Initial Proportion Research Articles

Factors Affecting Early Initiation of Breastfeeding Among Women Delivered in a Tertiary Care Hospital

Objective: To determine the proportion of early initiation of breastfeeding among women delivered in a tertiary care hospital before discharge and to identify factors affecting itMethodology: This cross-sectional analytical study was conducted in the Department of Obstetrics and Gynecology, Holy Family Hospital, Rawalpindi from Sep 2022 to Feb 2023. In the study, data were collected from 380 women through a structured questionnaire about the feeding practices and different factors affecting it after taking ethical approval and consent. Data were analyzed by using SPSS version 26.The Chi-square test was used to evaluate the association of the independent variables with the early initiation of breastfeeding. Binary logistic regression analysis was employed to identify the factors independently associated with early initiation of breastfeeding. A p- value of <0.05 was considered significant.Results: Early initiation of breastfeeding was found in only 12.6 % of women. Out of the remaining, 41% started breastfeeding within 2-12 hours. The most common reason for delayed breastfeeding was neonatal NICU admission (29%), followed by postoperative pain (28.6%) and perceived inadequate milk quantity (24.2%). On the Chi-square test, factors having significant association with EIBF are the mode of delivery (p=0.000), availability of guidance by family members or health care representatives (p=<0.001), parity (p-value=0.024) and sex of the baby (p=0.044). On binary logistic regression analysis, factors that were significantly associated with early initiation of breastfeeding, were the mode of delivery, parity and availability of help or guidance by family members or health care representatives (p<0.05).Conclusion: Early initiation of breastfeeding practices can be increased by antenatal counseling and training of mothers, limiting neonatal NICU admission by uniform protocols and training of health care workers.

Maternal health service utilization in the Jimma Zone, Ethiopia: results from a baseline study for mobile phone messaging interventions

BackgroundOver the last 20 years, global healthcare has placed a major focus on improving the survival rates of mothers and children, recognizing the potential to prevent a significant number of deaths resulting from pregnancy and childbirth. Nevertheless, there remains an ongoing obstacle to the insufficient utilization of critical obstetric services to achieve optimal health outcomes for pregnant women. This study aimed to assess the magnitude and determinants of maternal healthcare use in the Jimma Zone, Ethiopia.MethodsData were obtained from a household survey as part of the baseline assessment of a cluster randomized controlled trial. The study participants comprised 588 women in early pregnancy, specifically those with a gestational age of less than 20 weeks. Logistic regression analysis was employed to identify factors associated with the use of maternal health services. Adjusted odds ratios (AORs) were used to assess the strength of the associations, with significance level set at a p-value ≤ 0.05.ResultsThe overall prevalence of maternal health service utilization was 87.9% (CI: 85.1, 90.4) for antenatal care, 74.7% (CI: 73.2, 79.9) for health facility delivery, and 60.4% (CI: 56.4, 64.3) for postnatal care. Multivariable logistic analysis revealed that maternal health service use was significantly influenced by access to health facilities (AOR: 6.6; 95% CI: 2.39, 18.16), financial hardship (AOR: 3; 95% CI: 1.97, 4.61), perceived respectful care (AOR: 2.3; 95% CI: 1.07, 5.11), perceived privacy of service provisions (AOR: 2.4; 95% CI: 1.47, 4.06), and attitudes toward maternal service use (AOR: 2.2; 95% CI: 1.48, 3.24).ConclusionsThe study revealed slightly higher rates of antenatal care, facility delivery, and postpartum care utilization. However, there was a low proportion of early antenatal care initiation, and high rates of antenatal care dropout. Mobile phone-based messaging intervention may enhance maternal health service use by addressing factors such as lack of access, economic challenges, disrespectful care, no privacy of procedures, and unfavorable attitudes.

Caracterización de experiencias significativas de educación ambiental en Colombia: Un análisis descriptivo de la identificación de tendencias para el desarrollo sustentable

The current environmental crisis, resulting from humanity's subjugation and domination of nature, has significantly contributed to the decline of ecological biodiversity worldwide. In the case of Colombia, the main causes of biodiversity loss include land-use changes, urbanization, among others. This underscores the urgent need to strengthen environmental education (EE) in the country to promote a sustainable environmental culture in harmony with nature. Accordingly, this research aims to characterize environmental education experiences in Colombia based on the database "Experiencias significativas de Educación Ambiental – Listado Minambiente" Data processing was conducted using the statistical software STATA, with the goal of identifying educational trends related to environmental issues at the national level. The results reveal progress in the field of EE, highlighting a higher proportion of initiatives that adopt a naturalistic teaching model. Likewise, there is a prevalence of institutional initiatives over community ones. The results suggest that community initiatives tend to align with a systemic teaching model, while institutional initiatives prioritize the naturalistic perspective. Additionally, it was observed that community participation is sometimes conditioned by sectoral and non-sectoral entities in the country. Finally, the conclusions reaffirm the need for Colombian institutions to continue working on appropriate environmental education indicators that allow for the measurement and dissemination of EE experiences at the national level. Furthermore, the importance of strengthening systemic EE models is emphasized, as they promote the social re-appropriation of the environment through cultural changes.

Removing the FDA’s Boxed Hepatotoxicity Warning and Liver Function Testing Requirement for Ambrisentan

Endothelin receptor antagonists are first-line therapy for pulmonary arterial hypertension (PAH). The first 2 agents approved in the class, bosentan and ambrisentan, initially carried boxed warnings for hepatotoxicity and required monthly liver function tests (LFTs) as part of a risk evaluation and mitigation strategy (REMS); however, in 2011, as further safety data emerged on ambrisentan, the boxed hepatotoxicity warning and LFT requirements were removed. To analyze changes in the use of and LFT monitoring for ambrisentan and bosentan after changes to the ambrisentan labeling and REMS. This serial cross-sectional study used data from 3 longitudinal health care insurance claims databases-Medicaid, Optum's deidentified Clinformatics Data Mart, and Merative Marketscan-to perform an interrupted time series analysis of prescription fills and LFTs for patients taking ambrisentan and bosentan. Participants were patients filling prescriptions for ambrisentan and bosentan from July 1, 2007, to December 31, 2018. Data analysis was performed from April 2021 to August 2023. Removal of the boxed warning for hepatotoxicity and the REMS LFT monitoring requirements on ambrisentan in March 2011. The primary outcomes were use of ambrisentan (ie, individuals with at least 1 dispensing per 1 000 000 individuals enrolled in the 3 datasets) vs bosentan and LFT monitoring (ie, proportion of initiators with at least 1 ordered test) before initiation and before the first refill. A total of 10 261 patients received a prescription for ambrisentan during the study period (7442 women [72.5%]; mean [SD] age, 52.6 [17.6] years), and 11 159 patients received a prescription for bosentan (7931 women [71.1%]; mean [SD] age, 47.7 [23.7] years). Removal of the ambrisentan boxed hepatotoxicity warning and LFT monitoring requirement was associated with an immediate increase in the use of ambrisentan (1.50 patients per million enrollees; 95% CI, 1.08 to 1.92 patients per million enrollees) but no significant change in the use of bosentan. There were reductions in recorded LFTs before drug initiation (13.1% absolute decrease; 95% CI, -18.2% to -8.0%) and before the first refill (26.4% absolute decrease; 95% CI, -34.4% to -18.5%) of ambrisentan but not bosentan. In this serial cross-sectional study of ambrisentan, labeling changes and removal of the REMS-related LFT requirement were associated with shifts in prescribing and testing behavior for ambrisentan but not bosentan. Further clinician education may be needed to maximize the benefits of REMS programs and labeling warnings designed to ensure the safe administration of high-risk medications.

THE PARADOXICAL NATURE OF ORGANIZATIONAL CHANGE COMPANY: A THEORETICAL FOUNDATION AND KEY CONCEPTS

Organizational Change Management (OCM) is a crucial and really important process for companies that seek to adapt and succeed in a modern and dynamic world. However, despite the importance of Organizational Change Management and the numerous models and frameworks available, a significant proportion of change initiatives fail to achieve their desirable results. This problem instantly emphasizes the need for fresh ideas and innovative ways to address the complexities of organizational change in the modern world. First of all, this article explores the paradoxical theory of change as an alternative for better understanding and more efficient management of change that will be useful for various organizations. It reviews the theoretical foundations of this approach, rooted in Gestalt therapy and other relevant literature. Apart from that, the publication defines key concepts such as polarities and tensions, explaining how these seemingly contradictory forces are natural and necessary elements of dynamic systems. By embracing these tensions, organizations can foster adaptability, drive innovation, and enhance resilience. Secondly, the article also considers the concepts of the Real and Ideal Self in the context of organizational change, displaying how these two states' tensions can be a source of resistance or motivation. Understanding and managing these tensions is unarguably crucial for utilizing them as sources of energy and creativity, ultimately leading to more organizational transformations that would be more successful. What is more, this article provides practical insights on how to apply the paradoxical theory to some of the real-life situations. This shows the importance of balancing stability and change, autonomy and control, and exploration and exploitation in business corporations. Taking everything into consideration, by adopting these paradoxical components, organizations can create a holistic and more effective approach to change management, achieving lasting success and sustainability in the modern ever-evolving environment, which is vital for modern and successful business.

Real-world schedule de-escalation of teclistamab in patients with relapsed/refractory multiple myeloma.

7536 Background: Teclistamab (Tec) is the first BCMAxCD3 bispecific antibody approved for triple-class-exposed relapsed/refractory multiple myeloma (RRMM). The MajesTEC-1 study demonstrated an overall response rate (ORR) of 63% and a median progression-free survival (mPFS) of 11.3 months (mos). Herein, we examined real-world pt characteristics and outcomes associated with Tec in (1) pts treated within the first 4 mos of Tec approval (early initiators who were expected to have high disease burden) as compared to recent initiators, and (2) any pts who switched to de-escalated dosing schedules. Methods: This is a retrospective study of pts with RRMM treated with Tec at Memorial Sloan Kettering Cancer Center from 11/29/22 to 11/30/23 (analysis cut-off: 12/31/23). Responses were evaluated per IMWG Response Criteria. Pt characteristics were summarized by frequency (%) or median (interquartile range [IQR]). PFS was evaluated using the Kaplan-Meier method. Results: In 77 pts who received ≥1 Tec dose, the median age was 70 (IQR 63-77); 55% male; 14% Black; and 42% had high-risk cytogenetic abnormalities (HRCA). The ORR was 62% for 69 response-evaluable pts, including 42% with ≥very good partial response (VGPR). The median time to first response was 1.9 mos (IQR 1.0-2.4). After a median follow-up (mFU) of 7.6 mos, 6-mo PFS rate was 52.3% (95%CI 41.5-66%). The median duration of response has not been reached. In the cohort of early initiators (n=34), pts had more prior lines of therapy (LOT; median 8 vs 5, P=0.002) and higher proportion of prior BCMA therapy use (62% vs 23%; P=0.002) as compared to recent initiators treated after 3/31/23 (n=43). ORR was 67% and 59%, respectively (P=0.80; Table). Among all pts at data cut-off, 25 (32%) switched from weekly to every-other-week or monthly Tec after a median time of 3.1 mos from Tec initiation (95%CI 1.8-4.6) and based on achieving ≥PR and/or toxicity. At mFU of 5.3 mos since switching, 6-mo PFS rate was 94.1% (95%CI 83.6-100%). Conclusions: In this real-world study, Tec demonstrated comparable ORR to MajesTEC-1. Both early and recent Tec initiators had high baseline risk features. A higher proportion of early initiators had prior BCMA therapy and more LOTs, but both cohorts yielded consistently high treatment response rates. In pts who responded, schedule de-escalation was feasible with a high subsequent 6-mo PFS. Updated multicenter findings will be presented at the meeting. [Table: see text]

Breastfeeding and Complementary Feeding Practices Among Women with Infants Aged 0-24 Months: A Comparative Study of Pre-Pandemic and Pandemic Deliveries

Objectives: It is important to understand the impact of the pandemic on breastfeeding and complementary feeding practices. This study was conducted to examine the impact of COVID-19 restrictions on the complementary feeding and breastfeeding practices of mothers with 0-24-month-old infants who gave birth before and during the pandemic. Materials and Methods: This study used a cross-sectional, descriptive study design. An online survey including demographic variables, questions about breastfeeding, and complementary feeding practices was sent through the online data collection platform. Results: A total of 814 mothers [489 delivered before the pandemic (BP), 325 delivered during the pandemic (DP)] with infants infant 0-24 months old completed the survey. Mothers reported that 31.4% of DP infants were exclusively breastfed, while 67.5% of BP infants were breastfed+complementary fed. A perception of insufficient milk production was higher in DP mothers (27.0%, n = 80) than BP mothers (10.8%, n = 42) (p<0.001). The proportion of early initiation to infant formula was higher in DP mothers (2.3±2.64 months) than BP mothers (3.4±3.62 months) (p = 0.034). The rate of mothers who stated that they would not make any changes in the feeding practices of infants in case of being infected with COVID-19 was higher in DP mothers (83.1%) than BP mothers (75.9%) (p = 0.040). Conclusion: The results of this study suggest that the COVID-19 pandemic may affect the method of breastfeeding and complementary feeding practices. These results emphasize the need to receive professional support for breastfeeding and complementary feeding during the outbreak.

Barriers to dispatcher-assisted cardiopulmonary resuscitation in Thailand

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has proven effective in boosting bystander CPR rates in out-of-hospital cardiac arrests (OHCA). Recently, Thailand has implemented a DA-CPR program. Our objective was to delineate the obstacles to initiating chest compressions by callers. Methods: We reviewed dispatch recordings of OHCA cases received by the ambulance call center from July 2012 to March 2015. Excluding audio recordings of subpar quality, trained evaluators documented the successive stages of the dispatcher's CPR recognition, delivery of CPR instructions, and the caller's execution of CPR. The time required to achieve these milestones was recorded, while barriers hindering chest compressions were identified. Results: Throughout the study period, researchers identified 280 cases of OHCA. Among these cases, it was observed that 134 bystanders declined to administer CPR. Reasons for refusal varied: 25.4% cited difficulty in controlling their emotions, 21.65% encountered challenges accessing the scene, 20.9% refused to perform CPR, 14.9% dropped out of the call, 9.7% did not approach the emergency patient, 5.9% were unable to perform CPR due to physical limitations, and 2.9% faced difficulty moving the emergency patient to the ground floor. Conclusions: Barriers were present in 47.85% correlating with a reduced proportion of CPR initiation and longer delays in CPR initiation.

Transforming Arid and Semi-Arid Areas to be Food Secure: The Role of Small-Scale Irrigation Projects

The primary aim of this research was to evaluate the contribution of irrigation-based initiatives towards ensuring food security. The specific objectives encompassed assessing the role of labor within small-holder irrigation projects in bolstering food security, analyzing the impact of external donor assistance on food security outcomes within these projects, and appraising the extent of governmental backing for small-holder irrigation endeavors in the pursuit of food security goals. Employing a descriptive survey methodology, the study was conducted within various small-holder irrigation projects. The research population consisted of 1303 members affiliated with the irrigation schemes, alongside 12 agricultural officers. Utilizing a simple random sampling technique, two agricultural extension officers were selected from the irrigation schemes, while a stratified sampling approach identified 66 irrigation scheme members for participation in the study. Data collection primarily relied on the administration of questionnaires. Findings revealed that the majority of farmers predominantly relied on their labor or that of family members, with minimal utilization of hired labor observed in small-scale irrigation ventures. Consequently, labor scarcity emerged as a notable challenge within these projects. Furthermore, the study highlighted that a significant proportion of small-holder irrigation initiatives benefited from external donor support. To address labor shortages, the research suggested incentivizing specialized labor while recommending collaborative efforts among farmers to engage specialists in crop management, thereby enhancing crop productivity within the schemes.

A multistable composite hinge structure

A composite tape-spring (CTS) structure is a thin-walled open slit tube with fibres oriented at ±45°, which is stable in both extended and coiled configurations. The governing factors of its bistability include composite constitutive behaviour, initial geometrical proportions, and geometrically non-linear structural behaviour. Its bistable principle can be employed to produce a flexible multistable hinge structure with tailorable stability. This is achieved by introducing variable stiffness design within a cylindrical shell structure, where folding stability is dependent on central functional patch region, and then connected to linking ploy regions. Thus, a novel multistable composite hinge structure can be designed with positive Gaussian curvature deformation, and its multistability is highly tailorable: a lengthy one-dimensional mechanical arm can be designed to coil and fold multiple times to enable large folding ratio. An analytical model was established based on the strain energy principle, in order to determine effects from functional tape length; the typical structural stability and stable configurations were then predicted with respect to regional length of the functional layer. It is found that the stability of a multistable composite hinge structure is dependent on geometry and combination of both the functional patch region, and connecting ploy region; the stable criteria are then proposed and show good agreement with experimental observations and FE analysis. These enrich the diversities of functional deployable structures to benefit novel requirements for various deployable mechanisms, and enable customised design, as well as smart driving for flexible and multifunctional mechanical composite hinge applications.

Scoping Review: Inhibiting and Supporting Factors of Exclusive Breastfeeding in Teenage Moms

Breast milk has a very important role and is the best nutrition in preventing the onset of disease, and it can save lives and provide healthy growth and development during the first 1000 days of life. Findings in several studies show that adolescent mothers have a shorter duration of breastfeeding and have a lower proportion of breastfeeding initiation when compared to adult mothers, so this scoping review aims to review the inhibiting and supporting factors in adolescent mothers in breastfeeding. This scoping review method uses the Arksey &; O'Malley framework, which was developed using the PEOs framework; in searching and selecting articles through relevant databases, namely Pubmed, Ebsco, and Wiley, and using Grey Literature through Google Scholar; The literature search process used PRISMA Flowchart, and found that from 73 articles there were 7 articles selected based on inclusion and exclusion criteria. The findings based on inhibiting factors show that adolescent mothers lack knowledge about exclusive breastfeeding, practical knowledge in breastfeeding, difficult childbirth or other maternal complications, while supporting factors include maternal education, husband desires and support and support. It can be concluded that previous studies show that breastfeeding among adolescent mothers still requires special attention, which is related to inhibiting factors and very diverse supporting factors that occur among adolescent mothers

Effect of rapid cefpodoxime disk screening for early detection of third-generation cephalosporin resistance in Escherichia coli and Klebsiella pneumoniae bacteremia

BackgroundSeveral methods have been reported for detecting resistance genes or phenotypic testing on the day of positive blood culture in Escherichia coli or Klebsiella pneumoniae bacteremia. However, some facilities have not introduced these methods because of costs or other reasons. Toyota Kosei Hospital introduced cefpodoxime (CPDX) rapid screening on May 7, 2018, to enable early detection of third-generation cephalosporin resistance. In this study, we aimed to evaluate the effects of intervention with an Antimicrobial Stewardship Team using CPDX rapid screening.MethodsCefotaxime (CTX)-resistant E. coli or K. pneumoniae bacteremia cases were selected retrospectively and divided into two groups: the pre-CPDX screening (June 1, 2015, to May 6, 2018) and CPDX screening groups (July 7, 2018, to August 31, 2021). The primary outcome was the proportion of cases in which modifications were made to the administration of susceptible antimicrobial agents within 24 h of blood culture-positive reports.ResultsOverall, 63 patients in the pre-CPDX screening group and 84 patients in the CPDX screening group were eligible for analysis. The proportion of patients who modified to susceptible antimicrobial agents within 24 h of blood culture-positive reports was significantly increased in the CPDX screening group compared to that in the pre-CPDX screening group (6.3% vs. 22.6%, p = 0.010).ConclusionThe results demonstrated that in CTX-resistant E. coli or K. pneumoniae bacteremia, CPDX rapid screening increased the proportion of early initiation of appropriate antimicrobial agents.

Countermeasures for the Transformation of Migrant Workers to Industrial Workers in the Construction Industry Based on Evolutionary Game Theory

With the rapid development of new construction methods, China’s construction industry is facing the transformation challenges of industrialization and informationization. However, migrant workers are characterized by high mobility, low education, and poor skills in China’s national conditions, which can no longer meet the requirements of operations. The transformation of the low-level manual migrant workers in the construction industry to high-level skilled industrial workers is inevitable. In order to explore how to better achieve the transformation of construction workers, evolutionary game research with construction unit and labor company as the subjects was carried out. Three types of assumptions were introduced into the constructed evolutionary game model: cooperation mechanism, spillover effect, and incentive mechanism (CSI). Simulation experiments and analysis of the model were finally conducted. The results of the game analysis finally show: (1) a higher initial proportion of selected transformed industrial workers; (2) a fair benefit concession from the construction unit to the labor company; (3) a lower revenue spillover effect; (4) that a higher level of regulation and incentives are conducive to the evolutionary game to converge to the desired state at a faster rate. The findings provide ideas for improving the labor system in China’s construction industry and lay the foundation for solving the labor specialization problem of new construction methods.

1579. Incidence and Predicting Factors of Opportunistic Infections after Initiation of Antiretroviral Therapy: A Retrospective Cohort Study

Abstract Background Antiretroviral therapy (ART)-associated opportunistic infections (OIs) is the term proposed to encompass all OIs diagnosed after ART initiation, and it is not uncommon. We aimed to determine the incidence of OIs and the predicting factors for OIs developing after ART initiation among Thai people living with HIV (PLHIV). Methods In the university hospital setting, a retrospective cohort study was conducted among naïve PLHIV who initiated ART between January 2016 and December 2019. Results A total of 401 PLHIV were included in the analysis. Of these, the mean (SD) age was 37.1 (11.9) years, 74.3% were male, and 57.6% had heterosexual risk. There were 247 (61.6%) diagnosed with AIDS and a median (IQR) CD4 count at ART initiation was 166 (49-314) cells/µL. The most common prior OIs were tuberculosis (26.4%) and Pneumocystis jirovecii pneumonia (11.5%). Of all, 38 (9.5%) PLHIV developed OIs after initiating ART with an incidence rate of 25.6/1000 person-years. The median time (IQR) from ART initiation to the OIs occurrence was 26.5 (14-73) days. PLHIV who develop OI after ART initiation were more likely to have lower mean body mass index (BMI) (20.1 vs 22.3 kg/m2), lower median CD4 counts (36 vs 188 cells/µL), lower mean hemoglobin levels (10.8 vs 12.4 mg/dL), a higher proportion of AIDS diagnosis (86.5% vs 57.9%), having prior OIs (78.9% vs 35.5%), and a higher proportion of initiation with dolutegravir (DTG)-based regimen (10.5% vs 3%) (p < 0.05, all). By multivariate Cox proportional hazard regression, having BMI ≤18.5 kg/m2 (aHR 2.28; 95% CI 1.18-4.42, p=0.015), symptomatic at presentation (aHR 13.59; 95% CI 3.24-56.9, p < 0.001), SGPT >55 U/L (aHR 2.09; 95% CI 1.06-4.15, p=0.035), and initiation with DTG-based regimen (aHR 4.39, 95% CI 1.54-12.48, p=0.006) were statistically significant associated OIs after ART initiation. The OI-associated mortality was 5.3%. Conclusion The OIs after ART initiation are not uncommon. Malnutrition, symptomatic at presentation, abnormal liver enzyme, and initiation with DTG-based regimens is predicting factors of OI occurrences. It is crucial for physicians to monitor and appropriate treatment of OIs after ART initiation. Disclosures All Authors: No reported disclosures

Experimental study on effects of cyclic loading paths on cracking behavior and fracture characteristics of granite

To investigate the impact of cyclic loading paths on the Mode I fracture characteristics of granite, a series of fracture tests were conducted on semi-circular bend (SCB) specimens using acoustic emission (AE), digital image correlation (DIC) and 3D scanning. The tests included monotonic loading, variable amplitude (VA) cyclic loading, and tiered constant amplitude (TCA) cyclic loading. The results demonstrated that VA cyclic loading leads to an average enhancement of 5.6% in fracture toughness, whereas TCA cyclic loading results in an average reduction of 3.7% in fracture toughness. During cyclic loading and unloading, the TCA loading path exhibits a higher rate of cumulative plastic deformation growth and greater magnitude cumulative plastic deformation compared to the VA loading path. Additionally, detailed observations from 3D scanning revealed that under cyclic loading, the fracture trajectories and surface morphology exhibit more tortuosity and roughness compared to monotonic loading, particularly in the case of TCA cyclic loading. Furthermore, according to the AE and DIC analysis, the proportion of microcrack initiation and stable propagation stage, cumulative AE counts and fracture process zone (FPZ) size generated under VA cyclic loading are greater than those generated under TCA cyclic loading, displaying a consistent variation pattern with fracture toughness. The changes of fracture properties can be attributed to a competition between the compaction-induced hardening effect and the cracking-induced damage effect. A higher cyclic upper limit and incomplete unloading are more likely to accelerate the growth of the irreversible crack damage and rapid crack extension, resulting in weakened rock fracture properties. These findings provide important references for rock instability control in underground rock engineering.

A study on the promotion effect of government guidance on the construction of a national unified market logistics channel

Logistics channel is the lifeblood to ensure that logistics serves the circulation inside and outside the region, and to realize regional economic integration, it greatly contributes to the implementation of the national unified market strategy. As the government plays an important role in the construction of logistics channels, this paper further clarifies the effect of government participation and support policies by defining the role and functions of the government in the construction of logistics channels. Based on the evolutionary game theory, the paper reveals the equilibrium conditions of logistics channel construction under the market mechanism and government guidance under the assumption of bounded rationality. We construct an evolutionary game model among participating stakeholders, then study the evolutionary stability strategy of logistics channel participation behavior using the stability theorem for the model’s differential equations. In order to explore the dynamic evolution process of both parties’ choices under the two modes, we investigates the influence of the initial intention, cooperative income, cost proportion, penalty coefficient and construction cost of participating enterprises on both parties’ strategic decisions under the market mechanism and government guidance modes through numerical simulation. We find that: (1) under the market mechanism and government guidance modes, there is a game equilibrium in the participation behavior of logistics enterprises in the national unified market, and that the conditions for realizing the equilibrium of cooperation among stakeholders under the guidance of the government are easier to meet; (2) The initial intentions of the two players in the game along the logistics channel influence each other, and government participation can change the effects of cooperative income, the penalty coefficient and construction cost on the system game strategy, which has a positive effect on the channel construction; (3) At the same time the simulation shows that the government’s promotion effect has certain limitations, and the government should provide reasonable guidance to prevent enterprises from hindering the healthy development of logistics channels. This study provides a theoretical reference for the government and logistics enterprises, especially relying on logistics channels to support the regional coordination of national unified market development.

Analysis of the Game Behavior of Real Estate Mortgage Securities Issuers Based on Reciprocal Preferences

In recent years, the Chinese government has gradually begun to pay attention to the development of real estate investment trusts (REITs) and hopes to use REITs to increase the securitization of assets in the real estate market, making it possible to accelerate the circulation of funds in the real estate market. In order to enable issuers to price REITs effectively to form a mutually beneficial transaction model with investors, to increase the willingness and success rate of both parties and to ultimately create a harmonious and efficient REITs market, it is important to study the pricing decisions of issuers when issuing REITs. This study analyzes and investigates the issue of pricing decisions of REITs based on reciprocal preferences and evolutionary game theory. It is found that when the proportion of REITs issuers choosing to construct a reciprocal initial pricing decision is greater than the equilibrium probability of REITs issuers choosing a reciprocal pricing strategy, and when the initial proportion of investors choosing a reciprocal investment decision is greater than the equilibrium probability of investors choosing a reciprocal investment strategy, the overall REITs transaction market tends to be a reciprocal and harmonious transaction market at this time, the overall happiness of the REITs trading market is the highest, and the success rate of trading increases and the capital circulation of the real estate market is accelerated. Therefore, it is recommended that issuers choose reciprocal competitive decisions when pricing REITs in order to increase the success rate of their own REIT holdings; and it is recommended that the government, when regulating the pricing of REITs, pays attention to the psychological factors of reciprocal preferences of issuers and investors and that the government penalizes REIT issuers and investors when they choose self-serving decisions and rewards them when they choose reciprocal decisions.

External validation of PE-SARD bleeding score for early major bleeding in patients with acute pulmonary embolism: Insight from the COMMAND VTE Registry-2

Abstract Background/Introduction The current guidelines and existing bleeding risk scores focus on assessing the risk of anticoagulant-related bleeding in patients with pulmonary embolism (PE) who are candidates for extended anticoagulation therapy. However, there is no consensus on the risk of bleeding in the acute phase. The Syncope, Anemia, Renal Dysfunction (PE-SARD) bleeding score has been developed to predict early major bleeding in acute PE patients. However, the score has not yet been externally validated. Purpose The present study aimed to externally validate the PE-SARD bleeding score, using a large-scale multicenter observational database of patients with venous thromboembolism (VTE). Methods The COMMAND VTE Registry-2 is a multicenter registry enrolling 5197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. The present study population was consisted of 2722 patients with PE who received anticoagulation therapy during the acute phase and had a calculated PE-SARD bleeding score. The eligible patients were classified into three groups: high-risk group with a PE-SARD score >2.5 points, intermediate-risk group with a score of 1–2.5 points, and low-risk group with a score of 0 point. The discriminatory and calibration ability of the PE-SARD score for 30-day major bleeding were assessed by calculating the area under the receiver operating characteristic curve and creating a calibration plot, respectively. Results The high-risk group accounted for 537 patients (20%), intermediate-risk group for 1381 (51%), and low-risk group for 804 (30%). The proportion of thrombolysis use did not significantly differ across the groups. Among the patients who received direct oral anticoagulants (DOACs), the proportion of high-dose DOAC initiation was highest (54%) in the low-risk group and lowest in the high-risk group (29%). During the first 30 days of anticoagulation therapy, major bleeding occurred in 118 patients. The cumulative 30-day incidence of major bleeding substantially increased in the higher risk categories by the PE-SARD bleeding score (high-risk group: 8.2% [95% CI, 6.2%–10.9%], intermediate-risk group: 4.5% [95% CI, 3.5%–5.8%], and low-risk group: 1.8% [95% CI, 1.0%–3.0%], long-rank P<0.001). The discriminating power of the score was modest with a C-statistic of 0.65 (95%CI 0.61–0.70). Based on the calibration plot, the PE-SARD bleeding score was well calibrated. A sensitivity analysis excluding 275 outpatients showed similar results. Conclusions The risks of 30-day major bleeding in patients with PE substantially increased in the higher risk categories by using the PE-SARD bleeding score. The score is potentially helpful for management of anticoagulation therapy in the acute phase.The Kaplan-Meier curves

Abstract 336: Bystander CPR Maintains Shockable Rhythm in Sudden Cardiac Arrest Across EMS Response Times

Introduction: Presentation with shockable rhythm markedly improves survival from out-of-hospital sudden cardiac arrest (SCA). Shockable rhythms (ventricular fibrillation/tachycardia; VF/VT) are known to deteriorate to asystole or pulseless electrical activity (PEA) over time, but little population-based data is available regarding this phenomenon. Also, bystander CPR (BCPR) improves survival from SCA but its association with maintenance of shockable rhythms is unclear. Hypothesis: With longer EMS response time, the proportion of EMS-assessed shockable initial rhythms will decrease. BCPR may influence this association. Methods: We analyzed EMS-assessed initial rhythm of SCA cases from the Oregon SUDS study in the Portland, OR metro area (pop ~1 million). For this analysis, we included bystander-witnessed SCA cases (2002-2018) aged ≥18 with resuscitation attempted by EMS. SCA was defined as a sudden, unexpected pulseless condition of likely cardiac origin. We assessed initial rhythm proportions across EMS response times using Cochran-Armitage trend tests. Results: Among 3,309 SCA cases, 1,748 (53%) were bystander-witnessed, and of these, 706 (40%) received BCPR. Response time was 7.3 ± 3.4 minutes for cases with BCPR and 6.8 ± 3.1 minutes without BCPR (p=0.01). In the group receiving BCPR, the proportion with shockable rhythm remained near 60% across response times from <3 to ≥12 minutes (Figure, solid line; p=0.88), and proportions of PEA and asystole remained stable. In the group without BCPR, shockable rhythm declined from 70% at <3 minutes to 44% at ≥12 minutes response time (Figure, dashed line; p<0.001), while non-shockable rhythms increased. Conclusions: Among community-based SCA cases who received bystander CPR, there was no significant decrease in shockable rhythm as response time increased. In contrast, among SCA cases without bystander CPR, longer response times were associated with a lower proportion of shockable rhythms.

Privacy and evolutionary cooperation in neural-network-based game theory

How cooperation evolves is one of the fundamental research problems of multi-agent systems. With a deeper understanding of the forces that promote cooperation, we could increase the proportion of cooperative agents. However, existing methods for cultivating cooperation have two common limitations. Firstly, most do not take the privacy for the agents into account. Privacy preservation is an essential to the systems with multiple agents, because, without privacy preservation, an adversarial agent can use the private information of other agents to maximize its own payoff. Beyond the obvious black hat implication, this is also detrimental because maximizing one’s own payoff typically implies minimizing the payoffs of others, which tends to reduce the number of agents willing to cooperate. The second limitation is that most existing methods have a limited scope for generalization. Their performance is usually highly dependent on specific circumstances, e.g., the system topology, the initial proportion of cooperative agents, etc. To overcome these two drawbacks, we propose a novel method that combines differential privacy to protect an agent’s private information from adversaries with a neural network architecture to optimize the decision making power of agents in a wider range of situations. Through this joint implementation, each agent’s privacy is guaranteed, yet agents are still encouraged to cooperate even when adversaries are present. One notable application example is federated learning (FL) systems. In FL, clients can be incentivized by our method to actively cooperate with the central server by contributing high-quality model updates, while necessitating the utmost assurance of their data privacy protection.