Summary of the current guidelines for managing iatrogenic colorectal perforations and the evolving role of endoluminal vacuum therapy

Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.

Artificial intelligence-driven strategies for managing renal and urinary complications in inflammatory bowel disease

In this editorial,we discuss the article by Singh et al published in World Journal of Nephrology,stating the need for timely adjustments in inflammatory bowel disease(IBD)patients'long-term management plans.IBD is chronic and lifelong,with recurrence and remission cycles,including ulcerative colitis and Crohn's disease.It's exact etiology is unknown but likely multifactorial.Related to gut flora and immune issues.Besides intestinal symptoms,IBD can also affect various extrain-testinal manifestations such as those involving the skin,joints,eyes and urinary system.The anatomical proximity of urinary system waste disposal to that of the alimentary canal makes early detection and the differentiation of such symptoms very difficult.Various studies show that IBD and it's first-line drugs have nephro-toxicity,impacting the patients'life quality.Existing guidelines give very few references for kidney lesion monitoring.Singh et al's plan aims to improve treatment management for IBD patients with glomerular filtration rate decline,specifically those at risk.Most of IBD patients are young and they need lifelong therapy.So early therapy cessation,taking into account drug side effects,can be helpful.Artificial intelligence-driven diagnosis and treatment has a big potential for management improvements in IBD and other chronic diseases.

Effectiveness of RESET care program: A real-world-evidence on managing non-alcoholic fatty liver disease through digital health interventions

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)management requires sustainable lifestyle modifications.This study aimed to evaluate the effectiveness of the RESET care plan,a comprehensive program that is an integrated personalized diet,exercise,and cognitive behavior therapy,delivered via MyTatva’s digital health application enabled through a body composition analyzer(BCA)and smartwatch.AIM To evaluates the effectiveness of the comprehensive program delivered via My-Tatva’s digital health app enabled through internet of thing devices.METHODS This retrospective observational study analyzed deidentified data from 22 par-ticipants enrolled in the MyTatva RESET care program.Participants were divided into three groups:Group A,diet plan;Group B,diet+exercise plan;and Group C,diet+exercise+cognitive behavioral therapy plan.Participants were provided with a BCA and smartwatch for continuous monitoring of anthropometric para-meters.Statistical analysis,including one-way ANOVA and post-hoc Tukey’s Honest Significant Difference test,was conducted to compare mean changes in anthropometric parameters across the groups.INTRODUCTION Non-alcoholic fatty liver disease(NAFLD)has emerged as a global health burden,affecting approximately 1 in 4 in-dividuals worldwide.NAFLD ranges from simple steatosis(fat accumulation)to non-alcoholic steatohepatitis(NASH),and its global prevalence in the general population is estimated between 6.3%and 33%,with NASH affecting 3-5%[1,2].Obesity is a major risk factor of NAFLD,with studies showing that the likelihood of developing NAFLD increases 5-fold at a body mass index(BMI)of 30-32.5 kg/m²and up to 14-fold at BMI of 37.5-40 kg/m²compared to a BMI of 20-22.5 kg/m²[3,4].Effective NAFLD management requires both dietary and physical activity modifications.Healthy weight loss with sustained muscle mass plays a pivotal role,with a reduction of 3%-5%decreasing hepatic steatosis,5%-7%improving NASH conditions,and 10%or more needed to reverse hepatic fibrosis[5].Management also normalizes elevated liver enzymes(aspartate aminotransferase and alanine aminotransferase),enhances insulin sensitivity,and thereby reduces cardiovascular risk by improving endothelial function and increasing cardiorespiratory fitness[6].However,diet or exercise alone is often not as effective as a combined approach.Integrating both balanced dietary changes and increased physical activity yields more sustainable improvements in NAFLD and overall metabolic health[1,7].Traditional intervention methods usually involve in-person consultations,which often lack real-time and continuous patient monitoring.The recommendation of drastic changes in diet and exercise can also be overwhelming for patients,leading to low adherence rates.Many patients struggle to maintain these changes in the long-term due to a lack of con-tinuous motivational support[8,9].In recent years,the health ecosystem has witnessed a significant shift toward digital health platforms,which complement pharmacological treatments in chronic disease management,and increase scala-bility.These platforms provide continuous monitoring and personalized support,helping to bridge the gap between health care setups and patients[10].Recent digital advances enable internet of things(IoT)devices to be integrated into such management plans to track health metrics,to address the limitations of traditional methods[11,12].The MyTatva digital health application offers the RESET plan,a novel comprehensive approach for NAFLD mana-gement by integrating personalized support from nutrition,physiotherapy,and cognitive behavioral therapy(CBT)coaches.We aimed to evaluate the effectiveness of the RESET plan by analyzing the reduction in anthropometric para-meters across three different digital intervention groups.

Managing the surge:A comprehensive review of the entire disposal framework for retired lithium-ion batteries from electric vehicles

Anticipating the imminent surge of retired lithium-ion batteries(R-LIBs)from electric vehicles,the need for safe,cost-effective and environmentally friendly disposal technologies has escalated.This paper seeks to offer a comprehensive overview of the entire disposal framework for R-LIBs,encompassing a broad spectrum of activities,including screening,repurposing and recycling.Firstly,we delve deeply into a thorough examination of current screening technologies,shifting the focus from a mere enumeration of screening methods to the exploration of the strategies for enhancing screening efficiency.Secondly,we outline battery repurposing with associated key factors,summarizing stationary applications and sizing methods for R-LIBs in their second life.A particular light is shed on available reconditioning solutions,demonstrating their great potential in facilitating battery safety and lifetime in repurposing scenarios and identifying their techno-economic issues.In the realm of battery recycling,we present an extensive survey of pre-treatment options and subsequent material recovery technologies.Particularly,we introduce several global leading recyclers to illustrate their industrial processes and technical intricacies.Furthermore,relevant challenges and evolving trends are investigated in pursuit of a sustainable end-of-life management and disposal framework.We hope that this study can serve as a valuable resource for researchers,industry professionals and policymakers in this field,ultimately facilitating the adoption of proper disposal practices.

Nurse anesthetists’perceptions and experiences of managing emergence delirium:A qualitative study

BACKGROUND This study employs a descriptive phenomenological approach to investigate the challenges anesthesia nurses face in managing emergence delirium(ED),a common and complex postoperative complication in the post-anesthesia care unit.The role of nurses in managing ED is critical,yet research on their understanding and management strategies for ED is lacking.AIM To investigate anesthetic nurses’cognition and management experiences of ED in hopes of developing a standardized management protocol.METHODS This study employed a descriptive phenomenological approach from qualitative research methodologies.Purposeful sampling was utilized to select 12 anesthetic nurses from a tertiary hospital in Shanghai as research subjects.Semi-structured interviews were conducted,and the data were organized and analyzed using Colaizzi’s seven-step analysis method,from which the final themes were extracted.RESULTS After analyzing the interview content,four main themes and eight subthemes were distilled:Inefficient cognition hinders the identification of ED(conceptual ambiguity,empirical identification),managing diversity and challenges(patientcentered safe care,low level of medical-nursing collaboration),work responsibilities and pressure coexist(heavy work responsibilities,occupational risks and stress),demand for high-quality management(expecting the construction of predictive assessment tools and prevention strategies,and pursuing standardized management processes to enhance management effectiveness).CONCLUSION Nursing managers should prioritize the needs and suggestions of nurses in order to enhance their nursing capabilities and provide guidance for standardized management processes.

Surveying existing rockfall flexible barriers:a combined method for gathering data,managing information and prioritizing maintenance

Rockfall risk is often mitigated and managed by employing defensive structures to catch falling blocks(i.e.,passive works).Due to the widely spread nature of rockfall,the presence of such defensive structures is a common sight,especially in mountain areas.The most common passive defensive structures are rockfall flexible barriers,due to their significant flexibility and cost-effectiveness.The protective performance of said structures,though,can be severely reduced by prolonged exposure to weathering agents,vegetation growth,and rockfall impacts:these issues must be addressed by performing maintenance.With a view to optimizing the maintenance procedure,the need arises for a tool capable of providing useful information regarding the condition of existing rockfall barriers,in the simplest yet most complete and comprehensive way possible.The present work provides such a tool,alongside the required instruments for it to function properly.Basically,it consists of a survey spreadsheet to be used to collect raw data based on visual inspection of the barriers,coupled with the methodology to score their conditions and to produce a database with which to manage and plan their maintenance.An application to a suitable case study in the Central Italian Alps,featuring a number of barriers in different conditions,is then presented,and its results are discussed.

Issue of Managing Waste Computer Equipment in Conakry City (Republic of Guinea)

The digitization of administrative activities is a technique that not only optimizes resources, but also professionalizes the working methods of public and private services. This dematerialization process involves technologies based on computer equipment, which, after use, becomes cumbersome waste. The aim targeted consisted of taking stock of the management of waste computer equipment imported into the Republic of Guinea, with a view of proposing a mode of environmentally sustainable management methods in a short time. To achieve this, the data was collected through investigation methods (observations, interviews, and questionnaires). This study reveals an excess of imports of electrical and electronic equipment in general, and computer equipment in particular, over the last ten years (2009-2019), With an import rate ranging from 4.03 to 54.45%. This study demonstrated the different ways in which computer and electronic equipment of all kinds are managed, with her failings. This study demonstrated the different ways in which computer and electronic equipment of all kinds are managed, as well as their failings. For this purpose, the different ways in which electronic waste is managed by different users were identified as storage, recycling, or rejection into nature or at waste storage points, often mixed with household waste. Companies specializing in the management of this type of waste and the presence of a certain number of regulatory texts almost do not exist. One company is only for the entire country but unknown to the majority of users.

Identifying and Managing Technical Risks in the Process of Innovative Drugs Development in China

Objective To identify technical risks in the process of innovative drug development,and to provide reference for technical risk management so as to reduce the uncertainties and improve the efficiency of research and development.Methods The initial risk index was investigated by literature research.Then,the Likert scale was used to design a questionnaire,and the experts’opinion was used to analyze the risk factors affecting the different stages of the development of innovative drugs in China.Results and Conclusion Based on the analysis of questionnaire,31 risk indicators of five key stages in the development of innovative drugs from drug discovery to marketing authorization were established.The key risk indicators constructed in this study can provide reference for technology-related risk management in the process of innovative drug development.

Managing the Value of the Organization Based on Organizational Culture

Managing the value of the organization is taking place based on factors forming it. It is becoming possible thanks to such managing operations of the organization, when in the end an image in accordance with expectations, giving the state back to the value of organizations is being got. Creating the goodwill is based among others on immaterial factors, which although they are becoming impossible to include in balance, are taken hold in time value of the organization. Creation of the value of an organization may be based on the organizational culture. The article presents the essence of value management and organization characterized the factors affecting the formation of organizational culture, ways of dealing with an organization aimed at consolidating and strengthening the organizational culture. Sometimes organizations feel the need to change the culture in order to achieve increased efficiency and ensure the success of the company to implement the necessary changes. Therefore, the rest of this article presents the elements to ensure a smooth implementation and consolidation of cultural change.

“Managing Director”翻译小议

国际商务中常见到许多英、美公司头衔 (称谓 ) ,应进行比较分析 。

Managing Variation and Resolving the Trade-off Implications of Global Supply

The reduction of wasteful variation within the supp ly chain is naturally suited to high and stable volumes, as epitomised in the lean practices of the automotive industry. However, with the growth of innovative pr oducts, typically characterised by lower volumes and uncertain demand, it is als o important to develop strategies to effectively manage the externally imposed v ariation resulting from volatile market demand. Such strategies often come under the banner of quick response or agile supply. System variation is the common denominator, for whereas lean strategies emphasis e the need for stability and the reduction of wasteful supply chain variation, a gile emphasises the need to respond to externally imposed demand variation. Simi larly, lean supply is closely associated with level scheduling and investing in inventory to decouple demand variation from the supply chain, whereas, agile sup ply is associated with investing in responsive capacity as inventory requirement s cannot be effectively predicted. This distinction between lean and agile supply, highlights a trade-off between investing in responsive capacity and decoupling inventory, which is closely related to the conflicting manufacturing tasks of fast response and low cost. The implications of this conflict have been more widely felt in recent years, as companies have opted to outsource manufacture to low cost overseas suppliers. T he rationale is to reduce manufacturing costs, but the trade-off is a dramatic loss of responsive capacity with higher dependency on decoupling inventory. As with lean and agile supply, the trade-off implications of such choices need to be acknowledged, conceptually understood and then separate out or otherwise r esolved. This paper introduces the business need before exploring the significance of var iation and the concept of managing variation in a delivery system using responsi ve capacity and decoupling inventory. These concepts will then be used to unpack the lean and agile paradigms before applying the thinking to a more detailed in dustrial case concerning offshore supply decisions. The paper concludes with som e reflections.

Methylation reactions at dopaminergic nerve endings, serving as biological off-switches in managing dopaminergic functions

The mechanisms for the regulation of synaptic dopamine （DA） include its release from presynaptic vesicles, its interaction with post-synaptic and pre-synaptic DA receptors, the reuptake of DA, via dopamine transporter （DAT）, the diffusion of DA and its metabolism by mono-amine oxidase （MAO） and cate- chol-O-methyl transferase （COMT）. DA controls complex and specialized functions including, movements, behavior, mood, perception, reward, and more recently, neurogenesis （Popolo et al., 2004; Reimer et al., 2013） and neuroregeneration （Hoglinger et al., 2004; Yang et al., 2008）. These functions are varied and of high fidelity. Movement, as an example, requires regulatory mechanisms for initiating, stopping, slowing-down speed- ing-up, changing directions, for governing the relentless urges to move in the young and sedentariness in the old as well as in motor-freezing, catalepsy, tremor and stereotypy.

Managing and Measuring Business Networks in Russia

The research topic of this article ＂Managing and measuring business networks in Russia＂ has been under consideration in three successive research projects oriented to Russian business to business （B2B） networks. The projects have been accomplished by HAMK, VTT Technical Research Centre of Finland, and Tampere University of Technology （TUT）. Russian experts from The Higher School of Economics in Moscow and the Graduate School of Management in St. Petersburg were involved in these projects. We asked how managing and measuring B2B networks should be developed, when a company becomes established to Russian market. Both qualitative and quantitative analytical methods were used. Results concerning performance measurement presented in this article are based on data which was collected using survey and a questionnaire. Methodical triangulation was carried out as both research instruments produced 17 full answers for questions concerning performance measurement. Wider results are based on about 200 face-to-face interviews and answers for questionnaires. Results indicate that in Russia the management and leadership models as well as the company performance measurement should be adjusted to Russian traditions. Networked companies have difficulties in applying matrix type organizations in Russia, as management practices are based traditionally on authoritarian leadership. However, clear and specific targets should be set for projects and strategic business areas. Targets and bonuses should be agreed on with managers and staff throughout the company and the business network. Personal networks, within project stake- holders, have more emphasis in Russia than in Finland, because personal relations to authorities＇, and organizations are needed at every stage of the project. Therefore, managing SMEs working in B2B networks is challenging in Russia. In this article, a method for setting and implementing strategic targets for a business networked company is presented. Understanding networked performance measurement indicators will enable successful business for all networked partners in the long tenn.

Managing Health Risks during the Balkans Floods

Floods have always had and will continue to have significant consequences for society. In May 2014, there was widespread flooding in the Balkans affecting Bosnia and Herzegovina, Croatia and Serbia. The aim of this article is to show that resilient and proactive health systems that anticipate needs and challenges are more likely to reduce risks and respond effectively during emergencies, saving lives and alleviating human suffering. The method draws on multiple sources of information, including a Balkan case study questionnaire survey with public health professionals involved in response to floods (n = 18) from three affected countries, and focus group discussion results (n = 43) presented at the meeting on “Prevention, preparedness and response to reduce or avoid health effects of flood events”, held in Bonn, Germany, in October 2015. The proposed range of measures to protect population health, organized around flood prevention, preparedness, response and recovery listed issues and considerations largely corresponds to the identified needs by Member State requests, following the Balkan country experiences. The consideration of lessons for early warning, preparedness and response and the integration of research results would lead to improved preparedness measures to better prevent flooding risks. Experiences in the WHO European Region point to a need to shift the emphasis from disaster response to long-term risk management.

Analysis of Managing Creativity for Entrepreneurs

In Indonesia, open unemployment until August 2011 was 7,700,086. Although this number has decreased compared with the number of unemployed in February 2011, which is 8,117,631, but the decline is not very significant. Unemployment occurs because labor forces are not absorbed into employment. One way to reduce unemployment is to open their own employment or become entrepreneurs. In fact, the government of Indonesia has made some efforts to the growth of new entrepreneurs, for example, by providing funding for student entrepreneurship program to a number of universities in Indonesia. However, efforts by the government are useless if there is no intention in the individual itself, and there are five factors driving intention in entrepreneurship, which invest, creativity, market opportunity, autonomy, status. Meanwhile, some researchers have conducted research about factor which driving the entrepreneurial intention. The result of that research shows that the most encouraging factor is the creativity. However, creativity must be managed properly in order to give optimal results This article wants to analyze the management of creativity among entrepreneurs in order to give optimal results. The research was conducted among young entrepreneurs, which are still a college student or had graduated from college. The total informants for this research are five informants from three private universities/colleges. This research used interview to collect data. This study attempted to process qualitative data obtained from interviews with young entrepreneurs. The result of this research is all of the respondents use some techniques to maintain and enhance creativity, such as ＂allow you to creative＂, ＂think out of the box＂, and ＂be persistent＂. From the findings of this study, it also can be seen that the young entrepreneurs are able to overcome the barriers to creativity, ＂believing that I am not creative＇

Managing the Global Water Crisis: As China Goes, So Goes the World

WHENEVER high-level conversations turn to national or regional strategies for managing water-related climate impacts,many are compelled to look again and again to China as a model for imagining and then creating a sustainable future for all of humanity.Why?Because as China goes,so goes the world.

Systems research helping to meet the needs and managing the trade-offs of a changing world

Facing the challenges of an increasing world population, a changing climate and ever depleting resources, agricultural intensification （Keating et al. 2010） is one of the few options for meeting the demand of food security. It is necessary to apply a dynamic and systematic approach to effectively man- age the complex agri-eco production and green processing systems. Indeed, farming systems approach for appropriate technology development and simulation modeling is a result of adopting the system thinking by the agricultural research community （Norman et al. 1995）.

Practice and New Direction of Promoting the Construction of Managing System of Modern Hospital

If we want to enhance the medical level of modern hospital,we not only need to make the career morality and professional capability of the medical staff,but also require the perfection of the governance institution of hospital in accordance with the development of society.That said,the medical staff will provide the patients with the best service,which is significant to the development of hospital.In addition,every hospital should conduct deepening reform of public hospital comprehensively to respond to call of the government.And the hospital should also put forward professional and comprehensive managing system based on the concrete conditions of the hospital.That is how the hospital can serve the people better.That said,this article focuses on how to promote the system of managing the modern hospital.

Managing Strategic Alliances in China （2） --- Analysis and Successful Factors

A creating effective strategic alliance is a useful method for the global expansion of intemational companies and managing strategic alliances is an important research project to the success of strategic alliances. This paper focuses on the practical problems of strategic alliances in China and explores how to manage such alliances. This research aims to introduce the basic background of strategic alliances, analyze the primary reason for the current situation of strategic alliances, and discuss the advantages and disadvantages of strategic alliances, then give the successful factors managing strategic alliances and discuss what should be done in future research about strategic alliances.

Practical Tips for Managing Annuities in China

How to handle annuities with security and efficiency is always a big and complicated issue for patentees.All patentees are looking for a reliable,precise and efficient manner in which to handle the large portfolio of patents.As we know,many of the giant international companies always prefer having an annuity vendor to monitor and manage worldwide patent rights,which may save them the time