Perioperative echocardiographic strain analysis: what anesthesiologists should know

Abstract

Purpose

Echocardiographic strain analysis by speckle tracking allows assessment of myocardial deformation during the cardiac cycle. Its clinical applications have significantly expanded over the last two decades as a sensitive marker of myocardial dysfunction with important diagnostic and prognostic values. Strain analysis has the potential to become a routine part of the perioperative echocardiographic examination for most anesthesiologist-echocardiographers but its exact role in the perioperative setting is still being defined.

Clinical features

This clinical report reviews the principles underlying strain analysis and describes its main clinical uses pertinent to the field of anesthesiology and perioperative medicine. Strain for assessment of left and right ventricular function as well as atrial strain is described. We also discuss the potential role of strain to aid in perioperative risk stratification, surgical patient selection in cardiac surgery, and guidance of anesthetic monitor choice and clinical decision-making in the perioperative period.

Conclusion

Echocardiographic strain analysis is a powerful tool that allows seeing what conventional 2D imaging sometimes fails to reveal. It often provides pathophysiologic insight into various cardiac diseases at an early stage. Strain analysis is readily feasible and reproducible thanks to the use of highly automated software platforms. This technique shows promising potential to become a valuable tool in the arsenal of the anesthesiologist-echocardiographer and aid in perioperative risk-stratification and clinical decision-making.

Geological Features of Northwestern Himalaya, Ladakh, India: Geosites and Their Significance in the Ladakh Himalaya

Abstract

Geoheritage and geotourism are the two essential aspects of human appreciation of the Earth's geological resources. Ladakh Himalaya has fascinating and exquisite landforms and landscapes. The area of interest in the present study is located along the Indus Tsangpo Suture Zone (ITSZ), caused by the collision of the Indian and Eurasian plates. In the context of diverse geology, structure, topography, tectonic history, and climatic variability, there is an immense diversity of landforms (geodiversity) in the Ladakh region. The region has always attracted tourists/geoscientists from all over the world because of its unique culture, language, religion, geology, and others. Researchers have identified various geoheritage sites, including structural features, lacustrine lake deposits, geothermal hot springs, semi-precious minerals, etc. The protection and preservation of these geoheritage sites in Ladakh Himalaya are essential to promote geotourism and sustainable growth. The proposed sites need to be conserved as needs of the people living in the region. The present study identifies various geosites related to sedimentary (lacustrine deposits), high-grade metamorphic rocks, intrusives rocks and minerals of igneous origin etc. from the northwestern to southeastern Ladakh Himalaya based on their unique geological features and significance. Besides geological aspects, these geosites in Ladakh are habited with diverse flora and fauna which makes it more significant for preservation. A detailed evaluation of these geosites is established based on the extensive field investigation and literature review. The present study involves the strengths, weaknesses, opportunities, and threats to these geoheritage sites and emphasizes the importance of its recognition and geoconservation. The proposed geosites are facing serious challenges of its destruction due to anthropogenic activities, unsustainable growth of tourism, lack of public awareness, and non-involvement of any governmental agencies for its protection and conservation has put continuous pressure on the sensitive and fragile ecology of geosites in Ladakh and causing environmental and socio-cultural impact.

Geological Features of Northwestern Himalaya, Ladakh, India: Geosites and Their Significance in the Ladakh Himalaya

Abstract

Geoheritage and geotourism are the two essential aspects of human appreciation of the Earth's geological resources. Ladakh Himalaya has fascinating and exquisite landforms and landscapes. The area of interest in the present study is located along the Indus Tsangpo Suture Zone (ITSZ), caused by the collision of the Indian and Eurasian plates. In the context of diverse geology, structure, topography, tectonic history, and climatic variability, there is an immense diversity of landforms (geodiversity) in the Ladakh region. The region has always attracted tourists/geoscientists from all over the world because of its unique culture, language, religion, geology, and others. Researchers have identified various geoheritage sites, including structural features, lacustrine lake deposits, geothermal hot springs, semi-precious minerals, etc. The protection and preservation of these geoheritage sites in Ladakh Himalaya are essential to promote geotourism and sustainable growth. The proposed sites need to be conserved as needs of the people living in the region. The present study identifies various geosites related to sedimentary (lacustrine deposits), high-grade metamorphic rocks, intrusives rocks and minerals of igneous origin etc. from the northwestern to southeastern Ladakh Himalaya based on their unique geological features and significance. Besides geological aspects, these geosites in Ladakh are habited with diverse flora and fauna which makes it more significant for preservation. A detailed evaluation of these geosites is established based on the extensive field investigation and literature review. The present study involves the strengths, weaknesses, opportunities, and threats to these geoheritage sites and emphasizes the importance of its recognition and geoconservation. The proposed geosites are facing serious challenges of its destruction due to anthropogenic activities, unsustainable growth of tourism, lack of public awareness, and non-involvement of any governmental agencies for its protection and conservation has put continuous pressure on the sensitive and fragile ecology of geosites in Ladakh and causing environmental and socio-cultural impact.

Enhancement of Lightweight Secure Blockchain Based Edward-El Gamal in the Internet of Things (IoT)

Abstract

The Internet of Things (IoT) refers to the vast network of interconnected devices that collect, exchange, and analyze data, enabling automation and improved efficiency in various domains. However, the rapid growth of IoT also raises significant security concerns. With the unlimited number of devices connected to the internet, the IoT ecosystem becomes a prime target for cyberattacks, threatening the privacy, integrity, and availability of data, decentralization as well as the safety of individuals and critical infrastructure. The challenges mentioned above are inherent attributes of a novel and emerging technology, blockchain. The need to address challenges in the realm of IoT has led to the combination of it with Blockchain technology, prompting scholars to explore the most effective ways to leverage blockchain's capabilities in this context. The ubiquitous implementation of the IoT requires a uniform and resilient framework that can ensure security, compliance with data retention regulations, and efficacy in terms of commercial viability. The Lightweight Secure Blockchain (LSB) is among the various blockchain variations and arrangements created to address these requirements. This research focuses on improving security and performance by implementing various measures, including encryption of transaction delivery, enhancement of transaction flow, verification of blocks, optimization of hash rate, and improvement of hash quality. For the improved effectiveness of the research conducted in the field of IoT, an empirical evaluation was carried out using data collected from the Vainu Bappu Observatory (Indian Institute of Astro Physics, Kavalur) and the Temperature sensor. The study showcases achievements by implementing and comparing outcomes with the standard LSB. The utilization of the hybrid Edward Curve El Gamal approach in transaction encryption has been found to improve the security of transmitted transactions.

Investigating the spatial foundations of rural entrepreneurship development using a hybrid method of MCDM, ANN and DTree algorithm

Abstract

Growing evidence points to rural entrepreneurship as a critical tactic for promoting capacity building, sustainable development, and empowerment in rural communities. This study explored the spatial underpinnings of rural entrepreneurial development and was carried out in Iran. Using a descriptive-analytical methodology, the study surveys 20 experts and 100 active entrepreneurs in the Mochesh district of Kamyaran town. The research uses semi-structured interviews and sources to determine important characteristics for examining the spatial underpinnings. Data were collected using a researcher-made close-ended questionnaire. The validity and reliability of the research instrument were approved by experts opinions and Cronbach’s alpha coefficients, respectively. Analytical techniques used include decision tree data mining models, artificial neural networks (ANN), and Multi-Criteria Decision Making models. The results of the ANN model have shown that social and economic capital had been of the greatest importance in enhancing entrepreneur contexts, with a coefficient of 21 and 22%, respectively. Also, the findings of the data mining analysis show the high impact of environmental capital and structural-spatial components in the development of entrepreneurial activities in the study area. Finally, the entrepreneurs emphasized that one of the most important dimensions affecting the development of entrepreneurial activities and the prosperity of the rural economy is environmental capital and attracting the support of administrative institutions. Therefore, improvement in these components should be duly considered by managers and rural planners.

Evaluating plans for sustainable development in Arctic cities

Abstract

Cities located in the Arctic often have extreme geographic and environmental contexts and unique sociopolitical and economic trajectories that, when combined with amplified effects of climate change in the region, impact future sustainable development. Well-recognized and standardized sustainable development indicator (SDI) frameworks such as ISO 37120 or UN-Habitat City Prosperity Index are often used to compare data across cities globally using comprehensive sets of indicators. While such indexes help characterize progress toward development and guide short- and long-term decision-making, they often lack relevance to specific contexts or characterize future visions of urban growth. To evaluate the extent of these deficiencies and to provide a comparative analysis of approaches to sustainable urban growth in the Arctic, this paper analyzes city planning documents for five northern cities - Anchorage (USA), Utqiagvik (USA), Reyjavik (ISL), Iqaluit, (CAN), Whitehorse, (CAN) - for goals, targets, and indicators and compare these to thematic areas and indicators defined by ISO 37120:2018 Sustainable Cities and Communities. The results confirm that although international SDI frameworks may be useful for comparative analysis of cities across diverse regions, they exclude important local factors that influence goal-oriented urban sustainability planning strategies employed in the Arctic region.

Building Equitable Mental Health Care for Latino Children: Perspectives from Providers and Communities

Abstract

Background

The current pediatric mental health crisis has disproportionately impacted Latino youth in the United States (US), as demonstrated by their elevated risks of depression, substance use disorder, and anxiety. Despite this, research suggests Latino youth receive inequitable mental health services.

Objective

To understand best practices, challenges, and priorities in providing accessible and equitable mental health care for Latino youth from the perspectives of front-line mental health providers and Latino community members.

Methods

A bicultural, bilingual researcher conducted semi-structured interviews with 20 participants with expertise in Latino mental health. Topics included barriers and facilitators to mental health care access and cultural tailoring of treatment for Latino youth. Rapid qualitative analysis was used to identify themes.

Results

Four themes were identified: (1) Navigating immigration concerns and acculturation, practitioners should consider immigration-related concerns and be trained to address acculturation-related stressors respectfully; (2) Adapting to the cultural needs and strengths of the communities, cultural humility education can allow providers to engage with both the strengths and needs of Latino families; (3) Engaging Latino caregivers as partners, it is critical to engage with Latino caregivers’ cultural perspectives on parenting and mental health collaboratively; and (4) Addressing systemic barriers to promote access, providers must recognize and attempt to alleviate the systemic barriers that limit families from seeking care.

Conclusions

Participants identified several practical strategies to improve the provision of mental health services for Latino children. Future directions, policy and practice implications, and limitations are discussed.

Creating culturally-informed protocols for a stunting intervention using a situated values-based approach (WeValue InSitu): a double case study in Indonesia and Senegal

Abstract

International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing ‘cultural protocols’ to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu, to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which ‘crystallize’ their envelope of local shared values, making them communicable to outsiders.

Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful.

Meta-analysis indicates better climate adaptation and mitigation performance of hybrid engineering-natural coastal defence measures

Abstract

Traditional approaches to coastal defence often struggle to reduce the risks of accelerated climate change. Incorporating nature-based components into coastal defences may enhance adaptation to climate change with added benefits, but we need to compare their performance against conventional hard measures. We conduct a meta-analysis that compares the performances of hard, hybrid, soft and natural measures for coastal defence across different functions of risk reduction, climate change mitigation, and cost-effectiveness. Hybrid and soft measures offer higher risk reduction and climate change mitigation benefits than unvegetated natural systems, while performing on par with natural measures. Soft and hybrid measures are more cost-effective than hard measures, while hybrid measures provide the highest hazard reduction among all measures. All coastal defence measures have a positive economic return over a 20-year period. Mindful of risk context, our results provide strong an evidence-base for integrating and upscaling nature-based components into coastal defences in lower risk areas.