Coupling polyethylene microplastics with other pollutants: Exploring their combined effects on plant health and technologies for mitigating toxicity.

The presence of microplastics in agricultural soils has raised concerns regarding their potential impacts on ecosystem health and plant growth. The introduction of microplastics into soil can alter its physicochemical properties, leading to adverse effects on plant development. Furthermore, the adsorption capabilities of microplastics may enhance the toxicity of soil pollutants, potentially resulting in detrimental effects on plant life. Large-sized microplastics may become adhered to root surfaces, impeding stomatal function and restricting nutrient uptake. Conversely, smaller microplastics and nano-plastics may be internalized by plants, causing cellular damage and genotoxicity. In addition, the presence of microplastics in soil can indirectly affect plant growth and development by altering the soil environment. Therefore, it is essential to investigate the potential impacts of microplastics on agricultural ecosystems and develop strategies to mitigate their effects. This review describes the adsorption power between polyethylene microplastics and pollutants (heavy metals, polycyclic aromatic hydrocarbons and antibiotics) commonly found in agricultural fields and the factors affecting the adsorption process. Additionally, the direct and indirect effects of microplastics on plants are summarized. Most of the single or combined microplastic contaminants showed negative effects on plant growth, with a few beneficial effects related to the characteristics of the microplastics and environmental factors. Currently microbial action and the application of soil conditioners or plant growth promoters can alleviate the effects of microplastics on plants to a certain extent. In light of the complex nature of soil environments, future research should concentrate on mitigate and control these interactions and the impact of compound pollution on ecosystems.

The Surgical Management of Pancreatic Pseudocysts: A Narrative Review.

Pancreatic pseudocysts, commonly arising as a complication of acute or chronic pancreatitis, present a significant clinical challenge. This narrative review explores the surgical management of pancreatic pseudocysts, emphasizing advancements, techniques, and outcomes. We examine the indications for surgical intervention, including symptomatic pseudocysts, complications such as infection or hemorrhage, and pseudocysts resistant to conservative treatment. Various surgical approaches are discussed, including open surgery, laparoscopic techniques, and endoscopic interventions. The review highlights the evolution of surgical strategies, from traditional cystogastrostomy to minimally invasive methods, and assesses their efficacy and safety. Additionally, we address patient selection criteria, preoperative assessment, and postoperative care. By synthesizing current evidence and clinical experiences, this review aims to provide a comprehensive overview of the best practices in the surgical management of pancreatic pseudocysts, offering valuable insights for clinicians in optimizing patient outcomes.

Beyond conventional antibiotics approaches: Global perspectives on alternative therapeutics including herbal prevention, and proactive management strategies in bovine mastitis.

Mastitis, an intramammary inflammation resulting from microbial infectious agents, continues to pose a significant challenge within the dairy sector, adversely affecting animal well-being and leading to substantial economic losses. These losses are attributed to decreased milk production, heightened culling rates, and the expenses related to diagnostics, veterinary care, medication, and labor. Moreover, additional costs emerge due to reduced forthcoming milk yields, compromised reproductive health, and increased susceptibility to various illnesses. Identifying the responsible agents is crucial for disease management and the implementation of antimicrobial treatments. Despite the prevalent use of antibiotic treatment, the pressing need for new therapeutic alternatives to combat bovine mastitis arises from limitations, including low cure rates, rising resistance, and the presence of antibiotic residues in milk. This review explores the potential application of herbal extracts and essential oils known for their antimicrobial properties as alternative options for managing pathogens in mastitis treatment. It examines various treatment methods and management strategies, particularly emphasizing the progress of herbal remedies and natural therapeutics in addressing mastitis, a significant concern in bovine populations and dairy herds.

Postoperative Delirium and Neurocognitive Disorders: A Comprehensive Review of Pathophysiology, Risk Factors, and Management Strategies.

Postoperative delirium (POD) and neurocognitive disorders (NCDs) are common and serious complications that can occur after surgery, particularly in older adults and those with preexisting cognitive impairments. These conditions are associated with significant morbidity, increased healthcare costs, and reduced quality of life. Understanding the underlying mechanisms, risk factors, and effective management strategies for POD and NCDs is critical for improving patient outcomes and reducing the burden on healthcare systems. This comprehensive review aims to synthesize current knowledge on the pathophysiology, risk factors, and management strategies for POD and NCDs. It explores the neurobiological and molecular mechanisms contributing to these conditions, identifies the patient-related, surgical, and environmental factors that increase risk, and evaluates pharmacological and non-pharmacological approaches to prevention and treatment. A thorough literature review was conducted using recent studies, clinical guidelines, and expert consensus to provide a detailed overview of the pathophysiology, risk factors, clinical presentation, prevention, and management of POD and NCDs. The pathophysiology of POD and NCDs involves complex interactions between neuroinflammatory processes, neurotransmitter imbalances, and brain network disruptions. Risk factors include advanced age, preexisting cognitive impairment, type and duration of surgery, and perioperative complications. Management strategies emphasize a multidisciplinary approach, incorporating preoperative optimization, careful intraoperative management, and postoperative interventions. Pharmacological treatments, such as antipsychotics, and non-pharmacological approaches, including environmental modifications and cognitive rehabilitation, play crucial roles in management. Postoperative delirium and NCDs are multifactorial conditions with significant impacts on surgical outcomes. Effective management requires a comprehensive understanding of their pathophysiology and risk factors and the implementation of targeted prevention and treatment strategies. Future research should focus on personalized approaches to prevention and treatment, further elucidation of mechanisms, and developing predictive models to enhance care for patients at risk of these neurocognitive complications.

Pulmonary Shunt in Critical Care: A Comprehensive Review of Pathophysiology, Diagnosis, and Management Strategies.

Pulmonary shunt, an abnormal passage of blood through the pulmonary circulation without adequate gas exchange, poses significant challenges in critical care. This comprehensive review explores the pathophysiology, diagnostic approaches, and management strategies associated with pulmonary shunt. Pulmonary shunts are classified into anatomical and physiological types, each with distinct mechanisms and implications for gas exchange. Anatomical shunts result from structural heart defects, while physiological shunts arise from ventilation-perfusion (V/Q) mismatches. Both conditions can significantly impair oxygenation and contribute to multi-organ dysfunction. This review delves into various diagnostic modalities, including clinical assessment, imaging techniques such as chest X-ray and CT scans, and advanced diagnostic methods such as V/Q scanning and echocardiography. Challenges in diagnosing pulmonary shunt are discussed, emphasizing the limitations of current tools and the need for accurate differentiation of shunt types. Management strategies are examined, covering pharmacological interventions, non-pharmacological treatments such as mechanical ventilation and prone positioning, and surgical options. Emerging therapies and innovations in treatment are also highlighted. Special considerations are given to different patient populations, including pediatric and elderly patients and those with multiple comorbidities. This review concludes with an analysis of the prognosis and outcomes associated with pulmonary shunt, focusing on short-term and long-term impacts on survival and quality of life. This review aims to enhance understanding and guide effective management practices for pulmonary shunt in critical care settings by synthesizing current knowledge and identifying areas for further research.

Sterol regulatory element-binding proteins mediate intrinsic fungicide tolerance and antagonism in the fungal biocontrol agent Clonostachys rosea IK726.

Sterol regulatory element-binding proteins (SREBPs) are transcription factors governing various biological processes in fungi, including virulence and fungicide tolerance, by regulating ergosterol biosynthesis and homeostasis. While studied in model fungal species, their role in fungal species used for biocontrol remains elusive. This study delves into the biological and regulatory function of SREBPs in the fungal biocontrol agent (BCA) Clonostachys rosea IK726, with a specific focus on fungicide tolerance and antagonism. Clonostachys rosea genome contains two SREBP coding genes (sre1 and sre2) with distinct characteristics. Deletion of sre1 resulted in mutant strains with pleiotropic phenotypes, including reduced C. rosea growth on medium supplemented with prothioconazole and boscalid fungicides, hypoxia mimicking agent CoCl2 and cell wall stressor SDS, and altered antagonistic abilities against Botrytis cinerea and Rhizoctonia solani. However, Δsre2 strains showed no significant effect. Consistent with the gene deletion results, overexpression of sre1 in Saccharomyces cerevisiae enhanced tolerance to prothioconazole. The functional differentiation between SRE1 and SRE2 was elucidated by the yeast-two-hybridization assay, which showed an interaction between SREBP cleavage-activating protein (SCAP) and SRE1 but not between SRE2 and SCAP. Transcriptome analysis of the Δsre1 strain unveiled SRE1-mediated expression regulation of genes involved in lipid metabolism, respiration, and xenobiotic tolerance. Notably, genes coding for antimicrobial compounds chitinases and polyketide synthases were downregulated, aligning with the altered antagonism phenotype. This study uncovers the role of SREBPs in fungal BCAs, providing insights for C. rosea IK726 application into integrated pest management strategies.

Tailoring Hospice Care to the Veteran Population.

United States Military Veterans are an increasingly elderly population, and more and more veterans are choosing hospice care at the end of life. These veterans, particularly if they served in combat, can bring unique management challenges and opportunities to a hospice team. This review highlights the physical and psychosocial traumas experienced by many veterans, and discusses how these issues can affect their hospice care. Traumatic injury-related issues such as chronic pain, neuropathic pain, insomnia, and chronic headaches can worsen for veterans at the end of life, and the psychological sequelae of these traumatic events such as Post-Traumatic Stress Disorder (PTSD), Chronic Anxiety, Substance Abuse, and increased risk of suicide can also be magnified during this time. This review details these and other commonly seen service-related comorbidities, and offers evidence-based recommendations regarding their diagnosis and treatment. In addition, it discusses what is important to veterans at the end of life, and provides suggestions on how hospice programs can individualize and optimize their care of this special population. Honoring their service and respecting their sacrifices are also important aspects of "Best Care" for veterans at the end of life, and this review provides suggestions on how to do so and includes a list of resources that can greatly assist hospice programs, veterans, and families in delivering the most respectful, comprehensive, and thoughtful care possible.

Divergent temporal responses of native macroinvertebrate communities to biological invasions.

Biological invasions pose a major threat to biodiversity, ecosystem functioning, and human well-being. Non-native species can have severe ecological impacts that are transformative, affecting ecosystems across both short-term and long-term timescales. However, few studies have determined the temporal dynamics of impact between these scales, impeding future predictions as invasion rates continue to rise. Our study uses a meta-analytical approach to dissect the changing taxonomic and functional impacts of biological invasions on native macroinvertebrate populations and communities in freshwater ecosystems across Europe, using a recently collated European long-term time series spanning several decades. Our findings reveal a complex temporal pattern: while initial stages of invasions (i.e. five years after the first record of non-native species) often exhibited benign impacts on macroinvertebrate abundance, richness, or functional diversity, the long-term (i.e. the period following the early invasion) effects became predominantly negative. This pattern was consistent between taxonomic and functional metrics for impacts at both the population and species level, with taxonomic metrics initially positively affected by invasions and functional metrics being more stable before also declining. These results suggest that even initially benign or positively perceived impacts could be eventually superseded by negative consequences. Therefore, understanding the magnitude of invasion effects increasingly requires long-term studies spanning several years or decades to offer insights into effective conservation strategies prioritising immediate and future biodiversity protection efforts. These findings also highlight the importance of integrating multiple taxonomic, functional and temporal components to inform adaptive management approaches to mitigate the negative effects of current and future biological invasions.

Underlying mechanisms and management strategies for regorafenib-induced toxicity in hepatocellular carcinoma.

INTRODUCTION: Hepatocellular carcinoma (HCC) accounts for 85% of liver cancer cases and is the third leading cause of cancer death. Regorafenib is a multi-target inhibitor that dramatically prolongs progression-free survival in HCC patients who have failed sorafenib therapy. However, one of the primary factors limiting regorafenib's clinical utilization is toxicity. Using Clinical Trials.gov and PubMed, we gathered clinical data on regorafenib and conducted a extensive analysis of the medication's adverse reactions and mechanisms. Next, we suggested suitable management techniques to improve regorafenib's effectiveness. AREAS COVERED: We have reviewed the mechanisms by which regorafenib-induced toxicity occurs and general management strategies through clinical trials of regorafenib. Furthermore, by examining the literature on regorafenib and other tyrosine kinase inhibition, we summarized the mechanics of the onset of regorafenib toxicity and mechanism-based intervention strategies by reviewing the literature related to regorafenib and other tyrosine kinase inhibition. EXPERT OPINION: One of the primary factors restricting regorafenib's clinical utilization and combination therapy is its toxicity reactions. To optimize regorafenib treatment regimens, it is especially important to further understand the specific toxicity mechanisms of regorafenib as a multi-kinase inhibitor.

Navigating Primary Immune Thrombocytopenia During Pregnancy: Management Strategies and Considerations: A Comprehensive Review.

Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count due to the immune system's destruction of its platelets. During pregnancy, ITP poses significant challenges due to the need to balance maternal and fetal health. This comprehensive review aims to explore the pathophysiology, diagnostic approaches, and management strategies for ITP in pregnant women and discuss emerging treatments and future research directions. A thorough examination of current literature was conducted, including studies on the epidemiology, pathophysiology, diagnostic criteria, and treatment options for ITP in pregnancy. Relevant guidelines and expert consensus were also reviewed to provide a comprehensive understanding of best practices for managing this condition. The management of ITP in pregnancy requires a multidisciplinary approach and individualized treatment plans. First-line therapies include corticosteroids and intravenous immunoglobulin (IVIG), with second-line options such as thrombopoietin receptor agonists and immunosuppressive agents reserved for refractory cases. The choice of treatment depends on the severity of thrombocytopenia, the presence of bleeding symptoms, and gestational age. Special considerations include the risk of neonatal thrombocytopenia and the need for careful monitoring during labor and delivery. Emerging therapies and novel research offer promising advancements, though further studies are needed to validate their safety and efficacy. ITP in pregnancy is a complex condition that necessitates a careful balance between treating the mother and protecting the fetus. The management strategies must be tailored to each patient's needs, minimizing risks and optimizing outcomes. Continued research into the underlying mechanisms and treatment options will be crucial to improving care for pregnant women with ITP. This review provides a detailed synthesis of current knowledge and offers practical guidance for healthcare providers managing ITP during pregnancy.

Investigating the impact of the internet on managing green financial innovation and improving agricultural conditions in water-scarce Asian regions using ANN modeling.

This research focuses on the importance of management strategies, green innovation, and sustainable practices in the agricultural sector. These factors are crucial for job creation, food security, and environmental conservation. Particularly in water-scarce regions, effective management is necessary to overcome natural resource constraints and encourage a shift towards digital agriculture (AGRI). The study aims to identify and analyze the challenges and issues related to agricultural research and technology in Asian countries. The collected data were analyzed using exploratory factor analysis in the SPSS software. The analysis revealed a range of issues and challenges for agricultural development, including those related to the structure and policy framework, the availability and quality of resources and infrastructures, and the provision of effective support services, all of which encompassed factors such as research and technology investment, research management, productivity, research culture, networking, and the integration of higher education and agricultural research. To estimate the efficiency of technology development, agricultural development, and support services for AGRI, an artificial neural network (ANN) was utilized. The ANN was trained by incorporating changes in management strategies, green innovation, and sustainability across a broader range of experimental scenarios. The evaluation of the ANN's predictions showed that improvements in management strategies and the adoption of green innovation and sustainability significantly impacted the productivity of technology development, agricultural development, and support services for AGRI. The accuracy of the ANN's predictions was further assessed using linear regression. The results indicated an acceptable level of error when compared to the target results obtained from experimental tests. Overall, this study emphasizes the importance of effective management, green innovation, and sustainable practices in driving advancements in technology and agricultural development.

Exploring factors that affect Microcystis abundance in the sacramento san joaquin delta.

Cyanobacteria harmful algal blooms (cHABs) are increasing in frequency, intensity and duration in estuaries worldwide. In the upper San Francisco Estuary, also known as the Sacramento San Joaquin Delta (Delta), cHABs have been a topic of concern over the past two decades. In response, managers are urgently working to understand the factors that drive cHABs and identify feasible management options to avert ecological and human health consequences. We used a six year data set to explore relationships between flow parameters, temperature, and Microcystis biovolume to determine the potential for managing large scale hydrodynamic conditions to address Delta cHABs. We also looked at the relationship between Microcystis biovolume and the low salinity zone to see if it could be used as a proxy for residence time, because residence time is positively related to cyanobacteria abundance. We found the low salinity zone is not a useful proxy for residence time in the area of the Delta that experiences the most severe cHABs. Our finding suggest that climatic conditions (i.e., temperature and water year type) have the greatest influence on Microcystis biovolume in the Delta, with higher biovolume during years with lower flow and higher temperatures. Further, there are interannual differences in Microcystis biovolume that cannot be fully explained by flow parameters or temperature, meaning other factors not included in our model may be involved. We conclude that management actions to increase flow may be ineffective at reducing Microcystis to desired levels if water temperatures remain high.

Optimal techno-economic assessment of isolated microgrid integrated with fast charging stations using radial basis deep learning.

The global transportation electrification commerce sector is now booming. Stakeholders are paying an increased attention to the integration of electric vehicles and electric buses into  the transportation networks. As a result, there is an urgent need to invest in public charging infrastructure, particularly for fast charging facilities. Consequently, and to complete the portfolio of the green environment, these fast-charging stations (FCSs) are designed using 100% of renewable energy sources (RESs). Thus, this paper proposes an optimization model for the techno-economic assessment of FCSs comprising photovoltaic and wind turbines with various energy storage devices (ESDs). In this regard, the FCS performance is evaluated using flywheels and super capacitors due to their high-power density and charging/discharging cycles and rates. Then, optimal sizing of these distributed generators is attained considering diverse technical and economical key performance indicators. Afterwards, the problem gets more sophisticated by investigating the effect of RES's uncertainties on the selection criterion of the FCS's components, design and capacity. Eventually, as an effort dedicated to an online energy management approach, a deep learning methodology based on radial basis network (RBN) is implemented, validated, and carried out. In stark contrast to conventional optimization approaches, RBN demonstrates its superiority by obtaining the optimum solutions in a relatively short amount of time.

From Diagnosis to Delivery: Navigating Pregnancy With an Isthmocele.

Isthmocele is a myometrial defect in the uterine isthmus, often resulting from previous caesarean sections. With rising cesarean rates globally, including a significant increase in India, the prevalence of isthmocele has become a noteworthy clinical concern. Isthmocele can lead to symptoms such as abnormal uterine bleeding, dysmenorrhea, and secondary infertility, often detected through transvaginal ultrasound or MRI. Additionally, it can lead to caesarean scar pregnancy, a serious complication. The condition necessitates treatment, particularly in symptomatic cases or those planning future pregnancies. Early diagnosis and appropriate management are crucial for preventing complications and ensuring positive pregnancy outcomes. Here, we report a case that underscores the potential for successful pregnancy outcomes despite the presence of isthmocele, highlighting the need for tailored management strategies in such high-risk cases.

Symptom experiences and self-management strategies of patients with haematological malignancy undergoing chemotherapy: A qualitative study.

Objective: To explore symptom experiences and self-management strategies from the haematological malignancy patient's perspective. Methods: A qualitative descriptive approach was used to provide a direct and comprehensive understanding of the symptoms experienced and self-management strategies during treatment among patients with haematological malignancy. Fourteen patients with haematologic malignancies who received chemotherapy at a Chinese tertiary hospital were selected using purposeful sampling. Data were collected via semi-structured interviews and one-on-one patient sessions. The collected data were analysed using the content analysis methods. Reporting adhered to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. Results: The data from this study were categorized into four themes and eight subthemes: (1) the dynamics and complexity of symptom experience (nonlinear, and overloaded symptom burden); (2) strategies for coping with symptomatic change (actively responding to challenges, and facing symptoms negatively); (3) symptom affects interaction (symptoms affect family interactions, and symptoms affect social interactions); and (4) benefit from symptom management (promoting family relationships, and regaining a new role in society). Conclusions: Patients with haematological malignancy undergoing chemotherapy still face complex and variable symptoms, and there are still considerable challenges in symptom management. The findings underscore that health care providers should provide the necessary symptom assessment to enhance the well-being of patients based on the characteristics of the patient's symptom experience and symptom management needs at different stages of the disease.

Suboptimal disease control and contributing factors in Italian IBD patients: The IBD-PODCAST Study.

BACKGROUND AND AIM: Suboptimal disease control (SDC) and its contributing factors in IBD according to STRIDE-II criteria is unclear. IBD-PODCAST was a non-interventional, international, multicenter real-world study to assess this. METHODS: Data from the Italian IBD cohort (N=220) are presented here. Participants aged ≥19 with confirmed IBD diagnosis of ≥1 year were consecutively enrolled. A retrospective chart review and cross-sectional assessment by physicians and patients within the past 12 months were performed. SDC or optimal disease control was assessed using adapted STRIDE-II criteria. RESULTS: At the index date, 53.4 % of 116 CD patients and 49.0 % of 104 UC patients had SDC, mainly attributed to a Short Inflammatory Bowel Disease Questionnaire score <50, failure to achieve endoscopic remission, and the presence of active extra-intestinal manifestations in both diseases. Disease monitoring with imaging and/or endoscopy during the previous year was conducted in ∼50 % of patients, with endoscopy performed in ∼40 %. Potential therapeutic adjustments were reported for half of the patients. CONCLUSIONS: This study highlights SDC in a significant portion of IBD Italian patients. These results emphasize the need for more proactive management strategies in both CD and UC patients.

New findings on the incidence and management of CNS adverse reactions in ALK-positive NSCLC with lorlatinib treatment.

To explore the presentation and control of CNS adverse reactions in patients with ALK-positive NSCLC treated with lorlatinib. This study includes a retrospective case report from Sir Run Run Shaw Hospital on a lorlatinib-treated patient with CNS adverse reactions and a systematic literature review of similar cases until January 2023. The report detailed a case of a 74-year-old male with Grade III CNS adverse reactions 25 days after starting lorlatinib, which were reversible with dose modification and pharmacotherapy. The review indicated a 19.39% occurrence rate of such reactions, with a 17% improvement rate post-dose adjustment. CNS adverse reactions frequently occur in ALK-positive NSCLC patients on lorlatinib, yet they are reversible with appropriate management. Research should continue to optimize treatment protocols to decrease these reactions' frequency.

Fatigue Management in Advanced Prostate Cancer: Real-World Insights From Qualitative Interviews With Patients.

BACKGROUND: Patients with advanced prostate cancer (PC) commonly experience fatigue related to the disease itself and its treatment, which affects their quality of life. There are limited real-world data available on patients' experiences of fatigue while receiving PC treatment and its management. PATIENTS AND METHODS: This was a cross-sectional, noninterventional qualitative study involving individual concept-elicitation interviews with patients in the United States. Patients with advanced PC aged ≥18 years who had experienced fatigue and were on androgen-deprivation therapy in combination with second-generation androgen receptor pathway inhibitors were interviewed and their experiences quantified. RESULTS: Of the 143 patients screened, 13 qualified and 11 completed the interview. Most patients used the term "fatigue" (n = 8) to describe their experiences of tiredness, exhaustion, lack of energy, and weakness. Most patients (n = 8) did not receive any form of educational support from their healthcare providers (HCPs), but some expressed an interest in receiving this support (pamphlets, n = 4; discussion with HCPs, n = 4; online resources, n = 3). Most patients (n = 9) self-discovered fatigue-management strategies over the course of their disease and treatment. Patients found that rigorous exercise (n = 5), regular naps (n = 2), increased rest (n = 3), and a healthy diet (n = 3) were the most effective approaches for managing their fatigue. CONCLUSION: Tools are needed to support HCPs with counseling patients with PC for effective management of disease- and treatment-related fatigue.

Abundant resources compensate for the uneven distribution of ungulates in desert grassland.

Introduction: Strategically managing livestock grazing in arid regions optimizes land use and reduces the damage caused by overgrazing. Controlled grazing preserves the grassland ecosystem and fosters sustainability despite resource limitations. However, uneven resource distribution can lead to diverse grazing patterns and land degradation, particularly in undulating terrains. Methods: In this study, we developed a herbivore foraging algorithm based on a resource selection function model to analyze foraging distribution patterns, predict the probability of foraging, and identify the determinants of foraging probability in cattle. The study area was a complex desert landscape encompassing dunes and interdunes. Data on cattle movements and resource distribution were collected and analyzed to model and predict foraging behavior. Results: Our findings revealed that cattle prefer areas with abundant vegetation in proximity to water sources and avoid higher elevations. However, abundant resource availability mitigated these impacts and enhanced the role of water points, particularly during late grazing periods. The analysis showed that available resources primarily determine foraging distribution patterns and lessen the effects of landforms and water distance on patch foraging. Discussion: The results suggest that thoughtful water source placement and the subdivision of pastures into areas with varied terrain are crucial for sustainable grazing management. By strategically managing these factors, land degradation can be minimized, and the ecological balance of grassland ecosystems can be maintained. Further research is needed to refine the model and explore its applicability in other arid regions.

Top Three Healthcare Trends in Orthopaedics Affecting Musculoskeletal Care in the Elderly.

Several trends toward patient-centered multi-care models employing translational research strategies are currently emerging in orthopaedics. These align seamlessly with epigenetics discussions in pain, a clinical approach to pain management that prioritizes tailoring healthcare to individual needs, preferences, and circumstances. Recognizing the unique genetic and epigenetic factors influencing pain perception, healthcare providers can integrate personalized insights into their patient-centered approach, offering more targeted and effective pain management strategies tailored to each individual's experience. Custom 3D-printing technologies may also become increasingly relevant to more effectively and reliably treat painful degenerative structural abnormalities. They are expected to go hand-in-hand with the precision medicine redefinition of musculoskeletal care. More effective analysis of surgeons' clinical decision-making and patients' perception of high-value orthopaedic care is needed. Shared Decision Making (SDM) is critical to identifying the best solution for each patient and improving stakeholders' understanding of factors influencing the diverse prioritizing values of surgical or non-surgical treatments by payers, systems, and other providers. Identifying high-value orthopaedic surgeries via effective SDM in orthopedic surgery requires more than just presenting patients with information. The Rasch analysis of patient expectations can provide this nuanced approach that involves understanding patient values, addressing misconceptions, and aligning surgical recommendations with patient-specific goals. Optimizing orthopaedic treatment within the patient-centered framework can drive innovation in reimbursement policies that support the field more broadly. Research on separating high-value from low-value orthopaedic procedures may likely impact healthcare decision- makers' resource allocation.