Airway management of a patient with linear immunoglobulin A bullous dermatosis:A case report

BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.

A Novel Approach for Optimum Conjunctive Use Management of Groundwater and Surface Water Resources under Uncertainty

Uncertainty in determining optimum conjunctive water use lies not only on variability of hydrological cycle and climate but also on lack of adequate data and perfect knowledge about groundwater-surface water system interactions, errors in historic data and inherent variability of system parameters both in space and time. Simulation-optimization models are used for conjunctive water use management under uncertain conditions. However, direct application of such approach whereby all realizations are considered at every-iteration of the optimization process leads to a highly computational time-consuming optimization problem as the number of realizations increases. Hence, this study proposes a novel approach—a Retrospective Optimization Approximation (ROA) approach. In this approach, a simulation model was used to determine aquifer system responses (draw-downs) which were assembled as response matrices and incorporated in the optimization model (procedure) as coefficients in the constraints. The sample optimization sub-problems generated, were solved and analyzed through ROA-Active-Set procedure implemented under MATLAB code. The ROA-Active Set procedure solves and evaluates a sequence of sample path optimization sub-problems in an increasing number of realizations. The methodology was applied to a real-world conjunctive water use management problem found in Great Letaba River basin, South Africa. In the River basin, surface water source contributes 87% of the existing un-optimized total conjunctive water use withdrawal rate (6512.04 m3/day) and the remaining 13% is contributed by groundwater source. Through ROA approach, results indicate that the optimum percentages contribution of the surface and subsurface sources to the total water demand are 58% and 42% respectively. This implies that the existing percentage contribution can be increased or reduced by ±29% that is groundwater source can be increased by 29% while the surface water source contribution can be reduced by 29%. This reveals that the existing conjunctive water use practice is unsustainable wherein surface water system is overstressed while groundwater system is under-utilized. Through k-means sampling technique ROA-Active Set procedure was able to attain a converged maximum expected total optimum conjunctive water use withdrawal rate of 4.35 × 104 m3/day within a relatively few numbers of iterations (6 to 8 iterations) in about 2.30 Hrs. In conclusion, results demonstrated that ROA approach is capable of managing real-world regional aquifers sustainable conjunctive water use practice under hydro-geological uncertainty conditions.

Community-Based Approach in the Prevention and Management of Flood Disasters in Babessi Sub-Division (Ndop Plain, North West Cameroon)

Flood is a recurrent natural disaster that has caused enormous human and material damage in many places and continues to hit local committees at an alarming rate. The need to setup permanent committees to prevent and manage flood disasters by local communities is therefore indispensable. In rural areas, the creation of such a structure is always a welcome relief to flood victims but it is often marred by numerous management problems. This study aimed to analyze the community-based approach in the prevention and management of flood disasters in Babessi Subdivision (North West Cameroon), to identify the causes of flood disasters and the preventive strategies used by this local community. A total number of 300 questionnaires as well as structured interviews were used to collect data in the field and the data were analyzed by simple descriptive statistics. The main results revealed that the main cause of flood disasters is heavy and consistent rainfall. Also, poor refuse disposal and drainage system management contribute to floods. The identification of areas likely to be affected by floods and preventing the riparian population from constructing houses along these areas especially beside the main rivers are the flood preventive measures adopted by the local flood management committee. The flood victims are reluctant to relocate to the settlement site earmarked by the Government, meanwhile, the local flood committee do not have the legal tools to forcefully relocate them. The population of Babessi needs to be sensitized on the impending dangers of flood hazard and be encouraged to participate in implementing the adopted strategies to prevent and manage subsequent flood disasters.

Pancreatic duct disruption and nonoperative management: the SEALANTS approach

Pancreatic-duct disruption (PDD) can be difficult to manage, with diverse etiologies and sequelae in a heterogeneous population. Common etiologies include pancreatitis, iatrogenic injury, and trauma. Sequelae of PDD include pseudocyst, pancreatic ascites,

COVID-19:A pluralistic and integrated approach for efficient management of the pandemic

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which triggered the ongoing pandemic,was first discovered in China in late 2019.SARSCoV-2 is a respiratory virus responsible for coronavirus disease 2019(COVID-19)that often manifests as a pneumonic syndrome.In the context of the pandemic,there are mixed views on the data provided by epidemiologists and the information collected by hospital clinicians about their patients.In addition,the literature reports a large proportion of patients free of pneumonia vs a small percentage of patients with severe pneumonia among confirmed COVID-19 cases.This raises the issue of the complexity of the work required to control or contain the pandemic.We believe that an integrative and pluralistic approach will help to put the analyses into perspective and reinforce collaboration and creativity in the fight against this major scourge.This paper proposes a comprehensive and integrative approach to COVID-19 research,prevention,control,and treatment to better address the pandemic.Thus,this literature review applies a pluralistic approach to fight the pandemic.

Comparison of project management approaches in construction

The construction industry is acutely aware of the need to improve its management process. Currently,construction management is facing four major schools of thoughts. This paper reports the recent study results,the aim of which was to compare these approaches. The focus will be on the questions:What is the theory root for this school of thoughts? What is the position of planning? What are the techniques used or recommended by each of these schools of thoughts in managing construction projects? Recommendations are then given through a deep discussion of the capability of each approach in managing today's highly complex construction project.

Carbamazepine in osteoarthritis treatment:A novel approach targeting Nav1.7 channels

Osteoarthritis(OA)presents a growing health concern,with substantial societal and healthcare burdens.Current management focuses on symptom relief,lacking disease-modifying options.Emerging research suggests the sodium channel Nav1.7 as a pivotal target in OA treatment.Preclinical studies demonstrate carbamazepine's efficacy in Nav1.7 blockade,offering significant joint protection in animal models.However,human trials are needed to validate these findings.Carbamazepine's repurposing holds promise for OA management,potentially revolutionizing treatment paradigms.Further research is essential to bridge the gap between preclinical evidence and clinical application,offering hope for improved OA management and enhanced patient quality of life.

Epidemic Regularity and Control Effect of Huanglongbing (HLB) in Different Management Approaches

In order to reveal the epidemic regularity of Huanglongbing （HLB） in different management approaches, different citrus production areas were selected between 2002 and 2012 to compare epidemic regularity of different types and control effects of different management approaches with plant incidence rate. All survey data in 11 years were used to build a mathematical model, and epidemic evolution and control effects were quantitatively analyzed. The results indicated that diffusion and prevalence of HLB generally increased linearly. In naturally growing citrus orchards without artificial control, the annual diseased plant rate was 11.11%, and the epidemic diffusion model was y1 = 12. 24x - 1.382 8 （ n =9, r =0. 976 9 ＊ ＊ ）. Under general prevention and control conditions, the annual diseased plant rate was 4.69%, the epidemic diffusion model was Y2 = 5. 449 8x - 1.603 5 （ n = 11, r =0. 974 9 ＊ ＊ ）, and the control effect was 43.93% （22.93% - 55.04% ）. In citrus orchards with integrated prevention and control, the epidemic diffusion model was Y3 = 0. 366 3x - 0. 342 2 （ n = 11, r = 0. 989 8 ＊ ＊ ）, the control effect was 96.15% （94.95% -97.40% ）, and the annual diseased plant rate was 0.31%. Thus, HLB is preventable and controllable as long as integrated prevention and control work is implemented well.

Hajj Crowd Management Using CNN-Based Approach

Hajj as the Muslim holy pilgrimage,attracts millions of humans to Mecca every year.According to statists,the pilgrimage has attracted close to 2.5 million pilgrims in 2019,and at its peak,it has attracted over 3 million pilgrims in 2012.It is considered as the world’s largest human gathering.Safety makes one of the main concerns with regards to managing the large crowds and ensuring that stampedes and other similar overcrowding accidents are avoided.This paper presents a crowd management system using image classification and an alarm system for managing the millions of crowds during Hajj.The image classification system greatly relies on the appropriate dataset used to train the Convolutional neural network(CNN),which is the deep learning technique that has recently attracted the interest of the research community and industry in varying applications of image classification and speech recognition.The core building block of CNN is is a convolutional layer obtained by the getting CNN trained with patches bearing designated features of the trainee mages.The algorithm is implemented,using the Conv2D layers to activate the CNN as a sequential network.Thus,creating a 2D convolution layer having 64 filters and drop out of 0.5 makes the core of a CNN referred to as a set of KERNELS.The aim is to train the CNN model with mapped image data,and to make it available for use in classifying the crowd as heavily-crowded,crowded,semi-crowded,light crowded,and normal.The utility of these results lies in producing appropriate signals for proving helpful in monitoring the pilgrims.Counting pilgrims from the photos will help the authorities to determine the number of people in certain areas.The results demonstrate the utility of agent-based modeling for Hajj pilgrims.

Current management of liver diseases and the role of multidisciplinary approach

Liver is an organ having extremely diversified functions,ranging from metabolic and synthetic to detoxification of harmful chemicals.The multifunctionality of the liver in principle requires the multidisciplinary and pluralistic interventions for its management.Several studies have investigated liver function,dysfunction and clinic.This editorial work discusses new ideas,challenges and perspectives of current research regarding multidisciplinary and pluralistic management of liver diseases.In one hand the discussions have carried out on the involvement of extracellular vesicles,Na^(+)/H^(+) exchangers,severe acute respiratory syndrome coronavirus 2 and Epstein–Barr virus infections,Drug-induced liver injury,sepsis,pregnancy,and food supplements in hepatic disorders.In the other hand this study has discussed hepatocellular carcinoma algorithms and new bio-chemical and imaging experiments pertaining to liver diseases.Relevant articles with an impact index value">0"from reference citation analysis,which is an open multidisciplinary citation analysis database based on artificial intelligence technology,have served for the study’s argumentation.This work may be a useful tool for the clinical practice and research in managing and investigating liver disorders.

A mixed integer linear programming approach for municipal solid waste management

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Management of distal humeral coronal shear fractures

Coronal shear fractures of the distal humerus are rare,complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface fol owing distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach(direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails.

Health management based on fusion prognostics for avionics systems

Health management permits the reliability of a system and plays a increasingly important role for achieving efficient system-level maintenance.It has been used for remaining useful life（RUL） prognostics of electronics-rich system including avionics.Prognostics and health management（PHM） have become highly desirable to provide avionics with system level health management.This paper presents a health management and fusion prognostic model for avionics system,combining three baseline prognostic approaches that are model-based,data-driven and knowledge-based approaches,and integrates merits as well as eliminates some limitations of each single approach to achieve fusion prognostics and improved prognostic performance of RUL estimation.A fusion model built upon an optimal linear combination forecast model is then utilized to fuse single prognostic algorithm representing the three baseline approaches correspondingly,and the presented case study shows that the fusion prognostics can provide RUL estimation more accurate and more robust than either algorithm alone.

Combined hepatocellular-cholangiocarcinoma:An update on epidemiology,classification,diagnosis and management

Background:Combined hepatocellular-cholangiocarcinoma(CHC)is a rare subtype of primary hepatic malignancies,with variably reported incidence between 0.4%–14.2%of primary liver cancer cases.This study aimed to systematically review the epidemiological,clinicopathological,diagnostic and therapeutic data for this rare entity.Data sources:We reviewed the literature of diagnostic approach of CHC with special reference to its clinical,molecular and histopathological characteristics.Additional analysis of the recent literature in order to evaluate the results of surgical and systemic treatment of this entity has been accomplished.Results:The median age at CHC’s diagnosis appears to be between 50 and 75 years.Evaluation of tumor markers[alpha fetoprotein(AFP),carbohydrate antigen 19–9(CA19–9)and carcinoembryonic antigen(CEA)]along with imaging patterns provides better opportunities for CHC’s preoperative diagnosis.Reported clinicopathologic prognostic parameters possibly correlated with increased tumor recurrence and grimmer survival odds include advanced age,tumor size,nodal and distal metastases,vascular and regional organ invasion,multifocality,decreased capsule formation,stem-cell features verification and increased GGT as well as CA19–9 and CEA levels.In case of inoperable or recurrent disease,combinations of cholangiocarcinoma-directed systemic agents display superior results over sorafenib.Liver-directed methods,such as transarterial chemoembolization(TACE),percutaneous ethanol injection(PEI),hepatic arterial infusion chemotherapy(HAIC),radioembolization and ablative therapies,demonstrate inferior efficacy than in cases of hepatocellular carcinoma(HCC)due to CHC’s common hypovascularity.Conclusions:CHC demonstrates an overlapping clinical and biological pattern between its malignant ingredients.Natural history of the disease seems to be determined by the predominant tumor element.Gold standard for diagnosis is histology of surgical specimens.Regarding therapeutic interventions,major hepatectomy is acknowledged as the cornerstone of treatment whereas minor hepatectomy and liver transplantation may be applied in patients with advanced cirrhosis.Despite all therapeutic attempts,prognosis of CHC remains dismal.

Current controversies and advances in the management of pancreatic adenocarcinoma

Pancreatic adenocarcinoma is a lethal disease with a mortality rate that has not significantly improved over decades.This is likely due to several challenges unique to pancreatic cancer.Most patients with pancreatic cancer are diagnosed at a late stage of disease due to the lack of specific symptoms prompting an early investigation.A small subset of patients who are diagnosed at an early stage have a better chance at survival with curative surgical resection,but most patients still succumb to the disease in a few years.The dismal overall prognosis is due to suspected micro-metastasis at an early stage.Due to this reason,there is a recent interest in treating all patients with pancreatic cancers with systemic therapy upfront(including the ones that are surgically resectable).This approach is still not the standard of care due to the lack of robust prospective data available.Recent advancements in treatment regimens of chemotherapy,radiation and immunotherapy have improved the overall short-term survival but the long-term survival still remains poor.Novel approaches in diagnosis and treatment have shown promise in clinical studies but long-term clinical data is lacking.The following manuscript presents an overview of the epidemiology,diagnosis,staging,recent advances,novel approaches and controversies in the management of pancreatic adenocarcinoma.

QoS-Aware Dynamic Resource Management in Heterogeneous Mobile Cloud Computing Networks

In mobile cloud computing(MCC) systems,both the mobile access network and the cloud computing network are heterogeneous,implying the diverse configurations of hardware,software,architecture,resource,etc.In such heterogeneous mobile cloud(HMC) networks,both radio and cloud resources could become the system bottleneck,thus designing the schemes that separately and independently manage the resources may severely hinder the system performance.In this paper,we aim to design the network as the integration of the mobile access part and the cloud computing part,utilizing the inherent heterogeneity to meet the diverse quality of service(QoS)requirements of tenants.Furthermore,we propose a novel cross-network radio and cloud resource management scheme for HMC networks,which is QoS-aware,with the objective of maximizing the tenant revenue while satisfying the QoS requirements.The proposed scheme is formulated as a restless bandits problem,whose "indexability" feature guarantees the low complexity with scalable and distributed characteristics.Extensive simulation results are presented to demonstrate the significant performance improvement of the proposed scheme compared to the existing ones.