used. Semi-structured interviews were conducted with 12 managers of crisis cafés across England. These interviews explored managers’ views on the implementation of their services, and the factors that help and hinder successful implementation. Data were analysed using Braun and Clarke’s reflexive thematic approach.ResultsWe identified five main perceived aims for crisis cafés: providing an alternative to Emergency Departments; improving access to crisis care; providing people in acute distress with someone to talk to in a safe and comfortable space; triaging effectively; and improving crisis planning and people’s coping skills. Factors seen as influencing the effectiveness of crisis cafés included accessibility, being able to deliver person-centred care, relationships with other services, and staffing. These factors could both help and hinder access to care and the implementation of the intended model. There were a number of trade-offs that services had to consider when designing and running a crisis café: (1) Balancing an open-door policy with managing demand for the service through referral routes, (2) Balancing risk management procedures with the remit of offering a non-clinical environment and (3) Increasing awareness of the service in the community whilst avoiding stigmatising perceptions of it.ConclusionsFindings illustrate the aims of the crisis café model of care and factors which are influential in its implementation in current practice. Future research is needed to evaluate the efficacy of these services in relation to their aims. Crisis café service users’ views, and views of stakeholders from the wider crisis care system should also be ascertained.

Organizing the automated system of dispatch control over pump units at water pumping stations

The design and operation of modern dispatch control systems for pumping units involves comprehensive solution to separate engineering, technical, and scientific problems. The object of research is information processes enabling the operational modes of electrically driven pumping units at water pumping stations. This paper solves the scientific and technical task related to developing topology, hardware, and software tools, control algorithms, dispatch interface, and researching the modes of operation of pumping units in dispatch control systems at water pumping stations. Algorithms for controlling pumping units have been implemented, the advantage of which is the possibility of automated calculation of parameters for technological PID-controllers, taking into account the current electrical parameters of the frequency-controlled electric drive of pumping units and operating conditions. The WEB-oriented dispatch interface of the SCADA-based pumping unit control system was designed and tested, which enables control process in real time. Features of the developed dispatch control system are improved topology, expanded functionality, energy-saving control modes, and the possibility of further modernization based on the principles of standardization and unification of hardware and software tools and design procedures. The developed dispatch control system for pumping units at water pumping stations has been implemented and is successfully operated at an industrial water supply enterprise. The results provided for an increase in technical and economic indicators during the operation of technological equipment due to the efficiency of control and management procedures, energy-saving operational modes of the frequency-controlled electric drive of pumping units.

Impact of a Clinical Decision Support System on the Change over Time in the Anticholinergic Load in Geriatric Patients: The SADP-Antichol Study

Purpose: Anticholinergic drugs can cause adverse events (AEs) in older adults. Clinical decision support systems (CDSSs) can detect prescriptions with a high anticholinergic load. Our starting hypothesis was that the anticholinergic load could be reduced by combining a CDSS with a strategy for generating pharmacist interventions. The objective of the present study was to assess the impact of this combination on the change over time in the anticholinergic load in hospitalized older adults. Methods: This prospective, single-centre study was divided into two 6-week periods. During the interventional period, a pharmacist analyzed the alerts generated by the CDSS for 30 targeted anticholinergic drugs and decided whether to issue a pharmacist intervention. A control period corresponds to standard care. The primary endpoint of the study is the delta of the anticholinergic load between the alert and hospital discharge; the secondary endpoint is the incidence of anticholinergic adverse events (AEs). Results: Of the 144 alerts generated, 87 were considered to be relevant (36 in the interventional period and 51 in the control period). A significant difference was observed between the delta anticholinergic load between the experimental and control periods (1.61 vs. 0.67, p-value = 0.0115). For the targeted drugs (n = 94) over the 87 alerts, 46.8% were for antihistamines and 21.3% were for desloratadine. Of the 36 pharmacist interventions sent by the pharmacist, 19 (52.8%) were accepted. The most deprescribed drug class was the antihistamine class (n = 7), and the most deprescribed drug was amitriptyline (n = 5). Among these 87 patients with alerts, the correlation between the anticholinergic load and the number of AEs was not statistically significant (p = 0.887). The most common AE affecting the peripheral nervous system was constipation (28.6%), and the most common AE affecting the central nervous system was confusion (29.9%). Conclusions: Our results showed that the combination of specific CDSS rules with pharmacist-mediated risk management procedures could further reduce the anticholinergic load in hospitalized older adults, relative to routine care. It remains to be determined whether this reduction in the anticholinergic load has an impact on the incidence of peripheral and central anticholinergic AEs, and thus the health of these patients.

Big data-based reference centiles for body composition in Korean children and adolescents: a cross-sectional study

BackgroundThe changes in body composition during puberty not only contribute to the differences in body composition between adult males and females but also have associations with growth problems and metabolic disorders, including obesity. Therefore, understanding the changes in body composition during the pubertal period and analyzing reference values based on race and gender are essential research resources. The objective of this study was to generate reference centiles for body composition on a monthly basis using an extensive dataset of body composition information from Korean children and adolescents.MethodsA total of 88,069 measurements from 22,515 children (11,062 boys and 11,453 girls) aged 7–16 years using a bioelectrical impedance analysis were included in the study after performing a Z-score-based data management procedure. Height, weight, body fat mass (BFM), and fat-free mass (FFM) were measured and used to derive body fat percentage (BF%), body mass index (BMI), fat mass index (FMI), and fat-free mass index (FFMI). Sex- and age-specific centiles were estimated using generalized additive models for location, scale, and shape with the Box-Cox Cole and Green distribution (i.e., lambda-mu-sigma method).ResultsThe sex- and age-related disparities in body composition were most pronounced when weight was partitioned into BFM and FFM. In boys, the FFM increased markedly during pubertal growth spurts, whereas BFM remained relatively stable. In girls, the BFM increased steadily, whereas the rate of FFM increased slowly. The BMI increased steadily with age in both sexes. However, when BMI was parsed into FMI and FFMI, it became clear that the FFMI increased substantially during pubertal growth in boys, whereas the FMI peaked around age 11 and then declined. Conversely, the FMI increased steadily in girls, albeit with a slowing rate in the increase of the FFMI beginning around age 12.ConclusionsThis study produced age- and sex-specific reference percentiles for body composition indices in Korean children and adolescents using extensive biometric data.