Traditional Management Strategies Research Articles

Real-Time Application Optimization Control Algorithm for Energy Management Strategy of the Hybrid Power System Based on Artificial Intelligence

In recent years, due to the strengthening of our country’s comprehensive strength, the rapid development of science and technology and artificial intelligence has also attracted people’s attention. Artificial intelligence is a highly applicable subject, which has very good applications in power systems. In the experiment, the open circuit voltage method and the ampere-hour integration method are used to estimate the SOC of the lithium battery and the particle swarm energy management algorithm is used to allocate the output power of the fuel cell and the lithium battery. The particle swarm algorithm module calls the dual source hybrid power system module through the sim function to convert the actual value input in the system into a fuzzy quantity suitable for fuzzy control. The energy management strategy based on particle swarm optimization and fuzzy control was tested based on working conditions under the comprehensive test bench. Finally, the matching of the hybrid system is analyzed from the structure, component parameters, control strategy, and driving cycle of the vehicle. The experimental data show that the total fuel consumption of the three sets of experiments is averaged to get a fuel consumption rate of 26.3 m3/100 km for the hybrid city bus under the optimized energy management strategy. The results show that the real-time energy management strategy based on particle swarm algorithm can significantly improve the real-time performance of traditional instantaneous energy management strategies while reducing fuel consumption.

Palaeoecological records as a guide for fire management in Killarney National Park, Ireland

Climate change is allowing fire to expand into previously unburnt ecosystems and regions. While management policies such as fire suppression have significantly altered their frequency and intensity. To prevent future biodiversity/ecosystem services loss, and the large financial burden of wildfires, management plans will be required to adapt to future climate and land use changes. Long-term ecological data offer a unique perspective to assess fire variability under different climate and land-use conditions. In this study, we focus on Killarney National Park, Ireland. An area which today is under threat from an increase in fire activity. Comparing palaeoecological and archaeological records, we reconstruct the past fire dynamic and its impact on the landscape, and evaluate the role of climate vs humans in influencing the natural fire regime over the millennial time-scale. Our results indicate that fire has been present in the landscape since the beginning of the Holocene, with fire in the early Holocene being largely controlled by climate and microsite conditions, and in the late Holocene being increasingly influenced by human activity. The knowledge of past fire regimes can help inform future management in order to protect the semi-natural native woodland. The park's present landscape mosaic, could be preserved by limiting forest encroachment through moderate grazing and burning, while also protecting any fragmented forest from excessive grazing and large/intense fires, via traditional fire management strategies such as fuel load management. However, a fire management strategy should only be implemented following careful consideration of all ecosystem factors and controls.

Examining Thermal Management Strategies for a Microcombustion Power Device

Microcombustion attracts interest with its promise of energy dense power generation for electronics. Yet, challenges remain to develop this technology further. Thermal management of heat losses is a known hurdle. Simultaneously, non-uniformities in heat release within the reaction regions also affect the device performance. Therefore a combination of thermal management strategies are necessary for further performance enhancements. Here, a bench top platinum nanoparticle based microcombustion reactor, coupled with thermoelectric generators is used. Methanol-air mixtures achieve room temperature ignition within a catalytic cartridge. In the current study, the reactor design is modified to incorporate two traditional thermal management strategies. By limiting enthalpic losses through the exhaust and reactor sides, using multi-pass preheating channels and heat recirculation, expected improvements are achieved. The combined strategies doubled the power output to 1.01 W when compared to the previous design. Furthermore, a preliminary study of catalyst distribution is presented to mitigate non-uniform catalytic activity within the substrate. To do this, tailored distribution of catalyst particles was investigated. This investigation shows a proof-of-concept to achieve localized control, thus management, over heat generation within substrates. By optimizing heat generation, a highly refined combustion-based portable power devices can be envisioned.

A comparison of acute pain management strategies after cesarean delivery

There are approximately 1.2 million cesarean deliveries performed each year in the United States alone. While traditional postoperative pain management strategies previously relied heavily on opioids, practitioners are now moving toward opioid-sparing protocols using multiple classes of nonnarcotic analgesics. Multimodal pain management systems have been adopted by other surgical specialties including gynecology, although the data regarding their use for postoperative cesarean delivery pain management remain limited. To determine if a multimodal pain management regimen after cesarean delivery reduces the required number of morphine milligram equivalents (a unit of measurement for opioids) compared with traditional morphine patient-controlled analgesia while adequately controlling postoperative pain. This was a prospective cohort study of postoperative pain management for women undergoing cesarean delivery at a large county hospital. It was conducted during a transition from a traditional morphine patient-controlled analgesia regimen to a multimodal regimen that included scheduled nonsteroidal anti-inflammatory drugs and acetaminophen, with opioids used as needed. The data were collected for a 6-week period before and after the transition. The primary outcome was postoperative opioid use defined as morphine milligram equivalents in the first 48 hours. The secondary outcomes included serial pain scores, time to discharge, and exclusive breastfeeding rates. Women who required general anesthesia or had a history of substance abuse disorder were excluded. The statistical analyses included the Student t test, Wilcoxon rank-sum, and Hodges-Lehman shift, with a P value <.05 being considered significant. During the study period, 877 women underwent cesarean delivery and 778 met the inclusion criteria-378 received the traditional morphine patient-controlled analgesia and 400 received the multimodal regimen. The implementation of a multimodal regimen resulted in a significant reduction in the morphine milligram equivalent use in the first 48 hours (28 [14-41] morphine milligram equivalents vs 128 [86-174] morphine milligram equivalents; P<.001). Compared with the traditional group, more women in the multimodal group reported a pain score ≤4 by 48 hours (88% vs 77%; P<.001). There was no difference in the time to discharge (P=.32). Of the women who exclusively planned to breastfeed, fewer used formula before discharge in the multimodal group than in the traditional group (9% vs 12%; P<.001). Transition to a multimodal pain management regimen for women undergoing cesarean delivery resulted in a decrease in opioid use while adequately controlling postoperative pain. A multimodal regimen was associated with early successful exclusive breastfeeding.

Crop Production and Phosphorus Legacy with Long-Term Phosphorus- and Nitrogen-Based Swine Manure Applications under Corn-Soybean Rotation

The traditional manure management strategy, based on crop N needs, results in accumulation of phosphorus (P) in soil due to the imbalance of N/P ratio between crop requirement and manure supply. This study was conducted from 2004 to 2013 to evaluate the effects of P-based liquid and solid swine manure (LMP and SMP, for P-based liquid and solid swine manure, respectively) application, in comparison with N-based application (LMN and SMN, for N-based liquid and solid swine manure, respectively), on crop yield and soil residual P under corn (Zea mays L.)–soybean (Glycine max L.) rotation in a Brookston clay loam soil of the Lake Erie basin, ON, Canada. Chemical fertilizer P (CFP) and non-P treatments were included as controls (CK). For liquid manure treatments, corn yield for LMN showed a lower annual corn yield (7.82 Mg ha−1) than LMP (9.36 Mg ha−1), and their differences were even statistically significant at p &lt; 0.05 in some cropping years. The annual corn yield of LMP was also higher than those of SMP (7.45 Mg ha−1) and SMN (7.41 Mg ha−1), even the CFP (8.61 Mg ha−1), although the corresponding yield differences were not significant (p &lt; 0.05) in some cropping years. For soybean, the plots with P application produced an average of 0.98 Mg ha−1 greater annual yields than CK. No significant differences were found between CFP and manure treatments. The annual corn yield of SMN was close to that of the CK (7.19 Mg ha−1). The grain P removal (GPR) of SMN (18.6 kg ha−1) for soybean was significantly higher than that of the other treatments. The above-ground-P uptake (AGPU) in SMN, for both corn and soybean, was significantly higher than that of the other five treatments. The soil test P (STP) presented clear stratification, concentrating in the top 30 cm soil depth after 10 years of application. The contents of STP with LMN and SMN increased from 7.1 mg P kg−1 to 12.4 and 45.5 mg P kg−1, respectively. The sum of STP mass (0–30 cm) with LMP (31.6 kg ha−1) was largely identical to that with CFP (30.1 kg ha−1); however, with SMN (173.7 kg ha−1), it was significantly higher than the rest of the treatments. Manure P source availability coefficients were averaged at 1.06 and 1.07 for LMP and SMP, respectively. The addition of phosphorus-based liquid or solid swine manure can overcome the drawback of traditional N-based applications by potentially reducing the adverse impact on water quality while sustaining crop agronomic production.

Стратегічне управління розвитком галузі коноплярства

The purpose of the article - substantiation of theoretical, methodical and practical aspects of formation of strategic management of development of the hemp industry in Ukraine in the conditions of strengthening of competition and maintenance of sustainable development of rural territories. Research methods. The methodological basis of the study were the provisions of economic theory and systems analysis. The stages of development of cannabis were considered using the historical method. The dynamics of sown areas was studied using the statistical and economic method. Using a logical method, the tools (methods) of strategic management in the field of cannabis were evaluated on the example of the Institute of Bast Cultures of NAAS of Ukraine and the main directions of strategic management development. The method of analysis and synthesis was used to identify opportunities to expand the tools of strategic management (agricultural cluster as a consequence of the use of an innovative European tool - smart specialization). Theoretical generalizations to substantiate the use of existing and innovative tools of strategic management and conclusions were formed using the abstract-logical method. Research results. The historical key moments that influenced the development of the cannabis industry over the last hundred years are highlighted. The inefficiency of the traditional top-down management strategy is proved and a new tool of strategic management of the European model is substantiated - smart specialization as a basis for regional development. The algorithm of creation and efficiency of agrotourism cluster "Slobozhanske hemp" in Sumy region is given. The main directions of development of strategic management in the field of hemp are outlined. A SWOT analysis matrix was used to study in detail the strengths, weaknesses, opportunities and threats of the cannabis industry. On the example of the Institute of Bast Crops of NAAS of Ukraine, the main tools of strategic planning were outlined and analyzed. Scientific novelty. The necessity of reorientation of the strategy of regional management from vertical (top-down) to innovative, local, multilevel (smart specialization) is substantiated. With the help of SWOT-analysis, it identified weaknesses and threats that prevent the defense management strategy to move to a defensive - offensive base strategy. The combination of strengths and opportunities in the long run will provide an opportunity to choose a strategy for sustainable development of the cannabis industry. The expediency of creating the Agro-tourist cluster "Slobozhanske hemp" in Sumy region as a powerful economic mechanism and a "green tourist magnet" is considered. The analysis of the main tools of strategic management of ILK NAAS of Ukraine provided an opportunity to formulate the main directions of development of strategic management in the field of hemp. Practical significance. The reorientation of the regional management strategy from vertical to horizontal provides an opportunity for businesses not only to expand their capabilities in the field of growing and processing hemp products from the introduction of modern scientific advances, due to lower state regulation, but also to revive age-old traditions. everyday life. In general, the solution of the tasks will contribute to the expansion of sown areas of technical hemp, the creation of facilities for processing hemp, the creation of jobs and, consequently, the added value obtained by deep processing of products, increase tax revenues to budgets of various levels. Tabl.: 3. Figs.: 3. Refs.: 15.

Comparative Cost and Effectiveness of a New Algorithm for Early Lyme Disease Diagnosis: Evaluation in US, Germany, and Italy.

PurposeThis Lyme disease early detection economic model, for patients with suspected Lyme disease without erythema migrans (EM), compares outcomes of standard two-tier testing (sTTT), modified two-tier testing (mTTT) and the DiaSorin Lyme Detection Algorithm (LDA), a combination of both serology tests and Interferon-ɤ Release Assay.Patients and MethodsA patient-level simulation model was built to incorporate effectiveness estimation from a structured focused literature review, and health-care cost inputs for the United States, Germany, and Italy. Simulated clinical outcomes were 1) percent of patients with timely and correct diagnosis, 2) patients appropriately treated and exposed to antibiotics therapy, and 3) patients with late Lyme disease manifestations. Expected health outcomes were expressed in terms of differences in quality-adjusted life years (QALYs) due to disseminated Lyme disease and persisting symptoms, and economic outcomes were analyzed from a third-party payer perspective.ResultsThe DiaSorin LDA resulted in a better sensitivity compared to sTTT and mTTT, 84% vs 49% and 45%, respectively, in the base case (13% of infected patients in the tested population). Due to the improved diagnostic performance, the LDA-based strategy is expected to be more effective, providing mean incremental 0.024 QALYs per tested patient, or 0.19 per infected patient. Furthermore, from a third-party payer perspective, the adoption of the LDA-based strategy would reduce the expected health-care cost for suspected and confirmed Lyme disease by roughly 40%, ie about $410, €130, and €170 per tested patient in the United States, Germany, and Italy, respectively, compared to sTTT. The results are most sensitive to the infection rate in the tested population, with LDA maintaining a cost advantage for Lyme disease active infection rates ≥0.8-2.5%.ConclusionLDA early diagnostic testing and subsequent treatment of subjects with early Lyme disease without EM are expected to outperform traditional management strategies both clinically and economically in the US, Germany, and Italy.

A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management.

(1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We report our challenges caring for CARDS patients on VV-ECMO and alterations to traditional management strategies. (2) Methods: We conducted a retrospective review of our institutional strategies for managing patients with COVID-19 who required VV-ECMO in a dedicated airlock biocontainment unit (BCU), from March to June 2020. The data collected included the time course of admission, VV-ECMO run, ventilator length, hospital length of stay, and major events related to bleeding, such as pneumothorax and tracheostomy. The dispensation of sedation agents and trial therapies were obtained from institutional pharmacy tracking. A descriptive statistical analysis was performed. (3) Results: Forty COVID-19 patients on VV-ECMO were managed in the BCU during this period, from which 21 survived to discharge and 19 died. The criteria for ECMO initiation was altered for age, body mass index, and neurologic status/cardiac arrest. All cannulations were performed with a bedside ultrasound-guided percutaneous technique. Ventilator and ECMO management were routed in an ultra-lung protective approach, though varied based on clinical setting and provider experience. There was a high incidence of pneumothorax (n = 19). Thirty patients had bedside percutaneous tracheostomy, with more procedural-related bleeding complications than expected. A higher use of sedation was noted. The timing of decannulation was also altered, given the system constraints. A variety of trial therapies were utilized, and their effectiveness is yet to be determined. (4) Conclusions: Even in a high-volume ECMO center, there are challenges in caring for an expanded capacity of patients during a viral respiratory pandemic. Though institutional resources and expertise may vary, it is paramount to proceed with insightful planning, the recognition of challenges, and the dynamic application of lessons learned when facing a surge of critically ill patients.

549 Lessons Learned from Two Survivors of Greater Than 90% Total Body Surface Area Full Thickness Burn Injuries Using a Dermal Biodegradable Substitute and Autologous Skin Cell Suspension: A Case Series

Abstract Introduction Advances in burn injury knowledge, critical care, and pharmacological developments have increased survival rates among extensive burn patients. Survival now dependents not just on skin coverage, but effective control of SIRS response, metabolic derangement, fluid loss and sepsis. Novel synthetic dermal substitutes create robustness, thickness, and pliability of the skin in addition to an improved aesthetic appearance while; point-of-care autologous skin cell harvesting enhances treatment by amplifying small split-thickness skin samples to produce an autologous skin cell suspension (ASCS) to cover a larger burn area. This study reports on two survivors with greater than 90% total body surface area full-thickness burns utilizing a combined treatment of a dermal substitute along with ASCS and traditional burn management strategies. Methods Chart review of two patients with &amp;gt;90% burns and inhalation injury after being trapped in a burning vehicle following a traffic collision occurred. Most of the burns in both patients were “leathery” and consistent with full thickness, sparing only the plantar and dorsal aspect of the feet and bilateral small areas of the hip in Patient 1. Patient 2 had fourth-degree burns in some areas of the chest and flank with only the bilateral groin regions and feet spared. The patients were treated with a multi-step process which included using allograft, dermal substitute, and ASCS with split-thickness skin grafts (STSG) in place of cultured epidermal autograft to achieve coverage of &amp;gt;90% burns with high meshed ratio. Results The dermal substitute was limited to deep burns that penetrated down to fat, muscle, and/or joints. Fluid loss was well controlled by the dermal substitute during initial resuscitation. Post reconstruction, areas covered with the dermal substitute and grafted with autogenous STSG with ASCS exhibited less hypertrophy and contracture bands. The elbow and knee joints showed minimal restriction with passive motion and good skin compliance, but contractures persisted in areas where 4th degree tendon and fascia thermal injury occurred. Areas that showed signs of infection were trimmed or unroofed and allowed to drain while maintaining the remainder of the dermal substitute. Conclusions The use of dermal substitutes and ASCS allowed the care team to achieve SIRS control, improved fluid management, enhanced skin coverage, and reduced hospitalization stay. The process experienced in these cases shows promise for future patients with extensive burns. Both patients were able to survive and show improvement during rehabilitation.

Extracorporeal life support for cardiogenic shock during pregnancy and postpartum: a single center experience.

The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for cardiogenic shock in pregnant and postpartum patients remains limited by concerns of bleeding, hemolysis, and fetal risks. This case series examines the underlying characteristics and management strategies for this high-risk population. All pregnant and post-partum patients who underwent VA ECMO in the cardiovascular intensive care unit between January 1, 2016 and November 1, 2019, were included in this retrospective study. Management of maternal and fetal O2 delivery, left ventricular (LV) unloading, anticoagulation, and ECMO circuit characteristics were evaluated. Five patients required veno-arterial ECMO for restoration of systemic perfusion. Three patients developed peripartum cardiomyopathy, one septic cardiomyopathy, and one acute right ventricular (RV) failure. The median age was 30.6 years, with median gestational age in pregnant patients of 31 weeks. Maternal and fetal survival to discharge was 80%. Bleeding was the primary complication, with two patients requiring blood transfusions; one requiring interventional radiology (IR) embolization and the other requiring surgical intervention to control bleeding. One patient was successfully delivered on VA ECMO. No fetal complications were directly attributed to VA ECMO. VA ECMO can be employed successfully in obstetric patients with cardiogenic shock with appropriate patient selection. Further research is needed to determine if VA ECMO provides a survival advantage over traditional management strategies in this vulnerable population.

Meeting the affordability challenges posed by orphan drugs: a survey of payers, providers, and employers.

BACKGROUND: As an increasing number of orphan drugs are FDA approved, health care payers, employers, and providers are attempting to strike a balance between patient access to innovative treatments and overall affordability. Payers and employers are evaluating how traditional specialty pharmacy management strategies and innovative models can support continued coverage of orphan drugs. OBJECTIVE: To understand how health care stakeholders are meeting the financial challenges posed by the increasing number and cost of orphan drugs and how these strategies are affecting orphan drug acquisition for providers. METHODS: A survey was conducted with payer, provider, and employer decision makers recruited from both AMCP and a proprietary database of market-access decision makers in July and August 2020. Respondents were asked about their experiences and activities in the orphan disease space, including tactics to manage affordability of drugs to treat orphan diseases. RESULTS: Reinsurance was the most commonly utilized strategy to maintain affordability of the benefit for both payers (42%) and employers (55%). Although 31% of payers have adopted gene therapy carve-outs, no employers had done so. Approximately three quarters (76%) of payers believe that limited distribution networks impede their abilities to manage orphan drugs, compared with 4% who believe limited networks improve orphan drug management. For most payers (78%), the decision to cover orphan drugs on either the medical or pharmacy benefit depends on the specific drug. Medical benefit coverage was driven primarily by site-of-care policies (55%) and the lower drug cost of average sales price pricing (50%). Pharmacy benefit coverage was driven primarily by a greater ability to manage the orphan drug (71%) and by rebates (62%). One in 3 (33%) of providers with experience treating orphan diseases acquire orphan drugs exclusively through buy and bill, whereas 10% acquire them exclusively through a specialty pharmacy provider. Buy-and-bill acquisition by providers was driven primarily by improved patient affordability (47%) and 340b pricing (47%). Specialty pharmacy provider acquisition was driven primarily by payer requirements (64%) and reduced administrative burden (64%). CONCLUSIONS: Payers and employers are adopting innovative benefit designs and strategies to cover orphan drugs while maintaining plan affordability. Cost considerations are prominent factors in determining whether orphan drugs will be covered under the pharmacy or medical benefit and how providers will acquire orphan drugs. DISCLOSURES: This research was sponsored by AMCP and PRECISIONvalue. Lopata, Terrone, and Gopalan are employees of PRECISIONvalue. Ladikos and Richardson are employees of AMPC. The authors have nothing further to disclose. This research was presented during the AMCP Partnership Forum "Preparing for and Managing Rare Diseases" held virtually September 8-10, 2020.

Natural regeneration in urban forests is limited by early-establishment dynamics: implications for management.

Urban forested natural areas are valuable ecological and social resources, but long-term sustainability of these habitats is challenged by environmental and social factors associated with urban ecosystems. Advances in city-scale assessments of urban forests have increased the resolution of forest community types and conditions, allowing for improved understanding of ecological function, such as natural regeneration, in these urban habitats. By applying metrics of tree regeneration that are commonly used for the management of rural forests, urban ecologists can test the potential for traditional forest management strategies within our cities. In this study, we compare urban and rural oak-hickory forest composition and structure and the capacity for natural regeneration in the New York metropolitan area. Specifically, we use two metrics of advance regeneration that describe the abundance of seedlings and saplings at different size classes to test whether this management for natural regeneration is a viable option. We found differences in recruitment dynamics between urban and rural forests that have implications for the sustainability of these forests and new management strategies. First, after controlling for forest community type, species composition in urban and rural sites was significantly different across multiple strata and within the seed bank. Species-specific capacity for natural regeneration was different in urban and rural sites, signaling the possibility of divergent successional trajectories. Second, while differences in species composition exist, both urban and rural sites were dominated by native species across all forest strata except for urban seed banks. Third, despite finding significantly lower average annual seedling abundance in urban (1.9 seedlings/m2 ) compared to rural (7.1 seedlings/m2 ) sites, we observed greater density of saplings in urban forests, and no significant difference in stocking index between sites. These findings suggest that early-establishment barriers to recruitment are greater in urban forest sites. However, once established, seedling transition into advance regeneration stages may not be different between site types, and advance regeneration may, in some cases, be more viable in urban forested natural areas. These results highlight functional differences between urban and rural forest recruitment dynamics that may impact on the future community composition of oak-hickory forests in the two landscape settings.

The Effects of Dexamethasone on the Time to Pain Resolution in Dental Periapical Abscess.

Dental infections are frequently encountered in the emergency department (ED), with periapical abscesses being among the most painful. Traditional pain management strategies include local anesthetic injections, oral analgesics, and intravenous opioids. We sought to identify an alternative pain management strategy with early use of dexamethasone as adjunct to conventional therapies for inflammation and pain at the site of infection. We conducted a prospective, randomized, double-blind, placebo-controlled study comparing the analgesic effect of dexamethasone and placebo in ED patients with periapical abscess during a 2-year timeframe at two urban academic EDs. Adult patients presenting with physical examination findings consistent with a diagnosis of periapical abscess were randomized to receive oral dexamethasone or an identical placebo. Pain was assessed using the verbal numeric scale in person at discharge and via telephone at 12, 24, 48, and 72h after discharge from the ED. Seventy-three patients were enrolled, with 37 receiving dexamethasone and 36 receiving placebo. Follow-up pain scores were obtained for 52 patients at 12, 24, 48, and 72h. Ten patients from the dexamethasone group and 11 from placebo group were lost to follow-up. Patients who received dexamethasone reported a greater reduction in pain at 12h compared with the placebo group (p=0.029). Changes in pain scores from baseline and at 24, 48, and 72h were not statistically significant. No adverse events were reported. Single-dose dexamethasone as adjunct to conventional medical management for pain caused by periapical abscess demonstrated a significant reduction in pain 12h post treatment compared with placebo.

Valorizing municipal solid waste via integrating hydrothermal carbonization and downstream extraction for biofuel production

Abstract Hydrothermal carbonization (HTC) is a thermochemical process that can reduce the environmental burdens of wet, heterogeneous biomasses such as the organic fraction of municipal solid waste (OFMSW). Whilst the effect of processing parameters on hydrochar properties is well known, post-treatments to valorize hydrochars are infrequently investigated. Moreover, more severely carbonized hydrochars have a reactive species present on their surface that may limit hydrochars’ use as a solid fuel or soil amendment/environmental adsorbent. To address these potential limitations, a low-temperature (180 °C) thermal treatment and a chemical extraction (1:4 methanol: dichloromethane) were performed on OFMSW hydrochars. The thermal extraction removed up to 12% of this reactive volatile matter, comprised of alkanes, furans, ketones, and fatty acids. Chemical extraction removed up to 61% of the hydrochar, and the extract comprised mostly fatty acids, suggesting a potential pathway for recovery of fatty acids and condensation of fuel molecules in the solid hydrochar. The higher heating values of the extracts were much greater than the non-extractable solid hydrochar. The non-extractable primary char showed similar oxidative and pyrolytic behavior to a standard bituminous coal. The results indicate that HTC could valorize OFMSW by converting this wet waste into a dry solid fuel, soil amendment or environmental adsorbent while simultaneously extracting valuable biodiesel and biofuel precursors. Given increasing legislative pressure to divert OFMSW from landfills, this new pathway offers an alternative to traditional anaerobic digestion management strategies that produce only methane as a green energy product.

Dynamic Spectrum Allocation Following Machine Learning-Based Traffic Predictions in 5G

The popularity of mobile broadband connectivity continues to grow and thus, the future wireless networks are expected to serve a very large number of users demanding a huge capacity. Employing larger spectral bandwidth and installing more access points to enhance the capacity is not enough to tackle the stated challenge due to related costs and the interference issues involved. In this way, frequency resources are becoming one of the most valuable assets, which require proper utilization and fair distribution. Traditional frequency resource management strategies are often based on static approaches, and are agnostic to the instantaneous demand of the network. These static approaches tend to cause congestion in a few cells, whereas at the same time, might waste those precious resources on others. Therefore, such static approaches are not efficient enough to deal with the capacity challenge of the future network. Thus, in this paper we present a dynamic access-aware bandwidth allocation approach, which follows the dynamic traffic requirements of each cell and allocates the required bandwidth accordingly from a common spectrum pool, which gathers the entire system bandwidth. We perform the evaluation of our proposal by means of real network traffic traces. Evaluation results presented in this paper depict the performance gain of the proposed dynamic access-aware approach compared to two different traditional approaches in terms of utilization and served traffic. Moreover, to acquire knowledge about access network requirement, we present a machine learning-based approach, which predicts the state of the network, and is utilized to manage the available spectrum accordingly. Our comparative results show that, in terms of spectrum allocation accuracy and utilization efficiency, a well designed machine learning-based bandwidth allocation mechanism not only outperforms common static approaches, but even achieves the performance (with a relative error close to 0.04) of an ideal dynamic system with perfect knowledge of future traffic requirements.

The correlation of respiratory system compliance and mortality in COVID-19 acute respiratory distress syndrome: do phenotypes really exist?

Background: Recent literature suggests respiratory system compliance (Crs) based phenotypes exist among COVID-19 ARDS patients. We sought to determine whether these phenotypes exist and whether Crs predicts mortality. Methods: A retrospective observational cohort study of 111 COVID-19 ARDS patients admitted March 11-July 8, 2020. Crs was averaged for the first 72-hours of mechanical ventilation. Crs&lt;30ml/cmH2O was defined as poor Crs(phenotype-H) whereas Crs≥30ml/cmH2O as preserved Crs(phenotype-L). Results: 111 COVID-19 ARDS patients were included, 40 phenotype-H and 71 phenotype-L. Both the mean PaO2/FiO2 ratio for the first 72-hours of mechanical ventilation and the PaO2/FiO2 ratio hospital nadir were lower in phenotype-H than L(115[IQR87] vs 165[87], p=0.016), (63[32] vs 75[59], p=0.026). There were no difference in characteristics, diagnostic studies, or complications between groups. Twenty-seven (67.5%) phenotype-H patients died vs 37(52.1%) phenotype-L(p=0.115). Multivariable regression did not reveal a mortality difference between phenotypes; however, a 2-fold mortality increase was noted in Crs&lt;20 vs &gt;50ml/cmH2O when analyzing ordinal Crs groups. Moving up one group level (ex. Crs30-39.9ml/cmH2O to 40-49.9ml/cmH2O), was marginally associated with 14% lower risk of death(RR=0.86, 95%CI 0.72, 1.01, p=0.065). This attenuated (RR=0.94, 95%CI 0.80, 1.11) when adjusting for pH nadir and PaO2/FiO2 ratio nadir. Conclusion: We identified a spectrum of Crs in COVID-19 ARDS similar to Crs distribution in non-COVID-19 ARDS. While we identified increasing mortality as Crs decreased, there was no specific threshold marking significantly different mortality based on phenotype. We therefore would not define COVID-19 ARDS patients by phenotypes-H or L and would not stray from traditional ARDS ventilator management strategies.

Disciplinary Dissent: The Troubled Implementation of a Restorative Justice Program at E.C. Johnson High School

As many schools and school districts across the nation consider replacing traditional behavioral management strategies with restorative practices, this case asks the readers to consider the challenges a school leader may face when attempting to implement school-wide procedural change. In this case, a school leader faced with race-based discipline disparities attempts to challenge this nationwide trend by bringing in a local organization to conduct restorative justice facilitation and reduce the school’s out-of-school suspension numbers. This proves to be challenging due to the systems that existed prior to this change and her difficulties in getting buy-in from her staff. This case may be used in leadership preparation courses as an example of the complexity and considerations involved when implementing restorative justice as an alternative discipline strategy.

Enabling regional collaborative governance for sustainable recreation on public lands: the Verde Front

Collaborative governance approaches have been shown to build trust, reduce conflicts and be more responsive than traditional land management strategies because they incorporate diverse perspectives in the decision-making process. Traditional top-down land management often proves inadequate to address landscape-scale problems that cross jurisdictional borders and to produce sustainable outcomes for affected stakeholders. Collaborative governance is an alternative approach, which engages stakeholders – both civil society and public agencies – in a consensus-driven shared decision-making process. A neutral facilitator who clearly communicates the rules of engagement, participatory inclusiveness as well as opportunities to regularly interact face-to-face and generate small wins are among the key factors that have enabled success in previously studied small-scale collaborative governance arrangements. In this study, a collaborative governance effort within the Southwest United States provides insights into how collaborative outcomes can be achieved on public lands at a regional scale and the differences that makes as compared to past studies at smaller scales. This study used a participatory research approach to produce use-oriented research outcomes in tandem with transdisciplinary practitioners on the ground. Our examination provides a deeper understanding of the factors that enable successful collaborative outcomes to be achieved at a regional scale using a community-driven, transparent process.

Treatment options for unstable ankle fractures in older adults: A systematic review and meta-analysis

Background Ankle fractures are the third most common fracture in the elderly. Patients over 60 years are more severely affected by these injuries than their younger counterparts and have a higher rate of complications regardless of the management strategy. Traditional management strategies for unstable ankle fractures include plaster immobilisation and open reduction and internal fixation, with newer modalities such as intramedullary fixation becoming increasingly popular. The aim of this review is to establish the best current evidence for or against different treatment strategies. Methods A systematic review and meta-analysis of randomised controlled trials comparing treatment options for unstable ankle fractures in adults over 55 was conducted, with the primary outcome being functional assessment score at 6–12 months (Olerud and Molander Ankle Score). Secondary outcomes were adverse events including infection and re-operation. Results The search strategies identified 426 articles. After screening and full text review, four papers met the inclusion and exclusion criteria, providing data on 754 ankle fractures. Alternative treatment groups were tibio-talo-calcaneal nail, fibular nail and casting and were compared to open reduction and internal fixation. Meta-analysis of the data showed no difference in Olerud and Molander Ankle Score between treatment modalities at 6–12 months. There was, however, a significant reduction in the incidence of adverse events (OR 0.59 (0.44, 0.81)) and wound infection (0.13 (0.05, 0.31)) in the alternative treatment groups compared to open reduction and internal fixation. Conclusion The current evidence shows no significant difference between treatment modalities for ankle fractures in older adults in terms of functional outcome. Open reduction and internal fixation has a higher rate of adverse events and wound infection when compared to alternative treatments. Therefore, surgery should be carefully considered and if undertaken, in a select patient cohort other treatment modalities, such as intramedullary fixation should be considered.

A diversity of spatial management instruments can support integration of fisheries management and marine spatial planning

In an increasingly crowded ocean facing global drivers for economic expansion, many fisheries could benefit from spatial management that enhances traditional fisheries management strategies. In order to reduce risks to ocean health and promote social-ecological resilience, a diversity of spatial management instruments is needed to provide rapid responses and longer-term interventions that promote sustainability and security. To support marine spatial planning (MSP) in South Africa, existing legal instruments were investigated by: (i) describing the prevailing legal framework for spatial fisheries management; (ii) identifying existing legal instruments that are or could be implemented to support spatial fisheries management; (iii) assessing the way in which these instruments could be implemented; and (iv) providing research recommendations to enhance integration of fisheries management measures into MSP. Seven Acts were examined. Within these, nine instruments support fisheries management. Six instruments that could directly contribute to spatial fisheries management were analysed for diversity by comparing them against seven criteria that reflect the complexity and time for implementation, longevity in terms of security and permanence and, transgression consequences. Results show that there is a diversity of instruments available that, if used together in an integrated MSP framework, can provide rapid responses as well as address longer-term goals. Although South Africa does have diversity in the instruments available, two of them, namely fisheries management areas (FMAs) and priority fishing areas (PFAs), have never been implemented, representing missed opportunities. As South Africa begins to implement its new MSP process, we recommend integration of FMAs and PFAs in this process.