Aparadigm Shift Research Articles

Differences in sexual development-S2k guideline update

Human beings with adifference in sexual development (DSD) often underwent gender reassignment surgery during early childhood. However, the medical decision was often not congruent with the gender identity that affected persons developed later on. To represent the interests of affected persons, an interdisciplinary guideline in cooperation with support groups was written. The revision of the first version of the guideline, published in 2016, was edited by 18professional societies and working groups as well as 3support groups. Aliterature search was performed for each of the 12chapters. Recommendations and statements created by the working groups were voted on during four consensus conferences. The guideline highlights the right of self-determination of affected persons. In this context, new legal requirements are reported. Other than necessary primary diagnostics, medical procedures should be postponed. Most important is the psychological support of parents and patients. Tumor risk of the gonads and protection of fertility are analyzed and discussed in detail. The content of the guideline represents aparadigm shift in dealing with human beings with adifference of sexual development. Projects as DSD Care and Empower-DSD help to promote the practical implementation of the guideline's recommendations.

Smart Ride Connect (Revolutionizing Bus Pass Management through Innovative Transportation Solutions)

Smart Ride Connect introduces aparadigm shift in bus pass management by harnessing the power ofQrCodetechnology.Thesystemaimstostreamlinethecumbersomeprocessofissuing, validating, and managing bus passes, thereby enhancing the over all efficiency and user experience of public transportation systems. By providing personalized QR Code-enabled passes with essential user information and validity details encoded within, Smart Ride Connect ensures seamless access to transportation services while empowering administrators with real-time insights and control over the system Keywords: Bus pass managements, QR Code technology, Streamline, Issuing, Public transportation, QR Code-enabled passes, Validity details

Canada's guidance on alcohol and health : Aparadigm shift

Alcohol is asocially accepted food and beverage and as acultural asset is also part of religious rituals. It can be an intoxicant and an addictive substance. It is also anoxious substance as around 3million people worldwide die every year as aresult of alcohol consumption. With the publication by Zhao etal. 2023 the relationship between the quantity of alcohol consumption and mortality reached anew level and changed the recommendations of Canada's Guidance on Alcohol and Health. The J‑curve of the French paradox became alinear relationship between alcohol consumption and mortality because the review of several control groups in previous studies revealed arecruitment error from abstinent ex-drinkers. In their systematic analysis, taking this bias into account the assessment of small amounts of alcohol as acardioprotective stimulant had to be revised. This is aparadigm shift.

Significance of natural language processing and chat-based generative language models

Natural language processing (NLP) has experienced significant growth in recent years and shows potential for broad impacts in scientific research and clinical practice. This study comprises an exploration of the role of NLP in scientific research and its subsequent effects on traditional publication practices, as well as an evaluation of the opportunities and challenges offered by large language models (LLM) and areflection on necessary paradigm shifts in research culture. Current LLMs, such as ChatGPT, and their potential applications were compared and assessed. An analysis of the literature and case studies on the integration of LLMs into scientific and clinical practice was conducted. LLMs provide enhanced access to and processing capabilities of text-based information and represent avast potential for (medical) research as well as daily clinical practice. Chat-based LLMs enable efficient completion of often time-consuming tasks, but due to their tendency for hallucinations, have asignificant limitation. Current developments require critical examination and aparadigm shift to fully exploit the benefits of LLMs and minimize potential risks.

Diagnostics and surgical treatment of painful neuromas

Painful neuromas that often develop after peripheral nerve injury require adequate diagnosis and treatment because of the suffering they cause. The scientific basis for the development of painful neuromas has not yet been sufficiently investigated. In addition to conservative procedures, alarger number of surgical techniques are available for treatment of painful neuromas. Areview of the basic principles, diagnostic and treatment options for painful neuromas. Presentation of the scientific basis regarding the development of painful neuromas. Illustration and discussion of the most common diagnostic and treatment procedures. The scientific basis regarding the development of painful neuromas after peripheral nerve injury has not yet been adequately developed. In order to be able to make acorrect diagnosis, the use of standardized diagnostic criteria and adequate imaging techniques are recommended. In the sense of aparadigm shift, the use of the formerly neuroma-bearing nerve for reinnervation of target organs is to be preferred over mere burying in adjacent tissue. In addition to standardized diagnostics the management of painful neuromas often requires a surgical intervention after all conservative therapeutic measures have been exhausted. As an alternative to restoring the continuity of the injured nerve, targeted reinnervation of electively denervated target organs by the formerly neuroma-bearing nerve is preferable over other techniques.

Psychosomatic aspects in otorhinolaryngology-historical milestones

This investigation examined the development of psychosomatics in the field of otolaryngology in Germany using the examples of psychogenic deafness and chronic tinnitus by means of literature research. The focus of the study was on the period 1948-2022. Aliterature search was carried out in the PubMed database from 1948 and antiquarian ENT textbooks were evaluated. The search terms used were "ENT and psychosomatics," "tinnitus," "retraining therapy," "analytical psychology," "behavioral therapy," and "sensory systems." Psychosomatic phenomena were mentioned in the treatment of nasal diseases and ear ailments in writings of Byzantine and medieval medicine. Even older are references to tinnitus in ancient Egyptian and Indian scripts. From the nineteenth to the mid-twentieth century, psychological abnormalities in ENT symptoms were assigned to the term hysteria. From the middle of the twentieth century, aparadigm shift in the assessment of psychosomatic disorders in otolaryngology became apparent. In the 1950s, abroad psychosomatic discussion was opened in individual lectures and book contributions on mental abnormalities in ENT diseases. With the implementation of the Psychosomatics Working Group of the German Society of Otorhinolaryngology, Head and Neck Surgery, psychosomatics in the field of ENT received the framework for scientific and clinical activity at the turn of the millennium. Psychosomatics is scientifically represented and part of the continuing education regulations for otolaryngology in Germany and at European level. It shows high standards in research, qualification of otolaryngologists, and patient care. As of 2022, psychosomatics in otolaryngology has been steadily developing for over 70years. The standards achieved are to be further expanded and research on cognition, affectivity, and sensory analogies intensified.

A COMPARATIVE ANALYSIS OF TRANSLATION TECHNOLOGY RESEARCH IN CHINA AND RUSSIA IN THE DIGITAL AGE A COMPARATIVE ANALYSIS OF TRANSLATION TECHNOLOGY RESEARCH IN CHINA AND RUSSIA IN THE DIGITAL AGE

The onset of the digital age has led to the rapid development of translation technology. Nowadays, not only specialists in natural languages but also those in applied translation studies keep a close eye on machine translation research. This article examines research papers on translation technology in the humanities and social studies in Russia and China: based on the papers by Russian and Chinese specialists in translation studies, the author conducts a comparative analysis of the evolution and scientific achievements in this field, reveals their common and unique features. For instance, following current trends, Russian scientists offer a new perspective on the development of translation technology based on the concept of “digital translation” that relies on the introduction of modern technologies, in particular computeraided translation (CAT). On the other hand, following the idea of aparadigm shift in translation studies, Chinese scientists o er a new scientific approach expressed in the concept of the “technological shift”. Thus, the fusion of the new approach and a new perspective can contribute to further substantial improvement in translation technologies.

Exercise and physical activity for patients with prostate cancer

In the past, it was thought that physical rest was relevant for recovery of patients with prostate cancer; however, more recently there has been aparadigm shift towards physical activity parallel to oncological treatment. Diagnosis and treatment of prostate cancer are associated with limitations at various levels and side effects [9], which in the course of therapy can be apotentially therapy-limiting factor associated with dose reduction, delay or even discontinuation of therapy with negative consequences for outcome and median survival. The current study situation on the topic of physical activity in prostate cancer includes various studies with differentiated physical activity interventions and treatment time points. The studies measured physiological and psychological parameters such as physical performance, incontinence, quality of life, and fatigue. Further studies also show apositive influence of exercise therapy on the prevention of long-term complications [11, 14-16]. Various international guidelines recommend physical activity during ongoing oncological therapy [5].

New treatment options for metastatic HER2-low breast cancer : Consequences for histopathological diagnosis

Die standardisierte HER2-Bestimmung beim Mammakarzinom und bei anderen Tumoren ist eine wichtige Aufgabe der Pathologie. Ziel der bisherigen Bestimmung war es, zuverlässig diejenigen Tumoren zu identifizieren, die eine Überexpression des HER2-Proteins aufweisen, die in der Regel mit einer Genamplifikation einhergeht. Nur in dieser Gruppe von Tumoren war eine zielgerichtete Anti-HER2-Therapie sinnvoll und erfolgversprechend. Durch neue Substanzen und die Ergebnisse klinischer Studien beim metastasierten Mammakarzinom hat sich dies nun geändert. Es konnte gezeigt werden, dass Trastuzumab-Deruxtecan, ein Konjugat aus einem Anti-HER2-Antikörper und einer zytotoxischen Substanz, auch dann einen Anti-Tumor-Effekt aufweist, wenn nur eine geringe Expression von HER2 im Tumorgewebe vorliegt.Die aktuellen Daten bedeuten einen Paradigmenwechsel für die Behandlung von Patientinnen, deren Tumoren bislang als HER2-negativ eingeordnet wurden. Ziel ist es jetzt, neben den Tumoren mit einer HER2-Überexpression (IHC 3+) auch die Tumoren mit einer geringen HER2-Expression (HER2-low, definiert als IHC 1+ oder 2+/ISH-negativ) zuverlässig zu identifizieren. Aufgrund der therapeutischen Konsequenzen ist es wichtig, die diagnostischen Algorithmen und Befundtexte in allen pathologischen Instituten sehr kurzfristig an die neuen Erfordernisse anzupassen. Unabhängig davon ergeben sich neue wissenschaftliche Fragen und Herausforderungen für die Standardisierung, die aktuell bearbeitet werden.

Editorial 2022

The prevention, diagnosis, and management of medical emergencies are of utmost importance in the practice of dentistry. Dental students and dental surgeons must be well trained and prepared to manage all possible medical emergencies in their daily professional practices. The team must be competent and confident in handling the initial basic emergency treatment with quality. Proper management of life-threatening medical emergencies may lead to the prevention of possible death and complications. This may also avert the psychological trauma that the healthcare professional may go through and the stigma attached to the hospital or clinic. Besides that, the ethical and legal implications of medical emergencies related to the obligations of the healthcare practitioner cannot be overlooked. The teaching of medical emergencies in our dental schools starts at the pre-clinical undergraduate level. However, the program is not well structured. Despite the consensus on the importance of training in medical emergencies, several international studies show unsatisfactory results by demonstrating low knowledge and confidence of professionals in managing medical emergencies and first aid. As a result of these international research findings, there has been aparadigm shift in teaching undergraduate students in most developed countries. The fundamental change in the approach now is emphasizing on a more competency-based curriculum and more hands-on teaching. Hence the need for a revision and inclusion of medical emergencies in our curricula in Ghana.

Reconstruction of soft tissue defects of the lower extremities

Areliable reconstruction of soft tissue defects of the lower extremities especially in the distal third of the leg is still aspecial challenge for reconstructive surgeons. The possibility of salvaging the leg has to be evaluated in the setting of an interdisciplinary team and the timing of the operation(s) with respect to the safety of the patient and asystematic approach with the selection of asuitable flap have to be defined. Traditionally local muscle flaps or free flaps have been established for coverage of defects of the lower extremities. Recently perforator-based flaps have gained popularity for reconstruction of lower extremity defects. Furthermore, new surgical techniques and developments in association with the demographic change have led to aparadigm shift.

Challenges to Identify and Mentor Gifted Children in Developing Countries: The Indian Experience

The National Education Policy 2020 (NEP-2020) has recognized the need to identify and nurture gifted and talented children beyond the school curriculum. Through systematic research, the National Institute of Advanced Studies, Bengaluru has developed multiple protocols for identifying and multi-level, multi-stage mentoring of gifted children. This study argues that there is need for a paradigm shift in the identification process that predominantly uses psychometric measurements in the portfolio that captures the actual data points of gifted children. This is particularly relevant for developing countries like India, which has a diverse population predominantly from disadvantaged communities. Establishing norms for standardized psychometric tests developed for the western populations will have inherent limitations to identifying the gifted children in multi-lingual and multi-cultural contexts. Needless to state, India has far too few trained psychologists to accomplish this task.

Post COVID-19: Towards Human Leadership and new work modalities

Abstract:Covid-19 took us by surprise, sending us home to do home office; it forcedcompanies, with no option to reply, to adapt and take action on a vitalissue for the existence of life on our planet: To transform themselves intohuman and conscious companies. Emerging as a consequence, the needfor a new type of leadership; so, companies are now at the centre of aparadigm shift that leaves them very vulnerable. If they focus only onfacing the challenges, running the risk of not seeing the greatopportunities -that the situation due to Covid-19 has revealed - that theywill allow them to evolve and innovate from the management of humantalent, developing innovative work methods that could substantiallyincrease their productivity. Businesses are facing great challenges tosurvive, some are emerging victorious, but a large number of them havenot been able to adapt and respond quickly enough. The key factors thatare making the difference between a company that is getting ahead andanother that is not, are its leaders. They are the ones that will determinethe survival, growth or extinction of companies in the immediate future.This business context in which leaders play a starring role, opens up arange of work modalities.

Immunotherapy and tyrosine kinase inhibitors in first-line treatment of metastatic renal cell carcinoma-Which strategy when?

Immuntherapien mit Checkpoint-Inhibitoren haben beim metastasierten klarzelligen Nierenzellkarzinom (mRCC) zu einem Paradigmenwechsel geführt und einen neuen Standard in der Erstlinie etabliert. Einschließlich der bekannten Monotherapie mit Tyrosinkinaseinhibitoren ist das Spektrum an medikamentösen Therapieoptionen somit breiter geworden. In diesem Beitrag sollen anhand der aktuellen Studiendaten sowie Leitlinienempfehlungen mögliche Faktoren zur individuellen Therapieplanung in der Erstlinie des mRCC diskutiert werden. Hierbei ist das wichtigste Leitkriterium das Risikoprofil. Daneben sind Effektivität und Verträglichkeit der Substanzen, sowie Tumorlast, Alter und Präferenzen der Patienten sowie Überlegungen zur Sequenztherapie für die Therapiewahl ausschlaggebend. Real-world-Daten für die neuen Kombinationstherapien, Biomarker für eine personalisierte Medizin sowie Studien zur optimalen Sequenztherapie beim mRCC werden benötigt.

Preoperative imaging of spinopelvic pathologies

The field of musculoskeletal diagnostics and personalized medicine has undergone arevolutionary transformation due to adeeper understanding of skeletal biomechanics and due to technological advancements. Analogous to this transformation, our understanding of spinopelvic conditions has experienced aparadigm shift in terms of both static and dynamic changes in spinopelvic pathologies and enabled amore accurate delineation of the drivers of disability. The purpose of this review is to describe the standard and state of the art of preoperative diagnostic and planning methods for common spinopelvic pathologies and to discuss both the added clinical value and limitations. The rationale is to accelerate the accurate and timely diagnosis and as well as the efficient and safe preoperative workflow.

El juego del aprendizaje completo en la enseñanza de las ciencias

La presente comunicación está orientada a contribuir a la comprensión de algunas cuestiones vinculadascon la enseñanza y el aprendizaje de las ciencias en la Educación Superior, acudiendo a la categoría teóricade juego del aprendizaje completo de David Perkins, con el aporte de otros autores. Se plantean las razonesy propósitos por los cuales se propone un cambio de paradigma, se analizan los principios del aprendizajecompleto y se enuncian y ejemplifican algunas estrategias y condiciones de enseñanza pertinentes.

Checkpoint inhibitors in Hodgkin lymphoma

Checkpoint blockade contributes to the immunosuppressive microenvironment in classical Hodgkin lymphoma (cHL) and in particular the interaction of Hodgkin cells and macrophages with T‑cells and natural killer cells via programmed cell death1 (PD-1) and programmed cell death1 ligand1 (PD-L1). The aim of this article is the evaluation the role and potential of checkpoint blockade in cHL as compared with the results of standard chemo- and radiotherapy. We analyzed preclinical and clinical data from phaseI and phaseII studies with checkpoint blockade in cHL. In 60-70% of patients with chemotherapy-refractory cHL, PD‑1 blockade results in responses. Overall survival is excellent and asmall number of patients achieve persistent response. Thus, the use of anti-PD‑1 monoclonal antibodies has become an important treatment approach in relapsed cHL in line with the label. The results of first-line therapy are still preliminary; initial phaseII studies using nivolumab in combination with doxorubicin (=adriamycin), vinblastin and dacarbazin (AVD) in early unfavorable or advanced stages showed response rates of up to 90%. Thus, implementing immunomodulatory approaches using PD 1‑blockade have resulted in asignificant reduction of chemotherapy. This might represent aparadigm shift in the therapy of cHL.

The 8thedition of the TNM staging system-acurse or ablessing for oropharyngeal carcinoma?

At the beginning of 2017, the 8thedition of the TNM classification was presented. For oropharyngeal carcinoma, this was accompanied by aparadigm shift, as aseparation of the classification depending on the association with human papillomavirus (HPV) status has been established. By considering the literature, this paper provides an overview of the characteristics of HPV-associated carcinomas, the new features of the TNM classification, and the existing points of discussion. The revision has improved the prognostic significance of the TNM classification; however, there are still tumor- and patient-dependent influencing factors that must be considered for future versions.

Being Small at the Right Moment: Path Dependence after a Shift in the Technological Regime

This paper explores the impact of technological change on industry concentration and the underlying firm dynamics. In the agent-based model EURACE@Unibi I implement a paradigm shift in the technological frontier – a shift from a slow to a fast growing regime. The analysis shows that the acceleration in technological change causes a strong increase in market concentration. The reallocation of market shares towards a few large firms is driven by diverging productivities and skills across firms. An ex-post analysis reveals that after the paradigm shift small, but undervalued firms become the large dominating ones in the long-run. Their success gets initiated by a fortunate outcome on the labor market, which increases their skill level. With the faster technological change, their high skilled workforce incentivizes them to invest at the frontier and to build up the most productive capital stock. A virtuous cycle between their decisions on the labor and capital market further increases the productivity gap towards competitors enabling their rise.

Docetaxel or abiraterone in combination with androgen deprivation therapy for metastatic prostate cancer

Androgen deprivation therapy (ADT) alone has long been the standard of care in the treatment of metastatic prostate cancer (mCSPC). Aparadigm shift in the treatment of patients with mCSPC has now been initiated by the results of three major phase3 clinical trials (CHAARTED, STAMPEDE, LATITUDE): They demonstrated asignificant advantage of ADT in combination with docetaxel or abiraterone/prednisone over ADT alone. This review presents the current evidence for the use of docetaxel or abiraterone/prednisone in combination with ADT and discusses-in the absence of directly comparing studies-which patients may have an advantage of ADT plus abiraterone/prednisone over ADT plus docetaxel or vice versa. Asystematic review based on bibliographic literature search was conducted. Both the combinations of ADT with docetaxel and with abiraterone/prednisone represent amajor advance in the treatment of patients with mCSPC, in particular of patients with multiple metastases. Compared to chemotherapy, the use of abiraterone in addition to ADT avoids (rare) neutropenic complications and treatment-associated deaths. Long-term oral treatment with abiraterone/prednisone as acomplementary therapy to ADT replaces short-term intravenous treatment (docetaxel). In patients with mCSPC, ADT plus docetaxel or ADT plus abiraterone/prednisone is recommended. In particular in patients with pre-existing cardiovascular disease, ADT should be considered with aGnRH (gonadotropin-releasing hormone) antagonist to reduce the risk of cardiotoxic side effects.