Sustained Rates Research Articles

Efficacy and safety of once weekly selinexor 40 mg versus 60 mg with pomalidomide and dexamethasone in relapsed and/or refractory multiple myeloma.

To identify the optimal dose of selinexor in combination with pomalidomide and dexamethasone (SPd). An analysis of efficacy and safety of 2 once-weekly selinexor regimens (60 mg and 40 mg) with pomalidomide and dexamethasone (SPd-60 and SPd-40, respectively) given to patients with relapsed/refractory multiple myeloma (RRMM) in the STOMP (NCT02343042) and XPORT-MM-028 (NCT04414475) trials. Twenty-eight patients (60.7% males, median age 67.5 years) and 20 patients (35.0% males, median age 65.5 years) were analyzed in the SPd-40 and SPd-60 cohorts, respectively. Overall response rate was 50% (95% confidence interval [CI] 30.6-69.4%) and 65% (95% CI 40.8-84.6%), respectively. Very good partial response or better was reported in 28.6% (95% CI 13.2-48.7%) and 30.0% (95% CI 11.9-54.3%) of patients, respectively. Among 27 responders in both cohorts, the 12-month sustained response rate was 83.3% (95% CI 64.7-100.0%) for SPd-40 and 28.1% (95% CI 8.9-88.8%) for SPd-60. Median progression-free survival was 18.4 months (95% CI 6.5 months, not evaluable [NE]) and 9.5 months (95% CI 7.6 months-NE) for SPd-40 and SPd-60, respectively. Twenty-four-month survival rates were 64.2% (95% CI 47.7-86.3%) for SPd-40 and 51.1% (95% CI 29.9-87.5%) for SPd-60. Treatment-emergent adverse events (TEAEs) included neutropenia (all grades: SPd-40 64.3% versus SPd-60 75.0%), anemia (46.4% versus 65.0%), thrombocytopenia (42.9% versus 45.0%), fatigue (46.4% versus 75.0%), nausea (32.1% versus 70.0%) and diarrhea (28.6% versus 35.0%). The all-oral combination of SPd exhibited preliminary signs of efficacy and was generally tolerable in patients with RRMM. The overall risk-benefit profile favored the SPd-40 regimen.

The DPSIR Model-Based Sustainability Assessment of Urban Water Resources: A Comparative Study of Zhuhai and Macao

Based on the driving force-pressure-state-impact-response (DPSIR) model, 19 indicators were selected to construct a comparison between Zhuhai and Macao, two adjacent cities at the estuary of the Pearl River in China, which have different development models and water resource sustainable development strategies. Factors that may affect the sustainability of water resources were screened and placed according to the relationships of the five subsystems in the DPSIR model, establishing a sustainable evaluation model for water resources in the two cities. The results analyzed by Principal Component Analysis and Entropy methods showed that (1) Zhuhai City was greatly affected by the driving force, while Macao was greatly affected by the state system from 2012 to 2021. (2) From the trend changes, it can be seen that, in recent years, the water resources of the two cities have been moving towards sustainable development, and the management and protection of water resources have achieved remarkable results. From the evaluation results, it can be seen that implementing urban water-saving activities, strengthening the proportion of environmental water conservancy, public measures in public investment, upgrading sewage treatment machinery to improve sewage treatment rates, and other measures can effectively improve the current situation of water resources in both regions. In the future, the Zhuhai and Macao cities may continue to face a series of water resource pressures brought on by socio-economic developments. Therefore, an active adjustment of the development of the measurement of controlling wastewater discharge and saving water resources was proposed, adhering to the direction of sustainable development, and ensuring the benign development of socio-economic conditions and the ecological environment. This study can provide data to support regional water resource security and policy formulation with different political systems.

The purpose and instruments of the monetary policy of the central banks of the EU member states and Great Britain, their legal basis

The scientific article is devoted to the study of the purpose of the monetary policy of the central banks of the EU member states and Great Britain, its instruments and legal acts, in which they are fixed. The legislation of the member countries of the European Union (Germany, France, Spain, Poland, the Czech Republic, Hungary) and Great Britain, modern approaches in the science of constitutional and administrative law regarding the definition of the goal of the monetary policy of the central banks of the member countries of the EU, and the range of its instruments are analyzed. Emphasis is placed on the fact that the purpose and functions of national banks are interrelated, but not identical. The concept of the goal of the monetary policy of the Central Banks of the EU member states, the activities and instruments of the monetary policy, the functions of the central bank of the EU member states are delineated. It is argued that reducing the purpose of the activities of the central banks of EU member states and Great Britain exclusively to the implementation of legal regulation of currency circulation in the state and that the main purpose of the central banks of such EU member states as the Czech Republic, Poland, and Hungary is purely to ensure the stability of the currency - is not justified. It is argued that the main joint functions of the central banks of Germany, France, Spain, Poland, the Czech Republic, Hungary and Great Britain are to ensure the stability of the monetary unit, to promote the maintenance of sustainable rates of economic growth, to achieve and maintain price stability in the state, and to support economic policy. It is established that the goal of the monetary policy of the central banks of the EU member states is to ensure price stability, and it is additionally substantiated that the inflationary inclination of the financial policy is the most effective. It was established that the accounting policy, the interest rate policy, and the regulation of mandatory reserve norms, the volume of the money supply, operations on the open market and operations with credit resources, the amount of interest rates, interest rates of the mandatory reserve of banks are not the purpose of monetary and credit policies, instruments of monetary policy of the central banks of EU member states and Great Britain.

Education 4.0 framework for sustainable entrepreneurship through transdisciplinary and abductive thinking: a case study

The global challenges and problems that threaten sustainability and human well-being demand the provision of creative, innovative, and affordable solutions so that they are within the reach of different levels of society. From the point of view of Higher Education, this is a major challenge since it is responsible for training new generations with the competencies and knowledge that allow them to respond to contemporary challenges and problems. This study provides a framework to promote sustainable entrepreneurship through transdisciplinary and abductive thinking. This combination of approaches will allow students to identify, analyze, and understand contemporary problems and, through a systematized process based on the “design thinking” design model, propose creative, innovative, and affordable solutions that can be implemented through entrepreneurship mechanisms. The identified findings that will be presented in this work are (i) the relevance of the Education 4.0 model as a reference to promote transdisciplinarity in a current teaching-learning context, (ii) The relevance of “design for sustainable development” as a trigger for sustainable entrepreneurship, (iii) The formation of desirable competencies in the profile of the higher education student based on transdisciplinarity and abductive thinking within the active learning process, and (iv) quantitative and qualitative measurement that allows measuring acceptance and evaluation of the long-term sustainability of the solutions obtained. This work will present the implementation of the proposed framework through a case study. This case study allowed us to identify elements of the proposed reference framework. The case study will address the problem of water scarcity and pollution, describing initiatives to achieve ODS 6, where it explains how sustainable and visionary solutions can be forged through transdisciplinary collaboration and abductive thinking. The project named “STEAM-mural fountain” done by a transdisciplinary working team between academia-society-industry is described, which aims to make technological advances in water treatment and monitoring visible to society.

Ertapenem's therapeutic potential for Mycobacterium avium lung disease in the hollow fibre model

IntroductionGuideline-based therapy for Mycobacterium avium complex (MAC) pulmonary disease achieves sustained sputum conversion rates in only 43–53% of patients. Repurposing of β-lactam antibiotics such as ertapenem could expedite design of more efficacious regimens, compared to developing new drugs. MethodsWe performed an ertapenem exposure-response study in the hollow fibre system model of intracellular MAC (HFS-MAC). We recapitulated human-like intrapulmonary concentration-time profiles of eight once-daily intravenous doses of ertapenem over 28 days and performed repetitive sampling for drug concentration-time profiles and MAC burden. The % of time concentration persisted above MIC (%TMIC) mediating either 50% or 80% of maximal effect (E50, EC80) were identified. The EC80 was used as target exposure in a 10 000 subject Monte Carlo experiments for ertapenem doses of 1G, 2G, or 4G administered once versus twice daily. ResultsThe ertapenem MIC ranged from 0.5 to 2 mg/L on three occasions. Ertapenem achieved a half-life of 4.04 ± 0.80 h in the HFS-MAC and killed a maximum of 2.17 log10 CFU/mL below day 0. The EC50 was %TMIC of 75.9% (95% confidence interval: 68.43%–86.54%) and the EC80 was %TMIC of 100%. Target attainment probability was >90% for 1G twice daily up to an MIC of 2 mg/L, while for 2G twice daily the susceptibility MIC breakpoint was 4–8 mg/L. ConclusionsErtapenem microbial kill below day 0 burden was better than guideline-based therapy drugs in the HFS-MAC in the past. Ertapenem is a promising drug for novel combination therapies for MAC lung disease.

Systematic Development of a Novel Laser-Sintering Machine with Roving Integration and Sustainability Evaluation

Incorporating continuous carbon fibre-reinforced polymer (CCFRP) parts within additive manufacturing processes presents a significant advancement in the fabrication of robust lightweight parts, particularly relevant to aerospace, engineering, and various industrial sectors. Nonetheless, prevailing additive manufacturing methodologies for CCFRP parts exhibit notable limitations. Techniques reliant on resin and extrusion entail extensive and costly post-processing procedures to eliminate support structures, constraining design versatility and complicating small-scale production endeavours. In contrast, laser sintering (LS) emerges as a promising avenue for industrial application. It facilitates the efficient and cost-effective manufacturing of resilient parts without needing support structures. However, the current state of research and technological capabilities has yet to yield an LS machine that integrates the benefits of continuous fibre reinforcement with the inherent advantages of the LS process. This paper describes the systematic development process according to VDI 2221 of a new type of LS machine with automated continuous fibre integration while keeping the advantages of the LS process. The resulting physical prototype of the machine is also presented. Furthermore, this study presents an approach to integrate the cost and Product Carbon Footprint of the process in the product design. For this purpose, a machine state model was developed, and the costs and Product Carbon footprint of a part were analysed based on the model. The promising potential for future lightweight products is demonstrated through the production of CCFRP parts.

Comprehensive literature review on stakeholder prospects, responsibilities, and quality performance measurement in sustainable supply chain governance

The sustainable Governance of supply chains has become essential for businesses trying to balance economic success and ecological and ethical imperatives in an era of increased environmental awareness and social responsibility. Many stakeholders are pressuring companies to integrate sustainability into their supply chains as environmental degradation and social inequality worsen. Therefore, it is essential to include non-traditional supply chain stakeholders, such as competitors and non-governmental organizations, in supply chain operations to produce an SSCG. This comprehensive literature review synthesizes and examines the current body of information on stakeholder prospects, responsibilities, and measuring quality performance in sustainable supply chain governance. Therefore, this study's primary objective is to clearly show how SSC practices are related to stakeholder roles and responsibilities. A thorough literature examination was conducted, and 40 peer-reviewed journal publications from 2019 to 2023 were included. In this work, expectations, as stated in scholarly literature, are methodically categorized, and any gaps are reviewed critically. A reasonable explanation for stakeholders' discontent with the sustainability performance measurement and evaluation methods used nowadays is that, as the literature review demonstrates, stakeholder expectations have yet to be considered. The findings indicate that many external and internal supply chain stakeholders drive, enable, or check the application of sustainable supply chain Governance techniques.While governments and non-governmental organizations are essential drivers of sustainable supply chain Governance techniques, research can also help with their implementation. Furthermore, proactive interaction with external supply chain stakeholders improves organizational learning by boosting understanding and awareness of sustainability and developing knowledge.

The Effects of Exchange Rate Fluctuation on Bangladeshi Exports: An ARDL Bound Testing Technique

The Effects of Exchange Rate Fluctuation on Bangladeshi Exports: An ARDL Bound Testing Technique

Development and functional evaluation of a hyaluronic acid coated nano-formulation with kaempferol as a novel intra-articular agent for Knee Osteoarthritis treatment

Knee osteoarthritis (OA) involves articular cartilage degradation driven mainly by inflammation. Kaempferol (KM), known for its anti-inflammatory property, holds potential for OA treatment. This study investigated the potential of hyaluronic acid (HA)-coated gelatin nanoparticles loaded with KM (HA-KM GNP) for treating knee OA. KM was encapsulated into gelatin nanoparticles (KM GNP) and then coated with HA to form HA-KM GNPs. Physical properties were characterized, and biocompatibility and cellular uptake were assessed in rat chondrocytes. Anti-inflammatory and chondrogenic properties were evaluated using IL-1β-stimulated rat chondrocytes, compared with HA-coated nanoparticles without KM (HA GNP) and KM alone. Preclinical efficacy was tested in an anterior cruciate ligament transection (ACLT)-induced knee OA rat model treated with intra-articular injection of HA-KM GNP. Results show spherical HA-KM GNPs (88.62 ± 3.90 nm) with positive surface charge. Encapsulation efficiency was 98.34 % with a sustained release rate of 18 % over 48 h. Non-toxic KM concentration was 2.5 μg/mL. In IL-1β-stimulated OA rat chondrocytes, HA-KM GNP significantly down-regulated RNA expression of IL-1β, TNF-α, COX-2, MMP-9, and MMP-13, while up-regulating SOX9 compared to HA GNP, and KM. In vivo imaging demonstrated significantly higher fluorescence intensity within rat knee joints for 3 hours post HA-KM GNP injection compared with KM GNP (185.2% ± 34.1% vs. 45.0% ± 16.7%). HA-KM GNP demonstrated significant effectiveness in reducing subchondral sclerosis, attenuating inflammation, inhibiting matrix degradation, restoring cartilage thickness, and reducing the severity of OA in the ACLT rat model. In conclusion, HA-KM GNP holds promise for knee OA therapy.

Zero-waste approach to fluoride removal by contact precipitation using Hyriopsis cumingii shells with value-added products

We propose a zero-waste approach using Hyriopsis cumingii shells for fluoride (F) removal via contact precipitation with value-added products. H3PO4 was used as the precipitant for F removal. The F concentration could be reduced from 9.5 mg/L to 0.09–0.91 mg/L for over 900 BV with running-backwashing cycle. The precipitates formed during contact precipitation were easily stripped from the shell matrix by periodic backwashing, thus supporting the continuous dissolution of calcium (Ca) from the shell particles. X-ray diffraction (XRD)-Rietveld analysis showed that the backwashing residue was fluorapatite (FAP) with a small amount of hydroxy substitution. Therefore, FAP can be used as a raw material in phosphate fertilizer manufacturing. Economic analysis and sustainability evaluation showed that the contact precipitation process with H. cumingii shells as the substrate not only reduces chemical costs but also generates value-added products; thus, this process is environmentally friendly compared to traditional methods of F removal. The proposed approach for F elimination, waste shell utilization, and F and Ca resource recovery in the contact precipitation process represents a novel sustainable water treatment technology.

Implementation of an electronic health record system during global surgical outreach: A prospective evaluation of success and sustainability.

The burden of musculoskeletal conditions continues to grow in low- and middle-income countries. Among thousands of surgical outreach trips each year, few organizations electronically track patient data to inform real-time care decisions and assess trip impact. We report the implementation of an electronic health record (EHR) system utilized at point of care during an orthopedic surgical outreach trip. In March 2023, we implemented an EHR on an orthopedic outreach trip to guide real-time care decisions. We utilized an effectiveness-implementation hybrid type 3 design to evaluate implementation success. Success was measured using outcomes adopted by the World Health Organization, including acceptability, appropriateness, feasibility, adoption, fidelity, and sustainability. Clinical outcome measures included adherence to essential quality measures and follow-up numerical rating system (NRS) pain scores. During the 5-day outreach trip, 76 patients were evaluated, 25 of which underwent surgery beforehand. The EHR implementation was successful as defined by: mean questionnaire ratings of acceptability (4.26), appropriateness (4.12), feasibility (4.19), and adoption (4.33) at least 4.00, WHO behaviorally anchored rating scale ratings of fidelity (6.8) at least 5.00, and sustainability (80%) at least 60% follow-up at 6months. All clinical quality measures were reported in greater than 80% of cases with all measures reported in 92% of cases. NRS pain scores improved by an average of 2.4 points. We demonstrate successful implementation of an EHR for real-time clinical use on a surgical outreach trip. Benefits of EHR utilization on surgical outreach trips may include improved documentation, minimization of medical errors, and ultimately improved quality of care.

Early detection of phlebitis among hematology-oncology patients: a best practice implementation project.

Peripherally-inserted venous catheters (PIVC) are essential for cancer patients to receive treatment. Phlebitis is a major complication of PIVC. Currently, nurses' assessment of phlebitis mainly involves visual inspection. However, the latest literature suggests palpation for tenderness to promote the early detection of phlebitis. This project evaluated the effectiveness of a bundle approach to increase nurses' compliance with PIVC site assessment to promote early detection of phlebitis (grade 2 and above). The JBI Evidence Implementation Framework was used to conduct this project in a 28-bed hematology-oncology ward in a Singapore hospital. The bundle approach used in this project consisted of a training presentation, medical mannequin, and phlebitis scale card. The rate of nurses' compliance with best practice for PIVC site assessment was measured at 1 month and 6 months post-implementation. The incidence of phlebitis was monitored up until 12 months post-implementation. Baseline data indicated that only 18.75% (3 out of 16) nurses palpated for tenderness when assessing for phlebitis. Data at 1 month and 6 months post-implementation reported sustained high compliance rates of 85.71% (24 out of 28) and 89.29% (25 out of 28), respectively. Late detection of phlebitis was reduced by 66% (from three cases to one case) at 6 months post-implementation, and no patients required invasive interventions. The bundle approach used in this project facilitated early detection of phlebitis following the inclusion of palpation into nurses' assessment for phlebitis. http://links.lww.com/IJEBH/A204.

Research on the Application of Machine Learning Algorithms in Green Economy Indicator Modeling and Sustainable Development Evaluation

This study presents a comprehensive modeling and analysis framework for investigating the impact of green GDP on climate factors and its potential for promoting sustainable development. Our model utilizes the entropy weight method (EWM) and grey correlation analysis (GRA) to optimize and process data, while employing a BP neural network for model training. Results indicate that green GDP leads to smaller global climate damage compared to traditional GDP, indicating its potential to alleviate the global climate crisis and promote green development.Furthermore, we built a green GDP prediction model using LSTM to forecast future changes. From the perspective of economy and management, the results indicate that transitioning from GDP to green GDP initially leads to a decrease in the index, followed by an increase. This suggests that green GDP development has short-term drawbacks but long-term benefits, including reduced resource consumption, improved economic conditions, and contribution to sustainable development. Finally, we analyzed the learning rate, number of iterations, and thresholds of related parameters through Logistic binary classification. Results demonstrate that our model is relatively stable, highlighting how green GDP addresses ecological challenges while promoting economic prosperity. These findings underscore the urgency of adopting the concept of green GDP in the contemporary era for achieving sustainable development goals.Overall, this research provides critical insights on the potential benefits and feasibility of green GDP as a crucial tool for mitigating climate risks and enhancing global prosperity.

Sustainable Attributes of China’s Open-End Funds: Navigating to a Green Economy

China is in the midst of a critical transition to a carbon-neutral economy, with various policies and regulations being introduced to facilitate this shift. This study focuses on the open-end funds market in China, a significant component of the country’s capital market, to explore how it is adapting during this period of economic transformation. Specifically, we investigate the influence of carbon and Environmental, Social, and Governance (ESG) risks on the flow of open-end funds. Our findings indicate that sustainability factors are considered in the investment decision-making process by investors. Notably, there exists a negative relationship between sustainable risk factors and fund flows. This observation is particularly pronounced for funds that are designated as low carbon, have a high sustainability rating, or are primarily held by retail investors, underscoring the growing importance of sustainability considerations in the investment landscape of China’s capital market.

Combining mesocosms with models reveals effects of global warming and ocean acidification on a temperate marine ecosystem.

Ocean warming and species exploitation have already caused large-scale reorganization of biological communities across the world. Accurate projections of future biodiversity change require a comprehensive understanding of how entire communities respond to global change. We combined a time-dynamic integrated food web modeling approach (Ecosim) with previous data from community-level mesocosm experiments to determine the independent and combined effects of ocean warming, ocean acidification and fisheries exploitation on a well-managed temperate coastal ecosystem. The mesocosm parameters enabled important physiological and behavioral responses to climate stressors to be projected for trophic levels ranging from primary producers to top predators, including sharks. Through model simulations, we show that under sustainable rates of fisheries exploitation, near-future warming or ocean acidification in isolation could benefit species biomass at higher trophic levels (e.g., mammals, birds, and demersal finfish) in their current climate ranges, with the exception of small pelagic fishes. However, under warming and acidification combined, biomass increases at higher trophic levels will be lower or absent, while in the longer term reduced productivity of prey species is unlikely to support the increased biomass at the top of the food web. We also show that increases in exploitation will suppress any positive effects of human-driven climate change, causing individual species biomass to decrease at higher trophic levels. Nevertheless, total future potential biomass of some fisheries species in temperate areas might remain high, particularly under acidification, because unharvested opportunistic species will likely benefit from decreased competition and show an increase in biomass. Ecological indicators of species composition such as the Shannon diversity index decline under all climate change scenarios, suggesting a trade-off between biomass gain and functional diversity. By coupling parameters from multilevel mesocosm food web experiments with dynamic food web models, we were able to simulate the generative mechanisms that drive complex responses of temperate marine ecosystems to global change. This approach, which blends theory with experimental data, provides new prospects for forecasting climate-driven biodiversity change and its effects on ecosystem processes.

Protocol implementation during the COVID-19 pandemic: experiences from a randomized trial of stress ulcer prophylaxis

BackgroundDuring the COVID-19 pandemic, many intensive care units (ICUs) halted research to focus on COVID-19-specific studies.ObjectiveTo describe the conduct of an international randomized trial of stress ulcer prophylaxis (Re-Evaluating the Inhibition of Stress Erosions in the ICU [REVISE]) during the pandemic, addressing enrolment patterns, center engagement, informed consent processes, data collection, a COVID-specific substudy, patient transfers, and data monitoring.MethodsREVISE is a randomized trial among mechanically ventilated patients, comparing pantoprazole 40 mg IV to placebo on the primary efficacy outcome of clinically important upper gastrointestinal bleeding and the primary safety outcome of 90-day mortality. We documented protocol implementation status from March 11th 2020-August 30th 2022.ResultsThe Steering Committee did not change the scientific protocol. From the first enrolment on July 9th 2019 to March 10th 2020 (8 months preceding the pandemic), 267 patients were enrolled in 18 centers. From March 11th 2020-August 30th 2022 (30 months thereafter), 41 new centers joined; 59 were participating by August 30th 2022 which enrolled 2961 patients. During a total of 1235 enrolment-months in the pandemic phase, enrolment paused for 106 (8.6%) months in aggregate (median 3 months, interquartile range 2;6). Protocol implementation involved a shift from the a priori consent model pre-pandemic (188, 58.8%) to the consent to continue model (1615, 54.1%, p < 0.01). In one new center, an opt-out model was approved. The informed consent rate increased slightly (80.7% to 85.0%, p = 0.05). Telephone consent encounters increased (16.6% to 68.2%, p < 0.001). Surge capacity necessitated intra-institutional transfers; receiving centers continued protocol implementation whenever possible. We developed a nested COVID-19 substudy. The Methods Centers continued central statistical monitoring of trial metrics. Site monitoring was initially remote, then in-person when restrictions lifted.ConclusionProtocol implementation adaptations during the pandemic included a shift in the consent model, a sustained high consent rate, and launch of a COVID-19 substudy. Recruitment increased as new centers joined, patient transfers were optimized, and monitoring methods were adapted.

Hidden delta degradation due to fluvial sediment decline and intensified marine storms.

Deltas are threatened by erosion due to climate change and reduced sediment supply, but their response to these changes remains poorly quantified. We investigate the abandoned Yellow River delta that has transitioned from rapid growth to ongoing deterioration due to a river avulsion removing the sediment supply. Integrating bathymetric data, process observations, and sediment transport modeling, we find that while the subaerial delta was stabilized by engineering measures, the subaqueous delta continued to erode due to intensified storms, losing 39% of its mass deposited before the avulsion. Long-term observations show that winter storms initiate scouring of the subaqueous delta, contributing up to 70% of seabed erosion. We then analyze 108 global deltas to assess subaqueous delta erosion risks and identify 17 deltas facing similar situations of sediment decline and storm intensification during the past 40 years. Our findings suggest that subaqueous delta erosion must be integrated into delta sustainability evaluations.

EXPLORING THE SUSTAINABILITY OF CONCRETE BRIDGES

After the construction boom of the past 30-40 years, United Arab Emirates has been left with many costly structures that may or may not fulfill modern sustainability requirements. With the on-going economic recession seen by most of the world and a higher awareness among the population regarding the environmental and societal impact of construction, engineers and designers are carrying out sustainability studies for all kinds of infrastructure. Although most of past research has focused on sustainability rating of buildings, recent advances in this area shows a heightened interest in sustainability assessment of bridges as well. Several of the key sustainability indicators for buildings are also applicable for bridge; quantitative (construction cost and assembly, transportation of materials, service life, environmental impact, etc.) and qualitative (aesthetics, safety features, etc.). This paper contributes to an ongoing research project aimed at developing a sustainability rating system for bridges in the UAE. It includes a comprehensive survey designed to evaluate the relevance of current sustainability indicators for bridge projects within the region. The findings and analysis of this survey are discussed, providing insights into the adaptation of these sustainability metrics for UAE bridges.

EXPLORING THE SUSTAINABILITY OF CONCRETE BRIDGES

After the construction boom of the past 30-40 years, United Arab Emirates has been left with many costly structures that may or may not fulfill modern sustainability requirements. With the on-going economic recession seen by most of the world and a higher awareness among the population regarding the environmental and societal impact of construction, engineers and designers are carrying out sustainability studies for all kinds of infrastructure. Although most of past research has focused on sustainability rating of buildings, recent advances in this area shows a heightened interest in sustainability assessment of bridges as well. Several of the key sustainability indicators for buildings are also applicable for bridge; quantitative (construction cost and assembly, transportation of materials, service life, environmental impact, etc.) and qualitative (aesthetics, safety features, etc.). This paper contributes to an ongoing research project aimed at developing a sustainability rating system for bridges in the UAE. It includes a comprehensive survey designed to evaluate the relevance of current sustainability indicators for bridge projects within the region. The findings and analysis of this survey are discussed, providing insights into the adaptation of these sustainability metrics for UAE bridges.

Improving Pneumococcal Vaccination Rates in Immunosuppressed Pediatric Patients with Rheumatic Disease.

Patients with rheumatic diseases are at a high risk of invasive pneumococcal disease due to immunosuppression. We conducted a quality improvement project, and the first aim was to increase the percentage of patients with systemic lupus erythematosus and mixed connective tissue disease that is up to date on pneumococcal vaccinations from 9.6% to 80% within one year. Subsequently, the second aim was to increase the percentage of patients on immunosuppression with systemic lupus erythematosus, mixed connective tissue disease, juvenile dermatomyositis and systemic vasculitis that is up to date on pneumococcal vaccinations from 62.6% to 80% within one year. Two process measures were up-to-date vaccination status on (1) 13-valent pneumococcal conjugated vaccine (PCV13) and (2) 23-valent pneumococcal polysaccharide vaccine (PPSV23). Our outcome measure was being fully up to date on both pneumococcal vaccinations. Interventions included an immunization algorithm, reporting of eligible patients, education, reminders, and pre-visit planning. There were shifts in the centerline for all quality measures in both phases of this project. The combined pneumococcal vaccination rate for Phase 1 increased from 9.6% to 91.1%, and this centerline was sustained. Pneumococcal vaccination rates also significantly increased for Phase 2: 68.8% to 93.4% for PCV13, 65.2% to 88.5% for PPSV23, and 62.6% to 86.5% for the combined pneumococcal vaccination rate. Quality improvement methodology significantly increased and sustained pneumococcal vaccination rates in our high-risk, immunosuppressed patients. We continue to prioritize this important initiative to mitigate the risk of invasive pneumococcal disease.