Relevant Options Research Articles

Strategic Thinking and Its Role in Accelerating the Transition from the Linear to the Circular Economic Model—Case Study of the Agri-Food Sector in the Sibiu Depression Microregion, Romania

Our research provides solutions to alleviate the economic problems currently plaguing our planet that are responsible for the decline of its ecological systems. Our motivation is the need to identify elements that will encourage and accelerate the transition from a linear to a circular economic model, raising awareness of the limited nature of resources and the major pressures exerted by climate change and population growth. Our paper highlights the implications of strategic thinking, i.e., strategic management, in the development and promotion of the circular economy, including the concept of sustainability, in the agri-food sector. We propose strategic options based on information from our secondary analysis of statistical data and relevant literature, e.g., from PESTEL, SWOT, and DPSIR diagnostic models, for integrating resource flows into circular processes, which are meant to reduce resource consumption and minimise waste. Our paper elaborates on an integrated and dynamic model for the transition from a linear to a circular economic model; furthermore, we perform further research to create appropriate frameworks for elaborating on and implementing the most relevant policy options to accelerate this transition process.

A framework for local-level economic evaluation to inform implementation decisions: health service interventions to prevent hospital-acquired hypoglycemia.

Published evidence on health service interventions should inform decision-making in local health services, but primary effectiveness studies and cost-effectiveness analyses are unlikely to reflect contexts other than those in which the evaluations were undertaken. A ten-step framework was developed and applied to use published evidence as the basis for local-level economic evaluations that estimate the expected costs and effects of new service intervention options in specific local contexts. Working with a multidisciplinary group of local clinicians, the framework was applied to evaluate intervention options for preventing hospital-acquired hypoglycemia. The framework included: clinical audit and analyses of local health systems data to understand the local context and estimate baseline event rates; pragmatic literature review to identify evidence on relevant intervention options; expert elicitation to adjust published intervention effect estimates to reflect the local context; and modeling to synthesize and calibrate data derived from the disparate data sources. From forty-seven studies identified in the literature review, the working group selected three interventions for evaluation. The local-level economic evaluation generated estimates of intervention costs and a range of cost, capacity and patient outcome-related consequences, which informed working group recommendations to implement two of the interventions. The applied framework for modeled local-level economic evaluation was valued by local stakeholders, in particular the structured, formal approach to identifying and interpreting published evidence alongside local data. Key methodological issues included the handling of alternative reported outcomes and the elicitation of the expected intervention effects in the local context.

Depletion of dopamine in Parkinson's disease and relevant therapeutic options: A review of the literature.

Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects motor and cognition functions. The etiology of Parkinson's disease remains largely unknown, but genetic and environmental factors are believed to play a role. The neurotransmitter dopamine is implicated in regulating movement, motivation, memory, and other physiological processes. In individuals with Parkinson's disease, the loss of dopaminergic neurons leads to a reduction in dopamine levels, which causes motor impairment and may also contribute to the cognitive deficits observed in some patients. Therefore, it is important to understand the pathophysiology that leads to the loss of dopaminergic neurons, along with reliable biomarkers that may help distinguish PD from other conditions, monitor its progression, or indicate a positive response to a therapeutic intervention. Important advances in the treatment, etiology, and pathogenesis of Parkinson's disease have been made in the past 50 years. Therefore, this review tries to explain the different possible mechanisms behind the depletion of dopamine in PD patients such as alpha-synuclein abnormalities, mitochondrial dysfunction, and 3,4-dihydroxyphenylacetaldehyde (DOPAL) toxicity, along with the current therapies we have and the ones that are in development. The clinical aspect of Parkinson's disease such as the manifestation of both motor and non-motor symptoms, and the differential diagnosis with similar neurodegenerative disease are also discussed.

Graves’ Disease in Children: A Comprehensive Review on Diagnosis, Treatment, and Long-Term Considerations

This comprehensive review of Graves’ Disease (GD) addresses some of the challenges in diagnosing the condition and with the techniques utilized. Focus is given to the relevant clinical manifestations, management options, complications and long-term effects, and future directions in treatment. It highlights the critical role of thyroid function tests (TFTs) in confirming thyrotoxicosis, and the role of thyroid autoantibodies in distinguishing GD from other thyroid disorders. It discusses the role of antithyroid medications, radioactive iodine therapy, and surgical interventions in the management of GD in children. It sheds light on the risks and benefits associated with each approach. The paper also studies the impact of GD on growth, development, and ophthalmic complications in the pediatric population. Promising advancements in treatment such as B-lymphocyte depletion, CD40 blockage, and small molecule TSH-receptor antagonists are also explored. Lastly, the importance of risk factor assessment, screening programs, and increased research are underscored with an attempt to enhance the understanding and management of GD in children.

Аналіз методів та засобів вимірювання вологості сипких продуктів

Various methods of grain moisture measurement are considered in the article. The authors conducted the analysis of the conventional and modern methods of grain moisture measurement used in agriculture and the food industry. The principles of operation and the advantages and disadvantages of each method are described. The article examines in detail the methods used in international standards, and also analyzes the latest methods of grain moisture measurement, such as methods using infrared and microwave technology. The paper proposes a classification of methods for measuring the moisture content of bulk products and identifies the most relevant options for further research. Methods and means of grain moisture control are studied. The work established that the choice of grain moisture measurement method should depend on various factors, such as grain type, measurement accuracy, speed and cost of equipment. The authors analyzed each method in detail and made recommendations for choosing the optimal method of grain moisture measurement for specific conditions. The analysis was carried out and significant parameters affecting grain moisture measurements were selected. A comparison of the characteristics of hygrometers implemented by well-known ultra-high-frequency methods was carried out. The accuracy and errors of moisture measurement of significantly depends on the density of materials and indicators of the measurement medium. The considered hygrometers have high measurement error that does not meet the requirements of certain productions. The comparison of these parameters enabled to determine the optimal method for accurate moisture measurement.

The CONSENSYS approach: An instrument to support CONtextual SENsitivity in SYStematic reviews.

Contextual factors such as cultural values and traditions impact on implementation processes of healthcare interventions. It is one of the reasons why local stakeholders may decide to role out a programme differently from how it has originally been developed or described in scientific literature. This can result in different but most likely more context-specific outcomes. Systematic reviews are considered important in answering what works, for whom and in which circumstances. They often include a section on implications for policymakers and practitioners, in which they discuss relevant options to engage with. Implementation sections are coloured by the cultural background, theoretical and disciplinary perspective of the reviewers formulating them. They do not necessarily consider local contexts in which the evidence needs to be applied, hence the recommendations may be too general to be useful. When policy makers and practitioners implement systematic review findings the evidence presented needs to be translated to their local context. We propose CONSENSYS, an instrument that facilitates the transfer from review evidence into practice. CONSENSYS contains 52 contextual factors categorised as either of ecological and socio-cultural relevance or pitched as influencing actor. CONSENSYS is relevant for reviewers because it supports them in structuring and formulating context-sensitive implications sections. It may also guide end-users of systematic reviews in translating review evidence for use in local policies and practices. CONSENSYS is the first rigorously developed instrument that focusses on implications for policy and practice sections in systematic reviews.

THE SHIP MOTION CONTROL BY NAVIGATIONAL PARAMETERS AND PARALLEL INDEXES

The methods of using the main navigation parameters (bearing and distance) to ensure the control of the vessel movement on the planned track are considered. As the mathematical framework, classical navigation methods (determining the position of the vessel, the theory of isolines and position lines) are applied to implement the effective decisions of the corresponding parameters or their combination choice, depending on the current navigation situation. As a result, the most relevant options for choosing the leading, clearing and wheel over lines of position by bearings and distances for the planned route based on the navigation situation are identified and recommended. The expressions for accuracy estimation when using above mentioned navigation parameters and methods are proposed. The expediency of parallel indexing with errors estimation as a combination of bearing and distance as a universal variant of vessel movement control is substantiated. A new variant of the use of parallel indexing with a baseline by two landmarks as a transit line which allows to navigate the vessel in case of compass malfunctions is demonstrated. A graphical interpretation and a comparative analysis of the methods errors variation depending on the distance to the reference points are given. The recommendations and features of the practical application of methods for the vessel movement control on the planned route based on the situation of the navigation area are given. The formalization of these methods will allow the navigator, the automatic navigation complex or the control system of an autonomous ship to solve the problems of processing the corresponding navigation information at a qualitatively new level.

Genome Editing in Human Gametes and Embryos: The Legal Dimension in Europe

To date, the legal aspects of the ongoing debate on the application of genome editing in human gametes and early embryos have attracted little attention. In Europe, this seems to have changed with a recent official position that clarifies the meaning of the relevant provision of the common legal instrument on Human Rights and Biomedicine (Oviedo Convention). This provision explicitly prohibits modifications to the genome of future persons and adoptes a precautionary stance with regard to genetic interventions in the human reproductive material. In this article, we examine relevant interpretative options, following the new official clarifications, focusing on the research/clinical application distinctions that characterize their approach. From this viewpoint, we propose an approach that favors basic research activities involving genome editing, even for exploring potential clinical applications under conditions of safety, which may justify a future legislative amendment. Furthermore, we explore the patenting issue, based on the current approach of European case law, and give reasons that may justify patent rights in this ethically sensitive area.

Assessing and Promoting Cardiovascular Health for Adolescent Women: User-Centered Design Approach.

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. A considerable number of young women already have risk factors for CVD. Awareness of CVD and its risk factors is critical to preventing CVD, yet younger women are less aware of CVD prevalence, its risk factors, and preventative behaviors compared to older women. The purpose of this study is to assess CVD awareness among adolescent and young adult women and develop a lifestyle-based cardiovascular risk assessment tool for the promotion of CVD awareness among this population. This study used a 3-phase iterative design process with young women and health care practitioners from primary care and reproductive care clinics in Atlanta, Georgia. In phase 1, we administered a modified version of the American Heart Association Women's Health Survey to young women, aged 15-24 years (n=67), to assess their general CVD awareness. In phase 2, we interviewed young women, aged 13-21 years (n=10), and their health care practitioners (n=10), to solicit suggestions for adapting the Healthy Heart Score, an existing adult cardiovascular risk assessment tool, for use with this age group. We also aimed to learn more about the barriers and challenges to health behavior change within this population and the clinical practices that serve them. In phase 3, we used the findings from the first 2 phases to create a prototype of a new online cardiovascular risk assessment tool designed specifically for young women. We then used an iterative user-centered design process to collect feedback from approximately 105 young women, aged 13-21 years, as we adapted the tool. Only 10.5% (7/67) of the young women surveyed correctly identified CVD as the leading cause of death among women in the United States. Few respondents reported having discussed their personal risk (4/67, 6%) or family history of CVD (8/67, 11.9%) with a health care provider. During the interviews, young women reported better CVD awareness and knowledge after completing the adult risk assessment tool and suggested making the tool more teen-friendly by incorporating relevant foods and activity options. Health care practitioners emphasized shortening the assessment for easier use within practice and discussed other barriers adolescents may face in adopting heart-healthy behaviors. The result of the iterative design process was a youth-friendly prototype of a cardiovascular risk assessment tool. Adolescent and young adult women demonstrate low awareness of CVD. This study illustrates the potential value of a cardiovascular risk assessment tool adapted for use with young women and showcases the importance of user-centered design when creating digital health interventions.

Decision-Making Framework for Construction Clients in Selecting Appropriate Procurement Route

Procurement decision-making is a crucial determinant of project success. Although several objective, stage-based models have been proposed to guide clients’ procurement choices, little emphasis has been made on the subjective nature of construction clients. Recognizing the role of clients’ experiences in justifying procurement routes, this study develops a decision-making framework that is capable of guiding construction clients in making informed procurement choices. Adopting a mixed-method approach, comprising semi-structured interviews and multi-objective optimization, relevant procurement options were appraised based on clients’ specifications and project deliverables. The lived experiences of construction clients and the importance they attach to pre-defined selection rating criteria were subsequently evaluated, using a template that enables clients to prioritize procurement methods for different project types. The resultant framework offers a holistic, practical, and collaborative procurement selection process that promotes the efficient delivery of construction projects by reducing the cost overrun and delays associated with uninformed client decisions in construction procurement.

What is the most effective method to treat indirect carotid-cavernous fistula?

To review the most relevant treatment options for indirect carotid-cavernous fistulas (iCCF), cohorts of 20 patients or more published after 2000 were analyzed. Clinical and radiological outcomes, as well as embolization techniques and material, had to be clarified in the study to be considered. Statistical analysis was based on calculating the relative percentage of therapeutic methods or embolic material, followed by calculating parametric and nonparametric correlations. Some 22 studies and 1550 patients were included. Transvenous embolization (TVE) was used in 53% of the patients and was strongly associated with coiling (rw = 0.66, p = 0.0.0012; rs = 0.53, p = 0.0138), transarterial embolization (TAE) was preferred in 11% of the patients and was strongly linked to liquid embolics (rw = 0.44, p = 0.0434;rs = 0.64, p = 0.0018). A combination of TAE and TVE treatment was used in 7% and a combination of embolic materials in 13% of the patients. None of the endovascular techniques or embolization materials showed significant superiority over the others in clinical outcome and obliteration rate. Radiosurgery in 22% and mechanical compression in 5% of patients showed a lower obliteration rate (rw = - 0.48, p = 0.0254; rs = - 0.45, p = 0.0371). The clinical outcomes were comparable to endovascular treatment (EVT). The remaining 2% of the patients were treated by open surgery or a combination of EVT and radiosurgery. Transvenous coiling is the preferred EVT method for iCCF. However, comparable results may be accomplished with TAE using liquid. Radiosurgery may achieve a lower percentage of fistula occlusion, but the clinical results are equal to EVT.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

From Within and Without: Gender, Agency and Sustainable Management of Non-Timber Forest Products in Two Indian States

Non-timber forest products (NTFP) from trees are often collected using unsustainable practices, which contributes to the species’ decline and affects the livelihoods and wellbeing of the most forest-dependent groups, such as women, ethnic minorities and the landless. Here we assess opportunities to improve the sustainability of NTFP collection practices across two landscapes in India, using an agency perspective where male and female NTFP collectors themselves identified and evaluated practices and potential interventions for species of their choice. We developed a framework for identifying community-based solutions for NTFP management and carried out participatory exercises in gender-segregated groups in ten rural communities across two states. Unsustainable collection practices such as cutting branches to collect fruits were somewhat more common among women than men, and more common in the more degraded landscape with weaker forest management institutions. Participants described ecological and economic impacts of collection practices in detail, including impacts on future yields, regeneration and product prices. Proposed solutions to improve NTFP management in the less degraded landscape were focused on incentivising sustainable use and working through village institutions, external actors, or both in collaboration. In the more degraded landscape, participants emphasised sanctions and did not frequently propose the existing village institutions to take action. Women proposed collaboration with external actors less often than men. The results indicate that agency perspectives are useful in stimulating discussion about locally relevant NTFP management options, but that social and gender norms and poor relationships with forestry authorities constrain the agency of vulnerable groups in identifying opportunities for change.

Current situation of shared decision making in osteoporosis: A comprehensive literature review of patient decision aids and decision drivers.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microstructural deterioration of bone tissues, resulting in bone fragility and increased fracture risk. It is the most common bone-related disease in the population. However, the proportion of patients who start treatment but discontinue it during the first year is very high (around 50%). Endeavors are made to promote patient participation in treatment by implementing patient decision aids (PDA), whose function is to help the patient make disease-related decisions. We aim to summarize the characteristics of the currently available PDA for osteoporosis, as well as deciding factors. Comprehensive review of the literature. Currently, eleven PDAs can be found for osteoporosis. These PDA have different characteristics or options such as information about treatments tailored to patient needs, graphic information of the results (to facilitate understanding), personal histories (learning), tests to check the knowledge acquired, provision of evidence, clinical practice guidelines or a final summary to share with their doctor. Only five of these PDAs can be considered complete since they provide relevant disease information and therapeutic options to the patient, promote patient's reflection and foment patient-physician discussion. This study provides an update on the current state of decision making on osteoporosis and available PDA, which can help engage the patient through shared decision-making by considering, among other things, patient preferences. Physicians should consider PDA, as it may promote adherence and effectiveness of treatment.

Couples facing the "honeymoon period" of Parkinson's disease: A qualitative study of dyadic functioning.

The public health issue of the Parkinson's disease (PD) has led to a great deal of research that has highlighted the individual challenges faced by the person with the Parkinson's disease (PwPD) and the caregiving spouse. Few studies, however, have sought to understand the functioning of couples facing PD, by differentiating each stage, each of which has its own issues. In particular, the "honeymoon period", characterized by a symptomatic respite allowed by the effectiveness of treatments for motor symptoms, has been poorly documented, especially at the dyadic level. This qualitative study, based on Interpretative Phenomenological Analysis, aimed to understand the experience of couples and their functioning at this stage. Fifteen couples participated in separate semi-structured interviews for each partner. The analyses highlighted four dyadic dynamics, which call into question the relevance of the term "honeymoon" to describe the experience of couples. While some couples appear to adjust by means of flexible functioning and a positive reinterpretation of this experience, other dyads oscillate between rigid hyperprotection in the face of perceived distress or a vicious circle of control/avoidance and, in some cases, gradually slipping towards the erosion of the relationship. These results show that the relational difficulties suffered by partners at this stage should be taken into account as soon as possible after the diagnosis. Strengthening the communication and the togetherness between partners, as well as working on dyadic emotional regulation, are particularly relevant options for these couples.

Combining sustainable livelihood and farm sustainability approaches to identify relevant intensification options: Implications for households with crop-based and gathering-based livelihoods in Tanzania

In low-income countries, the livelihoods of smallholders are affected to different extent by multiple issues, such as food insecurity or low soil fertility, depending on their multiple assets and farming characteristics. In this study, we aim at assessing the current sustainability of households in Tanzania to suggest potential changes in farming system to increase the household́ sustainability. Household survey data from 891 households in two regions of Tanzania (dry Dodoma and humid Morogoro) were used to build composite sustainability indices representing the three pillars of sustainability (economic, environmental and social), based on 46 basic indicators. Then, a household typology was developed through principal component analysis and hierarchical clustering analysis of descriptive variables, and regression analysis linked the sustainability of farms with household characteristics. The analysis revealed significant differences in household types that relied on different livelihood strategies including particularly a “Gathering-based” type in Dodoma and two “Crop-based” types in both regions. These livelihoods significantly influenced the level of farming system sustainability. Particularly, the households in the “Gathering-based” type performed worst on all three pillars of sustainability. By examining the level of capitals from the different household types, we identified that the “Gathering-based” type and “Crop-based” types could improve their livelihood and be better off if they adopt various upgrading solutions. Such solutions include intercropping and optimised weeding to increase productivity and resource-use efficiency, for which these households have sufficient labour resources. Additionally, livestock rearing and use of fertilisers coupled with rainwater harvesting can increase soil fertility and water use efficiency, and hence food security, without compromising the environmental component of sustainability. To facilitate the adoption of these sustainable intensification options, agricultural policies and appropriate training need to be implemented to fit the local context and diversity of household types.

MINOCA: One Size Fits All? Probably Not-A Review of Etiology, Investigation, and Treatment.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of conditions that include both atherosclerotic (coronary plaque disruption) and non-atherosclerotic (spontaneous coronary artery dissection, coronary artery spasm, coronary artery embolism, coronary microvascular dysfunction, and supply–demand mismatch) causes resulting in myocardial damage that is not due to obstructive coronary artery disease. Failure to identify the underlying cause may result in inadequate and inappropriate therapy in these patients. The cornerstone of managing MINOCA patients is to identify the underlying mechanism to achieve the target treatment. Intravascular imaging is able to identify different morphologic features of coronary plaques, while cardiac magnetic resonance is the gold standard for detection of myocardial infarction in the setting of MINOCA. In this review, we summarize the relevant clinical issues, contemporary diagnosis, and treatment options of MINOCA.

Understanding Nasal Valve Compromise in Nasal Airway Obstruction: A New Classification System.

A key aspect of rhinoplasty is integrity of nasal valves area because of its fundamental role in patent nasal airway. furthermore, nasal obstruction is a dominant feature in patient with nasal valves dysfunction (NVD) which can be devastating outcome after rhinoplasty. Nonetheless, NVD has been widely investigated regarding their etiologies and management. However, it has been assumed that the anatomical complexity and interplay between its structures causing a confusion for a beginner surgeon to diagnose and treat NVD. This study was approved by the institutional review board of Chosun University Hospital, Gwangju, Korea (2022-11-005). To date, the lack of consensus on nasal valve pathologies and corrective procedures has led to its underestimations during analysis and management. As result, we proposed a classification system based on its affected anatomical part, location, and their management. Thus, implementing a classification system for NVD will help guide the practice of rhinoplasty and introduce a more structured approach. This approach will prove useful in expanding our understanding of how important to locate the pathology of NVD and apply the most relevant management options, particularly for a beginner surgeons. V.

Risk Factors of Benign Stricture of Anastomotic Stoma after Esophagectomy and Therapeutic Effect of Stent Implantation.

With the increase in the number of patients and prolongation of their lives after esophagectomy for esophageal cancer, the quality of life after surgery has attracted more and more attention. Although anastomotic stenosis is a common complication, it seriously affects the quality of life and psychological state of patients or even threatens their lives. At present, the exact independent influencing factors of anastomotic stenosis after esophageal cancer surgery have not been determined, and relevant treatment options are still controversial. Here, we analyzed the independent risk factors leading to good postoperative anastomotic stenosis, in order to provide a basis for late prevention. At the same time, we deeply discussed the advantages and safety of stent implantation in the treatment of anastomotic stenosis.

Akutes Nierenversagen

Das akute Nierenversagen oder die akute Nierenschädigung ist eine ernsthafte Erkrankung. Es gibt nur vage Zahlenangaben zum Auftreten. Im vorliegenden Beitrag wird versucht, die diabetologisch relevanten Aspekte dieser Erkrankung darzustellen. Die möglichen Ursachen werden aufgezeigt. Menschen mit Diabetes mellitus haben überwiegend ein höheres Risiko für ein akutes Nierenversagen als nicht von dieser Stoffwechselerkrankung Betroffene. Dies wird für diagnostische sowie klinisch relevante Risikokonstellationen dargestellt. Sowohl diagnostisch als auch therapeutisch ist die interdisziplinäre Kooperation insbesondere mit dem Fachgebiet Nephrologie erforderlich. Therapeutisch relevante Aspekte werden angerissen, auch medikamentöse Maßnahmen.