Subsequent Demand Research Articles

COMPLIANCE WITH THE SUSPECTED CAUDA EQUINA SYNDROME (CES) PATHWAY IN BETSI CADWALADR UNIVERSITY HEALTH BOARD (BCUHB) WEST: A RETROSPECTIVE AUDIT AGAINST NATIONAL STANDARDS

ObjectiveGuidelines published by the British Association of Spine Surgeons (BASS) and Society of British Neurological Surgeons (SBNS) recommend urgent MRI imaging and intervention in individuals suspected of having CES. The need for an evidence based protocol is driven by a lack of 24/7 MRI services and centralisation of neurosurgery to tertiary centres, compounded by CES's significant medico-legal implications. We conducted an audit to evaluate the pathway for suspected CES in BCUHB West between 2018 and 2021.MethodsA retrospective audit of patients managed for suspected CES between 01/11/2018 and 01/05/2021 was performed, using the SBNS/BASS guidelines as the standard.ResultsA total of 252 patients received an emergency MRI for suspected CES between 2018 and 2021. 99% of patients were scanned in compliance with SBNS/BASS standards. Radiological evidence of CES was found in 18% of patients. 33% of emergency scans were performed by out-of-hours services. 4% of patients had repeated scans within the same 6-month period. The majority of referrals originated from Orthopaedics surgeons (78%), or staff in the Emergency Department (8%). 92% of ambulatory patients were not admitted to hospital. During the peak of the COVID-19 pandemic, referrals increased from 2.5 to 3.5 per week.ConclusionSBNS/BASS standards were largely met, avoiding life changing disability and medico-legal consequences. The department should continue to follow SBNS/BASS guidance on the management of individuals with suspected CES. Challenges regarding the use of repeated scans should be addressed to avoid unnecessary costs. Introduction of new early recognition guidelines and Same Day Emergency Care (SDEC) has likely driven an increase in suspected CES referrals, and subsequent MRI demand. This audit should be utilised as an ongoing tool to ensure best practice continues, and to implement simple measures which may improve compliance with the pathway.

MASS RAPID TRANSIT (MRT) DEMAND AND CAPACITY ASSESSMENT FOR RAIL TRANSPORT IN MALAYSIA

Assessing the quality of MRT services unveils a generally satisfactory experience among respondents, with comfort emerging as a particularly noteworthy aspect. Satisfaction levels for MRT service quality range from 3.63 to 4.12, indicating a favorable perception overall. Notably, comfort stands out with the highest satisfaction rating, surpassing the "Satisfied" threshold, while accessibility receives the lowest rating. In essence, the majority of MRT passengers’ express contentment with the service, spanning operation, maintenance, and performance. Additionally, Bukit Bintang station emerges as a focal point during peak hours due to its proximity to diverse amenities. However, the prevalence of respondents underscores the necessity for broader demographic representation in future studies. Anticipated increases in MRT ridership necessitate proactive measures to accommodate the growing demand, with projected passenger numbers expected to rise significantly. Peak demand for the MRT SBK line is estimated at 115,498.543 passengers per day, reflecting a notable escalation of 281.82% across various purposes. Yet, reliance on responses may introduce biases in trip generation models and subsequent travel demand forecasting, emphasizing the importance of diversifying the respondent pool for more accurate predictions. Overall, the evaluation underscores the satisfactory nature of MRT services, particularly in terms of passenger comfort.

Comparison of Acute Physiological Responses to Different Passive Heating Modalities

The repeated use of passive heating has gained popularity as a therapeutic approach toward promoting health and wellness. Passive heating elicits a rise in core body temperature and subsequent cardiovascular demand that can result in physiological adaptations beneficial to health. Hot water immersion, traditional sauna, and far-infrared sauna are three common modalities of passive heating; however, current literature lacks a direct comparison between these modalities. The purpose of this study is to characterize and compare the acute thermoregulatory and cardiovascular responses to a single bout of hot water immersion (HWI), traditional sauna (TRAD), and far-infrared sauna (FIR). We hypothesized that HWI will induce more pronounced thermoregulatory and cardiovascular responses when compared to both TRAD and FIR. In a randomized cross-over study design, nineteen healthy adults (9 F; age 24±4 years; body mass index 26.47±5 kg/m2) completed three bouts of acute passive heating: HWI (45 minutes at 40°C), TRAD (3x10 minutes at 80°C, separated by 5 min of thermoneutral rest), and FIR (45 minutes at 45-65°C) separated by at least 1 week. These temperatures and durations were chosen based on previous research and reflect typical use of these modalities. Measurements of arterial pressure, core temperature (Tc), and heart rate (HR) were collected at pre-heating baseline and at 5-min intervals during passive heating. Cardiac output (Q) was measured before, halfway, and at the end of heating using the open-circuit acetylene wash-in method. Mean arterial pressure (MAP) was calculated as 1/3 systolic + 2/3 diastolic and stroke volume (SV) and systemic vascular resistance (SVR) were calculated by Q/HR and MAP/Q. Data were analyzed using one-way ANOVAs to compare the changes from baseline to end of heating and are presented as mean with 95% confidence intervals. The change in Tc from baseline to end of heating was greater in HWI [+1.1°C (1.0, 1.3)] vs TRAD [+0.4°C (0.2, 0.6), p<0.0001], HWI vs FIR [+0.1°C (-0.1,0.2), P <0.0001], and TRAD vs FIR (P=0.0291). The increase in HR was greater in HWI [+39 bpm (35, 43)] vs. FIR [+26 bpm (21, 32), P=0.0017], with no differences in HWI vs. TRAD [+34 bpm (28, 40), P=0.4247] or TRAD vs. FIR (P=0.0793). Cardiac output increased to a greater extent in HWI [+3.9 L (3.3, 4.4)] vs. TRAD [+2.4 L (1.8, 2.9), P=0.0003)] and HWI vs. FIR [+1.7 L (1.2, 2.1), p<0.0001], with no difference between TRAD vs FIR (P=0.1379). MAP decreased in HWI [-14 mmHg (-20, -9)] vs TRAD [-3 mmHg (-8, 1), P=0.0058] and HWI vs FIR [-0.5 mmHg (-5, 4), P=0.0003], with no difference between TRAD vs FIR (P= 0.7506). Conclusion: A single bout of HWI elicits the greatest thermoregulatory challenge and cardiovascular strain compared to both TRAD and FIR. Funded by American Heart Association (19TPA34890033) and NIH (R01HL144128). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

DIGITAL FRAUD: WHAT STUDENTS KNOW ABOUT IT (EXPERIENCE IN CONDUCTING A FOCUS GROUP INTERVIEW)

The article, based on statistical data and sociological research from a focus group interview conducted among students, updates the problem of cyber fraud. The dynamics of stolen funds of Russians over five years, the level of awareness of students about cyber fraud, the types and forms of fraud schemes that informants have encountered are shown. The most common forms of fraud are deception associated with the transfer of money for a purchase/service on the Internet with or without priority links, phishing sites and hacking of a page (account), with the subsequent demand for money for its return. This may be due to the fact that young people are active users of social media (social networks, instant messengers, games, marketplaces, etc.) and most often use online shopping. Next come less popular forms of cyber fraud, such as “raising” funds for SVO participants, the “anti-cafe” scheme, and telephone calls under the “relative in need” scheme. A number of signs to identify a fraudster (assertiveness, aggressiveness in response to the desire to check information, commanding tone, top secrecy during a call, etc.) have been identified. The reasons and factors (internal and external) contributing to the deception of a potential victim have been established (low awareness, lack of experience in dealing with digital fraud schemes, personal qualities (excessive gullibility, pliability, fear of public condemnation, greed), the use of external factors (SVO), social technologies engineering by attackers). In the context of simulated situations of cyber fraud, algorithms for the safe behavior of potential victims were identified, and students proposed measures to prevent digital fraud.

A spectral assessment for instant preliminary evaluation of structures after seismic events

This article introduces a simple, efficient spectral-based approach for rapid preliminary seismic assessment of earthquake-affected structures. Performance is validated using data from three highly earthquake-affected structures in New Zealand, where visual inspection with subjective outcomes missed damage, resulting in inaccurate and delayed decisions with significant social and economic losses. The three structures considered include (1) the instrumented Bank of New Zealand (BNZ) building; (2) the un-instrumented Queensgate Mall (QM) Complex; and (3) the un-instrumented Canterbury Television (CTV) building. This study uses these cases to highlight the importance of structural health monitoring (SHM) instrumentation and reliable quantified post-earthquake assessment methods in earthquake-prone areas, where each damaging earthquake and subsequent further-damaging aftershocks demand continuous monitoring to continuously assess damage and life safety risk. The simple, low-cost spectral analyses in this study clearly show the existence of damage and deterioration not fully discovered with standard visual inspection methods. This outcome highlights the importance of sensor networks and SHM instrumentation so quantitative, post-event analysis can rapidly augment and target further, more subjective visual inspection results.

Managing the new wave of weight loss medication in general practice: A qualitative study.

In early 2023, a new type of weight loss medication, Wegovy (semaglutide), was made available in Denmark. Both subsequent media coverage and public demand were huge. Wegovy is only available by prescription, primarily via general practitioners. However, there is very little knowledge about how healthcare professionals (HCPs) in general practice might deal with the great demand for and attention surrounding a new weight loss drug. The aim of this qualitative study was, therefore, to explore how Wegovy is managed and negotiated in general practice, particularly in terms of prescribing and follow-up. We conducted a focused ethnography study based on direct observation of consultations and both formal and informal interviews with seven doctors and four nurses from three general practices in Denmark. Using discourse analysis, we identified four central discourses revolving around trust in medicine, individual responsibility for health, the cost of weight loss medication, and the importance of shared decision-making. This study shows that the availability of a new, sought-after weight loss medication presents both opportunities and challenges for HCPs in general practice. The management of Wegovy involves numerous factors, including medical, economic, organizational, interpersonal and moral concerns.

Analysis of Renewable Energy Potential in South Sulawesi, Indonesia

The COVID-19 pandemic led to a temporary reduction in global energy usage, offering a glimpse of environmental benefits. However, subsequent rebounding energy demands underscored the need for cleaner alternatives. This paper examines renewable energy options for Indonesia, focusing on South Sulawesi. The region boasts significant solar irradiation and hydropower potential, with biomass also offering viable energy generation. While wind power is less potent, certain areas with high wind speeds could benefit. Transitioning to renewable sources could mitigate environmental and health concerns, addressing pollution and temperature rise. By leveraging these abundant resources, South Sulawesi could secure sustainable energy while minimizing adverse impacts on both the environment and public health.

Deux cents ans d’histoire des usages et mésusages du protoxyde d’azote

Deux cents ans d’histoire des usages et mésusages du protoxyde d’azote

Improving sporadic demand forecasting using a modified k-nearest neighbor framework

Forecasting sporadic or intermittent demand presents significant challenges in supply chain management, primarily due to the frequent occurrence of zero demand values and the inherent difficulty in capturing underlying hidden patterns in sporadic dataset. Although various parametric and non-parametric methods are available for sporadic demand forecasting, they often fail to detect these hidden patterns, underscoring the need for artificial intelligence (AI) algorithms which are effective in identifying irregular patterns. Among AI algorithms, the k-Nearest Neighbor (k-NN) is particularly good at identifying patterns with limited data. In the past, k-NN based frameworks have been recognized for their ability to effectively forecast sporadic demand, particularly when it is anticipated that patterns will reoccur in subsequent non-zero demand values. However, this assumption does not always hold true in different real-world scenario. In sporadic time series data, zero values often comprise a significant proportion (>30%). To address this, this paper proposes a “zero-inclusive k-NN framework” that leverages both zero and non-zero demand data to identify patterns. The proposed framework offers two significant features: it enables industrial managers to utilize a large number of nearest neighbors and provides adaptability in demand-vector length. Numerical investigations with both synthetic and real datasets affirm the superior forecasting performance of the proposed k-NN method when compared to existing k-NN framework and conventional parametric benchmark methods. The implications of our findings extend to domains where sporadic or intermittent demand forecasting plays a vital role.

Challenges With the Implementation of Machine Perfusion in Clinical Liver Transplantation.

Dynamic organ preservation is a relatively old technique which has regained significant interest in the last decade. Machine perfusion (MP) techniques are applied in various fields of solid organ transplantation today. The first clinical series of ex situ MP in liver transplantation was presented in 2010. Since then, the number of research and clinical applications has substantially increased. Despite the notable beneficial effect on organ quality and recipient outcome, MP is still not routinely used in liver transplantation. Based on the enormous need to better preserve organs and the subsequent demand to continuously innovate and develop perfusion equipment further, this technology is also beneficial to test and deliver future therapeutic strategies to livers before implantation. This article summarizes the various challenges observed during the current shift from static to dynamic liver preservation in the clinical setting. The different organ perfusion strategies are discussed first, together with ongoing clinical trials and future study design. The current status of research and the impact of costs and regulations is highlighted next. Factors contributing to costs and other required resources for a worldwide successful implementation and reimbursement are presented third. The impact of research on cost-utility and effectivity to guide the tailored decision-making regarding the optimal perfusion strategy is discussed next. Finally, this article provides potential solutions to the challenging field of innovation in healthcare considering the various social and economic factors and the role of clinical, regulatory, and financial stakeholders worldwide.

Organically Functionalized Porous Aluminum Phosphonate for Efficient Synthesis of 5-Hydroxymethylfurfural from Carbohydrates

Naturally occurring fossil fuels are the major resource of energy in our everyday life, but with the huge technological development over the years and subsequent energy demand, the reserve of this energy resource is depleting at an alarming rate, which will challenge our net energy resources in the near future. Thus, an alternative sustainable energy resource involving biomass and bio-refinery has become the most emerging and demanding approach, where biofuels can be derived effectively from abundant biomass via valuable chemical intermediates like 5-hydroxymethylfurfural (5-HMF). 5-HMF is a valuable platform chemical for the synthesis of fuel and fine chemicals. Herein, we report the synthesis of the organically functionalized porous aluminum phosphonate materials: Ph-ALPO-1 in the absence of any template and Ph-ALPO-2 by using 1,3-diaminopropane-N,N,N′,N′-tetraacetic acid as a small organic molecule template and phenylphosphonic acid as a phosphate source. These hybrid phosphonates are used as acid catalysts for the synthesis of 5-HMF from carbohydrates derived from biomass resources. These Ph-ALPO-1 and Ph-ALPO-2 materials catalyzed the dehydration of fructose to 5-HMF with total yields of 74.6% and 90.7%, respectively, in the presence of microwave-assisted optimized reaction conditions.

Investing in general human capital as a relational strategy: Evidence on flexible arrangements with contract workers

AbstractResearch SummaryThis article examines a firm's investment in the general skills of contract workers in flexible work arrangements. It theorizes that this investment may prolong a productive firm‐worker collaboration even when workers’ mobility barriers are low. It also proposes that achieving such benefits requires that the firm frames the relational benefits of the investments both to managers and workers. Such a “relational framing” mitigates worker concerns about subsequent productivity demands and manager concerns about worker mobility. Experimental and non‐experimental studies conducted in a multinational cosmetics direct sales company support the theory. Investments in the general skills of workers—even those in flexible work arrangements—can benefit both firms and workers by deepening the firm‐worker relationship while increasing value creation.Managerial SummaryShould companies train workers in general skills if the workers can easily leave and transfer productivity gains to competing firms? A common answer to this question is “no,” especially when targeting workers hired under flexible arrangements, such as gig workers and direct sales representatives. This article offers a different perspective. It predicts that these investments signal a company's commitment to nurture workers’ development. In turn, workers reciprocate by prolonging a more productive collaboration. Training thus benefits workers and companies. Using relational terms to frame training programs enables the promotion by managers of training opportunities, and uptake by workers. This framing overcomes managerial concerns about worker exit and worker concerns about subsequent productivity demands. Studies conducted in a multinational cosmetics direct sales company support these arguments.

A mapping of electric construction machinery and electric construction sites in Norway

The Norwegian construction industry is responsible for ca. 2.2 million tonnes CO2eq in 2021. The rise in GHG emissions, noise and air pollution in the built environment is becoming a potential hazard due to the large growth of construction activities within cities. As a response, actors from the Norwegian construction industry have converted diesel construction machinery to electric operation to reduce these impacts. As a result, the electric construction machinery market in Norway has grown exponentially. However, access to electric construction machinery varies greatly. The aim of this paper is to map the available electric construction machinery on the Norwegian market as first steps towards creating a database of electric construction machinery for subsequent energy and power demand modelling of fully electric construction sites. This paper also maps the regional differences in construction machine availability through mapping the known public construction sites in Norway that use electric construction machinery.

Supply and Demand for Radiation Oncologists in Canada: Workforce Planning Projections From 2020 to 2040

The number of Canadians diagnosed with cancer, and subsequent demand for radiation therapy, are expected to increase over time. This study aimed to update our needs-based workforce planning model to ensure appropriate staffing levels in the future. The supply of radiation oncologists, by age group, sex, and full-time equivalent status, was projected from 2020 to 2040 using a recursive-aging, input-output model developed with seeding parameters derived from national sources. The demand for radiation oncologists until 2040 was estimated using referral patterns for radiation therapy and consultation workload metrics applied to projected annual cancer incident cases to calculate required full-time equivalent positions. Baseline model parameters were also applied to the 2005-2019 workforce and incident case data to evaluate preprojection supply and demand trends. Preprojection trends for 2005 to 2019 revealed accelerated staffing growth that transitioned from a workforce shortage to a surplus state in 2014 followed by substantial growth slowdown in 2016. The model predicts a transient surplus of radiation oncologists until 2026 followed by a projected deficit in subsequent years. Sensitivity analyses using the plausible range for each parameter continued to favor an undersupply, suggesting a trainee shortage unable to meet workforce expansion needs. Considering possible future declining trends in radiotherapy utilization and workload, calculations to inform corrective efforts in resident numbers resulted in 25 entry positions per year, up from 21 per year currently. Geographic distribution of trainees, relative to workforce and cancer incidence distributions, could be improved with more residency positions in Canadian regions outside Ontario. Demand for radiation therapy and radiation oncologists in Canada are expected to grow more quickly than future expansion in staffing levels. Our workforce planning model provides evidence for more trainee requirements to inform stakeholders of possible corrective actions to training programs and recruitment. Further research is needed to explore additional strategies to expand capacity and high-quality delivery of radiation therapy to meet the foreseeable increase in Canadian patients with cancer.

Bioactivity Screening and Genomic Analysis Reveals Deep-Sea Fish Microbiome Isolates as Sources of Novel Antimicrobials.

With the increase in antimicrobial resistance and the subsequent demand for novel therapeutics, the deep-sea fish microbiome can be a relatively untapped source of antimicrobials, including bacteriocins. Previously, bacterial isolates were recovered from the gut of deep-sea fish sampled from the Atlantic Ocean.In this study, we used in vitro methods to screen a subset of these isolates for antimicrobial activity, and subsequently mined genomic DNA from isolates of interest for bacteriocin and other antimicrobial metabolite genes. We observed antimicrobial activity against foodborne pathogens, including Staphylococcus aureus, Listeria monocytogenes, Enterococcus faecalis and Micrococcus luteus. In total, 147 candidate biosynthetic gene clusters were identified in the genomic sequences, including 35 bacteriocin/RiPP-like clusters. Other bioactive metabolite genes detected included non-ribosomal peptide synthases (NRPS), polyketide synthases (PKS; Types 1 and 3), beta-lactones and terpenes. Moreover, four unique bacteriocin gene clusters were annotated and shown to encode novel peptides: a class IIc bacteriocin, two class IId bacteriocins and a class I lanthipeptide (LanM subgroup). Our dual in vitro and in silico approach allowed for a more comprehensive understanding of the bacteriocinogenic potential of these deep-sea isolates and an insight into the antimicrobial molecules that they may produce.

Densification vs Environmental Sustainability: A Study of the Residential Areas of Dhaka

The fast-evolving scenario of the global economy of the past few decades has contributed to the transformation of cities into prime economic hubs providing sustenance for the growing urban populace. In keeping pace with economic development and subsequent demand for shelter, cities are densifying through vertical expansion to avoid urban sprawl. Given the rapid urbanization along with the scarcityof developable urban land, open spaces have become a highly contested commodity, particularly in the residential of the Dhaka megacity. Driven by the profit-maximizing agenda of the developers the ongoing process of residential densification is exacerbating the situation. Urban densification of Dhaka is faced with the challenge in keeping the residential areas sustainable and environmentally friendly. This study attempts to investigate the impact of the densification process on the spatial quality of the residential built environment of Dhaka through the lens of environmental sustainability. The explorative research was conducted through a questionnaire survey, informal interviews, and field survey across seven residential areas of Dhaka undergoing the densification process. The primary data collected from the survey were categorized under four selected environmental aspects. Data collected through the questionnaire survey was analyzed with SPSS and Microsoft Excel. In the second phase, a correlation test was run to investigate the relationship between environmental sustainability and density. The findings revealed that the residential areas under densification intervention are facing an acute shortage of adequate accessible open spaces and the built environment is deprived of solar access, acoustic and visual privacy. But despite these shortcomings the overall livability was reported to be satisfactory from the resident perspective, which indicates a lack of awareness of the inhabitants about the long term environmental and health implications from living under such conditions.

Tracing metal footprints via global renewable power value chains

The globally booming renewable power industry has stimulated an unprecedented interest in metals as key infrastructure components. Many economies with different endowments and levels of technology participate in various production stages and cultivate value in global renewable power industry production networks, known as global renewable power value chains (RPVCs), complicating the identification of metal supply for the subsequent low-carbon power generation and demand. Here, we use a multi-regional input-output model (MRIO) combined with a value chain decomposition model to trace the metal footprints (MFs) and value-added of major global economies’ renewable power sectors. We find that the MFs of the global renewable power demand increased by 97% during 2005—2015. Developed economies occupy the high-end segments of RPVCs while allocating metal-intensive (but low value-added) production activities to developing economies. The fast-growing demand for renewable power in developed economies or developing economies with upper middle income, particularly China, is a major contributor to the embodied metal transfer increment within RPVCs, which is partly offset by the declining metal intensities in developing economies. Therefore, it is urgent to establish a metal-efficient and green supply chain for upstream suppliers as well as downstream renewable power installers for just transition in the power sector across the globe.

Вопросы квалификации преступлений в сфере компьютерной информации

In the article, based on the analysis of the practice of the preliminary investigation units of the internal affairs bodies, the problems of qualifying crimes in the field of computer information are identified and ways to solve them are proposed. The author proposes to amend the legislation for an adequate legal response to cybercrimes related to encryption of computer information and subsequent demands for the ransom of passwords for decryption, since this act is not covered by the current version of Article 163 of the Criminal Code of the Russian Federation.

The impacts of locus of crisis outcome control on responsibility attribution in hindsight: focusing on comparisons between the American and Chinese public

Through two equivalent national surveys in the United States (US) and China, this study investigated how people’s forethoughtful assessments of crisis outcomes affect their retrospective responsibility attribution and subsequent demand for regulatory intervention. The results revealed that when Americans and Chinese perceived that they could rely on the government as a proxy agent to achieve desirable crisis outcomes, they attributed more responsibility to the in-crisis company. The increased blame company attribution would spill over into their blame for social systems. These heightened attributional activities led to people’s calls for regulatory intervention. Inconsistent findings for the two countries are also discussed.

A longitudinal perspective on the interplay of job demands and destructive leadership on employees’ work ability in Germany

PurposeWork ability as a predictor of early retirement or lengthy/frequent sick leaves becomes more and more relevant due to the demographic change. Therefore, factors, which affect employees’ work ability, need to be further examined with a theoretical base. According to Karasek’s job demands–control (JDC) model, high job demands and low control are related to poor employee health. The subsequent job demands–control support (JDCS) model proposed that a lack of support, also from leaders, has a negative impact on health indicators. This article looked at whether destructive leadership reinforces the negative influence of high job demands on employees’ work ability.MethodsWe used the BAuA Working Time Survey waves 2015, 2017, and 2019 (BAuA-WTS), which are representative of employees in Germany. Our data set covers 2448 respondents, who took part in all three waves. Central to the analyses were the variables job demands, control, destructive leadership, and work ability.ResultsResults from pooled ordinary least squares (OLS) and fixed effect (FE) models revealed that job demands influenced work ability negatively, whereas neither control by the employee nor the interaction of job demands and control was significant regarding effecting work ability in the FE models. Destructive leadership exerted a negative effect on work ability and moderated job demands significantly in the FE models meaning a further decrease in work ability.ConclusionLeadership behavior should be further examined as an important factor for work ability.