Resource Utilization Research Articles

Decision fatigue in hospital settings: A scoping review.

"Decision Fatigue" (DF) describes the impaired ability to make decisions because of repeated acts of decision-making. We conducted a scoping review to describe DF in inpatient settings. To be included, studies should have explored a clinical decision, included a mechanism to account for the order of decision making, and be published in English in or after the year 2000. Six databases were searched. Retrieved citations were screened and retained studies were reviewed against the inclusion criteria. References of included studies were manually searched, and forward citation searches were conducted to capture relevant sources. The search retrieved 12,781 citations, of which 41 were retained following screening. Following review, 16 studies met the inclusion criteria. Half were conference abstracts and none examined hospitalists. Emergency medicine and intensive care settings were the most frequently studied clinical environments (n = 13, 81%). All studies were observational. The most frequently examined decisions were about resource utilization (n = 8, 50%), however only half of these examined downstream clinical outcomes. Decision quality against prespecified standards was examined in four (25%) studies. Work environment and patient attributes were often described but not consistently accounted for in analyses. Clinician attributes were described in four (25%) investigations. Findings were inconsistent: both supporting and refuting DF's role in the outcome studied. The role of clinician, patient, and work environment attributes in mediating DF is understudied. Similarly, the context surrounding the decision under study require further explication and when assessing resource use and decision quality, adjudication should be made against prespecified standards.

Cervical cancer screening: efficacy of PAX1 and JAM3 methylation assay in the triage of atypical squamous cell of undetermined significance (ASC-US).

Atypical squamous cells of undetermined significance (ASC-US) often present diagnostic challenges with cytology-based results, leading to potential underdiagnosis or overdiagnosis. An effective triage method is essential for managing these cases to reduce unnecessary referrals and treatment. A total of 322 women diagnosed with ASC-US were tested for HPV-DNA and the PAX1 and JAM3 methylation (PAX1m/JAM3m) test in the study. Methylation levels of PAX1 and JAM3 were significantly elevated in cervical lesions classified as CIN2 or more severe lesions (CIN2+). The methylation assay demonstrated a sensitivity of 83.8% and a specificity of 95.8%, outperforming HPV-DNA testing in differentiating high-grade cervical lesions among women with ASC-US. Moreover, PAX1m/JAM3m testing significantly reduced the colposcopy referral rate for further diagnostic procedures in high-risk HPV-positive women by 79.5%. PAX1m/JAM3m testing shows promise as a reliable supplemental method to HPV-DNA testing for the triage of women with cytologic ASC-US. In addition, the molecular triage based on the CISCER assay or single PAX1 or JAM3 methylation, had better effects in the women with non-HPV16/18 group. This approach could potentially minimize overtreatment and unnecessary referrals in clinical practice, enhancing patient management and resource utilization.

QLTI-21. STREAMLINING THE STUDY INTAKE PROCESS AT THE CANCER CLINICAL AND TRANSLATIONAL RESEARCH OFFICE (CCTRO)

Abstract Challenges in the Protocol Intake/Activation process at the Henry Ford Cancer Center, particularly during the budget negotiation and coverage analysis (CA) phases, hamper operational efficiency and financial prospects. This study aimed to improve budget time and process efficiency. Process flow mapping, Value Stream Mapping (VSM), and cause-effect analysis using a fishbone diagram were used to identify and analyze key bottlenecks, focusing on the budget negotiation and CA phases. Budget negotiation took an average of 121.5 days in 2023 due to multiple procedures and a lack of standardized practices. Delays ranged from 127.75 days in August to a low of 69.84 days in November of 2023. The budget build process averaged 13.31 days, with an additional 7.57 days for approval, totaling 20.89 days. The CA phase had an average cycle time of 10.82 days (range 2-10 days). To improve approval times, it was recommended to implement an Electronic Document Management System to automate routing, signing, and tracking of budget and CA-related documents, standardized budget templates to streamline negotiations, a detailed electronic checklist to streamline task lists for document collection and budget negotiation, automated reminders for internal and external stakeholders to ensure timely submission of necessary documents, and timely submission policies enforced by a dedicated finance member on committees. Newly developed Key Performance Indicators (KPIs) such as ‘time to collect documents,’ ‘time between committees,’ and ‘time for budget negotiation process,’ along with a dual tracking system in Excel, were proposed to monitor and improve these metrics. The recommendations are expected to significantly enhance the efficiency of the Protocol Intake/Activation process. By reducing the budget negotiation phase to less than 60 days and optimizing the CA process, faster study initiation, better resource utilization, and improved responsiveness to research opportunities will be achieved. This study underscores the critical need to address operational challenges in clinical trial management to enhance CCTRO’s capability to conduct timely and effective research.

Alleviation of COVID-19 Symptoms and Reduction in Healthcare Utilization Among High-Risk Patients Treated With Nirmatrelvir/Ritonavir (NMV/R): A phase 3 randomized trial.

Nirmatrelvir/ritonavir (NMV/r) is an oral antiviral treatment for mild to moderate COVID-19. This phase 2/3, double-blind, randomized (1:1) study assessed oral NMV/r 300 mg/100 mg versus placebo every 12 hours for 5 days in high-risk, unvaccinated, nonhospitalized, symptomatic adults with COVID-19 from 343 sites across 21 countries. In testing the primary endpoint of COVID-19‒related hospitalization and all-cause deaths and key secondary endpoints including symptom duration and COVID-19‒related medical visits, Type I error was controlled with prespecified sequential testing and the Hochberg procedure. Among 2113 randomized patients enrolled from July 2021 through December 2021, 1966 (NMV/r, n=977; placebo, n=989) were included in the prespecified analysis population (symptom onset ≤5 days, did not receive monoclonal antibodies). NMV/r significantly reduced times to sustained alleviation (median, 13 vs 15 days; hazard ratio [HR]=1.27, p<0.0001) and resolution (16 vs 19 days; HR=1.20, p=0.0022) through Day 28 and significantly reduced the number of COVID-19‒related medical visits and the proportion of patients with such visits. Hospitalized patients treated with NMV/r had shorter stays, none required ICU admission or mechanical ventilation, and all were discharged to home/self-care. Fewer NMV/r-treated patients required additional treatment for COVID-19. No NMV/r-treated patients died through Week 24 compared with 15 placebo-treated patients. In addition to reducing COVID-19‒related hospitalization or death from any cause through Day 28, NMV/r was found to also reduce duration of COVID-19 symptoms and utilization of healthcare resources versus placebo in patients at high risk of progressing to severe disease. ClinicalTrials.gov, NCT04960202, https://clinicaltrials.gov/study/NCT04960202.

Transcriptome-wide methylated RNA immunoprecipitation sequencing profiling reveals m6A modification involved in response to heat stress in Apostichopus japonicus.

Global warming-induced environmental stresses have diverse effects on gene expression and regulation in the life processes of various aquatic organisms. N6 adenylate methylation (m6A) modifications are known to influence mRNA transcription, localization, translation, stability, splicing, and nuclear export, which are pivotal in mediating stress responses. Apostichopus japonicus is a significant species in aquaculture and a representative of benthic organisms in ecosystems, thus there is a growing need for research on its heat stress mechanism. In this study, m6A-modified whole transcriptome profiles of the respiratory tree tissues of A. japonicus in the control (T18) and high-temperature stress (T32) groups were obtained using MeRIP-seq technology. The results showed that 7,211 common m6A peaks, and 9,459 genes containing common m6A were identified in three replicates T18 and T32 groups. The m6A peaks were found to be highly enriched in the 3' untranslated region, and the common sequence of the m6A peak was also enriched, which was shown as RRACH (R = G or A; H = A, C, or U). A total of 1,200 peaks were identified as significantly differentially enriched in the T32 group compared with the T18 group. Among them, 245 peaks were upregulated and 955 were downregulated, which indicated that high temperature stress significantly altered the methylation pattern of m6A, and there were more demethylation sites in the T32 group. Conjoint analysis of the m6A methylation modification and the transcript expression level (the MeRIP-seq and RNA-seq data) showed co-differentiated 395 genes were identified, which were subsequently divided into four groups with a predominant pattern that more genes with decreased m6A modification and up-regulated expression, including HSP70IV, EIF2AK1, etc. GO enrichment and KEGG analyses of differential m6A peak related genes and co-differentiated genes showed the genes were significantly associated with transcription process and pathways such as protein processing in the endoplasmic reticulum, Wnt signaling pathway, and mTOR signaling pathway, etc. CONCLUSION: The comparisons of m6A modification patterns and conjoint analyses of m6A modification and gene expression profiles suggest that m6A modification was involved in the regulation of heat stress-responsive genes and important functional pathways in A. japonicus in response to high-temperature stress. The study will contribute to elucidate the regulatory mechanism of m6A modification in the response of A. japonicus to environmental stress, as well as the conservation and utilization of sea cucumber resources in the context of environmental changes.

Numerical study on a new adjustable multi-hole throttling device for natural gas flooding

Natural gas flooding represents a significant technique for the enhancement of oil recovery, thereby facilitating the efficient utilization of oil and gas resources. In the injection and production system, the throttling gas nozzle is a key component that adjust the injection pressure according to the reservoir’s pressure. However, current throttling gas nozzles utilize a fixed structure, which presents a challenge in achieving online control of flow rate and pressure drop. Therefore, a new adjustable multi-hole throttling device was proposed in this paper, allowing for the regulation of pressure loss by changing the number of flowing holes. In order to gain insight into the operational principles and pressure drop characteristics of this new throttling device, the SST k-ω turbulence model and the NIST physical property model were employed to simulate the supercritical natural gas flow in the nozzle. The results demonstrate that there is an uneven distribution of velocity between the channels of the downhole multi-hole throttling device. The velocity in a single nozzle channel exhibits a trend of initially increasing rapidly and then decreasing, while the pressure exhibits an initial decrease, which is then followed by a slight increase. The pressure drops of the nozzle under different flow rates and flowing hole numbers were acquired, revealing that the pressure drop of the multi-hole throttling device is inversely proportional to the number of holes. The adjustment accuracy of pressure drop and flow rate is higher when the number of holes is between 4 and 6. However, a significant increase in pressure drop occurs when the number of holes is less than 3, resulting in poorer regulation accuracy. Furthermore, a pressure drop prediction model was developed based on the numerical results, which provides guidance for the application and design of the throttling device. In this study, a new natural gas flooding throttling device is proposed, offering a new approach for downhole equipment development. Additionally, this research provides guidance for the practical application and iterative improvement of this throttling device in future use.

Excess costs of depression among a population-based older adults with chronic diseases in Singapore.

There is limited evidence on the economic burden of depression among the older population in Singapore. We aim to evaluate the impact of depression on healthcare expenditure and productivity loss among older adults with chronic diseases in Singapore. Using the data from the Well-being of the Singapore Elderly study (WiSE), a 2011 national representative survey of older adults aged 60 years and above, 2510 respondents were included in this study. The sample comprised 44% male and 56% female respondents with 75% respondents aged between 60 and 74 years old. Healthcare utilisation data was obtained from respondents and healthcare cost was tabulated by multiplying each service unit by the unit cost price. These services include care from polyclinic doctors, private general practitioners (GP), outpatient specialists and inpatient care. We modelled the relationship of healthcare cost and depression using two-part models (probit & generalised linear model - loglink and gamma distribution). For total healthcare expenditure, older adults with both depression and chronic diseases were associated with an average annual incremental cost of $7940 (95% CI 1490-14400; p = 0.016), compared to those without these conditions. They were also associated with an average incremental cost of $257 (95% CI 38.7-475; p = 0.021) for primary care. Likewise, in the case of specialist outpatient clinics, they had an average incremental cost of $970 (95% CI 163-1780; p = 0.018). However, for inpatient setting, the average incremental cost of $6180 (95% CI 418-12800; p = 0.066) was not significant. Additionally, older adults with depression and chronic diseases contribute to an annual productivity loss of $676 (95% CI 346-1010; p < 0.001). This study provides evidence that there are significant incremental costs associated with depression amongst the older adults with chronic diseases in Singapore's primary healthcare setting. The increased somatic presentations among the depressed older adults and the underdiagnosis of depression in primary care may contribute to higher utilisation of healthcare resources which entail higher expenditure. This is one of the first studies to look at the cost of depression using a representative sample of Singaporean older adults and taking into account the multi-ethnic nature of the population. Analyses were restricted to a cross-sectional design, and data relied heavily on the accuracy of self-report utilisation on health care services which was subjected to recall bias. Depression was found to inflate the total healthcare expenditure among older adults with chronic disease by two-fold. This study provides evidence that there are significant incremental costs associated with depression among the older adults with chronic diseases, demonstrating a need for more resources to improve systematic and clinical care for depressed older adults with chronic diseases.

A Review of Algorithms and Platforms for Offloading Decisions in Mobile Cloud Computing

With the substantial growth of mobile applications and the emergence of cloud computing concepts, therefore mobile Cloud Computing (MCC) has been introduced as a potential mobile service technology. Mobile has limited resources, battery life, network bandwidth, storage, and processor, avoid mobile limitations by sending heavy computation to the cloud to get better performance in a short time, the operation of sending data, and get the result of computation call offloading. In this paper, a survey about offloading types is discussed that takes care of many issues such as offloading algorithms, platforms, metrics (that are used with this algorithm and its equations), mobile cloud architecture, and the advantages of using the mobile cloud. The trade-off between local execution of tasks on end-devices and remote execution on the cloud server for minimizing delay time and energy saving. In the form of a multi-objective optimization problem with a focus on reducing overall system power consumption and task execution latency, meta-heuristic algorithms are required to solve this problem which is considered as NP-hardness when the number of tasks is high. To get minimum cost (time and energy) apply partial offloading on specific jobs containing a number of tasks represented in sequences of zeros and ones for example (100111010), when each bit represents a task. The zeros mean the task will be executed in the cloud and the ones mean the task will be executed locally. The decision of processing tasks locally or remotely is important to balance resource utilization. The calculation of task completion time and energy consumption for each task determines which task from the whole job will be executed remotely (been offloaded) and which task will be executed locally. Calculate the total cost (time and energy) for the whole job and determine the minimum total cost. An optimization method based on metaheuristic methods is required to find the best solution. The genetic algorithm is suggested as a metaheuristic Algorithm for future work.

Atrial Fibrillation in Young Patients: Insights From the National Inpatient Sample.

The burden of atrial fibrillation (AF) hospitalizations in young patients is not well characterized. We aimed to study the burden, comorbidities, outcomes, and resource utilization of AF hospitalizations in young patients. We conducted a retrospective analysis of all primary AF hospitalizations in patients 18-45 years of age using the National Inpatient Sample data from January 1, 2008 to December 31, 2019. We collected data on various clinical and socioeconomic features including demographics and clinical outcomes. AF hospitalizations decreased over time from 18.7 per 100,000 in 2008 to 13.0 per 100,000 in 2019 (p<0.001). AF hospitalizations were higher amongst males compared to females (24.0 vs. 7.5 per 100,000), and higher in Black patients compared to other ethnicities (20.4 for Black vs. 15.6 for White vs. 8.5 Hispanic per 100,000). The utilization of electrical cardioversion increased from 17.6% in 2008 to 21.9% in 2019 (p<0.001), and catheter ablation decreased from 7.1% in 2008 to 4.3% in 2019 (p<0.001). Men were more likely to undergo electrical cardioversion than women (20.1% vs. 14.8%, p < 0.001). White patients were more likely to undergo electrical cardioversion (20.8% vs. 14.3% vs. 15.5%, p< 0.001) and catheter ablation (6.1% vs. 3.3% vs. 4.2%, p<0.001) compared to Black and Hispanic patients, respectively. Patients in the highest income residence quartile were more likely to undergo electrical cardioversion (21.9% vs. 16.4%, p<0.001) and catheter ablation (8.0% vs. 3.7%, p<0.001) compared to patients in the lowest income residence quartile. We found significant differences in inpatient AF management based on sex, ethnicity, and SES.

Immobilization of arsenic wastes and retardation effect on cement hydration: Experimental and molecular dynamic analysis

AbstractThis work was designed to investigate the influence of arsenic dosage, variety on the mechanical properties, hydration, and solidification from the perspective of Portland cement (PC) performance evolution. The results demonstrate that using PC could solidify the arsenic wastes effectively, with arsenic leaching concentrations consistently below 5 mg/L. Arsenic wastes retard cement hydration, leading to a slower rate of hydrates formation, disrupting the calcium silicate hydrate (C–S–H) stacking structure, and thus detrimental to strength development especially at early age. The adverse effect is highly dependent on the arsenic variety. The insoluble calcium arsenate exhibits the least impact, while the arsenates show the largest challenging to immobilization due to the instability of hydrates. Molecular dynamic simulation indicates that arsenic can be chemically immobilized with Ca2+, and be physically adsorbed onto the positively charged C–S–H by forming As‐O···Ca···Si‐O units, accompanied by a significant reduction in adsorption energy by 46.5%. The arsenic solidification behavior provides a basis for the resource utilization of arsenic wastes in cementitious materials.

Sustainable intensification of livestock systems using forage legumes in the Anthropocene

AbstractSustainable intensification of livestock systems implies greater efficiency in resource utilization resulting in greater output of products and other ecosystem services per unit of resource input. Integrating forage legumes into livestock systems is a viable way to reduce the input of industrial N fertilizer, reducing the use of fossil fuels and helping to mitigate global warming, a major problem during the Anthropocene. Some forage legumes have greater concentrations of secondary compounds, such as condensed tannins, that might reduce the emission of greenhouse gases (GHG) from ruminant eructation and excreta. Furthermore, forage legumes might enhance cattle performance because of greater nutritive value, resulting in greater production per unit of GHG released. Shortening the production cycle and improving cattle reproductive efficiency could have a major impact on reducing the overall carbon footprint of the system. Grazing systems with more diversified plant species are typically more resistant and resilient, adapting to current climate changes during the Anthropocene. Novel technologies might accelerate the development of future grazing systems using forage legumes as a key component. Breeding efforts for the next‐generation legumes must focus on adaptation and potential use for mitigation of negative environmental impacts. There are examples of successful integration of forage legumes into livestock systems in different regions of the world, with a major reduction in off‐farm inputs and maintaining the system productive. These successful examples could be used to increase adoption and improve the efficiency of current livestock systems.

Fe/Co-modified Enteromorpha bio-hydrochar enhanced anaerobic digestion of chicken manure with sulfadimethazine: focusing on synergistic mechanism and microbial community succession

Abstract Residual antibiotics in chicken manure may interfere with the stability of anaerobic digestion (AD) and inhibit resource utilization efficiency. In this study, we aimed to enhance chicken manure bio-methanation in AD with high-concentration of sulfamethazine (SMZ) by adding metal (Fe, Co)-modified Enteromorpha-based hydrochar (Co-HC, Fe-HC). The results showed that Fe-HC and Co-HC increased the degree of acidogenesis by 1.25 times and 1.58 times, respectively. The maximum protein concentration in EPS was increased by 47.64% and 72.5% after adding Fe-HC and Co-HC. However, only Co-HC demonstrated notable improvements in both methane production and SMZ removal efficiency. Electrochemical analysis showed that Co-HC possessed a richer variety of oxygen and nitrogen functional groups, along with superior electron exchange capabilities compared to Fe-HC. Furthermore, microbiological assessments revealed that Co-HC enriched syntrophic bacteria (such as Syntrophomonas and Mesotoga), facilitating direct interspecies electron transfer (DIET) and subsequently enhancing biomethane production. The abundance of genes involved in electron transfer increased significantly with Co-HC, with a maximum increase of 75.86% in Co1.5-HC treatment. Additionally, the elimination of antibiotic resistance genes (sul1, sul2) increased by 65.66% in the Co1.5-HC treatment. This study offers a theoretical foundation and empirical support for the synergistic improvement of livestock and poultry manure containing high antibiotic concentrations, thereby helping to overcome challenges posed by recalcitrant substances. Graphical Abstract

The Impact of Health Administration on Healthcare Quality: A Systematic Review of Effective Management Practices

Health administration plays a crucial role in shaping the quality of healthcare delivery by implementing effective management practices that enhance patient outcomes and operational efficiency. This systematic review aims to examine the impact of key administrative practices on healthcare quality, focusing on strategies that improve patient satisfaction, reduce errors, and optimize resource utilization. A comprehensive literature search was conducted across databases including PubMed, Scopus, and Google Scholar, reviewing studies published from 2016 onwards. Inclusion criteria targeted research on management practices such as resource allocation, leadership models, operational efficiency, and quality assurance systems. Findings indicate that health administration practices, particularly in leadership and operational efficiency, have a significant positive effect on quality metrics, such as reduced patient wait times, lower readmission rates, and increased patient satisfaction. However, challenges like limited resources and resistance to change often hinder implementation. This review underscores the need for adopting evidence-based administrative strategies and suggests directions for future research to further enhance healthcare quality through effective management practices.

October 7th 2023 mass casualty incident in southern Israel: lessons for emergency preparedness and management.

Mass Casualty Incidents (MCIs) pose significant challenges for healthcare systems. While policies are typically crafted based on past experiences, the lessons learned from each incident play a crucial role in enhancing emergency preparedness. On October 7th, 2023, Israel came under the largest terror attack in its history. During an ongoing terror attack, more than 1300 Israelis were killed, and more than 200 were abducted to Gaza. During the first day of the attack, 1457 casualties were evacuated to a hospital, approximately half of them to Soroka University Medical Center (SUMC). This MCI surpassed conventional MCI challenges, necessitating a need to face the unexpected under fire. Through a description of this extreme MCI, we delve into the challenges faced, the strategic interventions deployed to address them, and the invaluable lessons learned. Injury characteristics, severity and outcomes of casualties are presented based on the medical records of all casualties arriving to SUMC between October 7th 6:30 a.m. andOctober 8th 7:00 a.m. Data regarding patient influx, capacity and hospital resource utilization, were collected from the Patient Registration System and other hospital information systems. During the incident, a total of 673 injured arrived at SUMC within a mere 24-h period, at a peak rate of 83 injured per hour. The mean casualty age was 29.6, with male predominance. Gunshot wounds and shrapnel injuries were the dominant types of injuries. Out of the casualties arrived, about half were hospitalized or transferred to receive definitive care at other hospitals after initial care at SUMC. Mortality rate was low, at 2.9% of those admitted alive. In this article, we describe the injury characteristics and outcomes of casualties seen at SUMC on October 7th 2023, during one of the largest MCIs in history. We present a detailed overview of the challenges encountered, strategies implemented to address them and lessons learned. These insights hold global relevance, offering actionable guidance for the refinement of future emergency protocols and policies on a global scale.

Evaluation of Watershed Development Programme: A Framework for Selection and Aggregation of Key Indicators

The measure of the effectiveness of watershed development programmes depends on selecting the right set of evaluation indicators that reflect the programme’s goals, including resource management, environmental sustainability, and socio-economic benefits. In this paper, the focus is on the process of selecting and aggregating the key indicators to assess the success of watershed development initiatives. By categorizing indicators into relevant themes such as Terrain Management, Water Resources Utilization, Agronomic Vitality, Livestock Vitality, Employability, Human Empowerment, and Sustainability. This paper highlights the importance of using a structured approach to ensure comprehensive evaluation. Proper selection and aggregation of indicators emphasize the importance of context-specific indicators to ensure accurate and effective programme evaluation and lead to providing valuable insights for programme assessment and future improvements.

Empowering primary care physicians in child and adolescent psychiatry: a needs assessment on collaborative care in Dubai

BackgroundChild and adolescent psychiatric disorders pose significant public health concerns necessitating prompt intervention. Primary care physicians (PCPs) play a critical role as initial points of contact, facilitating early detection, management, and referral of these conditions. In Dubai, integrating mental health services into primary care faces unique challenges, highlighting the need for systemic reforms and enhanced PCP training.ObjectiveThis study investigated perceptions, barriers, and systemic challenges encountered by PCPs in managing child and adolescent psychiatric conditions in Dubai’s primary care setting. It also assessed family physicians’ involvement and preparedness in this domain.MethodsUsing a mixed-methods approach, we conducted a survey among family physicians in Dubai Health facilities and analyzed patient data from family medicine clinics. The survey evaluated formal training, preparedness, encounter frequency, and referral patterns for psychiatric care in young patients. Qualitative insights from open-ended survey questions provided additional understanding of specific challenges.ResultsFindings revealed significant gaps in formal training, with only 33.3% of respondents trained in child and adolescent psychiatry during medical education, and 21.1% participating in Continuing Medical Education (CME). A majority (54.4%) of PCPs felt unprepared to manage psychiatric care in young patients. Patient data analysis showed a predominance of male patients (59.9%) and identified Autism Spectrum Disorder (43.1%) as the most common condition, emphasizing the reliance on specialized care through a high referral rate (63.1%). Major barriers included time constraints, limited psychiatric knowledge, resistance to mental health services, systemic and structural issues, communication challenges, and resource shortages.ConclusionEnhanced training and systemic reforms are urgently needed to integrate mental health services effectively into Dubai’s primary care. Implementing structured collaborative care models, fostering interdisciplinary collaboration, and addressing systemic barriers are crucial for improving child and adolescent psychiatric condition management. These initiatives promise better patient outcomes and more efficient healthcare resource utilization.

A Comparative Analysis of the Sustainable Development of Urban Agriculture in Chengdu and Singapore

With the deepening global concern for sustainable development, urban agriculture has received more and more attention as an important combination of urban development and ecological environmental protection. This paper provides a comprehensive evaluation and comparison of two areas, Chengdu and Singapore, in terms of their capacity for sustainable development of urban agriculture through an empirical analysis method. To make a multidimensional evaluation index system, the study uses the hierarchical analysis method (AHP) and the fuzzy comprehensive evaluation method. The index covers important areas like the level of agricultural development, the intensity of applied inputs, the rate of energy use, the rate of resource utilization, and the level of agricultural factors. The results show that Chengdu performs significantly in terms of resource utilization rate and agricultural factor level, while Singapore performs better in terms of energy utilization rate. The study provides targeted recommendations, including strengthening scientific and technological innovation, policy support, and ecological and environmental protection, with the aim of providing references and lessons for the sustainable development of urban agriculture in the two places and other areas around the world.

Spatiotemporal Pattern of a Macrofungal Genus Phylloporia (Basidiomycota) Revealing Its Adaptive Evolution in China

The understanding of distribution and the evolutionary scenario is crucial for the utilization and conservation of biological resources; nevertheless, such explorations rarely focus on macrofungi. The current study selects a macrofungal genus, Phylloporia, and explores its spatiotemporal pattern in China. A total of 117 available occurrence records of Phylloporia in China were summarized for the current analyses. Ensemble modeling supports the highly suitable habitat of Phylloporia concentrated in southern, especially southeastern, China, where the ancestor of Phylloporia originated 77.74 million years ago and then dispersed to other parts of China. Benefitting from the available suitable habitats, Phylloporia rapidly diversified after its divergence in Southeast China. Then, the net diversification rate slowed down when the rapidly diversifying species filled available niches in Southeast China and the dispersed species in other parts of China inhabited the less suitable and unsuitable habitats. During adaptive evolution, precipitation, temperature and the host plant are the major environmental variables that shape the spatiotemporal pattern of Phylloporia. In conclusion, the current study reveals the adaptive evolutionary scenario of Phylloporia and provides the first exploration of the spatiotemporal pattern of macrofungi.

The Spatiotemporal Evolution of the Mudflat Wetland in the Yellow Sea Using Landsat Time Series

Mudflat wetland, one of the 27 surface elements identified by the International Geographic Data Committee, has undergone substantial transformations with the rapid growth of the social economy and marine hazards, resulting in significant changes in its area and distribution. Quick identification of mudflat wetland evolution is vital to improve the mudflat ecological service value. We employed object-oriented and decision tree classification methods to map the mudflat wetland in the Yellow Sea using the Landsat time series from 1983 to 2020. The Improved Spectral Water Index (IWI) was established by combining the characteristics of many ratio indices and using ratio operation and quadratic power operation. The coefficient of variation (CV) of the IWI was calculated, and the range of the intertidal zone in 1983, 1990, 2000, 2010, and 2020 was obtained by using a threshold method. The results indicate that the mudflat wetland area decreased continuously from 1983 to 2020, with a reduction of 337.38 km2/10a. Among the total area, the natural wetland experienced a decline of 446.9 km2/10a, with the most drastic changes occurring between 2000 and 2010. In contrast, the area of the human-made wetland increased by 109.56 km2/10a. Over the 38 years, the tidal flat has undergone the most drastic reduction, with an average of 157.45 km2/10a. From 1983 to 2020, the intertidal zone area decreased, with a reduction of 429.02 km2/10a. Human activities were the key factors causing mudflat wetland loss. Based on these findings, we propose several policy suggestions. This study provides a scientific basis for understanding the synergetic evolution mechanism of coastal resources utilization and mudflat wetland protection under global change.

An Efficient Parallel CRC Computing Method for High Bandwidth Networks and FPGA Implementation

A cyclic redundancy check (CRC) is a widely used technique in data communication for detecting data transmission errors. However, existing FPGA-based parallel CRC hardware implementation schemes often face problems of excessive resource utilization and timing convergence difficulties in high-bandwidth networks. In addition, these problems are further exacerbated by the variable length of the end of the checksum data frame during data transmission. To address these challenges, this paper proposes a parallel CRC computation method based on precomputed seed values for bit-width normalization (named PSV-WN-CRC). The algorithm selects the corresponding primitive seed value according to the length of the data frame tail and converts the CRC computation with arbitrary bit-width to the CRC computation with fixed bit-width, thus adapting to the case of the indefinite length of the data frame tail. Based on this algorithm, this paper designs an efficient parallel CRC circuit on FPGA to reduce the consumption of resources. The experimental results show that the CRC algorithm and circuit proposed in this paper implemented on Virtex UltraScale+ FPGAs with 1024-bit wide CRC consumes only 5981 LUTs and achieves a maximum throughput of 392.2 Gbps. The method effectively reduces the resource consumption and improves the maximum throughput as compared to three advanced works.