[Prehabilitation and enhanced recovery after surgery: a continuum for the benefit of the patient]. / La préhabilitation et la récupération améliorée après chirurgie : un continuum au bénéfice du patient.

Improved recovery after surgery leads to a significant reduction in postoperative morbidity, but this is concentrated in the intra- and postoperative periods. Prehabilitation complements this, by taking charge of the pre-operative phase. Its aim is to improve pre-operative functional capacity and physical, nutritional and psychosocial status. Interdisciplinary collaboration is a key element of this integrated approach.

Electronic Integrated Management of Childhood Illness (eIMCI): a randomized controlled trial to evaluate an electronic clinical decision-making support system for management of sick children in primary health care facilities in South Africa.

BACKGROUND: Electronic clinical decision-making support systems (eCDSS) aim to assist clinicians making complex patient management decisions and improve adherence to evidence-based guidelines. Integrated management of Childhood Illness (IMCI) provides guidelines for management of sick children attending primary health care clinics and is widely implemented globally. An electronic version of IMCI (eIMCI) was developed in South Africa. METHODS: We conducted a cluster randomized controlled trial comparing management of sick children with eIMCI to the management when using paper-based IMCI (pIMCI) in one district in KwaZulu-Natal. From 31 clinics in the district, 15 were randomly assigned to intervention (eIMCI) or control (pIMCI) groups. Computers were deployed in eIMCI clinics, and one IMCI trained nurse was randomly selected to participate from each clinic. eIMCI participants received a one-day computer training, and all participants received a similar three-day IMCI update and two mentoring visits. A quantitative survey was conducted among mothers and sick children attending participating clinics to assess the quality of care provided by IMCI practitioners. Sick child assessments by participants in eIMCI and pIMCI groups were compared to assessment by an IMCI expert. RESULTS: Self-reported computer skills were poor among all nurse participants. IMCI knowledge was similar in both groups. Among 291 enrolled children: 152 were in the eIMCI group; 139 in the pIMCI group. The mean number of enrolled children was 9.7 per clinic (range 7-12). IMCI implementation was sub-optimal in both eIMCI and pIMCI groups. eIMCI consultations took longer than pIMCI consultations (median duration 28 minutes vs 25 minutes; p = 0.02). eIMCI participants were less likely than pIMCI participants to correctly classify children for presenting symptoms, but were more likely to correctly classify for screening conditions, particularly malnutrition. eIMCI participants were less likely to provide all required medications (124/152; 81.6% vs 126/139; 91.6%, p= 0.026), and more likely to prescribe unnecessary medication (48/152; 31.6% vs 20/139; 14.4%, p = 0.004) compared to pIMCI participants. CONCLUSIONS: Implementation of eIMCI failed to improve management of sick children, with poor IMCI implementation in both groups. Further research is needed to understand barriers to comprehensive implementation of both pIMCI and eIMCI. (349) CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov ID: BFC157/19, August 2019.

Integrated Management of Childhood Illness implementation in Nepal: understanding strategies, context, and outcomes.

BACKGROUND: Health system-delivered evidence-based interventions (EBIs) are important to reducing amenable under-5 mortality (U5M). Implementation research (IR) can reduce knowledge gaps and decrease lags between new knowledge and its implementation in real world settings. IR can also help understand contextual factors and strategies useful to adapting EBIs and their implementation to local settings. Nepal has been a leader in dropping U5M including through adopting EBIs such as integrated management of childhood illness (IMCI). We use IR to identify strategies used in Nepal's adaptation and implementation of IMCI. METHODS: We conducted a mixed methods case study using an implementation research framework developed to understand how Nepal outperformed its peers between 2000-2015 in implementing health system-delivered EBIs known to reduce amenable U5M. We combined review of existing literature and data supplemented by 21 key informant interviews with policymakers and implementers, to understand implementation strategies and contextual factors that affected implementation outcomes. We extracted relevant results from the case study and used explanatory mixed methods to understand how and why Nepal had successes and challenges in adapting and implementing one EBI, IMCI. RESULTS: Strategies chosen and adapted to meet Nepal's specific context included leveraging local research to inform national decision-makers, pilot testing, partner engagement, and building on and integrating with the existing community health system. These cross-cutting strategies benefited from facilitating factors included community health system and structure, culture of data use, and local research capacity. Geography was a critical barrier and while substantial drops in U5M were seen in both the highest and lowest wealth quintiles, with the wealth equity gap decreasing from 73 to 39 per 1,000 live births from 2001 to 2016, substantial geographic inequities remained. CONCLUSIONS: Nepal's story shows that implementation strategies that are available across contexts were key to adopting and adapting IMCI and achieving outcomes including acceptability, effectiveness, and reach. The value of choosing strategies that leverage facilitating factors such as investments in community-based and facility-based approaches as well as addressing barriers such as geography are useful lessons for countries working to accelerate adaptation and implementation of strategies to implement EBIs to continue achieving child health targets.

Infant Mortality Screening and Prevention Initiatives in Nepal.

Infant mortality is one of the leading public health crises in Nepal. While Nepal has made significant advances in mitigating under-five mortality, much work is still needed to be done regarding the healthcare of infants. The Nepalese government has identified this as a problem and has introduced a series of interventions to improve the health outcomes of infants. The aim of this review is to identify the goals, interventions, and effectiveness of major infant mortality prevention programs around the country. A comprehensive literature search was performed using PubMed and Google Scholar. The literature search revealed six programs that Nepal has utilized to combat infant mortality. The Community Based Management of Childhood Illness (CB-IMCI) program utilizes specially trained community workers to help identify and treat children with common childhood illnesses. The National Neonatal Health Strategy (NNHS) links families to the community and then to the broader healthcare system, with success found in its referral system. The Safe Delivery Incentives Program (SDIP) has found success with monetizing safe delivery practices, and shown an increase in safe deliveries with skilled healthcare workers present. Free Newborn Care (FNC) services were aimed at treating sick newborns for free, but ongoing concerns for program sustainability have led to further revision. The Every Newborn Action Plan (ENAP) is another plan aimed at preventing newborn deaths through improving health system administration and finances, but with limited efficacy data, it is hard to determine its success due to the lack of objective benchmark markers and data collected. Finally, the Birth Preparedness Package (BPP) is a highly efficacious program that encourages communities to plan for pregnancies by planning for delay barriers. Nepal has made significant strides in reducing infant mortality; however, much work still needs to be done. From 1990 to 2020, Nepal has reduced the under-five mortality rate from 138.8 deaths per 1,000 live births to 28.2 deaths per 1,000 live births.

Understanding for whom, under what conditions, and how an integrated approach to atrial fibrillation service delivery works: a realist review.

AIMS: To understand for whom, under what conditions, and how an integrated approach to atrial fibrillation (AF) service delivery works (or does not work). METHODS AND RESULTS: A realist review of integrated approaches to AF service delivery for adult populations aged ≥18 years. An expert panel developed an initial programme theory, searched and screened literature from four databases until October 2022, extracted and synthesized data using realist techniques to create context-mechanism-outcome configurations for integrated approaches to AF service, and developed an integrated approach refined programme theory. A total of 5433 documents were screened and 39 included. The refined programme theory included five context-mechanism-outcome configurations for how clinical and system-wide outcomes are affected by the way integrated approaches to AF service delivery are designed and delivered. This review identifies core mechanisms underpinning the already known fundamental components of integrated care. This includes having a central coordinator responsible for service organization to provide continuity of care across primary and secondary care ensuring services are patient centred. Additionally, a fifth pillar, lifestyle and risk factor reduction, should be recognized within an AF care pathway. CONCLUSION: It is evident from our provisional theory that numerous factors need to interlink and interact over time to generate a successfully integrated model of care in AF. Stakeholders should embrace this complexity and acknowledge that the learnings from this review are integral to shaping future service delivery in the face of an aging population and increased prevalence of AF.

Antiteuchus tripterus (Fabricius, 1787) (Heteroptera: Pentatomidae): First Record of This Native Stink Bug Damaging the Threatened Araucaria angustifolia in Brazil.

This is the first report of Antiteuchus tripterus (Fabricius, 1787) (Heteroptera: Pentatomidae) damaging Araucaria angustifolia (Bertol.) Kuntze, 1898 (Pinales: Araucariaceae) plants in Brazil. This bug, native to the neotropical region, damaged this plant on fragments of mixed rain forest in Bueno Brandão, Minas Gerais state, Brazil. Araucaria angustifolia, native and with ecological and economic values, was widely used in the lumber market and, therefore, threatened with extinction. Nymphs and adults of A. tripterus were observed in March and April with a population reduction until June 2022. The bioecology and damage caused by A. tripterus on A. angustifolia are not known.

Challenges in Providing Care for Patients with Chronic Diseases during Disasters: A Qualitative Study with Focus on Diabetes and Chronic Respiratory Diseases in Iran.

Background: Non-communicable diseases are of the major health challenges and the leading cause of death in Iran and at the global level. Moreover, Iran is a disaster-prone country and considering the exacerbation of diabetes and chronic respiratory diseases in natural disasters, its healthcare system is facing challenges. This study was designed to explore challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during disasters in Iran. Materials and Methods: The conventional content analysis is used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 of stakeholders were experienced and had theoretical knowledge. Participants' selection started by means of purposive sampling and continued to the point of data saturation. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method. Results: Based on participants' experiences, four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management (with three subcategories: control and supervision, patient data management, volunteer management), physical, psychosocial health (with three subcategories: psychological impacts, exacerbation of signs and symptoms, special patient characteristics), health literacy and the behavior (with three subcategories: risk perception, values and beliefs, education and awareness) and barriers to healthcare delivery (with three subcategories: facilities and human resources, financial and living problems and insurances, accessibilities and geographic access). Conclusion: Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters, and potentially promote health outcomes during and after disasters.

Integrated soil-fruit-climate management system to improve apple production stability.

Unstable agricultural systems, such as unreliable fruit production, threaten global food security and could negatively impact human nutrition. However, methods of maintaining a stable fruit supply have received little attention. Therefore, this study explored the impact of a systematic service model on the establishment of an integrated soil-fruit-climate management (ISM) approach and stabilization of apple yield based on a fixed-effects model using sample data from Fuji apple farmers in China for six consecutive years (2016-2021). The results showed that the systematic service model dramatically improved the adoption of ISM-based technology. By 2021, the rate of ISM technology adoption among farmers reached 84.4 %, especially pendulous branch-fruiting technology and Osmia pollination, which increased by 82.2 % and 37.8 %, respectively, compared to that in 2016. With the adoption of the ISM approach, apple yields and tree loadings stabilized over time. For example, the yield change rate and tree loading change rate were 14.8 % and 7.3 % lower, respectively, in 2021 than in 2016. We demonstrated through a fixed-effects analysis that the ISM approach exerts a fully mediated effect on the mechanism of action of service measure quantity disclosure, which positively impacted the rate of change in yield and tree loadings. This finding indicated that the six-in-one systematic service model of soil testing, pest and disease diagnosis, course training, meteorological monitoring, on-site guidance, and experimental demonstration established by the Science and Technology Backyard model resolved the information, goal, and hardware gaps that limited the adoption of this technology by farmers and promoted the construction of an integrated soil-fruit-climate management approach, which in turn has stabilized the apple production system.

Metarhizium carneum Formulations: A Promising New Biological Control to Be Incorporated in the Integrated Management of Meloidogyne enterolobii on Tomato Plants.

The increase in the populations of root-knot nematode Meloidogyne enterolobii in various vegetables such as tomatoes grown under greenhouse conditions as well as increasing restrictions on the use of certain chemical nematicides have led to the search for new, effective management strategies, preferably ones that are sustainable biological alternatives. In this work, two formulations of the nematophagous fungus Metarhizium carneum, one concentrated suspension and one wettable powder, were evaluated under greenhouse conditions to reduce the M. enterolobii infestation in tomato plants. In addition, the effectiveness of the liquid formulation of M. carneum was compared with two biological and three chemical commercial nematicides. The results show that the two M. carneum formulations reduced the M. enterolobii population density by 78 and 66% in relation to the control treatment. In comparison, the liquid formulation of M. carneum and Purpureocillium lilacinum treatments reduced nematode population density by 72 and 43%, respectively, while for metam sodium preplanting applications followed by M. carneum applications during the tomato growth stage, the reduction was 96%. The alternate use of some chemical compounds plus the application of M. carneum as a biocontrol is a good starting strategy for managing M. enterolobii populations. These results confirm that M. carneum is a serious candidate for the short-term commercialization of an environmentally friendly biological nematicide.

Update on the state of research to manage Fusarium head blight.

Fusarium head blight (FHB) is one of the most devastating diseases of cereal crops, causing severe reduction in yield and quality of grain worldwide. In the United States, the major causal agent of FHB is the mycotoxigenic fungus, Fusarium graminearum. The contamination of grain with mycotoxins, including deoxynivalenol and zearalenone, is a particularly serious concern due to its impact on the health of humans and livestock. For the past few decades, multidisciplinary studies have been conducted on management strategies designed to reduce the losses caused by FHB. However, effective management is still challenging due to the emergence of fungicide-tolerant strains of F. graminearum and the lack of highly resistant wheat and barley cultivars. This review presents multidisciplinary approaches that incorporate advances in genomics, genetic-engineering, new fungicide chemistries, applied biocontrol, and consideration of the disease cycle for management of FHB.

Antibiotic Prescription Patterns in Children Under 5 Years of Age With Acute Diarrhea in Quito-Ecuador.

BACKGROUND: Diarrheal disease remains a significant cause of child mortality, particularly in regions with limited access to healthcare and sanitation. Inappropriate practices, including unjustified medication prescriptions, pose challenges in the management of acute diarrhea (AD), especially in low- and middle-income countries. OBJECTIVE: This study analyzed antibiotic prescription patterns and assessed compliance with Integrated Management of Childhood Illness (IMCI) guidelines in children under 5 with AD in the Ministry of Public Health (MOPH) Ambulatory Care Centers of Quito city, Ecuador. METHODS: A cross-sectional design was used, collecting electronic health records (EHR) of patients diagnosed with AD from 21 health facilities in District 17D03. A probabilistic and stratified sampling approach was applied. Patient characteristics, prescriber characteristics, treatments, and compliance of IMCI guideline recommendations were evaluated. A stepwise logistic regression analysis examined the association between antibiotic prescription and patient and physician characteristics. RESULTS: A total of 359 children under 5 years of age were included, with 58.77% being girls. 85.24% of the cases of AD were attributed to gastroenteritis and colitis of infectious and unspecified origin. Amebiasis and other protozoal intestinal diseases accounted for 13.37% and 1.11% of the cases, respectively. The completion rates of recording various IMCI parameters varied; parameters such as duration of diarrhea, presence of blood in stool, and evidence of sunken eyes had high completion rates (100%, 100%, and 87.47%, respectively), while parameters like state of consciousness, presence of thirst, and type of diarrhea had low completion rates (0.28%, 0.28%, and 0.84%, respectively). None of the cases had all parameters fully recorded. Antimicrobials were prescribed in 38.72% of the cases. Children aged 3 to 5 years had higher odds of receiving antimicrobial prescription for AD (aOR: 4.42, 95% CI 2.13-9.18, P < .0001) compared to those under 1 year, after adjusting for the number of loose stools per day, gender, and age of the health professional. CONCLUSION: Variations in IMCI guideline compliance were observed, with no cases fully adhering to the guidelines. Antimicrobial prescription rates were notably high, especially among older children. Further research and specialized interventions are necessary to gain comprehensive insight into the factors underlying non-compliance with the IMCI guidelines.

Assessing the Effectiveness of Eco-Friendly Management Approaches for Controlling Wheat Yellow Rust and Their Impact on Antioxidant Enzymes.

Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici (Pst), is a destructive disease that causes significant yield losses in wheat production worldwide, including in Egypt. The use of biocontrol agents is among the best eco-friendly management strategies to control this disease, as they are more sustainable and environmentally friendly than traditional chemical control methods. In a comparative analysis, antioxidant enzyme activity and various management approaches were compared with two bacterial biocontrol agents, Bacillus subtilis and Pseudomonas putida. This study showed the remarkable efficacy of endophytic bacteria, B. subtilis and P. putida, in mitigating wheat stripe rust infection across three wheat varieties, namely Misr1, Gimmeiza11, and Sids12. B. subtilis exhibited superior performance compared to P. putida, resulting in infection types of 1 and 2.66, respectively, following inoculation. The highest reduction rate was observed with Tilit fungicide (500 ppm), followed by B. subtilis and Salicylic acid (1000 ppm), respectively. Variations in wheat varieties' response to Pst infection were observed, with Misr1 exhibiting the lowest infection and Sids12 showing high susceptibility. Among the tested inducers, Salicylic acid demonstrated the greatest reduction in disease infection, followed by Indole acetic acid, while Oxalic acid exhibited the lowest decrease. Additionally, the study evaluated the activities of five antioxidant enzymes, including Catalase, Ascorbate peroxidase (APX), glutathione reductase (GR), Superoxide dismutase (SOD), and peroxidase (POX), in the wheat-stripe rust interaction under different integrated management approaches. The wheat variety Misr1 treated with Tilit (500 ppm), B. subtilis, Salicylic acid, Montoro (500 ppm), and P. putida exhibited the highest increase in all enzymatic activities. These findings provide valuable insights into the effectiveness of B. subtilis and P. putida as biocontrol agents for wheat stripe rust control in Egypt, emphasizing their potential role in sustainable, integrated, and environmentally friendly management practices.

Ginger blotches on Agaricus bisporus due to monoacetylphloroglucinol production by the pathogen Pseudomonas 'gingeri'.

BACKGROUND: Agaricus bisporus is the most widely cultivated and consumed mushroom worldwide. Pseudomonas 'gingeri' is the only pathogenic causative agent of ginger blotch in A. bisporus. Current research on mushroom pathogenic biotoxins is limited to P. tolaasii, which causes brown blotch, while understanding of P. 'gingeri' is lacking, therefore identifying the toxins produced by P. 'gingeri' and evaluating their toxicity on A. bisporus is essential for understanding its pathogenic mechanisms. RESULTS: A pathogenic bacterium isolated from fruiting bodies of A. bisporus with ginger blotch was identified as P. 'gingeri', and its main toxin identified as 2', 4', 6'-trihydroxyacetophenone monohydrate, also known as monoacetylphloroglucinol (MAPG). Its first known extraction from a mushroom pathogen is reported here. MAPG at 250 µg/mL significantly inhibited the host's mycelial growth, increased branching, caused the structure to become dense and resulted in folds appearing on the surface. An MAPG concentration of 750 µg/mL MAPG led to mycelial death. P. 'gingeri' had high MAPG production in medium containing 0.1 mol/L of either glucose or mannitol (4.30 and 1.85 µg/mL, respectively), and mycelia were inhibited by 69.6% and 41.1%, respectively. The MAPG content was significantly lower in other carbon source media. CONCLUSION: This work provides a detailed description of the structure and virulence of the P. 'gingeri' biotoxin, which has implications for understanding its pathogenic mechanism and for exploring precise control strategies for A. bisporus ginger blotch disease, such as the development of MAPG inhibitory factors. © 2023 Society of Chemical Industry.

Modelación de los flujos de pacientes de alto riesgo con COVID-19 en Matanzas con enfoque Lean

Introducción: En el contexto de la pandemia, la gestión eficiente de los flujos de pacientes con enfoque en su trayectoria es crucial. En este sentido, el enfoque Lean permite aumentar el rendimiento del sistema sanitario, al eliminar actividades que no generan valor al paciente. Objetivo: Realizar un análisis integral de los flujos de pacientes de alto riesgo con COVID-19 en Matanzas, utilizando el enfoque Lean. Materiales y métodos: Se implementó una metodología de tipo cuantitativa, estructurada en cuatro etapas, para la gestión integrada de los flujos de pacientes de alto riesgo con COVID-19, mediante el enfoque Lean. Esta metodología integra herramientas para la selección de expertos, representación de procesos, análisis estructural y mapas de flujos de valor. Se aplicó durante del período de mayor incidencia de la pandemia en Matanzas (1 de mayo al 1 de agosto de 2021). Resultados: Se identificaron deficiencias relacionadas con los flujos de pacientes de alto riesgo con COVID-19 en Matanzas. Se realizó un análisis integral de los flujos, con el fin de realizar una propuesta de mejoras con enfoque Lean. La propuesta garantizó una optimización de 1510 minutos por ciclos de atención, con una eficiencia del 85,86 % del tiempo total de cada ciclo (etapa del tratamiento), y del 59,38 % de los tiempos de espera entre ellos. Conclusiones: Las herramientas Lean permiten realizar un análisis integral de los flujos de pacientes, además de mostrar una vía para su gestión, centrada en la trayectoria y no en la ocupación del recurso.

Introduction: In the context of the pandemic, the efficient management of the patients flow with a focus on their trajectory is crucial. In this sense, the Lean approach allows to increase the performance of the health care system, eliminating activities that do not generate value for the patient. Objective: To carry out an integral analysis of the high risk patients flow with COVID-19 in Matanzas, using the Lean approach. Materials and methods: A quantitative methodology, structured in four stages was implemented for the integrated management of the flow of high risk patients with COVID-19, using the Lean approach. This methodology integrates tools for the selection of experts, process representation, structural analysis and value flow maps. It was applied during the period of highest incidence of the pandemic in Matanzas (May 1st to August 1st 2021). Results: Deficiencies related to the flows of high risks patients with COVID-19 in Matanzas were identified. A comprehensive analysis of the flows was carried out in order to make a proposal for improvements with a Lean approach. The proposal guaranteed an optimization of 1 500 minutes per service cycle, with an efficiency of 85.86% of the total time of each cycle (treatment stage), and 59.38% of the waiting times between them. Conclusions: Lean tools allow a comprehensive analysis of the patients' flow, in addition to showing a route for their management, focused on the trajectory and not on the occupation of the resource.

Adherence to Atrial Fibrillation Better Care (ABC) Pathway Management of Chinese Community Elderly Patients with Atrial Fibrillation: A Cross-Sectional Study.

Background: Investigating adherence to the Atrial Fibrillation Better Care (ABC) pathway management and identifying gaps between the real world and established guidelines can lead to better integrated management of AF. Current data on adherence to ABC pathway management among community elderly patients with atrial fibrillation (AF) in Chinese communities is limited. Aim: To investigate the adherence to ABC pathway management among community elderly patients with AF in China. Methods: In this cross-sectional study, data were collected from the 2020 National Basic Public Health Service Program database that includes health examination information for all residents >65 years of age in Yuexiu, Guangzhou, Guangdong Province. Demographic and clinical characteristics data from 197 community AF patients were obtained. Results: Among the 197 AF patients, 103 (52.3%) were male, 117 (59.4%) were ≥75 years of age, 127 (64.5%) had a senior middle school education or above, 84.3% were married, and 195 (99.0%) had medical insurance. The most common comorbidities were hypertension (72.1%, 142/197), dyslipidaemia (28.4%, 56/197), CAD (28.9%, 57/197), and diabetes (24.9%, 49/197). In terms of the ABC management pathway, 21.8% (43/197), 82.7% (163/197), and 31.5% (62/197) of AF patients were classified into the A-adherent group, B-adherent group, and C-adherent group, respectively. The level of adherence to ABC pathway management was very low (9.1%, 18/197) and independently associated with age and multimorbidity. Conclusion: The level of adherence to ABC pathway management in community elderly patients with AF was unsatisfactory. Further research is warranted to improve the integrated management of AF.

[Integrated management during the perinatal period for total anomalous pulmonary venous connection]. / å®Œå ¨æ€§è‚ºé™è„‰å¼‚ä½è¿žæŽ¥çš„å›´ç”ŸæœŸä¸€ä½“åŒ–ç®¡ç†.

OBJECTIVES: To evaluate the clinical effectiveness of integrated management during the perinatal period for fetuses diagnosed with total anomalous pulmonary venous connection (TAPVC) by prenatal echocardiography. METHODS: Clinical data of 64 cases of TAPVC fetuses diagnosed by prenatal echocardiography and managed with integrated perinatal care in Qingdao Women and Children's Hospital from January 2017 to December 2021 were retrospectively analyzed. Integrated perinatal care included multidisciplinary collaboration among obstetrics, fetal medicine, ultrasound, pediatric cardiology, pediatric anesthesia, and neonatology. RESULTS: Among the 64 TAPVC fetuses, there were 29 cases of supracardiac type, 27 cases of intracardiac type, 2 cases of infracardiac type, and 6 cases of mixed type. Chromosomal analysis was performed in 42 cases, and no obvious abnormalities were found. Among the 64 TAPVC fetuses, 37 were induced labor, and 27 were followed up until term birth. Among the 27 TAPVC cases, 2 cases accepted palliative care, 2 cases were referred to another hospital for treatment and lost to follow-up, while the remaining 23 cases underwent primary repair surgery. One case died within 6 months after the operation due to low cardiac output syndrome, while the other 22 cases were followed up for (2.1±0.3) years with good outcomes (2 cases underwent a second surgery within 1 year after the first operation due to anastomotic stenosis or pulmonary vein stenosis). CONCLUSIONS: TAPVC fetuses can achieve good outcomes with integrated management during the perinatal period.

The Potential of Two Entomopathogenic Fungi and Enhanced Diatomaceous Earth Mixed with Abamectin: A Comprehensive Study on Mortality, Progeny Production, Application Method, and Surface Application against Tribolium castaneum.

This study determined the efficacy of Beauveria bassiana (Bals. -Criv.) Vuill., Metarhizium anisopliae (Metchnikoff) Sorokin, and diatomaceous earth mixed with abamectin (DEA) alone and in their combinations for the integrated management of larvae and adults of Tribolium castaneum (Herbst) from three field populations of Pakistan (Multan, Rawalpindi, and Rahim Yar Khan) and one laboratory population (Faisalabad). Treatments were applied on three surfaces, namely, viz. steel, concrete, and jute bags, implementing two application methods, dusting and spraying. The combined treatments were more effective in comparison with single treatments for both larvae and adults. Overall, the highest mortality rates were recorded in the Faisalabad population, followed by the Rehaim Yar Khan, Rawalpindi, and Multan populations. Progeny production was suspended 21 days after exposure to the combined treatment of DEA and both fungi in all populations except Rawalpindi. Larvae were found to be more susceptible than adults in all treatments and intervals. Dusting was more efficient than spraying for both larvae and adults and for all the populations studied. The present study provides a wholistic understanding of the impact of different factors on the success of the combined treatments using DEA and entomopathogenic fungi, supporting their use as surface treatments.

Surgery: an ideal profession.

Numerous concepts from the social sciences shed light on the experience and goals of surgeons. We are motivated to strive for self-fulfillment and meet our potential. Meeting our potential can best be achieved when there is the correct balance between challenge and skill, which permits us to achieve flow and reach our goals. Achieving flow requires commitment, concentration, and confidence. As we work with patients, it is also important to consider I-Thou and I-It relationships. The former relates to having authentic relationships, involving dialogue and compassion. The latter involves attending to the careful anticipation and planning needed to operate. The challenges faced in the profession have decreased some external rewards. Our response to these challenges defines who we are. By serving patients, we can achieve our own fulfillment and our growth in relationship with others.

Public authorities for transformative change: integration principle in public funding.

Although science widely supports moving towards transformative change through integrating biodiversity into decision-making, and arguing for the essential role of public authorities, it falls short on suggesting specific means to that end. This article considers the EU's approach to fostering the green transition as part of its post-pandemic recovery while exploring how the integration of biodiversity considerations could be integrated into decision-making. The rationale and implementation of the EU's do no harm principle is examined, which functioned as a condition for public funds. The analysis shows the mentioned EU policy innovation has a very limited impact. The role of do no harm has been limited to validating, rather than initiating policy measures. It has failed to influence the design of measures such that they would benefit biodiversity and not encouraged synergies between the climate and biodiversity goals. Based on the experience with do no harm as well as the more focussed regulatory action directed at the goal of climate neutrality, the article lists key steps for fostering biodiversity integration in policy planning and policy implementation. These steps encompass substantive and procedural approaches and aim for deliberation, target-setting, tracking, verification and screening. There is considerable scope for robust regulation to play a role in support of the biodiversity goals alongside transformative bottom-up initiatives.