Administration Strategies Research Articles

RETRACTED: Assessing nonpoint source pollution risk in watersheds using a water-functioning zone approach

A thorough understanding of the geographical and spatial attributes of nonpoint source pollution risk in watersheds is crucial for conducting nonpoint source pollutant studies and implementing effective scientific administration strategies. The inclusion of a water-related functioning zone was considered during the nonpoint source's pollution risks assessment procedure. Nevertheless, there has not been a thorough investigation into the potential risk of nonpoint sources of pollution to adequately safeguard the quality of water in watersheds having varying capacities to handle contaminants in the water. This research presents an innovative approach for assessing the risk of nonpoint sources contamination. This allows for a quantitative evaluation of the effect of discharges of pollution from a sub-catchment on the quality of water bodies nearby. The nonpoint source losses of nutrients process, as modeled by the Water and Soil Assessment Tool, had been used to assess the hazard of nonpoint source contamination in Le ‘a River Watersheds. This assessment happened on both yearly and monthly scales. The findings indicated that the risk of nonpoint source contamination exhibits both seasonal and regional variations and is significantly impacted by the ability of the fluid ecosystem. Elevated nonpoint sources pollutants do not always equate to elevated pollutant dangers. On the other hand, a small amount of nutrients in the nonpoint sources does not indicate an insignificant degree of susceptibility to region risk. Furthermore, by utilizing a risk assessment method that considers the capacity of the water's environment, it is possible to identify variations in risk levels that may be overlooked when solely considering nonpoint sources contaminant losses, and fluid functioning zone. This approach allows for precise regulation of nonpoint sources of pollution administration.

Emotional Intelligence as a Strategy for Effective Administration of Schools in a Culturally Pluralist Classroom

Emotional Intelligence as a Strategy for Effective Administration of Schools in a Culturally Pluralist Classroom

Evaluating ‘pocket’ public spaces in Al Wehdat refugee camp, Jordan: challenges and opportunities

ABSTRACT The main objective of this research is to evaluate public ‘pocket’ spaces in Al Wehdat Refugee Camp, Jordan. The paper aims to identify the challenges associated with implementing pocket space upgrades and make visible some opportunities that enhances their socio-economic viability. By doing so, the research seeks to contribute to providing long-term solutions for refugee settlements, going beyond basic shelter provision, and creating community facilities and public spaces to enhance the living conditions and well-being of camp residents. The study addresses three key questions: What are the different types of pocket spaces in the camp? How do community members perceive their potential uses? What are the challenges and opportunities for implementing pocket space upgrades in Al Wehdat camp? The research utilised mapping and semi-structured interviews, which revealed various pocket space types. This exposed distinct pattern of public space appropriation within different camp zones, including informal privatisation of public space, linked to the spaces’ morphology rather than ownership. Community preferences for upgrading strategies differed based on pocket types, with small-scale greening and place-making strategies favoured in informally privatised pockets to maintain privacy, while parks or playgrounds were preferred in mixed-use areas. The research found that the main challenge facing public space upgrades lies in the conflicting dual management structure between UNRWA and the local municipality, necessitating administrative strategies for long-term improvement. Community involvement and heritage preservation proved crucial for sustaining upgrades. While specific to Al Wehdat, the findings offer insights into creating community public spaces in refugee camps and informal settings, potentially benefiting other long-term refugee camps.

Hydrological Drought Risk Assessment and Its Spatial Transmission Based on the Three-Dimensional Copula Function in the Yellow River Basin

Administrative strategies to cope with drought are steadily changing, from emergency procedures to day-to-day monitoring. More consideration must be paid to long-term and preventive drought control measures in the future. This paper discusses the risk of hydrological drought in the Yellow River Basin. The standardized runoff index (SRI) was used to characterize hydrological drought, and the run theory was used to identify drought states and quantify drought characteristic variables. Based on the drought severity and duration, a drought development plan was proposed and a three-dimensional copula function was constructed to obtain the joint distribution function of three-dimensional drought characteristic variables. A drought risk assessment system based on the loss × probability risk theory was constructed to explore the spatial and temporal characteristics of hydrological drought risk in the Yellow River Basin. Finally, according to the risk assessment results, the risk level was divided into low, medium and high risk, and a Bayesian network was used to explore the probability of hydrological drought. The main results are as follows: (1) From 1960 to 2018, the severity of hydrological drought in the Yellow River Basin increased, the duration lengthened, and the development speed accelerated. (2) The hydrological drought risk in the Yellow River Basin showed an overall upward trend, with the fastest increase in the HJ region of 0.041/10a. The highest annual average drought risk in the TDG region is 0.598. (3) The spatial transmission of hydrological drought risk is divided into three types: constant, enhanced and mitigation types, of which the constant type is the most common. The transmission probabilities of low, medium and high risk of hydrological drought from the HYK region to the low, medium and high risk of hydrological drought in the LJ region are 0.68, 0.66 and 0.78, respectively.

Machine Learning-based fixed access Network Interface Congestion Prediction

Network interface congestion refers to a situation in which network interfaces or communication channels within a network experience high levels of traffic, leading to performance degradation or potential network failures. In modern networking, this issue remains relevant and can manifest in various contexts due to a surge in data traffic, Internet of Things (IoT) devices can generate substantial data, increased use of VPNs for remote work and when multiple users or applications concurrently access and transfer data in and out of the cloud. Efforts to forecast and address network interface bottlenecks are crucial to sustaining the performance and consistency of modern networks. In the PTCL fixed access network infrastructure, network blocking is a serious problem that necessities to be addressed. The main objective of this study is to overcome network congestion problems that occur in PTCL's fixed access network through the use of machine learning techniques. Despite having real-time monitoring tools such as SolarWinds, there remains a dearth of software capable of predicting imminent bottlenecks in the network interface. The primary aim is to build an analytical model which can predict potential blockages within 30 days and facilitate proactive management strategies for better administration. Top of Form The study classifies the most effective machine learning technique for this purpose and evaluates its performance against current methods. To achieve the goal, a diagnostic dataset was created, leveraging appropriate configurations, software tools, and hardware resources. Data was sourced from SolarWinds, consisting of information from over 23,000 interfaces across 11,000 access network nodes. This data was analyzed in PTCL's Data Warehouse, where a historical aggregated dataset was constructed. Exploratory data analysis was performed using Python libraries, including Matplotlib, NumPy, Pandas, and Seaborn. This investigation sets the foundation for proactive network management and enhanced user experiences within PTCL's fixed access network, addressing the critical essential for advanced predictive tools to combat congestion and enhance network competence.

Enhancing trade policy education: A review of pedagogical approaches in public administration programs

This literature review rigorously examines pedagogical approaches in trade policy education within public administration programs, with the goal of enhancing educational strategies for future public administrators in the context of global trade. Recognizing the vital role of trade policy in economic development, international relations, and governance, the review explores the evolution, current state, and challenges of trade policy education. The scope includes an analysis of traditional lectures, case studies, experiential learning, interdisciplinary teaching, and the role of technology in modernizing educational practices. Using a qualitative methodology, the review synthesizes insights from literature reviews, case studies, and comparative analyses of curricula across various public administration programs. Findings indicate that while traditional lectures provide essential theoretical knowledge, their effectiveness is significantly enhanced by case studies and experiential learning methods, such as simulations and role-playing exercises. These methods foster practical application and critical thinking, which are crucial for comprehending complex trade policies. The integration of technology, including online courses and digital simulations, further improves learning outcomes by making education more interactive and accessible. Interdisciplinary teaching, which incorporates perspectives from economics, law, political science, and international relations, enriches the educational experience and prepares students for the multifaceted nature of trade policy. The review concludes that a balanced pedagogical approach, combining traditional and innovative methods, is essential for effective trade policy education. It recommends incorporating active learning strategies, continuous assessment, and professional development for educators. Additionally, fostering interdisciplinary collaboration and leveraging technological advancements are vital for enhancing the curriculum. These strategies aim to equip future public administrators with the comprehensive knowledge and skills necessary to navigate the complexities of global trade, thereby contributing to informed and effective policymaking. Keywords: Trade Policy Education, Public Administration, Pedagogical Approaches, Experiential Learning, Interdisciplinary Teaching, Technology Integration.

Systemic oncological therapy in breast cancer patients on dialysis.

The advancement of renal replacement therapy has significantly enhanced the survival rates of patients with end-stage renal disease (ESRD) over time. However, this prolonged survival has also been associated with a higher likelihood of cancer diagnoses among these patients including breast cancer. Breast cancer treatment typically involves surgery, radiation, and systemic therapies, with approaches tailored to cancer type, stage, and patient preferences. However, renal replacement therapy complicates systemic therapy due to altered drug clearance and the necessity for dialysis sessions. This review emphasizes the need for optimized dosing and administration strategies for systemic breast cancer treatments in dialysis patients, aiming to ensure both efficacy and safety. Additionally, challenges in breast cancer screening and diagnosis in this population, including soft-tissue calcifications, are highlighted.

Concerting magnesium implant degradation facilitates local chemotherapy in tumor-associated bone defect

Effective management of malignant tumor-induced bone defects remains challenging due to severe systemic side effects, substantial tumor recurrence, and long-lasting bone reconstruction post tumor resection. Magnesium and its alloys have recently emerged in clinics as orthopedics implantable metals but mostly restricted to mechanical devices. Here, by deposition of calcium-based bilayer coating on the surface, a Mg-based composite implant platform is developed with tailored degradation characteristics, simultaneously integrated with chemotherapeutic (Taxol) loading capacity. The delicate modulation of Mg degradation occurring in aqueous environment is observed to play dual roles, not only in eliciting desirable osteoinductivity, but allows for modification of tumor microenvironment (TME) owing to the continuous release of degradation products. Specifically, the sustainable H2 evolution and Ca2+ from the implant is distinguished to cooperate with local Taxol delivery to achieve superior antineoplastic activity through activating Cyt-c pathway to induce mitochondrial dysfunction, which in turn leads to significant tumor-growth inhibition in vivo. In addition, the local chemotherapeutic delivery of the implant minimizes toxicity and side effects, but markedly fosters osteogenesis and bone repair with appropriate structure degradation in rat femoral defect model. Taken together, a promising intraosseous administration strategy with biodegradable Mg-based implants to facilitate tumor-associated bone defect is proposed.

Intraoperative application of low-dose dexmedetomidine or lidocaine for postoperative analgesia in pediatric patients following craniotomy: a randomized double-blind placebo-controlled trial.

Postoperative pain is a common occurrence in pediatric patients following craniotomy, often leading to negative outcomes. Intravenous dexmedetomidine and lidocaine are commonly used adjuvant medicines in general anesthesia to reduce perioperative opioid consumption and relieve postoperative pain in adults. While they show promise for use in pediatrics, the evidence of their application in pediatric craniotomy patients is limited. Therefore, we aimed to compare the effects of dexmedetomidine and lidocaine on postoperative pain in pediatric patients following craniotomy. We conducted a randomized, double-blind, single-center trial on children scheduled for craniotomy. The 255 recruited participants aged 1-12 years were randomly assigned to intraoperatively receive a loading intravenous dose of either dexmedetomidine 1 μg·kg-1 or lidocaine 2 mg·kg-1 or normal saline for 15 min followed by dexmedetomidine 0.5 μg·kg-1·h-1 or lidocaine 1 mg·kg-1·h-1 or normal saline until the sutures of endocranium were completed. The primary outcome was the cumulative sufentanil consumption within 24 h post-surgery. A total of 241 patients were included in the statistical analysis. The primary outcome did not show any significant differences among the three groups (median (IQR) lidocaine group: 3.36 (1.32-5.64) μg vs. dexmedetomidine group: 3.12 (1.36-6.39) μg vs. control group 3.46 (1.77-7.62) μg, p = 0.485). Among the secondary outcomes, there was a statistically significant but small reduction in sufentanil consumption within 2 h, postoperative FLACC/WBFS/NRS pain scores within 4 h after surgery and postoperative Ramsay sedation scores in dexmedetomidine group (p < 0.05). Regarding postoperative complications, the incidence of electrolyte disturbance within 24 and 48 h after surgery was significantly higher in control group compared to the other two groups. There were no significant differences in intraoperative opioid consumption, postoperative frequency of remedy medication, or length of hospitalization among the three groups. No adverse events related to lidocaine or dexmedetomidine were observed. There were no significant differences in the primary outcome among the three groups. Although dexmedetomidine showed some benefits in reducing postoperative opioid consumption within the first 2 h and pain intensity within the first 4 h post-surgery, these findings should be interpreted with caution. Further research is required to comprehensively assess the outcomes and determine the optimal administration strategy. [http://www.chictr.org.cn/index.aspx], identifier [ChiCTR1800019411].

Luxurious Locks: Harnessing the Power of Lipids for Transformative Hair Care Solutions

Abstract: The hair is a distinguishing feature of animals that has several functions, such as providing warmth, providing protection, facilitating sweating and pheromone evaporation, providing sensory stimulation, and, in certain situations, acting as color-based camouflage. Hair grooming and styling have progressed significantly over the years, and modern hair treatments primarily focus on enhancing hair quality. However, standard active ingredients in formulations display suboptimal performance, and some may present toxicity issues, demanding a stronger formulation design that is appropriate for performance and safety. The need for natural ingredients, such as macromolecules and biomolecules sourced from plants, animals, and marine environments, is increasing among consumers. The favorable benefits induced by including lipid-rich components in Personal Care Products (PCP) formulations are regarded as valuable elements. A lipid-based preparation is specifically employed for innovative medicine-targeted distribution of bioactive substances among all medication administration strategies. The distribution of LBDDS transdermally and topically is exciting since the lipid bilayer might enter the uppermost layer of skin with ease and release medicine in a regulated way. It offers benefits in terms of stability, bioacceptability, and biodegradability, as well as receptor-mediated fast absorption by the particular site. Various lipid-based formulations for hair care therapy have been created, showing some improvement in hair care. This review focuses on several lipid-based formulations for hair care therapy, including their thorough mechanism of action, efficacy on hair care, patents, obstacles, and future prospects, along with the challenges and future prospects in the hair care industry

Exploring the Landscape of e-Government Maturity Models: Insights from Systematic Mapping Study and Comparative Analysis

e-Government Maturity Models are essential tools for governments to assess and improve their e-government capabilities, performance, and impact. This article offers a pioneering systematic mapping study and comparative analysis of e-Government Maturity Models proposed between 2010 and 2022, marking a significant stride in the realm of e-government research. The review focuses on these recent models and compares their approaches, frameworks, and dimensions. Previous comparison research studies conducted before 2010 are also reviewed to provide an inclusive context for understanding the evolution and advancement of e-government maturity models. The study is the first to systematically map and compare e-Government Maturity Models proposed in recent years, also comparing with the previous decade. Employing a mixed-methods approach, this article meticulously dissects and contrasts various models, shedding light on the evolution, strengths, and weaknesses of e-government maturity frameworks over more than a decade. The research contributes to the literature by revealing underlying discrepancies in current models and proposing a synthesized perspective that integrates technological advancements and administrative strategies, providing insights into opportunities for future research and practice. The findings of the study can be used to develop a new generation of e-government maturity models that are more comprehensive and relevant to the current needs of governments.

Boosting TNBC immune checkpoint blockade with an imaging-therapy coupled ozone delivery nano system

Synchronizing therapy and diagnosis is an ideal mode for clinical treatment of localized disease, e.g., tumor. Here, we develop a diagnosis-therapy coupled sonodynamic nano delivery system ZSMT which is constructed with a TiO2 embedding hollow Mn-MOF. Loaded with perfluorohexane, the ZSMT nanoparticle is not only capable for carrying ozone as a ROS donor but also endowed with double modes of imaging, namely ultrasound and magnetic resonance imaging. The TiO2-Mn-MOF can efficiently generate ROS by sonodynamic catalyzing ozone. Moreover, fluorescent tracer indicates the ZSMT particle can be internalized by tumor cells. With the stimulation of ultrasound, ozone carried ZSMT potently inhibits cell proliferation and promotes immunogenic cell death in vitro and in vivo by inducing a mitochondrial related cell death. Remarkably, combination of ultrasound-responsive ozone catalytic nano system and PD-1 blockade systematically suppresses the tumor growth by reprogramming the immune microenvironment. In conclusion, our sonodynamic nano system not only proves the principle of drug administration strategy on “treat-as-you-see” but also provides a combo regimen of improving PD-1 blockade with precision localized antigen boosting.

The effects of sodium bicarbonate ingestion and sports performance in female athletes during different phases of the menstrual cycle

Sodium Bicarbonate (SB) is recognised as an effective ergogenic aid for enhancing high-intensity exercise capacity and performance. However, the lack of consistency in scientific research findings involving female participants and SB, attributed to the variations in hormonal profiles during the menstrual cycle (MC), has led to a disproportionate focus on studies exclusively conducted in a male population. Purpose: The purpose of the present study is to assess the effects of SB ingestion and sports performance in female athletes during different phases of the MC. There is currently no evidence showing whether different phases of the MC would enhance exercise performance following SB ingestion. Given this gap in the literature, it yet remains unclear that if different hormonal fluctuations throughout the MC affected absorption, nutrient capacity, or exercise performance, the stimulating effect of buffering agents could be further enhanced in future research, by identifying optimal administration strategies of SB, as well as investigating if different phases of the MC impacted exercise performance, however this is still unknown. Methods: In a double-blind, randomised, placebo-controlled trial, six eumenorrheic female athletes will complete four all-out 30-second sprints on the Wattbike, each separated by a 5-minute recovery period after receiving either 0.3g/kg body mass (BM) of SB or a placebo containing plain flour in enteric coated capsules. Performance variables collected across the duration of the experimental trials are, rate of perceived exertion (RPE), peak power output (PPO), relative peak power (RPP), heart rate (HR), anaerobic capacity (AC), and fatigue index (FI). Experimental trials will be performed in each of the following two phases of a participant’s individually characterised MC: (i) the follicular phase and (ii) the luteal phase. MC phase will be determined by using a set of home ovulation strips for the whole duration of the study. In order to control any dietary variables, participants are asked to record a 24-hour food diary for the days prior to exercise testing and are encouraged to replicate identical food and fluid intake on the day prior to experimental testing to ensure a similar metabolic state. The development of this study in this area of research could greatly enhance our understanding of how the MC and the ingestion of SB may impact female athletes and performance outcomes. Furthermore, this study would provide valuable insights into the potential impact of different MC phases on athletes and help optimise their training and performance strategies.

Optimizing treatment administration strategies using negative mNGS results in corticosteroid-sensitive diffuse parenchymal lung diseases

Timely adjustments of antibiotic and corticosteroid treatments are vital for patients with diffuse parenchymal lung diseases (DPLDs). In this study, 41 DPLD patients with negative metagenomic next-generation sequencing (mNGS) results who were responsive to corticosteroids were enrolled. Among these patients, about 26.8% suffered from drug-induced DPLD, while 9.8% presented autoimmune-related DPLD. Following the report of the negative mNGS results, in 34 patients with complete antibiotics administration profiles, 79.4% (27/34) patients discontinued antibiotics after receiving negative mNGS results. Moreover, 70.7% (29/41) patients began or increased the administration of corticosteroid upon receipt of negative mNGS results. In the microbiota analysis, Staphylococcus and Stenotrophomonas showed higher detection rates in patients with oxygenation index (OI) below 300, while Escherichia and Stenotrophomonas had higher abundance in patients with pleural effusion. In summary, our findings demonstrated the clinical significance of mNGS in assisting the antibiotic and corticosteroid treatment adjustments in corticosteroid-responsive DPLD. Lung microbiota may imply the severity of the disease.

Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients.

Enhanced Recovery After Surgery (ERAS) protocols have substantially proven their merit in diminishing recuperation durations and mitigating postoperative adverse events in geriatric populations undergoing colorectal cancer procedures. Despite this, the pivotal aspect of postoperative pain control has not garnered the commensurate attention it deserves. Typically, employing a multimodal analgesia regimen that weaves together nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, and nerve blocks stands paramount in curtailing surgical complications and facilitating reduced convalescence within hospital confines. Nevertheless, this integrative pain strategy is not devoid of pitfalls; the specter of organ dysfunction looms over the geriatric cohort, rooted in the abuse of analgesics or the complex interplay of polypharmacy. Revolutionary research is delving into alternative delivery and release modalities, seeking to allay the inadvertent consequences of analgesia and thereby potentially elevating postoperative outcomes for the elderly post-colorectal cancer surgery populace. This review examines the dual aspects of multimodal analgesia regimens by comparing their established benefits with potential limitations and offers insight into the evolving strategies of drug administration and release.

3D printed dispersible efavirenz tablets: A strategy for nasogastric administration in children

Enteral feeding tubes (EFTs) can be placed in children diagnosed with HIV which need nutritional support due to malnutrition. EFTs are the main route for medication administration in these patients, bringing up concerns about off label use of medicines, dose inaccuracy and tube clogging. Here we report for the first time the use of selective laser sintering (SLS) 3D printing to develop efavirenz (EFZ) dispersible printlets for patients with HIV that require EFT administration. Water soluble polymers Parteck® MXP and Kollidon® VA64 were used to obtain both 500 mg (P500 and K500) and 1000 mg printlets (P1000 and K1000) containing 200 mg of EFZ each. The use of SLS 3D printing obtained porous dosage forms with high drug content (20 % and 40 % w/w) and drug amorphization using both polymers. P500, K500 and K1000 printlets reached disintegration in under 230 s in 20 mL of water (25 ± 1 °C), whilst P1000 only partially disintegrated, possibly due to saturation of the polymer in the medium. As a result, the development of dispersible EFZ printlets using hydrophilic polymers can be explored as a potential strategy for drug delivery through EFTs in paediatrics with HIV, paving the way towards the exploration of more rapidly disintegrating polymers and excipients for SLS 3D printing.

Effects of Balanced Versus Saline-based Solutions on Acute Kidney Injury in Off-pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial

To determine whether balanced solutions can reduce the incidence of acute kidney injury after off-pump coronary artery bypass surgery compared with saline. Randomized controlled trial. Single tertiary care center. Patients who underwent off-pump coronary artery bypass surgery between June 2014 and July 2020. Balanced solution-based chloride-restrictive intravenous fluid strategy. The primary outcome was acute kidney injury within 7 postoperative days, as defined by the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of acute kidney injury was 4.4% (8/180) in the balanced group and 7.3% (13/178) in the saline group. The difference was not statistically significant (risk difference, -2.86%; 95% confidence interval [CI], -7.72% to 2.01%; risk ratio, 0.61, 95% CI, 0.26 to 1.43; p = 0.35). Compared with the balanced group, the saline group had higher levels of intraoperative serum chloride and lower base excess, which resulted in a lower pH. In patients undergoing off-pump bypass surgery with a normal estimated glomerular filtration rate, the intraoperative balanced solution-based chloride-restrictive intravenous fluid administration strategy did not decrease the rate of postoperative acute kidney injury compared with the saline-based chloride-liberal intravenous fluid administration strategy.

The History of Nerve Growth Factor: From Molecule to Drug.

Nerve growth factor (NGF), the first neurotrophin to be discovered, has a long and eventful research journey with a series of turning points, setbacks, and achievements. Since the groundbreaking investigations led by Nobel Prize winner Rita Levi-Montalcini, advancements in the comprehension of NGF's functions have revolutionized the field of neuroscience, offering new insights and opportunities for therapeutic innovation. However, the clinical application of NGF has historically been hindered by challenges in determining appropriate dosing, administration strategies, and complications related to the production process. Recent advances in the production and scientific knowledge of recombinant NGF have enabled its clinical development, and in 2018, the United States Food and Drug Administration approved cenegermin-bkbj, a recombinant human NGF, for the treatment of all stages of neurotrophic keratitis. This review traces the evolutionary path that transformed NGF from a biological molecule into a novel therapy with potential research applications beyond the eye. Special emphasis is put on the studies that advanced NGF from discovery to the first medicinal product approved to treat a human disease.

Projected environmental and public health benefits of extended-interval dosing: an analysis of pembrolizumab use in a US national health system

Health care is a major source of greenhouse gas emissions, leading to climate change and public health harms. Changes are needed to improve the environmental sustainability of health-care practices, but such changes should not sacrifice patient outcomes or financial sustainability. Alternative dosing strategies that reduce the frequency with which specialty drugs are administered, without sacrificing patient outcomes, are an attractive possibility for improving environmental sustainability. We sought to inform environmentally sustainable cancer care by estimating and comparing the environmental and financial effects of alternative, clinically equivalent strategies for pembrolizumab administration. We conducted a retrospective analysis using a cohort of patients from the Veterans Health Administration (VHA) in the USA who received one or more pembrolizumab doses between May 1, 2020, and Sept 30, 2022. Using baseline, real-world administration of pembrolizumab, we generated simulated pembrolizumab use data under three near-equivalent counterfactual pembrolizumab administration strategies defined by combinations of weight-based dosing, pharmacy-level vial sharing and dose rounding, and extended-interval dosing (ie, every 6 weeks). For each counterfactual dosing strategy, we estimated greenhouse gas emissions related to pembrolizumab use across the VHA cohort using a deterministic environmental impact model that estimated greenhouse gas emissions due to patient travel, drug manufacture, and medical waste as the primary outcome measure. We identified 7813 veterans who received at least one dose of pembrolizumab-containing therapy in the VHA during the study period. 59 140 pembrolizumab administrations occurred in the study period, of which 46 255 (78·2%) were dosed at 200 mg every 3 weeks, 12 885 (21·8%) at 400 mg every 6 weeks, and 14 955 (25·3%) were coadministered with infusional chemotherapies. Adoption of weight-based, extended-interval pembrolizumab dosing (4 mg/kg every 6 weeks) and pharmacy-level stewardship strategies (ie, dose rounding and vial sharing) for all pembrolizumab infusions would have resulted in 24·7% fewer administration events than baseline dosing (44 533 events vs 59 140 events) and an estimated 200 metric tons less CO2 emitted per year as a result of pembrolizumab use within the VHA (650 tons vs 850 tons of CO2, a relative reduction of 24%), largely due to reductions in distance travelled by patients to receive treatment. Similar results were observed when weight-based and extended-interval dosing were applied only to pembrolizumab monotherapy and pembrolizumab in combination with oral therapies. Alternative pembrolizumab administration strategies might have environmental advantages over the current dosing and compounding paradigms. Specialty medication dosing can be optimised for health-care spending and environmental sustainability without sacrificing clinical outcomes. None.

Interagency Coordination to Manage Co-Occurring Intellectual and Developmental Disabilities and Mental Health Conditions.

The authors aimed to identify barriers to and strategies for supporting coordination between state agencies for intellectual and developmental disability (IDD) or mental health to meet the mental health needs of people with co-occurring IDD and mental health conditions. Forty-nine employees of state agencies as well as advocacy and service delivery organizations across 11 U.S. states with separate IDD and mental health agencies were interviewed between April 2022 and April 2023. Data were analyzed with a thematic analysis approach. Interviewees reported that relationships between the IDD and mental health agencies have elements of both competition and coordination and that coordination primarily takes place in response to crisis events. Barriers to interagency coordination included a narrow focus on the populations targeted by each agency, within-state variation in agency structures, and a lack of knowledge about co-occurring IDD and mental health conditions. Interviewees also described both administrative (e.g., memorandums of understanding) and agency culture (e.g., focusing on whole-person care) strategies that are or could be used to improve coordination to provide mental health services for people with both IDD and a mental health condition. Strategies that support state agencies in moving away from crisis response toward a focus on whole-person care should be prioritized to support coordination of mental health services for individuals with co-occurring IDD and mental health conditions.