Ethics of Human Resources Management in the Cameroonian Health System, Medical Nomadism and the Ineffectiveness of the Fight against High Blood Pressure

Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.

Reinforcement Learning-Based Energy Management for Hybrid Power Systems:State-of-the-Art Survey,Review,and Perspectives

The new energy vehicle plays a crucial role in green transportation,and the energy management strategy of hybrid power systems is essential for ensuring energy-efficient driving.This paper presents a state-of-the-art survey and review of reinforcement learning-based energy management strategies for hybrid power systems.Additionally,it envisions the outlook for autonomous intelligent hybrid electric vehicles,with reinforcement learning as the foundational technology.First of all,to provide a macro view of historical development,the brief history of deep learning,reinforcement learning,and deep reinforcement learning is presented in the form of a timeline.Then,the comprehensive survey and review are conducted by collecting papers from mainstream academic databases.Enumerating most of the contributions based on three main directions—algorithm innovation,powertrain innovation,and environment innovation—provides an objective review of the research status.Finally,to advance the application of reinforcement learning in autonomous intelligent hybrid electric vehicles,future research plans positioned as“Alpha HEV”are envisioned,integrating Autopilot and energy-saving control.

AI-Driven Learning Management Systems:Modern Developments, Challenges and Future Trends during theAge of ChatGPT

COVID-19 pandemic restrictions limited all social activities to curtail the spread of the virus.The foremost and most prime sector among those affected were schools,colleges,and universities.The education system of entire nations had shifted to online education during this time.Many shortcomings of Learning Management Systems(LMSs)were detected to support education in an online mode that spawned the research in Artificial Intelligence(AI)based tools that are being developed by the research community to improve the effectiveness of LMSs.This paper presents a detailed survey of the different enhancements to LMSs,which are led by key advances in the area of AI to enhance the real-time and non-real-time user experience.The AI-based enhancements proposed to the LMSs start from the Application layer and Presentation layer in the form of flipped classroom models for the efficient learning environment and appropriately designed UI/UX for efficient utilization of LMS utilities and resources,including AI-based chatbots.Session layer enhancements are also required,such as AI-based online proctoring and user authentication using Biometrics.These extend to the Transport layer to support real-time and rate adaptive encrypted video transmission for user security/privacy and satisfactory working of AI-algorithms.It also needs the support of the Networking layer for IP-based geolocation features,the Virtual Private Network(VPN)feature,and the support of Software-Defined Networks(SDN)for optimum Quality of Service(QoS).Finally,in addition to these,non-real-time user experience is enhanced by other AI-based enhancements such as Plagiarism detection algorithms and Data Analytics.

Design and analysis of an advanced thermal management system for the solar close observations and proximity experiments spacecraft

In this paper,the mission and the thermal environment of the Solar Close Observations and Proximity Experiments(SCOPE)spacecraft are analyzed,and an advanced thermal management system(ATMS)is designed for it.The relationship and functions of the integrated database,the intelligent thermal control system and the efficient liquid cooling system in the ATMS are elaborated upon.For the complex thermal field regulation system and extreme space thermal environment,a modular simulation and thermal field planning method are proposed,and the feasibility of the planning algorithm is verified by numerical simulation.A solar array liquid cooling system is developed,and the system simulation results indicate that the temperatures of the solar arrays meet the requirements as the spacecraft flies by perihelion and aphelion.The advanced thermal management study supports the development of the SCOPE program and provides a reference for the thermal management in other deep-space exploration programs.

Overview of the immunological mechanisms in hepatitis B virus reactivation:Implications for disease progression and management strategies

Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.

Systematic review of risk factors,prognosis,and management of colorectal signet-ring cell carcinoma

BACKGROUND Colorectal signet-ring cell carcinoma(CSRCC)is a rare clinical entity which accounts for approximately 1%of all colorectal cancers.Although multiple studies concerning this specific topic have been published in the past decades,the pathogenesis,associated risk factors,and potential implications on treatment are still poorly understood.Besides the low incidence,historically confusing histological criteria have resulted in confusing data.Nevertheless,the rising incidence of CSRCC along with relatively young age at presentation and associated dismal prognosis,highlight the actual interest to synthesize the known literature regarding CSRCC.AIM To provide an updated overview of risk factors,prognosis,and management of CSRCC.METHODS A literature search in the MEDLINE/PubMed database was conducted with the following search terms used:‘Signet ring cell carcinoma’and‘colorectal’.Studies in English language,published after January 1980,were included.Studies included in the qualitative synthesis were evaluated for content concerning epidemiology,risk factors,and clinical,diagnostic,histological,and molecular features,as well as metastatic pattern and therapeutic management.If possible,presented data was extracted in order to present a more detailed overview of the literature.RESULTS In total,67 articles were included for qualitative analysis,of which 54 were eligible for detailed data extraction.CSRCC has a reported incidence between 0.1%-2.4%and frequently presents with advanced disease stage at the time of diagnosis.CSRCC is associated with an impaired overall survival(5-year OS:0%-46%)and a worse stagecorrected outcome compared to mucinous and not otherwise specified adenocarcinoma.The systematic use of exploratory laparoscopy to determine the presence of peritoneal metastases has been advised.Surgery is the mainstay of treatment,although the rates of curative resection in CSRCC(21%-82%)are lower compared to those in other histological types.In case of peritoneal metastasis,cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should only be proposed in selected patients.CONCLUSION CSRCC is a rare clinical entity most often characterized by young age and advanced disease at presentation.As such,diagnostic modalities and therapeutic approach should be tailored accordingly.

Insights into the interplay between gut microbiota and lipid metabolism in the obesity management of canines and felines

Obesity is a prevalent chronic disease that has significant negative impacts on humans and our companion animals,including dogs and cats.Obesity occurs with multiple comorbidities,such as diabetes,hypertension,heart disease and osteoarthritis in dogs and cats.A direct link between lipid metabolism dysregulation and obesity-associated diseases has been implicated.However,the understanding of such pathophysiology in companion animals is lim-ited.This review aims to address the role of lipid metabolism in various metabolic disorders associated with obesity,emphasizing the involvement of the gut microbiota.Furthermore,we also discuss the management of obesity,including approaches like nutritional interventions,thus providing novel insights into obesity prevention and treatment for canines and felines.

Etiology and management of urethral calculi:A systematic review of contemporary series

Objective:To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology,investigation,and management patterns.Methods:A systematic search of MEDLINE and Cochrane Central Register of Controlled Trials(CENTRAL)databases was performed.Articles,including case reports and case series on urethral calculi published between January 2000 and December 2019,were included.Full-text manuscripts were reviewed for clinical parameters including symptomatology,etiology,medical history,investigations,treatment,and outcomes.Data were collated and analyzed with univariate methods.Results:Seventy-four publications met inclusion criteria,reporting on 95 cases.Voiding symptoms(41.1%),pain(40.0%),and acute urinary retention(32.6%)were common presenting features.Urethral calculi were most often initially investigated using plain X-ray(63.2%),with almost all radio-opaque(98.3%).Urethral calculi were frequently associated with coexistent bladder or upper urinary tract calculi(16.8%)and underlying urethral pathology(53.7%)including diverticulum(33.7%)or stricture(13.7%).Urethral calculi were most commonly managed with external urethrolithotomy(31.6%),retrograde manipulation(22.1%),and endoscopic in situ lithotripsy(17.9%).Conclusion:This unique systematic review of urethral calculi provided a summary of clinical features and treatment trends with a suggested treatment algorithm.Management in contemporary urological practice should be according to calculus size,shape,anatomical location,and presence of urethral pathology.

Role of outdoor trees on pedestrian wind and thermal conditions around a pre-education building for sustainable energy management

Finding sustainable energy resources is essential to face the increasing energy demand.Trees are an important part of ancient architecture but are becoming rare in urban areas.Trees can control and tune the pedestrian-level wind velocity and thermal condition.In this study,a numerical investigation is employed to assess the role of trees planted in the windward direction of the building complex on the thermal and pedestrian wind velocity conditions around/inside a pre-education building located in the center of the complex.Compared to the previous studies(which considered only outside buildings),this work considers the effects of trees on microclimate change both inside/outside buildings.Effects of different parameters including the leaf area density and number of trees,number of rows,far-field velocity magnitude,and thermal condition around the main building are assessed.The results show that the flow velocity in the spacing between the first-row buildings is reduced by 30%-40% when the one-row trees with 2 m height are planted 15 m farther than the buildings.Furthermore,two rows of trees are more effective in higher velocities and reduce the maximum velocity by about 50%.The investigation shows that trees also could reduce the temperature by about 1℃around the building.

Uncovering the Challenges of Faecal Sludge Management in Benin’s Urban Hubs: The Cases of Abomey-Calavi and Natitingou

The issue of faecal sludge management in developing countries remains a significant challenge due to the indiscriminate discharge of sludge into the environment. This practice generates more environmental problems than it solves. This study aims to assess the management of household faecal sludge in the communes of Abomey-Calavi and Natitingou, Benin, in order to optimise the best storage conditions for subsequent more effective treatment. To this end, a sociological survey was conducted among households in Abomey-Calavi and Natitingou, as well as among manual emptiers. The results of our studies revealed that two types of latrines are used in households. 20.55% of households use traditional latrines, while 59.83% use ordinary latrines. 7.97% of households use both types of latrine. Moreover, the depth of the latrines varies from 2.5 m to 7 m in Abomey-Calavi and from 2.5 m to 8 m in Natitingou. Among households with a latrine, 28.26% empty their pit at least once, while 71.74% have never emptied it. The emptying cost varies between 35,000 FCFA and 90,000 FCFA. The mixing of faecal sludge with solid waste, including plastic materials, makes emptying difficult due to the obstruction of the vacuum pump. The results obtained will serve as a reliable database to facilitate decision-making in the context of faecal sludge management.

The Role of Impulsivity and Addiction in Gambling Behaviors: How Applied Neuroscience Research Can Help in the Monitoring and Management of Mental Health Issues

One in five Americans experience symptoms associated with at least one mental health disorder every year. These include behavioral addictions, which have long been overlooked despite their similar neural bases with substance addictions. Gambling addiction, a type of behavioral addiction, deserves particular attention given the significant negative effects, this addiction has on financial and interpersonal health. The purpose of this paper is to review the available literature concerning the behavioral and neural processes involved in gambling addiction, including: the anticipation of reward, the role of dopamine, and the neural substrates of the decision-making processes involved in gambling addiction. Market research has also identified solutions that integrate applied neuroscience and self-tracking systems to monitor and manage mental health issues associated with gambling addiction. The authors then propose a gambling treatment-focused mobile app solution that addresses outstanding issues with a special design aimed at reversing plasticity in order to relieve the effects of gambling addiction. .

Knowledge,management,and complications of sepsis and septic shock:A significant therapeutic challenge in the intensive care unit

Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar databases with keywords sepsis,septic shock,sepsis management,and sepsis complications.Articles published up to July 2023 in English were included.Diagnosis and management should be carried out without unnecessary delay.Cooperation between various medical specialties including intensive care doctors,neurologists,hepatologists,cardiologists,and pediatric doctors is needed if a child is affected.New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.

The Association between Fear of COVID-19,Obsession with COVID-19,and Post Traumatic Stress Disorder in Korean Emergency Rescue Firefighters:A Cross-Sectional Study

During the rapid spread of COVID-19,first responders are at risk of being exposed to COVID-19 due to their role in providing first aid and responding to an unspecified number of people.This uncertainty can have adverse mental health effects,such as increased anxiety and fear.This study aimed to investigate the degree of association between fear of COVID-19,obsession with COVID-19,and post-traumatic stress disorder(PTSD)in emergency rescue firefighters.The participants were 150 emergency rescue firefighters working in Region S,Korea.They filled out self-report questionnaires:The data obtained through the Fear of COVID-19 Scale,Obsession with COVID-19 Scale,and Impact of Event Scale-Revised Korean version were subjected to nonparametric statistical analysis using SPSS WIN 25.0.The study found a significant correlation between emergency rescue firefighters’fear of COVID-19,obsession with COVID-19,and PTSD.Fear and obsession with COVID-19 were higher among first responder firefighters who were directly involved in COVID-19-related tasks.Furthermore,a one-point increase in obsession was associated with a 2.837-point increase in PTSD.Based on the results,we found that there is a need for effective control of obsessions and fears among first responder firefighters during COVID-19,and we suggest that there is a need for mental health care for first responder firefighters during the pandemic through the development and support of programs to prevent and mitigate obsessions.

Security Monitoring and Management for the Network Services in the Orchestration of SDN-NFV Environment Using Machine Learning Techniques

Software Defined Network(SDN)and Network Function Virtualization(NFV)technology promote several benefits to network operators,including reduced maintenance costs,increased network operational performance,simplified network lifecycle,and policies management.Network vulnerabilities try to modify services provided by Network Function Virtualization MANagement and Orchestration(NFV MANO),and malicious attacks in different scenarios disrupt the NFV Orchestrator(NFVO)and Virtualized Infrastructure Manager(VIM)lifecycle management related to network services or individual Virtualized Network Function(VNF).This paper proposes an anomaly detection mechanism that monitors threats in NFV MANO and manages promptly and adaptively to implement and handle security functions in order to enhance the quality of experience for end users.An anomaly detector investigates these identified risks and provides secure network services.It enables virtual network security functions and identifies anomalies in Kubernetes(a cloud-based platform).For training and testing purpose of the proposed approach,an intrusion-containing dataset is used that hold multiple malicious activities like a Smurf,Neptune,Teardrop,Pod,Land,IPsweep,etc.,categorized as Probing(Prob),Denial of Service(DoS),User to Root(U2R),and Remote to User(R2L)attacks.An anomaly detector is anticipated with the capabilities of a Machine Learning(ML)technique,making use of supervised learning techniques like Logistic Regression(LR),Support Vector Machine(SVM),Random Forest(RF),Naïve Bayes(NB),and Extreme Gradient Boosting(XGBoost).The proposed framework has been evaluated by deploying the identified ML algorithm on a Jupyter notebook in Kubeflow to simulate Kubernetes for validation purposes.RF classifier has shown better outcomes(99.90%accuracy)than other classifiers in detecting anomalies/intrusions in the containerized environment.

Controllable preparation of graphene glass fiber fabric towards mass production and its application in self-adaptive thermal management

Direct synthesis of graphene on nonmetallic substrates via chemical vapor deposition (CVD) has become a frontier research realm targeting transfer-free applications of CVD graphene.However,the stable mass production of graphene with a favorable growth rate and quality remains a grand challenge.Herein,graphene glass fiber fabric (GGFF) was successfully developed through the controllable growth of graphene on non-catalytic glass fiber fabric,employing a synergistic binary-precursor CVD strategy to alleviate the dilemma between growth rate and quality.The binary precursors consisted of acetylene and acetone,where acetylene with high decomposition efficiency fed rapid graphene growth while oxygencontaining acetone was adopted for improving the layer uniformity and quality.Notably,the bifurcating introducing-confluent premixing (BI-CP) system was self-built for the controllable introduction of gas and liquid precursors,enabling the stable production of GGFF.GGFF features solar absorption and infrared emission properties,based on which the self-adaptive dual-mode thermal management film was developed.This film can automatically switch between heating and cooling modes by spontaneously perceiving the temperature,achieving excellent thermal management performances with heating and cooling power of~501.2 and~108.6 W m-2,respectively.These findings unlock a new strategy for the large-scale batch production of graphene materials and inspire advanced possibilities for further applications.

Development and Application of Procedures for the Management of Skin Toxicity Related to Immune Checkpoint Inhibitors in Patients with Lung Cancer

Objective: To establish the procedures for the management of skin toxicity related to immune checkpoint inhibitors in patients with lung cancer and explore the effect of application. Methods: A total of 24 evidence-based evidences were collected from 7 aspects, including risk factors, baseline screening, ICIs monitoring, daily skin care, multidisciplinary management, symptom management and health education. A total of 157 lung cancer patients and 94 nurses from 8 wards of the Oncology department of our hospital from November 2022 to May 2023 were selected by convenience sampling. A total of 77 patients and 46 nurses from ward 1 - 4 were divided into the baseline group. There were 80 patients and 48 nurses in Ward 5 - 8 as the evidence-based practice group. In the baseline group, patients were treated with routine methods such as assessing skin symptoms, taking medication according to symptoms, guiding to keep skin clean and moist, eating a light diet, and avoiding scratching. The evidence-based practice group adopts an evidence-based continuous improvement model for nursing. The differences in the severity of symptoms of skin toxicity in the second cycle of medication and the knowledge and practice of self-care of skin toxicity were compared between the two groups before and after the use of the syndrome, as well as the differences in the implementation rate of review indicators, evidence-based ability and knowledge and practice of skin toxicity care before and after the use of the syndrome. Results: The incidence and severity of cutaneous toxicity were significantly lower after treatment than before treatment (P P < 0.05). Conclusion: The implementation of immune checkpoint inhibitor-related skin toxicity management procedures can effectively reduce the incidence and severity of skin toxicity symptoms, optimize the clinical pathway, and improve the quality of care.

Ruptured Ectopic Pregnancy: Epidemiology and Management in the General Surgery Department of the Ignace Deen National Hospital, Conakry University Hospital

Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.

Evaluation of the Impact of Refined Quality Control Management Model on the Qualified Rate of Disinfection and Sterilization of Surgical Instruments in the Sterilization Supply Center

Objective:To evaluate the application value of a refined quality control management model for a sterilization supply center.Methods:A retrospective analysis was conducted on the work situation of the sterilization supply center from January 2021 to January 2023.The work situation before January 31,2022,was classified as the control group;a routine quality control management model was implemented,and the work situation after January 31,2022,was classified as the observation group.The quality of medical device management and department satisfaction between the two groups were compared.Results:The timely recovery and supply rate,classification and cleaning pass rate,disinfection pass rate,packaging pass rate,sterilization pass rate,and department satisfaction score in the observation group were all higher than those of the control group(P<0.05).Conclusion:Implementing a refined quality control management model in the sterilization supply center can improve the quality management level of medical devices and department satisfaction and is worthy of promotion.

Design and Implementation of Library Seating Management System

The library seating management system is an important part of the library’s modern services. The system is based on the Spring and Spring Boot framework, and the system realizes a series of functions such as real-time query, reservation, and cancellation of seat resources, providing users with great convenience. With a simple operation, users can know the availability of seats in the library in real time and reserve them according to their needs. At the same time, the system also provides rich management functions, enabling administrators to easily configure and manage seat resources. The addition, deletion, modification and review of users, the generation of seats, the viewing of user usage records, and the addition or deletion of points for users’ usage can also be carried out. This not only improves the management efficiency, but also provides more scientific and accurate data support for the management of the library. The system not only optimizes the user experience, but also promotes the scientific management and efficient utilization of library resources, and provides strong support for the modern services of the library.

Water and nitrogen footprint assessment of integrated agronomic practice management in a summer maize cropping system

The footprints of water and nitrogen(WF and NF)provide a comprehensive overview of the type and quantity of water consumption and reactive nitrogen(Nr)loss in crop production.In this study,a field experiment over two years(2019 and 2020)compared three integrated agronomic practice management(IAPM)systems:An improved management system(T2),a high-yield production system(T3),and an integrated soil-crop management system(ISCM)using a local smallholder farmer’s practice system(T1)as control,to investigate the responses of WF,Nr losses,water use efficiency(WUE),and nitrogen use efficiency(NUE)to IAPM.The results showed that IAPM optimized water distribution and promoted water use by summer maize.The evapotranspiration over the whole maize growth period of IAPM increased,but yield increased more,leading to a significant increase in WUE.The WUE of the T2,T3,and ISCM treatments was significantly greater than in the T1 treatment,in 2019 and 2020respectively,by 19.8-21.5,31.8-40.6,and 34.4-44.6%.The lowest WF was found in the ISCM treatment,which was 31.0%lower than that of the T1 treatment.In addition,the ISCM treatment optimized soil total nitrogen(TN)distribution and significantly increased TN in the cultivated layer.Excessive nitrogen fertilizer was applied in treatment T3,producing the highest maize yield,and resulting in the highest Nr losses.In contrast,the ISCM treatment used a reduced nitrogen fertilizer rate,sacrificing grain yield partly,which reduced Nr losses and eventually led to a significant increase in nitrogen use efficiency and nitrogen recovery.The Nr level in the ISCM treatment was34.8%lower than in the T1 treatment while NUE was significantly higher than in the T1 treatment by 56.8-63.1%in2019 and 2020,respectively.Considering yield,WUE,NUE,WF,and NF together,ISCM should be used as a more sustainable and clean system for sustainable production of summer maize.