Objectives As the epidemiological transition continues in sub-Saharan Africa, we will see in future more conditions that require invasive treatment (surgery, cancer and anaesthesia, ie..). Olders patients are vulnerable to complications such as functional decline, increased length of stay and mortality as a result of this type of treatment. Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process aimed at identifying older people at risk of negative outcome. It is delivered by a multidisciplinary team and its benefits in reducing functional disability, incidence of mortality and other adverse health outcomes are well established. It is important to know whether this approach integrates care management strategies for older people in a context where health services for older people are scarce and staff have little training in geriatrics. The objective of this work was to review the literature on the use of CGA on invasive care (cancer, surgery, etc.) among older people in SSA. Methods A MEDLINE/PubMed database search was conducted to identify articles reporting CGA and conditions requiring invasive treatment in older patients in SSA. Results/Conclusion Taken together, the studies examined in this review show that little work has been done on the impact of CGA in older people invasive care in SSA. This review can help to assess the role of CGA in the care trajectories of older people in terms of prognosis, and thus encourage more in-depth research on this topic.

Managing the multisystemic symptoms of type I Gaucher Disease (GD) requires a multidisciplinary team approach that includes disease-specific treatments, as well as supportive care. This involves a range of medical specialists, general practitioners, supportive care providers, and patients. Phenotype classification and the setting of treatment goals are important for optimizing the management of type I GD, and providing personalized care. The ability to classify disease severity using validated measurement tools allows the standardization of patient monitoring, and the measurement of disease progression and treatment response. Defining treatment goals is useful to provide a benchmark for assessing treatment response, and managing the expectations of patients and their families. Although treatment goals will vary depending on disease severity, they include the stabilization, improvement or reversal (if possible) of clinical manifestations. Enzyme replacement therapy (ERT) is the standard care for patients with type I GD, but a novel substrate reduction therapy (SRT), Eliglustat has demonstrated safety and efficacy in selected patients. To ensure that treatment goals are being achieved, regular, comprehensive follow up is necessary.

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality worldwide and a major global health burden. The treatment of HCC has experienced a paradigm shift in the last few years, following the discovery of immunotherapy. However, despite the profound success of immunotherapy in other cancer types, their response in HCC remains unsatisfactory. Some of the reasons that can explain this poor response include the immunosuppressive microenvironment of HCC, the absence of reliable biomarkers for response, and drug resistance. Previous preclinical and clinical studies have highlighted the role of combination therapy in overcoming some of these hurdles. In this article, we discuss the benefit of combining immune checkpoint inhibitors (ICIs) with stereotactic body radiation therapy (SBRT) in HCC and shed light on promising clinical trials.

CKD in HF patients is very common condition, their dysfunction is closely linked and influence each other, so their management required multidisciplinary and personalized approaches. The diagnosis of HF and CDK relies on signs and symptoms. Several tools, such as blood-based biomarkers and echography help us to clarify and discriminate the main characteristics of these patients. Evidence in improving survival due to new drug-employment in HF, has increasingly challenged physicians to manage patients with multiple diseases, especially in patients with CKD. The difficulty is in the safe administration of these drugs in patients with HF and CKD. Knowing up to which values ​​of creatinine or renal clearance any drug can be administered is fundamental. We wanted to summarize, on this sizable and complex topic, the experiences of various prior study to get clearer ideas and a more precise reference about the assessment and management of HF and CKD.

(1) Background: Chronic musculoskeletal pain (CMP) in adolescents can negatively affect physical, psychological and social functioning, resulting in functional disability. This study aims to evaluate the effectiveness of an outpatient rehabilitation program based on graded exposure in vivo (EP) compared with care as usual (CAU) in a RCT. The aim of the interventions (EP and CAU) is to improve functional ability in adolescents with CMP, CAU is interdisciplinary outpatient rehabilitation care, based on graded activity. (2) Methods: A pragmatic multicenter randomized clinical trial with a 12-month follow-up was used. Adolescents (12-21 years) with musculoskeletal pain were invited to participate. Primary outcome was functional disability (Functional Disability Inventory). Most important secondary measures: perceived harmfulness, pain catastrophizing and intensity. Data analysis was performed by intention-to-treat linear mixed model analysis. (3) Results: Sixty adolescents were randomized to EP or CAU and data of 53 adolescents (93% female) could be analyzed (25 EP, 28 CAU). Mean age was 16.0 years (SD=1.87). Adolescents in EP showed a clinically relevant and statistically significant decrease in functional disability (estimated mean difference at least -8.81,p-values≤0.01) compared with CAU at all time points. Significant differences in favor of EP were found for perceived harmfulness at all time points (p-values≤0.002), for pain catastrophizing (PCS) at 2 months follow-up (p-value=0.039) and for pain intensity at 4 and 10 months follow-up (p-values≤0.028). (4) Conclusion: The effectiveness of the trial is in favor of the EP and leads to a significant and clinically relevant decrease in functional disability compared to usual care.

Generative adversarial networks (GANs) have become a recent and rapidly developing research topic in Machine Learning. Since their inception in 2014, a significant number of variants have been proposed to address various topics across many fields, and has particularly excelled not only in image and language processing, but also in the medical and data science domains. In this paper, we aim to highlight the significance and advance that these GAN models can introduce in the field of Business Economics, where they have yet to be fully developed. To this end, a review of the literature of GANs is presented in general together with a more specific review in the field of Business Economics wherein only a few papers can be found. Furthermore, the most relevant papers are analysed in order to provide an approach the opportunity to research into GANs in the field of Business Economics.

Wind energy is becoming increasingly important as a renewable energy source due to its environmental and economic benefits. Wind turbines are key components in wind energy systems, and their performance is critical for efficient power generation. Wind turbine blades are the most critical components as they interact with the wind, and their design has a significant impact on the overall system performance. Therefore, it is essential to optimize the design of wind turbine blades to enhance their efficiency and reduce their costs. This paper presents an aero-structural optimization approach for wind turbine blade design. The optimization aims to maximize the torque generated by the blade while minimizing its mass. The optimization is implemented using DAFoam software for CFD simulation, TACS for FEM simulation, and Mphys under the OpenMDAO framework for fluid-structure interaction between the CFD and FEM. The optimization results show a 6.78% increase in torque and a 4.22% decrease in mass, which demonstrates the effectiveness of the proposed approach. Aerodynamic optimization focuses on maximizing the blade's torque by modifying the blade's shape. The optimization results show that the optimized blade generates more torque than the original blade design. Additionally, structural optimization aims to minimize the blade's mass while maintaining its structural integrity. This is achieved by adjusting the thickness of the blade's cross-section. The proposed aero-structural optimization approach presents an effective solution for the design optimization of wind turbine blades. The approach considers the interaction between the aerodynamic and structural aspects of the blade and optimizes them simultaneously. This leads to an optimized design that is efficient and cost-effective, which is crucial for the widespread adoption of wind energy systems. The results of this study highlight the importance of considering the interaction between the aerodynamic and structural aspects of wind turbine blades and the effectiveness of the proposed optimization approach in enhancing their performance.

Most head and neck cancers are diagnosed in advanced stages, when the curative interventions are no longer possible. The assessment and the multidisciplinary therapeutic approach of the locally advanced cases are difficult since the onset of the disease becomes a significant challenge for the whole attending team (including both the patient and his family) because they have to deal with to an extensive symptomatology (abundant secretions, refractory pain, mutilations predominantly in the cephalic area), with the cure of stomas (tracheostomy, gastrostomy) and with various post-therapeutic sequelae. The present paper reflects the impact of late diagnosis, the complexity of the multimodal specific oncological treatment (chemotherapy, radiotherapy, immunotherapy, pal-liative and terminal treatment), the adaptation of medical care to the psycho-emotional structure, having as an example the case of 54-year old patient (with his consent) diagnosed with pharyn-golaryngeal neoplasm who presented himself to “St. Luca” Chronic Disease Hospital, the Oncol-ogy-Palliative Care Department, in September 2021. In patients with locally advanced head and neck cancers, besides the specifically oncological therapeutic decisions, the empathic-emotional connection between the medical team with the patient and his family plays a key role in the ther-apeutic conduct.

Objective: Evaluation of patients with prosthetic valves who developed infective endocarditis by comparing treatment outcomes in both early- and late-onset IE episodes following prosthetic valve replacement surgery. This study sought to conduct a comprehensive assessment of the efficacy of these methodologies. The insights derived from this assessment will be utilized to enhance the quality of care for individuals with infective endocarditis who have received prosthetic valve replacement surgery. Results: During the period of investigation (January 2018 - December 2022), 78 patients diagnosed with infective endocarditis (IE) on prosthetic valve were admitted to the Infectious Diseases Department of the "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest. In 28 cases (35.8%), the onset of PVE occurred within 12 months of surgery (early onset), whereas in 50 patients (64.2%), the onset occurred more than 12 months after surgery (late onset). The mortality rate was 35.9% (53.6% among the early onset patients and 26% among the late-onset patients). Among patients who received surgical and medical therapy, the mortality rate was 29.6%, whereas among those who underwent only medical therapy, a 39.2% mortality rate was reported. According to the extracted data, antibiotic therapy was successful in 72.6% of patients. In contrast, a combination of surgical and drug-based approaches resulted in a cure in 76.1% of the patients. The most common etiological agent was Staphylococcus aureus (38.5%), followed by Enterococcus faecalis (26.9%), and Streptococcus mitis (10.3%). The mortality rate of patients with S. aureus was 29.2%, indicating the severity of this infectious agent. Conclusions: Prosthetic valve endocarditis (PVE) is a serious condition associated with a high mortality rate both in the short and long term. Regardless of the therapy used, the risk of death remains high. All patients with PVE who survived received effective early treatment, highlighting the need for prophylactic measures.

The emergence of the H3N2 influenza virus in 1968 marked a significant event as it crossed the species barrier. Since then, ongoing mutational dynamics have led to the formation of antigenic clusters, prompting the World Health Organization to advocate for regular updates to H3N2 vaccines. Research in the Western Pacific region underscores the necessity for heightened awareness and effective control strategies. Stemming from avian influenza A, the 1968 H3N2 influenza pandemic resulted in the deaths of one million people globally, with its seasonal variants primarily affecting older individuals and causing severe illness due to antigenic drift. To address the challenge of vaccine efficacy against H3N2 mutations, researchers are exploring innovative strategies such as precise antigenic material administration, controlled release patterns, understanding immune system mechanisms, and glycan engineering. This review comprehensively examines various aspects of the Influenza A (H3N2) virus, encompassing its virological characteristics, evolutionary trends, global epidemiology, vaccination strategies, antiviral interventions, and emerging diagnostic approaches. It underscores the impact of antigenic variation on vaccine design and effectiveness, seasonal outbreak patterns, pandemic potential, and the interplay between viral factors and host immune responses. Moreover, the review evaluates antiviral therapies and the issue of drug resistance, emphasising the necessity for multidisciplinary approaches involving researchers, healthcare professionals, and policymakers to comprehend H3N2 and enhance public health interventions.

This review will deal with the most relevant unmet needs and clinical questions concerning scintigraphy with bone tracers in ATTR-CA, providing expert opinions on possible future developments in the clinical application of these radiotracers, in order to offer practical information for interpretation of nuclear images to physicians involved in the care of patients with this ATTR-CA.

This bibliometric analysis delves into the realm of botanical gardens through the process of mapping literature and discerning research frontiers, underlying themes, and interconnections within the extant body of knowledge. The study uses a dataset of 1340 publications and employs methodologies such as authors' keywords co-occurrence data to examine the discipline's trends, patterns, and knowledge gaps. The study finds significant growth in literature from 1960 to 2023, emphasizing botanical gardens, conservation, taxonomy, biodiversity, ex-situ conservation, and diversity. Key influencers such as Sanja Kovačić, Elaissi, and Chemli have steered research directions towards ex-situ conservation and essential oils, reflecting the field's interdisciplinary nature. The study shows global institutional variation, with entities like the Chinese Academy of Sciences, the Royal Botanic Gardens UK, and the New York Botanical Garden US leading the discourse. Thematic analyses have identified core themes and emerging research topics, with ecological restoration, essential oils, invasive species, and climate change mirroring the field's expanding scope. The consistent prevalence of themes such as 'botanical gardens' and 'conservation' over time underscores their enduring significance. Emerging topics like climate change and biodiversity are gaining prominence, signaling a shift in research priorities. The expanding array of subjects, including 'invasive species' and 'genetic diversity,' indicates an amplified scope and growing complexity in botanical garden research. This study aims to bridge a crucial gap by outlining the developmental trajectory of botanical gardens and offering guidance for future research directions. Diverse research domains within botanical garden studies, including biodiversity, essential oils, taxonomy, and ex-situ conservation, present extensive avenues for exploration. Future research endeavors should delve into these impactful themes to better understand botanical ecosystems and their conservation. The study emphasizes the importance of nurturing interdisciplinary collaborations and multidisciplinary projects, advocating for a comprehensive and collaborative approach to future research in botanical garden studies.

The current study aims to develop a methodology for obtaining topology-optimal structures made of short fiber-reinforced polymers, which include the fluid-structure interaction. Accounting for the molding process during the internal iterations of topology optimization makes it possible to enhance the weight efficiency of structures—a crucial aspect, especially in aerospace. Anisotropy is considered through the fiber orientation tensor, which is modeled by solving the plastic molding equations for non-Newtonian fluids, and then introduced as a variable of the stiffness matrix during the structural analysis. The materials used were non-linearly modeled using an exponential-and-linear hardening law. The evaluation of weight efficiency in structures composed of short-reinforced composite materials using a dimensionless criterion is addressed. Experimental verification was performed to confirm the validity of the developed methodology. The evidence illustrates that considering anisotropy leads to stiffer structures and structural elements should be oriented in the direction of maximal stiffness. The load-carrying factor can be expressed in terms of failure criteria. The presented multidisciplinary methodology can be used to improve the quality of the design of structures made of short fiber-reinforced composites (SFRC) where high stiffness, high strength, and minimum mass are the primary required structural characteristics.

Early discharge after childbirth has led to a rise in neonatal readmission, becoming a major concern in recent decades. Our research aimed to identify the risk factors and incidence of neonatal readmission, as well as explore preventive measures. Our study at the Clinical Hospital of Pediatrics in Ploiești, Romania included 108 neonates admitted during the neonatal period. This accounted for 2.06% of all admissions (5226). The most prevalent cases were malnutrition (25%), fever (20.3%) and bronchiolitis (17.5%). Diarrhea and infectious gastroenteritis were also observed (14.8%), along with acute rhinoconjunctivitis (9.2%) and late onset sepsis (3.7%). No deaths were recorded. The most significant characteristics identified were number of children (p<0.001) and age at maternity discharge (p<0.001). By following the prevention rules, malnutrition, feeding errors, and infections can be avoided. This includes practicing proper hand hygiene for both mothers and medical staff, as well as educating and demonstrating to mothers the benefits of breastfeeding. In addition, all newborns discharged from the maternity ward should benefit from follow-up at 7-10 days of life. Our results confirm the effectiveness of a multidisciplinary team and endorse promoting breastfeeding. Implementing quality control measures and regularly evaluating the surveillance program will help improve its effectiveness.

Chronic Low Back Pain (CLBP), defined as pain persisting for at least 12 weeks, is a significant public health issue, with prevalence intensifying due to an ageing global population, amassing approximately 619 million cases in 2020 and projected to escalate to 843 million by 2050. Given the multitude of therapeutic modalities available for CLBP, this research sought to ascertain their respective efficacies in ameliorating pain and disability. We specifically scrutinized Multidisciplinary Biopsychosocial Rehabilitation (MBR) among adults enduring non-specific low back pain for over 12 weeks, excluding acute pain conditions and pre-study surgical interventions. MBR is an approach encompassing various modalities, including exercise, behavioral therapies, educational programs, and work conditioning aspects, necessitating a comprehensive Network Meta-Analysis (NMA) to fully grasp the extensive scope of its impact. The constructed network comprised diverse MBR modalities (behavioral, educational, and work conditioning) alongside exercise therapy (ET), minimal intervention, and usual care, serving as controls with pain and disability as outcomes. Through the analysis of 4,619 initially identified studies, 93 were included, encompassing a total of 8,059 participants. The NMA conducted substantiated that both ET and MBR modalities were notably effective in alleviating CLBP, with education-oriented MBR emerging as the most efficacious for pain mitigation and behavior-focused MBR for disability reduction. Nevertheless, the discerned differences amongst the treatments were minimal and uncertain, highlighting that no modality was definitively superior to the others. The analysis revealed low global and local inconsistency within the network, underscoring the reliability of the observed outcomes. Given the intricate nature of CLBP, embodying various facets, our findings advocate for a combined therapeutic approach to optimize treatment efficacy. Nonetheless, the presence of high study heterogeneity and potential biases necessitates cautious interpretation of the results, prompting future research.

Background: Post-Covid condition can reduce activity and quality of life, resulting in a significant socioeconomic and health burden. Understanding its impact on patients' health is important for the development of personalized rehabilitation interventions. An independent association between obesity and post-covid condition was found because of complications and comorbidities. Methods: Sixteen patients with obesity and post-COVID symptoms (i.e., dyspnea, pain, poor sleep quality, muscle fatigue) admitted to the Istituto Auxologico Italiano, Piancavallo (VB), Italy, were recruited for a four-week rehabilitation program including conventional exercise therapy, nutritional intervention, psychological support and whole-body cryostimulation (WBC). Results: All participants attended all sessions of the program. Anthropometric data showed statistically significant changes in weight, waist circumference and body mass index. Biochemical analyses showed significant reductions in lipid and inflammatory profiles. There was a significant improvement in physical performance, reduction in pain and improvement in psychological well-being. Conclusion: A multidisciplinary rehabilitation protocol including WBC designed for patients with obesity and post-covid condition is safe and feasible. The overall improvements demonstrate that multidisciplinary rehabilitation was effective on post COVID patients and suggest that the use of WBC is safe and could play a role as a booster in rehabilitation programs.

The need for new technologies into healthcare services has been stressed. However, little is known about the effectiveness of digital interventions integrated in psychosomatic rehabilitation processes. Data from 724 patients from psychosomatic rehabilitation clinics were analyzed for effectiveness of digital trainings examined by a change in symptoms related to depression, anxiety, stress and loneliness from pre- to post-rehabilitation. Rehabilitation satisfaction was examined in association with reaching rehabilitation goals and satisfaction with communication. Mixed repeated measures analysis of covariances, analysis of covariances, and hierarchical stepwise regression analyses were performed. Results indicated a superior effectiveness for the intervention group receiving all offered digital treatments in addition to the regular face-to-face rehabilitation program with regard to symptoms of depression, F(2,674)=3.93, p<.05, ηp2=.01), and anxiety, F(2,678)=3.68, p<.05, ηp2=.01), post-rehabilitation with large effect sizes for both depression (d=1.28) and anxiety (d=1.08). In addition, rehabilitation satisfaction was positively associated with reaching rehabilitation goals and perceived communication with healthcare workers. Digital interventions appeared effective in supporting mental health of psychosomatic rehabilitation patients post-rehabilitation. This finding supports the inclusion of multidisciplinary and interdisciplinary digital and face-to-face treatment programs and call for more implementations of new technologies in a context of complexity to improve health and healthcare service.

This article investigates the prospect of implementing multidisciplinary and multicultural student teamwork (MMT) involving Case-based Learning (CBL) and Problem-based Learning (PBL) as a sustainable teaching practice. Based on a mixed methods approach, which includes direct observation (both physical and virtual), questionnaire distribution and focus-group interviews the study reveals that MMT through CBL and PBL can both facilitate and hinder sustainable learning. Our findings show that while MMT enhances knowledge sharing, it also poses a wide range of challenges, raising questions about its social significance as a sustainable teaching practice. The study suggests the implementation of certain mechanisms, such as ‘Teamwork Training’ and ‘Pedagogical Mentors’, aiming to strengthen the sustainable orientation of MMT through CBL and PBL.

Modern fighter aircraft increasingly need to conjugate aerodynamic performance and low observability. In this paper we showcase a methodology for a gradient-based bidisciplinary aero-stealth optimization. The shape of the aircraft is parametrized with the help of a CAD modeler, and we optimize with the SLSQP algorithm. The drag, computed with the help of a RANS method, is used as the aerodynamic criterion. The stealth criterion, a function is derived from the radar cross section in a given cone of directions, weighed with a function whose goal is to cancel the electromagnetic intensity in a given direction. Stealth is achieved passively by scattering back the electromagnetic energy away from the radar antenna and no energy is absorbed by the aircraft, which is considered as a perfect conductor. A Pareto front is identified by varying the weights of the aerodynamic and stealth criteria. The Pareto front allows for an easy identification of the CAD model corresponding to a chosen aero-stealth trade-off.

Purpose: To meet the challenges of the precision medicine era, quality assessment of shared sarcoma care becomes pivotal. The MDT approach is the most important parameter for succesfull outcome. Because of all MDTs disciplines surgery is the key step to render sarcoma patients disease free, defining the spectrum of a sarcoma surgeon is critical. To the best of the authors knowledge, a comprehensive interoperable digital platform to assess the scope of sarcoma surgery and the experience of a sarcoma surgeon in its full complexity is lacking. Methods: A web-based real-world data (RWD) registry on sarcoma surgery has been created to assess the clinical exposure, tumor characteristics, and surgical settings and techniques applied for both resections and reconstructions of sarcomas and thereby the surgical exposure of an individual surgeon over time. Results: During 10 years, there were 723 sarcoma board/MDT meetings discussing 3130 patients. A total of 1094 patients underwent 1250 surgical interventions on mesenchymal tumors by one single sarcoma surgeon. These included 615 deep soft tissue tumors (197 benign, 102 intermediate, 281 malignant, 27 simulator, 7 metastasis, 1 blood), 116 superficial soft tissue tumors (45 benign, 12 intermediate, 40 malignant, 18 simulator, 1 blood) and 519 bone tumors (129 benign, 112 intermediate, 182 malignant, 18 simulator, 46 metastasis, 14 blood and 18 sequelae of 1st treatment). Detailed types of resections and reconstructions were analyzed. Conclusion: A web-based RWD sarcoma surgeon registry with transparent real-time descriptive analytics is feasible and enables large scale definition of the surgical complexity and ultimately quality of sarcoma care.

Background and objective: Iliopsoas abscess (IPA) is a rare condition with varied symptomology and etiology. Less than one-third of patients with IPA present on the emergency department (ED) admission with the traditional triad of fever, back pain, and restricted hip motion (or limp), leading to delays in diagnosis and management. This case report aims to bring awareness among healthcare professionals regarding the atypical presentation and introduce a potential differential diagnosis when evaluating patients with fever and back pain. The intention is to provide insights into the signs and symptoms that may indicate the presence of an iliopsoas abscess and prompt additional investigations. Case report: Here, we describe a case of primary iliopsoas abscess associated with drug-induced acute liver failure in our ED. The patient complained of pain in the left lumbar region and fatigue that started two weeks before this presentation, claiming that, during the previous night, the pain suddenly worsened. She had a fever, pain at palpation in the right hypochondriac and left lumbar regions, accompanied by fever and vomiting, jaundiced skin, and sclera at the examination in ED. On abdominal ultrasonography, the diagnosis of acute cholangitis was suspected. The laboratory test shows leukocytosis with neutrophilia, thrombocytosis, hepatocytolysis syndrome, and hyperbilirubinemia with the predominance of indirect bilirubin. We performed then abdominal and pelvic computed tomography, which confirmed the diagnosis of cholelithiasis observed with the diameter of the bile duct within normal limits but also showed an abscess-like collection fused to the interfibrillar level of the left iliopsoas muscle; a diagnosis we most likely would have been missed. After that, the patient was hospitalized in the General Surgery Department, and surgery drainage of the abscess was performed. The patient's evolution was excellent; she was discharged after 11 days. Conclusions: The case presented here exemplifies how iliopsoas abscess, a rare cause of back pain, can quickly go unrecognized, especially in the emergency department. Our experiences will raise awareness among doctors in emergency departments about this uncommon but essential diagnosis. With advancements in diagnostic tools and techniques, we aspire that more cases of iliopsoas abscess will be accurately diagnosed.

Aims: Multidisciplinary diabetic foot clinics have been shown to be an effective therapeutic model for reducing major amputations and mortality rates. The aim of this article is to assess the economic impact of the implementation of a multidisciplinary diabetic foot clinic in a hospital in Barcelona, Spain. Methods: Observational cost-benefit study of all subjects with diabetes admitted with the diagnosis of a major amputation due to diabetic foot from 2010 to 2020. Direct and indirect costs were compared before and after the introduction of the multidisciplinary diabetic foot clinic. Results: The individual cost per patient with diabetic foot was €14,768 before the implementation of the unit. After the implementation of the clinic, the expected cost was reduced to €5,985 due to a 40% reduction in the probability of hospitalization. Overall, the implementation of the clinic resulted in cost savings per patient valued at €8,783, of which, €7,165 are related to hospital benefits. Conclusion: The results of this analysis contributes to the evidence suggesting that multidisciplinary diabetic foot clinics are cost-effective, by demonstrating that they have a positive impact on patient health while also reducing the utilization of healthcare resources.

(1) Background: This case presents a rare and challenging clinical scenario involving a 50-year-old female patient diagnosed with Inflammatory Carcinoma, a particularly aggressive and rapidly growing form of breast cancer. The disease is characterized by heat, redness, swelling and noticeable changes in the breast's skin texture, resembling the skin of an orange (peau d'orange). This case is important because it contributes to the limited clinical literature on such aggressive forms of breast cancer.; (2) Methods: The multidisciplinary approach was employed. Diagnostic procedures such as imaging tests, biopsy, and histopathological examination were performed to confirm the diagnosis of Inflammatory Carcinoma and assess the extent of the disease. The presence of the HER2 protein on the tumor cells supported the selection of a combination therapy involving systemic chemotherapy and targeted biological therapy.; (3) Results: The patient responded positively to the combination therapy consisting of systemic chemotherapy and targeted biological therapy. The aggressive nature of Inflammatory Carcinoma, characterized by rapid growth and distinct skin changes, was effectively addressed. The presence of the HER2 protein on the tumor cells indicated the potential efficacy of the combination therapy in aggressive forms of breast cancer.; (4) Conclusions: This case highlights the critical importance of a multidisciplinary approach in managing complex cases of breast cancer, especially rare and aggressive subtypes like Inflammatory Carcinoma. The positive response of the patient to the combination therapy involving systemic chemotherapy and targeted biological therapy demonstrates the potential for favorable outcomes in aggressive disease presentations.

Patients with chronic obstructive pulmonary disease (COPD) may require frequent hospitalization due to worsening symptoms. Preventing prolonged hospital stay and readmission becomes a challenge for healthcare professionals treating patients with COPD. Although the integration of health and social care supports greater collaboration and enhanced patient care, organisational structure and poor leadership may hinder the implementation of patient-oriented goals. This paper presents a case of a 64-years-old chronic smoker with severe COPD who was to be discharged on long-term oxygen therapy (LTOT). It further highlights the healthcare decisions made to ensure the patient’s safety at home, and further provide a long-lasting solution to the existing medical and social needs. The goal was accomplished through a discharge plan that reflects multidisciplinary working, efficient leadership and change management using Havelock’s theory. While COPD is characterized by frequent exacerbation and hospital readmission, it was emphasized that most failed discharge could be attributed to bureaucratic organizational workflow which might not be in the patient’s best interest. It was further demonstrated that healthcare professionals are likely to miss the window of opportunity to apply innovative and long-lasting solutions to the patient’s health condition in an attempt to remedy the immediate symptoms of COPD.

There are multiple factors determined causing the land subsidence (e.g. man-made and natural-climate change) which have impact on the urban built environment economic spectrum e.g. buildings, properties, infrastructures and land. This paper presents the cause-effect investigation of the causing factors which influence the direct-indirect impacting urban economic factor via multi-regression analysis using Shanghai megacity as case study. Factors are selected based on existing UUS-subsidence-economic impact (USEM) framework as well as modification and adaptation from Shanghai Masterplan 2017-2035 (SM 2035) and Sustainable Development Goals (SDGs) 2030. Data are gathered secondarily via open sources e.g. scientific journal articles and reports. The results are parallel to previous studies on the current trend for rapid and unconscious UUS exploration development including tunneling seepage and leakage as leading causes for further land subsidence in Shanghai. A further concrete multi-integrated macro-scale USEM’s awareness and knowledge is needed to avoid future costlier damage. The highly regressed causing factors include increasing population, UUS-induced subsidence, underground tunnel leakage, cumulative UUS development and subsidence whereas building prices, reconstruction area ratio, land price, green buildings, tunnel settlement, loss of arable land, number of death and government revenue are the among the most impacted. Officials in Shanghai may further consider results for future USEM masterplans to prevent further unsustainability. It is also found that developing megacity may possess different factors according to their distinct condition.

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

Digital weight-loss services (DWLSs) combining pharmacotherapy and health coaching have the potential to make a major contribution to the global struggle against obesity. However, there is currently no evidence to counter the widespread concern that these services enable large numbers of unsuitable patients to obtain Glucagon-like peptide-1 receptor agonists (GLP-1 RA). This study retrospectively analysed the rate at which the partner pharmacy network of Australia’s largest DWLS provider committed GLP-1 RA dispensing errors over a 6-month period. The analysis found that 191 (0.14%) of the 135131 dispensed Semaglutide orders contained an error. Non-compliant dose escalation (44.5%) and dispatch errors (32.5%) were the two most common error types. Most errors (89%) were deemed to have been of medium urgency, with 6.8% considered high urgency. A disproportionate number of high urgency cases were from wrong medication (31%) and general complaint errors (15%). A Chi-square test revealed a statistically higher dispensing error rate among orders to female patients (0.16%) compared to males (0.076%). The results lay an important foundation in digital pharmacy literature and suggest that comprehensive DWLSs have the potential to safely collaborate with third-party pharmacies in dispensing GLP-1 RAs.

Background: This work presents Com@Rehab, a technological patient-centred activity for individuals needing a physical rehabilitation approach and with a specific loss of functionality. Within this scope, this paper focuses on the description of the activity in virtual reality (VR), its components, design and user profile, and its versatility and future adaptability regarding different ages, pathologies and rehabilitation contexts. Methods: The VR activity has been customised according to the patient's clinical needs while replicating an activity of daily living, namely showering. In addition, to validate and get feedback on the developed system, a validation questionnaire was applied to a group of healthy individuals to test the efficiency of the technology that supports the VR activity. Results: Preliminary results show that 94% of the participants recommended the experience, the performance of the various components of the system was successfully implemented, participants quickly adhered to the VR technology, and the UI assistant’s functionality should be improved. Conclusion: This solution creates a more effective, interactive, humanised rehabilitation approach based on a Virtual Reality (VR) activity. The Com@Rehab Communication Module improves human-human and human-machine communication while contributing to health literacy.

Relationships between geoheritage and cultural heritage are increasingly becoming a topic of study, especially in urban contexts. Their integrated reading adds value for educational and urban geotourism purpose, being the latter an emerging sector of sustainable tourism. The case study of the monumental complex of San Francesco le Moniche, built in the ancient Norman county Aversa, in the northern Campania (Italy), is analyzed here. The cultural heritage of the monumental complex and the additional value associated with the natural heritage (geological and geomorphological context, building stones) have been linked. The building stratification of the complex has been read not only from documentary sources, but also from the distribution and architecture of the existing underground cavities, the building stones, from ancient images and even postcards, integrating disciplines such as geosciences, architecture, archaeology, speleology, engineering. The results provide a clear example of a geoheritage-cultural heritage interface and the importance of an integrated approach in the valorization of the cultural and natural heritage of urban areas. The results allowed us to improve the knowledge of the study site and provide useful tools for the planning of future targeted investigations.

The analysis of the radon-seismicity relationship has been carried out so far in the Vrancea (Ro-mania) seismic zone, with monitoring stations positioned on tectonic faults. The article analyzes the evolution of radon under the conditions of the existence of deep and surface seismicity and the presence of mud volcanoes along with live fires caused by gases emitted from the soil. The monitoring area was extended to the Black Sea and the area of the Făgăraș Câmpulung fault, where a special radon detection system was set up, which was proposed for patenting. A case study is the effect of the earthquakes in Turkey (7.8 R and 7.5 R on 2023/02/06) on the seismically active areas in Romania in terms of gas emissions (radon, CO2). The main analysis methods on radon (we also included CO2) are applied to integrated time series and the use of anomaly detection algorithms. Data analysis shows that the effects of global warming introduce deviations in seasonal gas emissions compared to previous years. This makes it difficult to analyze the data and correlate them with seismicity. The main conclusions related to the development of a radon monitoring network and in general the emission of gases in seismic areas refer to the importance of the choice of equipment, the monitoring location and the installation method.

In this study, an optimization of the first blade in new test rig presented. Blade tuning is conducted using 3D geometrical parameters. Sweep and dihedral play an essential role in this study. Compressor characteristics and blades vibrational behavior are the main objective of the evaluation. Here, the attachments are designed to isolate blade dynamics from Disk. So, the Vibrational behaviors of the one's blade are tuned based on the self-excited and forced vibration phenomenon. Using a semi analytical MATLAB code instability conditions are satisfied. The code takes advantages of whitehead and force response theory to predict classically and stall flutter speeds. Beside, Forced vibrations instability is controlled using a theory presented by Campbell. Aerodynamics of new blade geometry determined using multistage simulations Computational fluid dynamics (CFD) software. Numerical results show increasing performance near the surge line and working interval along with increasing mass flow.

Electrifying aircraft, a crucial advancement in the aviation industry, aims to cut pollutive emissions and boost energy efficiency. Traditional aircraft depend on fossil fuels, which contribute significantly to greenhouse gas emissions and environmental pollution. Despite progress in electric propulsion and energy storage technologies, challenges such as low energy density and integration issues persist. This paper provides a comprehensive thematic and bibliometric analysis to map the research landscape in aircraft electrification, identifying key research themes, influential contributors, and emerging trends. The study applies natural language processing to unstructured bibliographic data and cross-sectional statistical methods to analyze publications, citations, and keyword distributions across various categories related to aircraft electrification. The findings reveal significant growth in research output, particularly in energy management and multidisciplinary design analysis. Collaborative networks highlight key international partnerships, with the United States and China being key research hubs, while citation metrics highlight the impact of leading researchers and institutions in these countries. This study provides valuable insights for researchers, policymakers, and industry stakeholders, guiding future research directions and collaborations.

The world is moving to the next phase of the energy transition with high penetrations of renewable energy. Flexible and scalable redox flow battery (RFB) technology is expected to play an important role in ensuring electricity network security and reliability. Continuous performance improvements will further enhance their value by reducing parasitic losses and maximizing available energy conversion over broader operating conditions. Concentration overpotentials from poor internal reactant distribution at high and low states of charge (SOC) limit power densities and are thus an important area of investigation. However, efforts to address these coupled electrochemical phenomena can compromise mechanical performance. Modelling and simulation of cell design innovations have shown it is possible to reduce losses from pump energy while increasing the availability of active species where required. The combination of wedge-shaped cells with static mixers investigated in this paper can reduce pressure drop and improve energy efficiency. Toroidal vanadium redox flow battery (VRB/VRFB) designs incorporating this innovation are presented for further development to improve community engagement with the technology.

A method for calibrating models of agricultural production and resource use presented by Howitt [1] for policy analysis is proposed to leverage multidisciplinary agricultural research at the National Center for Alluvial Aquifer Research (NCAAR). An illustrative example for Sunflower County, MS is presented to show how plot-level research can be extended to draw systemic region or basin wide implications. A hypothetical improvement in yields for dryland soybean varieties is incorporated to the model and shown to have a positive impact on aquifer outcomes and producer profits. The example illustrates that a change in one practice-crop combination can have system-wide impacts as evidenced by the change in acreages for all crops and practices.