Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rat...Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial.This editorial critically appraises the study by Kupietzky et al,which explored the relationship between appendicolith characteristics and NOM outcomes.Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA,comparing recurrence rates between those with and without appendicoliths.The study focused on long-term follow-up(median 44.2 months)and subgroup analyses of stone characteristics.The study revealed no significant difference in overall recurrence rates between groups(26.5%vs 19.1%,P=0.14).However,patients with appendicoliths experienced earlier recurrence(3.9 months vs 5.9 months,P=0.04)and had larger appendix diameters(10.2 mm vs 8.5 mm,P=0.001).Subgroup analyses showed no correlation between stone size,location,or number and recurrence risk.Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines.Clinical decisions should prioritize individualized risk assessment,considering patient age,symptom severity,and radiological features.These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.展开更多
Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rat...Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.展开更多
AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed us...AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.展开更多
Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority...Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls.The Individual,societal and economic costs are enormous.Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department.We review the initial assessment,criteria for imaging and clearing the spine,and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.展开更多
There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between ...There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between various national and international guidelines on NOM of rectal cancer.The main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical interventions.In many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is achieved.However,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.展开更多
BACKGROUND Majority of adhesive small bowel obstruction(SBO)cases can be managed nonoperatively.However,a proportion of patients failed non-operative management.AIM To evaluate the predictors of successful non-operati...BACKGROUND Majority of adhesive small bowel obstruction(SBO)cases can be managed nonoperatively.However,a proportion of patients failed non-operative management.AIM To evaluate the predictors of successful non-operative management in adhesive SBO.METHODS A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018.Data collated included basic demographics,clinical presentation,biochemistry and imaging results and management outcomes.The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes.The patients were divided into group A operative(including those that failed initial non-operative management)and group B non-operative for analysis.RESULTS Of 252 patients were included in the final analysis;group A(n=90)(35.7%)and group B(n=162)(64.3%).There were no differences in the clinical features between both groups.Laboratory tests of inflammatory markers and lactate levels were similar in both groups.From the imaging findings,the presence of a definitive transition point[odds ratio(OR)=2.67,95%confidence interval(CI):0.98-7.32,P=0.048],presence of free fluid(OR=2.11,95%CI:1.15-3.89,P=0.015)and absence of small bowel faecal signs(OR=1.70,95%CI:1.01-2.88,P=0.047)were predictive of the need of surgical intervention.In patients that received water soluble contrast medium,the evidence of contrast in colon was 3.83 times predictive of successful non-operative management(95%CI:1.79-8.21,P=0.001).CONCLUSION The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.展开更多
Purpose:Non-operative management(NOM)has been validated for blunt liver and splenic injuries.Literature on continuous intra-abdominal pressure(IAP)monitoring as a part of NOM remains to be equivocal.The study aimed to...Purpose:Non-operative management(NOM)has been validated for blunt liver and splenic injuries.Literature on continuous intra-abdominal pressure(IAP)monitoring as a part of NOM remains to be equivocal.The study aimed to find any correlation between clinical parameters and IAP,and their effect on the NOM of patients with blunt liver and splenic injury.Method:A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries.Hemodynamically unstable patients or those on ventilators were excluded,as well as patients who suffered significant head,spinal cord,and/or bladder injuries.The study predominantly included males(83.9%)with a mean age of 32.5 years.IAP was monitored continuously and the relation of IAP with various parameters,interventions,and outcomes were measured.Data were summarized as frequency(percentage)or mean±SD or median(Q1,Q3)as indicated.χ2 or Fisher's exact test was used for categorical variables,while for continuous variables parametric(independent t-test)or nonparametric tests(Wilcoxon rank sum test)were used as appropriate.Clinical and laboratory correlates of IAP<12 with p<0.200 in the univariable logistic regression analysis were included in the multivariable analysis.A p<0.05 was used to indicate statistical significance.Results:Intra-abdominal hypertension(IAH)was seen in 19.0%of the study population.IAH was strongly associated with a high injury severity score(p<0.001),and other physiological parameters like respiratory rate(p<0.001),change in abdominal girth(AG)(p<0.001),and serum creatinine(p<0.001).IAH along with the number of solid organs involved,respiratory rate,change in AG,and serum creatinine was associated with the intervention,either operative or non-operative(p=0.001,p=0.002,p<0.001,p<0.001,p=0.013,respectively).On multivariable analysis,IAP(p=0.006)and the mean change of AG(p=0.004)were significantly associated with the need for intervention.Conclusion:As a part of NOM,IAP should be monitored as a continuous vital.However,the decision for any intervention,either operative or non-operative cannot be guided by IAP values alone.展开更多
Purpose: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of an...Purpose: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE. Methods: A systematic literature review searched "liver trauma" , "hepatic trauma" , "conservative management" , "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs;studies reported NOM complications together with those post-intervention;case reports;studies including less than 5 cases;studies not written in English;and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test. Results: A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications were hepatic collection (3.1%), followed by bile leak (1.5%), with variability between the studies. Other complications included hepatic haematoma, bleeding, fistula, pseudoaneurysm, compartment syndrome, peritonitis, and gallbladder ischemia, all with an incidence below 1%. Conclusion: NOM with simple clinical observation showed an overall low incidence of complications, but higher for bile leak and collections. In patients with grade III and above injuries, the incidence of bile leak, collections and compartment syndrome did not show a statistically significant difference with the AE group. However, the latter result is limited by the small number of studies available and it requires further investigations.展开更多
Purpose-Interface management is the process of managing communications,responsibilities and coordination of project parties,phases or physical entities which are dependent on one another.Interface management is a cruc...Purpose-Interface management is the process of managing communications,responsibilities and coordination of project parties,phases or physical entities which are dependent on one another.Interface management is a crucial part of managing any construction project-but particularly important for high-speed railway projects that often have several contractual parties and stakeholders,very long project timelines and huge upfront cost overlays.This paper discusses how various project interfaces were managed during the design and construction of the civil engineering infrastructure for the High Speed Two(HS2)project in the United Kingdom.Design/methodology/approach-The paper uses the case study methodology.Key interfaces on the HS2 project are grouped into various categories and the paper discusses how they were managed within the Area North Integrated Project Team(IPT)of the HS2 project made up of contractor Balfour Beatty VINCI(BBV),the Mott MacDonald SYSTRA Design Joint Venture(DJV)and client HS2 Ltd.3 different case studies drawn from across the IPT are used,each of them highlighting different interfaces and how these interfaces were managed.Findings-The paper shows how innovative technical designs and modern methods of construction were used to address some of the unique and peculiar challenges of designing a brand-new railway in the United Kingdom.Addressing the contrasting and often competing requirements of different stakeholders,coupled with challenging physical constraints of the very limited land available for the project and the use of a rarely used Act of Parliament in the delivery of the project required different approach to interface management.Collaboration and proactive stakeholder engagement are necessary for successful interface management on megaprojects.The authors posit that adopting an integrated approach to engineering and construction management is an essential ingredient for the successful delivery of high-speed railway projects.Originality/value-With many high-speed railway projects around the world coming up in the next few years,understanding the context and challenges for each country will help engineering and design managers adopt appropriate approaches for their projects.The lessons learned on the HS2 project are also transferable to other mega infrastructure projects with complex project interfaces.展开更多
Journal Introduction″International Journal of Plant Engineering and Management″is in the charge of Ministry of Industry and Information Technology of the People′s Republic of China,and organized by Northwestern Pol...Journal Introduction″International Journal of Plant Engineering and Management″is in the charge of Ministry of Industry and Information Technology of the People′s Republic of China,and organized by Northwestern Polytechnical University.It is a kind of English aca-demic quarterly publication publicly issued at home and abroad.Plant engineering and management is a comprehensive interdisciplinary subject mainly reporting academic research on the application technology of equipment and industry management.It is of the characteristics of reporting both engineering and management while giving more priority to engineering as well as mechanics and electrics while giving priority to mechanics.Its contents involves technology,economy,management etc.展开更多
Objective:To investigate the application effect of intelligent empowerment standardized airway management process in patients receiving mechanical ventilation.Methods:A retrospective analysis was conducted on the clin...Objective:To investigate the application effect of intelligent empowerment standardized airway management process in patients receiving mechanical ventilation.Methods:A retrospective analysis was conducted on the clinical data of 79 EICU inpatients who underwent tracheal intubation and mechanical ventilation treatment at our hospital from January 2023 to May 2025.The patients were divided into a control group(conventional airway management process,n=40)and a study group(intelligent empowerment standardized airway management process,n=39)based on the intervention protocols they received.Oral health scores,dental plaque index,oral odor,serum inflammatory markers[C-reactive protein(CRP),procalcitonin(PCT)],clinical pulmonary infection score(CPIS),as well as the incidence of ventilator-associated pneumonia(VAP),duration of mechanical ventilation,and length of stay in the EICU were assessed before and after treatment.Results:The baseline values of all indicators were consistent between the two groups before intervention(p>0.05).After corresponding interventions,both groups showed significant improvements in Beck oral health scores,dental plaque index,and oral odor,with more pronounced improvements observed in the study group(p<0.05).After the intervention,the research group showed a significant decrease in serum CRP and PCT levels,as well as CPIS scores(p<0.05).In contrast,the control group experienced an increase in these three indicators to a certain extent(p<0.05).Moreover,the incidence of ventilator-associated pneumonia(VAP),duration of mechanical ventilation,and length of stay in the EICU were all lower in the research group compared to the control group,while the nurse’s compliance rate with the protocol was higher in the research group(p<0.05).Conclusion:The standardized airway management protocol empowered by intelligent technology can significantly improve nursing compliance,benefit oral health status,reduce the risk of pulmonary infection and systemic inflammation levels,and promote rapid patient recovery,demonstrating considerable potential for widespread adoption.展开更多
The proton exchange membrane fuel cell(PEMFC)and the hydrogen hybrid power system are studied by the fuzzy-PID(FPID)controlmethod and the fuzzy-PID controlmethod by Artificial Bee Colony algorithm(ABCFPID),respectivel...The proton exchange membrane fuel cell(PEMFC)and the hydrogen hybrid power system are studied by the fuzzy-PID(FPID)controlmethod and the fuzzy-PID controlmethod by Artificial Bee Colony algorithm(ABCFPID),respectively.The results reveal that compared with the FPID control method,the temperature overshoot of the PEMFC stack under the ABC-FPID control method is decreased by 0.6%.Moreover,the circulating water flow rate within the full operating envelope(about 3 min)is reduced by 19.46 L,which means the ABC-FPID control method is more effective in regulating the stack temperature.Then,the ABC-FPID control method is proposed to study the hydrogen hybrid power system,and the system output power matching,operating characteristic curve of the fuel cell,state of charge(SOC)of the lithium battery,system efficiency and hydrogen demand are obtained.The results indicate that the maximum system efficiency reaches 46.3%,the average system efficiency is 33.8%,and the average hydrogen demand is 0.192 kg/s.Overall,the ABC-FPID control method can efficiently ensure the stability of the fuel cell’s output power,and actively prompt the lithium battery to fulfill the function of“peak shaving and valley filling”under variable load power conditions.展开更多
Understanding the complex interactions between human activities and ecosystem functions is a prerequisite for achieving sustainable development.Since the implementation of the“Grain for Green”Project in 1999,ecosyst...Understanding the complex interactions between human activities and ecosystem functions is a prerequisite for achieving sustainable development.Since the implementation of the“Grain for Green”Project in 1999,ecosystem functions in China’s Loess Plateau have significantly improved.However,intensified human activities have also exacerbated the pressures on the region’s fragile ecological environment.This study investigates the spatiotemporal variations in the human activity intensity index(HAI)and net ecosystem benefits(NEB)from 2000 to 2020,using expert-based assessments and an enhanced cost-benefit evaluation framework.Results indicate that HAI increased by 16.7% and 16.6% at the grid and county levels,respectively.NEB exhibited pronounced spatial heterogeneity,with a total increase of USD 36.2 trillion at the grid scale.At the county level,the average NEB rose by 75%.The degree of trade-off was higher at the grid scale than at the county scale,while the synergistic areas initially expanded and then declined at both scales.Key areas for improvement and regions of lagging development were identified as priority zones for ecological management and spatial planning at both spatial resolutions.This study offers scientific insights and practical guidance for harmonizing ecological conservation with high-quality development in ecologically vulnerable regions.展开更多
To address the severe challenges of PM_(2.5) and ozone co-control during the"14^(th) Five-Year Plan"period and to enhance the precision and intelligence level of air environment governance,it is imperative t...To address the severe challenges of PM_(2.5) and ozone co-control during the"14^(th) Five-Year Plan"period and to enhance the precision and intelligence level of air environment governance,it is imperative to build an efficient comprehensive management platform for regional air quality.In this paper,the specific practice in Zibo City,Shandong Province is as an example to systematically analyze the top-level design,technical implementation,and innovative application of a comprehensive management platform for regional air quality integrating"perception monitoring,data fusion,research judgment of early warnings,analysis of sources,collaborative dispatching,and evaluation assessment".Through the construction of an"sky-air-ground"integrated three-dimensional monitoring network,the platform integrates multi-source heterogeneous environmental data,and employs big data,cloud computing,artificial intelligence,CALPUFF/CMAQ,and other numerical model technologies to achieve comprehensive perception,precise prediction,intelligent source tracing,and closed-loop management of air pollution.The platform innovatively establishes a full-process closed-loop management mechanism of"data-early warning-disposition-evaluation",and achieves a fundamental transformation from passive response to active anticipation and from experience-based judgment to data driving in environmental supervision.The application results show that this platform significantly improves the scientific decision-making ability and collaborative execution efficiency of air pollution governance in Zibo City,providing a replicable and scalable comprehensive solution for similar industrial cities to achieve the continuous improvement of air quality.展开更多
With the intensification of population aging in China,the problem of cognitive impairment in the elderly has become increasingly prominent,attracting widespread attention from all sectors of society.Geriatric cognitiv...With the intensification of population aging in China,the problem of cognitive impairment in the elderly has become increasingly prominent,attracting widespread attention from all sectors of society.Geriatric cognitive impairment is characterized by chronicity,which not only seriously threatens the health of the elderly and reduces their quality of life,but also imposes a heavy burden on families and society due to its long course.Attaching importance to and strengthening the chronic disease management of elderly cognitive impairment has profound significance for delaying disease progression,improving patients’quality of life,and reducing the burden of family care.Therefore,this paper first comprehensively understands elderly cognitive impairment by briefly elaborating on its definition and characteristics;on this basis,it focuses on exploring effective strategies for the chronic disease management of elderly cognitive impairment,hoping to provide new ideas and methods for the management of this condition and offer useful references for relevant clinical research and practice.展开更多
The environmental wind tunnel of high-speed railway trains serves as a crucial experimental facility for the research and development of high-speed railway technology.The refrigeration system within the wind tunnel is...The environmental wind tunnel of high-speed railway trains serves as a crucial experimental facility for the research and development of high-speed railway technology.The refrigeration system within the wind tunnel is an important subsystem.However,the design of the wind tunnel refrigeration system management program presents significant scientific challenges and limitations.Traditional management approaches in wind tunnel refrigeration systems suffer from prolonged decision-making times and reliance on experiential knowledge,necessitating the need for intelligent transformation.This paper aims to address these issues by exploring existing intelligent management methodologies and defining the concept of a wind tunnel intelligent laboratory along with its primary modules.Furthermore,we propose a water cooler failure prediction model based on the existing equipment model of the wind tunnel's refrigeration system.This model effectively predicts the Remaining Useful Life(RUL) of the water cooler in the case of fouling failure,contributing to enhanced efficiency,cost reduction,and safety improvements in laboratories.展开更多
Chronic pain represents a significant global health challenge,and the limitations of conventional analgesics have urged a search for alternative therapeutic strategies.Cannabinoids derived from Cannabis sativa have em...Chronic pain represents a significant global health challenge,and the limitations of conventional analgesics have urged a search for alternative therapeutic strategies.Cannabinoids derived from Cannabis sativa have emerged as prominent candidates.While psychotropic cannabinoids are known for their analgesic effects,their psychoactive properties often limit their clinical utility.Consequently,interest has shifted towards non-psychotropic cannabinoids that offer potential pain relief without inducing cognitive or euphoric effects.This comprehensive review investigates the pain-modulating mechanisms of cannabinoids,encompassing interactions with the endocannabinoid system and other non-traditional pathways,and summarizes the existing preclinical and clinical evidence supporting their use in various pain states.Furthermore,it discusses the therapeutic potential,clinical considerations,significant challenges,and the need for product standardization.This review also aims to evaluate the role and prospects of non-psychotropic cannabinoids as a therapeutic option for pain management.展开更多
Purpose-This study explores how managerial leadership and organizational innovation interact to enhance resilience and risk management in railway supply chains and how these capabilities contribute to sustained compet...Purpose-This study explores how managerial leadership and organizational innovation interact to enhance resilience and risk management in railway supply chains and how these capabilities contribute to sustained competitive advantage.It emphasizes the strategic importance of resilience in railway systems that face operational complexity,regulatory pressures and increasing exposure to systemic risks.Design/methodology/approach-A mixed-methods design was employed,integrating survey data from 186 railway organizations with six case studies involving railway operators,rolling stock manufacturers and supply chain partners across multiple regions.Constructs were measured using validated scales and hypothesized relationships were tested using Structural Equation Modeling(SEM).Case study interviews were analyzed thematically to provide contextual understanding of leadership practices and innovation strategies.Findings-The results confirm that transformational managerial leadership significantly predicts innovation adoption,which in turn strengthens resilience and risk management capabilities.Resilience emerged as a powerful driver of competitive advantage,reinforcing its role as a strategic capability rather than a reactive response to disruptions.Furthermore,innovation was shown to partially mediate the relationship between leadership and resilience,highlighting its function as the operational channel through which vision translates into capability.Originality/value-This study contributes to the literature by integrating the Resource-Based View(RBV)and Dynamic Capabilities(DC)framework into the context of railway supply chains.It is among the first to empirically validate the mediating role of innovation between leadership and resilience,offering both theoretical advancements and actionable strategies for building resilient and competitive railway systems.展开更多
Water resources health diagnosis is increasingly recognized as a critical tool.It should not only guide the preservation of water volume,quality,and ecological integrity but also assess the viability of carbon-neutral...Water resources health diagnosis is increasingly recognized as a critical tool.It should not only guide the preservation of water volume,quality,and ecological integrity but also assess the viability of carbon-neutral development pathways.But current research tends to consider water health assessment and carbon-neutrality planning as separate endeavors,which results in imprecise boundaries,disjointed metrics,and a weak linkage between diagnostic outcomes and testable management actions.This review brings together indicator systems,diagnostic systems,and environmental management systems architectures that make it possible to have integrated water-carbon governance.We define fundamental concepts and delimiting decisions followed by the examination of indicator designs across the hydrological regime,water quality,ecological integrity,service performance,resilience,and carbon-related measures,including intensity of energy/emissions,emissions caused by the watershed process of wastewater treatment,as well as the potential sink of the watershed.We compare diagnostic methods,such as composite indices and multi-criteria decision analysis,data-driven early-warning models,process-based and integrated simulations,as well as uncertainty-aware robustness models.Here,based on this synthesis,we suggest an environmental management systems(EMS)-based pathway,which connects the setting of the baseline,the diagnosis,the design of the intervention portfolio,and the measurement-reporting-verification into the closed-loop adaptive cycle.Digital enablement,comprising Internet of Things(IoT)monitoring,remote sensing,data fusion,optimization,and digital twins,is considered a viable way of scaling implementation,subject to interoperability,validation,and model governance.Among the major gaps,there are causal attribution to outcomes,cross-scale coupling of facility emissions and basin health,propagation of uncertainty in a coupled model,and credible Measurement,Reporting,and Verification(MRV)of non-CO_(2) gases and nature-based removals.The review gives a roadmap to normalize core metrics and fast-deployable systems to protect the health of the water resources and give verifiable progress towards carbon neutrality.展开更多
文摘Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial.This editorial critically appraises the study by Kupietzky et al,which explored the relationship between appendicolith characteristics and NOM outcomes.Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA,comparing recurrence rates between those with and without appendicoliths.The study focused on long-term follow-up(median 44.2 months)and subgroup analyses of stone characteristics.The study revealed no significant difference in overall recurrence rates between groups(26.5%vs 19.1%,P=0.14).However,patients with appendicoliths experienced earlier recurrence(3.9 months vs 5.9 months,P=0.04)and had larger appendix diameters(10.2 mm vs 8.5 mm,P=0.001).Subgroup analyses showed no correlation between stone size,location,or number and recurrence risk.Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines.Clinical decisions should prioritize individualized risk assessment,considering patient age,symptom severity,and radiological features.These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.
文摘Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.
基金Supported by In part by a Canada Research Chair to Dr.Bhandariin part by the Canadian Institutes of Health Research and Vancouver Coastal Health Research Institute to Dr.Slobogean
文摘AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.
文摘Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls.The Individual,societal and economic costs are enormous.Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department.We review the initial assessment,criteria for imaging and clearing the spine,and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.
文摘There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between various national and international guidelines on NOM of rectal cancer.The main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical interventions.In many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is achieved.However,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.
文摘BACKGROUND Majority of adhesive small bowel obstruction(SBO)cases can be managed nonoperatively.However,a proportion of patients failed non-operative management.AIM To evaluate the predictors of successful non-operative management in adhesive SBO.METHODS A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018.Data collated included basic demographics,clinical presentation,biochemistry and imaging results and management outcomes.The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes.The patients were divided into group A operative(including those that failed initial non-operative management)and group B non-operative for analysis.RESULTS Of 252 patients were included in the final analysis;group A(n=90)(35.7%)and group B(n=162)(64.3%).There were no differences in the clinical features between both groups.Laboratory tests of inflammatory markers and lactate levels were similar in both groups.From the imaging findings,the presence of a definitive transition point[odds ratio(OR)=2.67,95%confidence interval(CI):0.98-7.32,P=0.048],presence of free fluid(OR=2.11,95%CI:1.15-3.89,P=0.015)and absence of small bowel faecal signs(OR=1.70,95%CI:1.01-2.88,P=0.047)were predictive of the need of surgical intervention.In patients that received water soluble contrast medium,the evidence of contrast in colon was 3.83 times predictive of successful non-operative management(95%CI:1.79-8.21,P=0.001).CONCLUSION The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.
文摘Purpose:Non-operative management(NOM)has been validated for blunt liver and splenic injuries.Literature on continuous intra-abdominal pressure(IAP)monitoring as a part of NOM remains to be equivocal.The study aimed to find any correlation between clinical parameters and IAP,and their effect on the NOM of patients with blunt liver and splenic injury.Method:A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries.Hemodynamically unstable patients or those on ventilators were excluded,as well as patients who suffered significant head,spinal cord,and/or bladder injuries.The study predominantly included males(83.9%)with a mean age of 32.5 years.IAP was monitored continuously and the relation of IAP with various parameters,interventions,and outcomes were measured.Data were summarized as frequency(percentage)or mean±SD or median(Q1,Q3)as indicated.χ2 or Fisher's exact test was used for categorical variables,while for continuous variables parametric(independent t-test)or nonparametric tests(Wilcoxon rank sum test)were used as appropriate.Clinical and laboratory correlates of IAP<12 with p<0.200 in the univariable logistic regression analysis were included in the multivariable analysis.A p<0.05 was used to indicate statistical significance.Results:Intra-abdominal hypertension(IAH)was seen in 19.0%of the study population.IAH was strongly associated with a high injury severity score(p<0.001),and other physiological parameters like respiratory rate(p<0.001),change in abdominal girth(AG)(p<0.001),and serum creatinine(p<0.001).IAH along with the number of solid organs involved,respiratory rate,change in AG,and serum creatinine was associated with the intervention,either operative or non-operative(p=0.001,p=0.002,p<0.001,p<0.001,p=0.013,respectively).On multivariable analysis,IAP(p=0.006)and the mean change of AG(p=0.004)were significantly associated with the need for intervention.Conclusion:As a part of NOM,IAP should be monitored as a continuous vital.However,the decision for any intervention,either operative or non-operative cannot be guided by IAP values alone.
文摘Purpose: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE. Methods: A systematic literature review searched "liver trauma" , "hepatic trauma" , "conservative management" , "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs;studies reported NOM complications together with those post-intervention;case reports;studies including less than 5 cases;studies not written in English;and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test. Results: A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications were hepatic collection (3.1%), followed by bile leak (1.5%), with variability between the studies. Other complications included hepatic haematoma, bleeding, fistula, pseudoaneurysm, compartment syndrome, peritonitis, and gallbladder ischemia, all with an incidence below 1%. Conclusion: NOM with simple clinical observation showed an overall low incidence of complications, but higher for bile leak and collections. In patients with grade III and above injuries, the incidence of bile leak, collections and compartment syndrome did not show a statistically significant difference with the AE group. However, the latter result is limited by the small number of studies available and it requires further investigations.
文摘Purpose-Interface management is the process of managing communications,responsibilities and coordination of project parties,phases or physical entities which are dependent on one another.Interface management is a crucial part of managing any construction project-but particularly important for high-speed railway projects that often have several contractual parties and stakeholders,very long project timelines and huge upfront cost overlays.This paper discusses how various project interfaces were managed during the design and construction of the civil engineering infrastructure for the High Speed Two(HS2)project in the United Kingdom.Design/methodology/approach-The paper uses the case study methodology.Key interfaces on the HS2 project are grouped into various categories and the paper discusses how they were managed within the Area North Integrated Project Team(IPT)of the HS2 project made up of contractor Balfour Beatty VINCI(BBV),the Mott MacDonald SYSTRA Design Joint Venture(DJV)and client HS2 Ltd.3 different case studies drawn from across the IPT are used,each of them highlighting different interfaces and how these interfaces were managed.Findings-The paper shows how innovative technical designs and modern methods of construction were used to address some of the unique and peculiar challenges of designing a brand-new railway in the United Kingdom.Addressing the contrasting and often competing requirements of different stakeholders,coupled with challenging physical constraints of the very limited land available for the project and the use of a rarely used Act of Parliament in the delivery of the project required different approach to interface management.Collaboration and proactive stakeholder engagement are necessary for successful interface management on megaprojects.The authors posit that adopting an integrated approach to engineering and construction management is an essential ingredient for the successful delivery of high-speed railway projects.Originality/value-With many high-speed railway projects around the world coming up in the next few years,understanding the context and challenges for each country will help engineering and design managers adopt appropriate approaches for their projects.The lessons learned on the HS2 project are also transferable to other mega infrastructure projects with complex project interfaces.
文摘Journal Introduction″International Journal of Plant Engineering and Management″is in the charge of Ministry of Industry and Information Technology of the People′s Republic of China,and organized by Northwestern Polytechnical University.It is a kind of English aca-demic quarterly publication publicly issued at home and abroad.Plant engineering and management is a comprehensive interdisciplinary subject mainly reporting academic research on the application technology of equipment and industry management.It is of the characteristics of reporting both engineering and management while giving more priority to engineering as well as mechanics and electrics while giving priority to mechanics.Its contents involves technology,economy,management etc.
文摘Objective:To investigate the application effect of intelligent empowerment standardized airway management process in patients receiving mechanical ventilation.Methods:A retrospective analysis was conducted on the clinical data of 79 EICU inpatients who underwent tracheal intubation and mechanical ventilation treatment at our hospital from January 2023 to May 2025.The patients were divided into a control group(conventional airway management process,n=40)and a study group(intelligent empowerment standardized airway management process,n=39)based on the intervention protocols they received.Oral health scores,dental plaque index,oral odor,serum inflammatory markers[C-reactive protein(CRP),procalcitonin(PCT)],clinical pulmonary infection score(CPIS),as well as the incidence of ventilator-associated pneumonia(VAP),duration of mechanical ventilation,and length of stay in the EICU were assessed before and after treatment.Results:The baseline values of all indicators were consistent between the two groups before intervention(p>0.05).After corresponding interventions,both groups showed significant improvements in Beck oral health scores,dental plaque index,and oral odor,with more pronounced improvements observed in the study group(p<0.05).After the intervention,the research group showed a significant decrease in serum CRP and PCT levels,as well as CPIS scores(p<0.05).In contrast,the control group experienced an increase in these three indicators to a certain extent(p<0.05).Moreover,the incidence of ventilator-associated pneumonia(VAP),duration of mechanical ventilation,and length of stay in the EICU were all lower in the research group compared to the control group,while the nurse’s compliance rate with the protocol was higher in the research group(p<0.05).Conclusion:The standardized airway management protocol empowered by intelligent technology can significantly improve nursing compliance,benefit oral health status,reduce the risk of pulmonary infection and systemic inflammation levels,and promote rapid patient recovery,demonstrating considerable potential for widespread adoption.
基金supported by the Natural Science Foundation of Jiangsu Province(BK20231445)Aeronautical Science Foundation of China(20230028052001).
文摘The proton exchange membrane fuel cell(PEMFC)and the hydrogen hybrid power system are studied by the fuzzy-PID(FPID)controlmethod and the fuzzy-PID controlmethod by Artificial Bee Colony algorithm(ABCFPID),respectively.The results reveal that compared with the FPID control method,the temperature overshoot of the PEMFC stack under the ABC-FPID control method is decreased by 0.6%.Moreover,the circulating water flow rate within the full operating envelope(about 3 min)is reduced by 19.46 L,which means the ABC-FPID control method is more effective in regulating the stack temperature.Then,the ABC-FPID control method is proposed to study the hydrogen hybrid power system,and the system output power matching,operating characteristic curve of the fuel cell,state of charge(SOC)of the lithium battery,system efficiency and hydrogen demand are obtained.The results indicate that the maximum system efficiency reaches 46.3%,the average system efficiency is 33.8%,and the average hydrogen demand is 0.192 kg/s.Overall,the ABC-FPID control method can efficiently ensure the stability of the fuel cell’s output power,and actively prompt the lithium battery to fulfill the function of“peak shaving and valley filling”under variable load power conditions.
基金National Natural Science Foundation of China(Grant No.U2243225)the Strategic Priority Research Program of the Chinese Academy of Sciences(Grant No.XDB40000000)+2 种基金the Natural Science Basic Research Program of Shaanxi(Grant No.Z2024-ZYFS-0065)the Funding of Top Young talents of Ten Thousand talents Plan in China(2021)the Fundamental Research Funds for the Central Universities(Grants No.2452023071 and 2023HHZX002).
文摘Understanding the complex interactions between human activities and ecosystem functions is a prerequisite for achieving sustainable development.Since the implementation of the“Grain for Green”Project in 1999,ecosystem functions in China’s Loess Plateau have significantly improved.However,intensified human activities have also exacerbated the pressures on the region’s fragile ecological environment.This study investigates the spatiotemporal variations in the human activity intensity index(HAI)and net ecosystem benefits(NEB)from 2000 to 2020,using expert-based assessments and an enhanced cost-benefit evaluation framework.Results indicate that HAI increased by 16.7% and 16.6% at the grid and county levels,respectively.NEB exhibited pronounced spatial heterogeneity,with a total increase of USD 36.2 trillion at the grid scale.At the county level,the average NEB rose by 75%.The degree of trade-off was higher at the grid scale than at the county scale,while the synergistic areas initially expanded and then declined at both scales.Key areas for improvement and regions of lagging development were identified as priority zones for ecological management and spatial planning at both spatial resolutions.This study offers scientific insights and practical guidance for harmonizing ecological conservation with high-quality development in ecologically vulnerable regions.
文摘To address the severe challenges of PM_(2.5) and ozone co-control during the"14^(th) Five-Year Plan"period and to enhance the precision and intelligence level of air environment governance,it is imperative to build an efficient comprehensive management platform for regional air quality.In this paper,the specific practice in Zibo City,Shandong Province is as an example to systematically analyze the top-level design,technical implementation,and innovative application of a comprehensive management platform for regional air quality integrating"perception monitoring,data fusion,research judgment of early warnings,analysis of sources,collaborative dispatching,and evaluation assessment".Through the construction of an"sky-air-ground"integrated three-dimensional monitoring network,the platform integrates multi-source heterogeneous environmental data,and employs big data,cloud computing,artificial intelligence,CALPUFF/CMAQ,and other numerical model technologies to achieve comprehensive perception,precise prediction,intelligent source tracing,and closed-loop management of air pollution.The platform innovatively establishes a full-process closed-loop management mechanism of"data-early warning-disposition-evaluation",and achieves a fundamental transformation from passive response to active anticipation and from experience-based judgment to data driving in environmental supervision.The application results show that this platform significantly improves the scientific decision-making ability and collaborative execution efficiency of air pollution governance in Zibo City,providing a replicable and scalable comprehensive solution for similar industrial cities to achieve the continuous improvement of air quality.
文摘With the intensification of population aging in China,the problem of cognitive impairment in the elderly has become increasingly prominent,attracting widespread attention from all sectors of society.Geriatric cognitive impairment is characterized by chronicity,which not only seriously threatens the health of the elderly and reduces their quality of life,but also imposes a heavy burden on families and society due to its long course.Attaching importance to and strengthening the chronic disease management of elderly cognitive impairment has profound significance for delaying disease progression,improving patients’quality of life,and reducing the burden of family care.Therefore,this paper first comprehensively understands elderly cognitive impairment by briefly elaborating on its definition and characteristics;on this basis,it focuses on exploring effective strategies for the chronic disease management of elderly cognitive impairment,hoping to provide new ideas and methods for the management of this condition and offer useful references for relevant clinical research and practice.
文摘The environmental wind tunnel of high-speed railway trains serves as a crucial experimental facility for the research and development of high-speed railway technology.The refrigeration system within the wind tunnel is an important subsystem.However,the design of the wind tunnel refrigeration system management program presents significant scientific challenges and limitations.Traditional management approaches in wind tunnel refrigeration systems suffer from prolonged decision-making times and reliance on experiential knowledge,necessitating the need for intelligent transformation.This paper aims to address these issues by exploring existing intelligent management methodologies and defining the concept of a wind tunnel intelligent laboratory along with its primary modules.Furthermore,we propose a water cooler failure prediction model based on the existing equipment model of the wind tunnel's refrigeration system.This model effectively predicts the Remaining Useful Life(RUL) of the water cooler in the case of fouling failure,contributing to enhanced efficiency,cost reduction,and safety improvements in laboratories.
文摘Chronic pain represents a significant global health challenge,and the limitations of conventional analgesics have urged a search for alternative therapeutic strategies.Cannabinoids derived from Cannabis sativa have emerged as prominent candidates.While psychotropic cannabinoids are known for their analgesic effects,their psychoactive properties often limit their clinical utility.Consequently,interest has shifted towards non-psychotropic cannabinoids that offer potential pain relief without inducing cognitive or euphoric effects.This comprehensive review investigates the pain-modulating mechanisms of cannabinoids,encompassing interactions with the endocannabinoid system and other non-traditional pathways,and summarizes the existing preclinical and clinical evidence supporting their use in various pain states.Furthermore,it discusses the therapeutic potential,clinical considerations,significant challenges,and the need for product standardization.This review also aims to evaluate the role and prospects of non-psychotropic cannabinoids as a therapeutic option for pain management.
文摘Purpose-This study explores how managerial leadership and organizational innovation interact to enhance resilience and risk management in railway supply chains and how these capabilities contribute to sustained competitive advantage.It emphasizes the strategic importance of resilience in railway systems that face operational complexity,regulatory pressures and increasing exposure to systemic risks.Design/methodology/approach-A mixed-methods design was employed,integrating survey data from 186 railway organizations with six case studies involving railway operators,rolling stock manufacturers and supply chain partners across multiple regions.Constructs were measured using validated scales and hypothesized relationships were tested using Structural Equation Modeling(SEM).Case study interviews were analyzed thematically to provide contextual understanding of leadership practices and innovation strategies.Findings-The results confirm that transformational managerial leadership significantly predicts innovation adoption,which in turn strengthens resilience and risk management capabilities.Resilience emerged as a powerful driver of competitive advantage,reinforcing its role as a strategic capability rather than a reactive response to disruptions.Furthermore,innovation was shown to partially mediate the relationship between leadership and resilience,highlighting its function as the operational channel through which vision translates into capability.Originality/value-This study contributes to the literature by integrating the Resource-Based View(RBV)and Dynamic Capabilities(DC)framework into the context of railway supply chains.It is among the first to empirically validate the mediating role of innovation between leadership and resilience,offering both theoretical advancements and actionable strategies for building resilient and competitive railway systems.
文摘Water resources health diagnosis is increasingly recognized as a critical tool.It should not only guide the preservation of water volume,quality,and ecological integrity but also assess the viability of carbon-neutral development pathways.But current research tends to consider water health assessment and carbon-neutrality planning as separate endeavors,which results in imprecise boundaries,disjointed metrics,and a weak linkage between diagnostic outcomes and testable management actions.This review brings together indicator systems,diagnostic systems,and environmental management systems architectures that make it possible to have integrated water-carbon governance.We define fundamental concepts and delimiting decisions followed by the examination of indicator designs across the hydrological regime,water quality,ecological integrity,service performance,resilience,and carbon-related measures,including intensity of energy/emissions,emissions caused by the watershed process of wastewater treatment,as well as the potential sink of the watershed.We compare diagnostic methods,such as composite indices and multi-criteria decision analysis,data-driven early-warning models,process-based and integrated simulations,as well as uncertainty-aware robustness models.Here,based on this synthesis,we suggest an environmental management systems(EMS)-based pathway,which connects the setting of the baseline,the diagnosis,the design of the intervention portfolio,and the measurement-reporting-verification into the closed-loop adaptive cycle.Digital enablement,comprising Internet of Things(IoT)monitoring,remote sensing,data fusion,optimization,and digital twins,is considered a viable way of scaling implementation,subject to interoperability,validation,and model governance.Among the major gaps,there are causal attribution to outcomes,cross-scale coupling of facility emissions and basin health,propagation of uncertainty in a coupled model,and credible Measurement,Reporting,and Verification(MRV)of non-CO_(2) gases and nature-based removals.The review gives a roadmap to normalize core metrics and fast-deployable systems to protect the health of the water resources and give verifiable progress towards carbon neutrality.
