Wearable Clinic: From Microneedle-Based Sensors to Next-Generation Healthcare Platforms

The rapid development of wearable biosensing calls for next-generation devices that allow continuous, real-time, and painless monitoring of health status along with responsive medical treatment. Microneedles have exhibited great potential for the direct access of dermal interstitial fluid (ISF) in a minimally invasive manner. Recent studies of microneedle-based devices have evolved from conventional off-line detection to multiplexed, wireless, and integrated sensing. In this review, the classification and fabrication techniques of microneedles are first introduced, and then the representative examples of microneedles for transdermal monitoring with different sensing modalities are summarized. State-of-the-art advances in therapeutic and closed-loop systems are presented to formulate guidelines for the development of next-generation microneedle-based healthcare platforms. The potential challenges and prospects are discussed to pave a new avenue toward pragmatic applications in the real world.

Reproductive development of dairy heifers in an integrated livestock-forest system during the summer

This study aimed to assess the cortisol, body and reproductive development of prepubertal Holstein and Holstein-Gir ¾ heifers at 27 months of age maintained in an integrated livestock-forest (ILF) system for 60 summer days compared to the monoculture system in full sun (FS). The ILF system promoted changes (P=0.02) in the cortisol levels of Holstein-Gir ¾ heifers and did not affect weight gain in any of the breed groups studied. Animals in ILF system presented a lower (P=0.006) vulvar development for the rima height parameter and similar for the vulva width parameter. The ovarian follicular population of Holstein-Gir ¾ heifers in the ILF system was lower (P=0.004); however, for the Holstein heifers, no statistical difference was found, and numbers were higher (P=0.08) in the ILF system. None of the other ovarian parameters studied had any changes, and we also found important racial differences. Weight gain (P=0.003), vulvar development (P<0.001), and mean follicular size (P=0.008) were higher in the Holstein-Gir ¾ animals. Based on such results, the effect of the ILF system at 27 months of age on stress and reproductive parameters in the Holstein breed is considered positive, although negative effects have been detected on reproductive parameters in the Holstein-Gir ¾ breed.

UV-Assisted Hyperbranched Poly(β-amino ester) Modification of a Silica Membrane for Two-Step Microfluidic DNA Extraction from Blood

Integrating nucleic acid extraction in amplification-based point-of-care diagnostics will be a significant feature for next-generation point-of-care virus detection devices. However, extracting DNA efficiently on a microfluidic chip poses many technological and commercialization challenges, including manual steps, multiple instruments, pretreatment processes, and the use of organic solvents (ethanol, IPA) that inhibit detection, which is not viable with routine testing such as viral load monitoring of transplant patients for post-operative care. This paper presents a microfluidic system capable of two-step DNA extraction from blood using a UV-assisted hyperbranched poly(β-amino ester) (HPAE)-modified silica membrane for cytomegalovirus (CMV) detection in a rapid and instrument-free manner without the presence of amplification inhibitors. HPAEs of varying branch ratios were synthesized, screened, and coated on a silica membrane and bonded between two layers of poly(methyl methacrylate) (PMMA) substrates. Our system could selectively extract DNA from blood with an efficiency of 94% and a lower limit viral load of 300 IU/mL in 20 min. The extracted DNA was used as the template for real-time loop-mediated isothermal amplification (LAMP)-based detection of CMV and was found to produce a fluorescent signal intensity that was comparable with commercially extracted templates. This system can be integrated easily with a nucleic acid amplification system and used for routine rapid testing of viral load in patient blood samples.

An Integrated System of Braden Scale and Random Forest Using Real-Time Diagnoses to Predict When Hospital-Acquired Pressure Injuries (Bedsores) Occur

BACKGROUND AND OBJECTIVES

Bedsores/Pressure Injuries (PIs) are the second most common diagnosis in healthcare system billing records in the United States and account for 60,000 deaths annually. Hospital-Acquired Pressure Injuries (HAPIs) are one classification of PIs and indicate injuries that occurred while the patient was cared for within the hospital. Until now, all studies have predicted who will develop HAPI using classic machine algorithms, which provides incomplete information for the clinical team. Knowing who will develop HAPI does not help differentiate at which point those predicted patients will develop HAPIs; no studies have investigated when HAPI develops for predicted at-risk patients. This research aims to develop a hybrid system of Random Forest (RF) and Braden Scale to predict HAPI time by considering the changes in patients' diagnoses from admission until HAPI occurrence.

METHODS

Real-time diagnoses and risk factors were collected daily for 485 patients from admission until HAPI occurrence, which resulted in 4619 records. Then for each record, HAPI time was calculated from the day of diagnosis until HAPI occurrence. Recursive Feature Elimination (RFE) selected the best factors among the 60 factors. The dataset was separated into 80% training (10-fold cross-validation) and 20% testing. Grid Search (GS) with RF (GS-RF) was adopted to predict HAPI time using collected risk factors, including Braden Scale. Then, the proposed model was compared with the seven most common algorithms used to predict HAPI; each was replicated for 50 different experiments.

RESULTS

GS-RF achieved the best Area Under the Curve (AUC) (91.20 ± 0.26) and Geometric Mean (G-mean) (91.17 ± 0.26) compared to the seven algorithms. RFE selected 43 factors. The most dominant interactable risk factors in predicting HAPI time were visiting ICU during hospitalization, Braden subscales, BMI, Stimuli Anesthesia, patient refusal to change position, and another lab diagnosis.

CONCLUSION

Identifying when the patient is likely to develop HAPI can target early intervention when it is needed most and reduces unnecessary burden on patients and care teams when patients are at lower risk, which further individualizes the plan of care.

Roles of MXene in Pressure Sensing: Preparation, Composite Structure Design, and Mechanism

Flexible pressure sensors are one of the most important components in the fields of electronic skin (e-skin), robotics, and health monitoring. However, the application of pressure sensors in practice is still difficult and expensive due to the limited sensing properties and complex manufacturing process. The emergence of MXene, a red-hot member of the 2D nanomaterials, has brought a brand-new breakthrough for pressure sensing. Ti₃ C₂ T_x is the most popular studied MXene in the field of pressure sensing and shows good mechanical, electrical properties, excellent hydrophilicity, and extensive modifiability. It will ameliorate the properties of the sensitive layer and electrode layer of the pressure sensor, and further apply pressure sensing to many fields, such as e-skin flexibility. Herein, the preparation technologies, antioxidant methods, and properties of MXene are summarized. The design of MXene-based microstructures is introduced, including hydrogels, aerogels, foam, fabrics, and composite nanofibers. The mechanisms of MXene pressure sensors are further broached, including piezoresistive, capacitive, piezoelectric, triboelectric, and potentiometric transduction mechanism. Moreover, the integration of multiple devices is reviewed. Finally, the chance and challenge of pressure sensors improved by MXene smart materials in future e-skin and the Internet of Things are prospected.

Recent Advances in Intelligent Wearable Medical Devices Integrating Biosensing and Drug Delivery

The primary roles of precision medicine are to perform real-time examination, administer on-demand medication, and apply instruments continuously. However, most current therapeutic systems implement these processes separately, leading to treatment interruption and limited recovery in patients. Personalized healthcare and smart medical treatment have greatly promoted research on and development of biosensing and drug-delivery integrated systems, with intelligent wearable medical devices (IWMDs) as typical systems, which have received increasing attention because of their non-invasive and customizable nature. Here, the latest progress in research on IWMDs is reviewed, including their mechanisms of integrating biosensing and on-demand drug delivery. The current challenges and future development directions of IWMDs are also discussed.

Lab-on-a-Contact Lens: Recent Advances and Future Opportunities in Diagnostics and Therapeutics

The eye is one of the most complex organs in the human body, containing rich and critical physiological information (e.g., intraocular pressure, corneal temperature, and pH) as well as a library of metabolite biomarkers (e.g., glucose, proteins, and specific ions). Smart contact lenses (SCLs) can serve as a wearable intelligent ocular prosthetic device capable of noninvasive and continuous monitoring of various essential physical/biochemical parameters and drug loading/delivery for the treatment of ocular diseases. Advances in SCL technologies and the growing public interest in personalized health are accelerating SCL research more than ever before. Here, the current status and potential of SCL development through a comprehensive review from fabrication to applications to commercialization are discussed. First, the material, fabrication, and platform designs of the SCLs for the diagnostic and therapeutic applications are discussed. Then, the latest advances in diagnostic and therapeutic SCLs for clinical translation are reviewed. Later, the established techniques for wearable power transfer and wireless data transmission applied to current SCL devices are summarized. An outlook, future opportunities, and challenges for developing next-generation SCL devices are also provided. With the rise in interest of SCL development, this comprehensive and essential review can serve as a new paradigm for the SCL devices.

Advanced Multifunctional Aqueous Rechargeable Batteries Design: From Materials and Devices to Systems

Multifunctional aqueous rechargeable batteries (MARBs) are regarded as safe, cost-effective, and scalable electrochemical energy storage devices, which offer additional functionalities that conventional batteries cannot achieve, which ideally leads to unprecedented applications. Although MARBs are among the most exciting and rapidly growing topics in scientific research and industrial development nowadays, a systematic summary of the evolution and advances in the field of MARBs is still not available. Therefore, the review presented comprehensively and systematically summarizes the design principles and the recent advances of MARBs by categories of smart ARBs and integrated systems, together with an analysis of their device design and configuration, electrochemical performance, and diverse smart functions. The two most promising strategies to construct novel MARBs may be A) the introduction of functional materials into ARB components, and B) integration of ARBs with other functional devices. The ongoing challenges and future perspectives in this research and development field are outlined to foster the future development of MARBs. Finally, the most important upcoming research directions in this rapidly developing field are highlighted that may be most promising to lead to the commercialization of MARBs and to a further broadening of their range of applications.

Advances in Si and SiC Materials for High-Performance Supercapacitors toward Integrated Energy Storage Systems

Silicon (Si), as the second most abundant element on Earth, has been a central platform of modern electronics owing to its low mass density and unique semiconductor properties. From an energy perspective, all-in-one integration of power supply systems onto Si-based functional devices is highly desirable, which inspires significant study on Si-based energy storage. Compared to the well-known Si-anode Li-ion batteries, Si-based supercapacitors possess high power density, long life, and simple working mechanisms, which enables their ease of integration onto a wide range of devices and applications. Besides Si, silicon carbide (SiC), as a physicochemically stable wide-bandgap semiconductor, also attracts research attention as an energy storage material in harsh environments. In this review, a detailed overview of latest advances in materials design, synthesis methods, and performances of Si-based and SiC-based supercapacitors will be provided. Some successful integrated devices, future perspectives, and potential research directions are also highlighted and discussed.

Effects of Corn Silage Inclusion Level and Type of Anabolic Implant on Animal Growth Performance, Apparent Total Tract Digestibility, Beef Production per Hectare, and Carcass Characteristics of Finishing Steers

Simple Summary

Corn silage has long been a staple feed ingredient in cattle diets throughout the Midwest region of the United States. The most recent Feedlot Consulting Nutritionist Survey indicated that corn silage was the primary and secondary roughage source used in finishing diets by 37.5% of respondents. Using the entirety of the corn plant for feed allows for producers to quickly harvest feed tonnage. A common belief is that one should only include enough corn silage in a finishing ration to maintain rumen health. However, previous research conducted by our research group suggested that feeding increased levels of corn silage could increase the quantity of beef produced per hectare of cropland. Another aspect to consider when finishing cattle is implant type. Today a wide variety of implants are available, including polymer barrier coated and non-coated implants. Coated implants can provide an extended release of trenbolone acetate and estradiol for up to 200 days post-implantation. The objectives of the current study were to determine the influence of corn silage inclusion level and terminal implant type on animal growth performance, apparent total tract digestibility, carcass traits, and beef production per hectare of cropland in finishing steers harvested at common rib fat thickness.

Abstract

Maine-Anjou × Angus cross-bred steers (n = 156 steers; initial body weight (BW) 366 ± 37.2 kg) were used in a 132 d finishing study conducted at the Ruminant Nutrition Center (RNC) in Brookings, SD. Steers were blocked by weight (n = 5 BW blocks) and randomly assigned to an implant and dietary treatment of a randomized complete block design with each pen containing seven to eight steers (n = 20 pens). Dietary treatments consisted of (1) 15% (CS15) or (2) 30% corn silage (CS30) where corn silage displaced corn grain in the diet. Steers received one of two implants (both from Zoetis, Parsippany, NJ) containing equal doses of trenbolone acetate (TBA) and estradiol benzoate (EB): (1) Synovex PLUS (non-coated implant; 200 mg TBA and 28 mg EB; PLUS) or (2) Synovex ONE Feedlot (coated implant; 200 mg TBA and 28 mg EB; ONE-F). Bunks were managed using a slick bunk approach, and all diets contained dry matter (DM) basis 33 mg/kg monensin sodium. All steers were offered ad libitum access to feed, and feeding occurred twice daily in equal portions. There was no interaction between the implant and dietary treatment for any variables measured (p ≥ 0.08). Carcass-adjusted basis final BW, average daily gain (ADG), and grain to feed (G:F) were increased (p ≤ 0.02) by 2.2%, 6.5%, and 7.2%, respectively, for CS15. Observed net energy (NE) and the ratio of observed-to-expected NE for maintenance and gain was not influenced (p ≥ 0.15) by silage inclusion treatment. Beef production per hectare was not impacted (p ≥ 0.13) by corn silage inclusion level. Fecal output was increased, and digestibility coefficients for dry matter, organic matter, and crude protein were decreased in CS30 (p ≤ 0.03). Dressing percent and hot carcass weight (HCW) were greater (p ≤ 0.02) in CS15. Implant type did not influence any traits measured (p ≥ 0.14) except for marbling. Marbling was decreased for PLUS (433 vs. 466 ± 17.5; p = 0.02) compared to ONE-F steers. Similar beef produced per hectare of crop land-based upon silage feeding level means producers can feed greater inclusions of corn silage to finishing cattle without impacting carcass quality or beef production; implanting with a coated implant had no detrimental effects to growth performance but increases marbling scores.

The Future of Carbon Dioxide Chemistry

The utilization of carbon dioxide as building block for chemicals or source of carbon for energy products has been explored for over 40 years now, with varying allure. In correspondence with oil-crises, the use of CO₂ has come into the spotlight, soon set aside when the crisis was over due to the low price of fossil carbon and the convenience of using established technologies. Nowadays, there is a continuous shift from fossil-C-based to perennial (solar, wind, geothermal, hydro-power) energy-driven processes that will also have a great potential to convert large amounts of carbon dioxide. The integration of biotechnology and catalysis will be a key player towards the utilization of CO₂ in several different applications, reducing both the extraction of fossil carbon and the carbon transfer to the atmosphere.

Modular and Integrated Systems for Nanoparticle and Microparticle Synthesis-A Review

Nanoparticles (NPs) and microparticles (MPs) have been widely used in different areas of research such as materials science, energy, and biotechnology. On-demand synthesis of NPs and MPs with desired chemical and physical properties is essential for different applications. However, most of the conventional methods for producing NPs/MPs require bulky and expensive equipment, which occupies large space and generally need complex operation with dedicated expertise and labour. These limitations hinder inexperienced researchers to harness the advantages of NPs and MPs in their fields of research. When problems individual researchers accumulate, the overall interdisciplinary innovations for unleashing a wider range of directions are undermined. In recent years, modular and integrated systems are developed for resolving the ongoing dilemma. In this review, we focus on the development of modular and integrated systems that assist the production of NPs and MPs. We categorise these systems into two major groups: systems for the synthesis of (1) NPs and (2) MPs; systems for producing NPs are further divided into two sections based on top-down and bottom-up approaches. The mechanisms of each synthesis method are explained, and the properties of produced NPs/MPs are compared. Finally, we discuss existing challenges and outline the potentials for the development of modular and integrated systems.

Effect of inclusion rate of silage with or without alpha-amylase trait on finishing steer growth performance, carcass characteristics, and agronomic efficiency measures

One hundred ninety-two Continental × British steers [initial body weight (BW) = 420 kg (standard deviation = 24.7)] were used in a randomized complete block design finishing study to evaluate the effects of feeding two types of silage germplasm at two inclusion rates. A 2 × 2 factorial arrangement of treatments was used with either a conventional hybrid (Golden Harvest G07B39-311A, Syngenta Seeds LLC, Minnetonka, MN; CON) or a hybrid with increased expression of alpha-amylase (Syngenta Enogen Feed corn, Golden Harvest E107B3-3011A-EVT5, Syngenta Seeds, LLC; ENO) fed at either 12% (12SIL) or 24% (24SIL) of diet dry matter. Steers were blocked by source and location (source 1: first three pen replicates, n = 10 steers per pen with a fourth pen replicate of six steers per pen; source 2: one pen replicate, n = 12 steers per pen) and assigned randomly within block to treatments, resulting in five pens and 48 steers per treatment. Steers were harvested after 126 (12SIL) or 140 (24SIL) days on feed (DOF). There were no silage hybrid by inclusion rate interactions detected for live growth performance (P ≥ 0.15). Silage hybrid did not affect average daily gain (ADG), gain-to-feed ratio (G:F), or final BW (FBW; P ≥ 0.35). Feeding 24% silage reduced ADG (P = 0.04) and increased G:F (P = 0.01) but increased FBW (P = 0.02) because of greater DOF compared with 12SIL. A hybrid by inclusion rate interaction was detected (P = 0.04) for calculated yield grade (YG) with steers fed 24SIL having increased YG within CON but not ENO. Hot carcass weight and rib fat were unaffected by silage hybrid (P ≥ 0.81) but were increased by feeding 24SIL (P = 0.03 and P = 0.02, respectively). Feeding increased amounts of silage increased beef produced per hectare (P = 0.05). Source of silage did not affect feedlot growth performance of cattle but, because of slight differences in estimated silage yield, conventional silage produced more kilograms of beef per hectare (P < 0.01). Feeding increased amounts of silage reduced G:F on both a live and carcass-adjusted basis but increased kilograms of beef produced per unit of land, which is paramount to cattle feeders who grow their own feedstuffs.

Monitoring Water-Soil Dynamics and Tree Survival Using Soil Sensors under a Big Data Approach

The high importance of green urban planning to ensure access to green areas requires modern and multi-source decision-support tools. The integration of remote sensing data and sensor developments can contribute to the improvement of decision-making in urban forestry. This study proposes a novel big data-based methodology that combines real-time information from soil sensors and climate data to monitor the establishment of a new urban forest in semi-arid conditions. Water-soil dynamics and their implication in tree survival were analyzed considering the application of different treatment restoration techniques oriented to facilitate the recovery of tree and shrub vegetation in the degraded area. The synchronized data-capturing scheme made it possible to evaluate hourly, daily, and seasonal changes in soil-water dynamics. The spatial variation of soil-water dynamics was captured by the sensors and it highly contributed to the explanation of the observed ground measurements on tree survival. The methodology showed how the efficiency of treatments varied depending on species selection and across the experimental design. The use of retainers for improving soil moisture content and adjusting tree-watering needs was, on average, the most successful restoration technique. The results and the applied calibration of the sensor technology highlighted the random behavior of water-soil dynamics despite the small-scale scope of the experiment. The results showed the potential of this methodology to assess watering needs and adjust watering resources to the vegetation status using real-time atmospheric and soil data.

Electrophoretic Deposition of WS2 Flakes on Nanoholes Arrays-Role of Used Suspension Medium

Here we optimized the electrophoretic deposition process for the fabrication of WS₂ plasmonic nanohole integrated structures. We showed how the conditions used for site-selective deposition influenced the properties of the deposited flakes. In particular, we investigated the effect of different suspension buffers used during the deposition both in the efficiency of the process and in the stability of WS₂ flakes, which were deposited on an ordered arrays of plasmonic nanostructures. We observed that a proper buffer can significantly facilitate the deposition process, keeping the material stable with respect to oxidation and contamination. Moreover, the integrated plasmonic structures that can be prepared with this process can be applied to enhanced spectroscopies and for the preparation of 2D nanopores.

Smart Bandages: The Future of Wound Care

Chronic non-healing wounds are major healthcare challenges that affect a noticeable number of people; they exert a severe financial burden and are the leading cause of limb amputation. Although chronic wounds are locked in a persisting inflamed state, they are dynamic and proper therapy requires identifying abnormalities, administering proper drugs and growth factors, and modulating the conditions of the environment. In this review article, we discuss technologies that have been developed to actively monitor the wound environment. We also highlight drug delivery tools that have been integrated with bandages to facilitate precise temporal and spatial control over drug release and review automated or semi-automated systems that can respond to the wound environment.

Recent Progress of Self-Powered Sensing Systems for Wearable Electronics

Wearable/flexible electronic sensing systems are considered to be one of the key technologies in the next generation of smart personal electronics. To realize personal portable devices with mobile electronics application, i.e., wearable electronic sensors that can work sustainably and continuously without an external power supply are highly desired. The recent progress and advantages of wearable self-powered electronic sensing systems for mobile or personal attachable health monitoring applications are presented. An overview of various types of wearable electronic sensors, including flexible tactile sensors, wearable image sensor array, biological and chemical sensor, temperature sensors, and multifunctional integrated sensing systems is provided. Self-powered sensing systems with integrated energy units are then discussed, separated as energy harvesting self-powered sensing systems, energy storage integrated sensing systems, and all-in-on integrated sensing systems. Finally, the future perspectives of self-powered sensing systems for wearable electronics are discussed.

Recent Progress of Self-Powered Sensing Systems for Wearable Electronics

Wearable/flexible electronic sensing systems are considered to be one of the key technologies in the next generation of smart personal electronics. To realize personal portable devices with mobile electronics application, i.e., wearable electronic sensors that can work sustainably and continuously without an external power supply are highly desired. The recent progress and advantages of wearable self-powered electronic sensing systems for mobile or personal attachable health monitoring applications are presented. An overview of various types of wearable electronic sensors, including flexible tactile sensors, wearable image sensor array, biological and chemical sensor, temperature sensors, and multifunctional integrated sensing systems is provided. Self-powered sensing systems with integrated energy units are then discussed, separated as energy harvesting self-powered sensing systems, energy storage integrated sensing systems, and all-in-on integrated sensing systems. Finally, the future perspectives of self-powered sensing systems for wearable electronics are discussed.

Lab-on-chip systems for integrated bioanalyses

Biomolecular detection systems based on microfluidics are often called lab-on-chip systems. To fully benefit from the miniaturization resulting from microfluidics, one aims to develop 'from sample-to-answer' analytical systems, in which the input is a raw or minimally processed biological, food/feed or environmental sample and the output is a quantitative or qualitative assessment of one or more analytes of interest. In general, such systems will require the integration of several steps or operations to perform their function. This review will discuss these stages of operation, including fluidic handling, which assures that the desired fluid arrives at a specific location at the right time and under the appropriate flow conditions; molecular recognition, which allows the capture of specific analytes at precise locations on the chip; transduction of the molecular recognition event into a measurable signal; sample preparation upstream from analyte capture; and signal amplification procedures to increase sensitivity. Seamless integration of the different stages is required to achieve a point-of-care/point-of-use lab-on-chip device that allows analyte detection at the relevant sensitivity ranges, with a competitive analysis time and cost.

The Economics of Medicare Accountable Care Organizations

BACKGROUND

Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs.

OBJECTIVE

To examine whether the current Medicare ACOs are likely to be successful.

DISCUSSION

Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful.

CONCLUSION

The question remains whether Medicare ACOs can achieve the Triple Aim of "improving the experience of care, improving the health of populations, and reducing per capita costs of health care." Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs.

A systems approach towards an intelligent and self-controlling platform for integrated continuous reaction sequences

Performing reactions in flow can offer major advantages over batch methods. However, laboratory flow chemistry processes are currently often limited to single steps or short sequences due to the complexity involved with operating a multi-step process. Using new modular components for downstream processing, coupled with control technologies, more advanced multi-step flow sequences can be realized. These tools are applied to the synthesis of 2-aminoadamantane-2-carboxylic acid. A system comprising three chemistry steps and three workup steps was developed, having sufficient autonomy and self-regulation to be managed by a single operator.