Careful Review Research Articles

Review of pediatric emergency care and the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic posed new challenges in health care delivery for patients of all ages. These included inadequate personal protective equipment, workforce shortages, and unknowns related to a novel virus. Children have been uniquely impacted by COVID-19, both from the system of care and socially. In the initial surges of COVID-19, a decrease in pediatric emergency department (ED) volume and a concomitant increase in critically ill adult patients resulted in re-deployment of pediatric workforce to care for adult patients. Later in the pandemic, a surge in the number of critically ill children was attributed to multisystem inflammatory syndromein children. This was an unexpected complication of COVID-19 and further challenged the health care system. This article reviews the impact of COVID-19 on the entire pediatric emergency care continuum, factors affecting ED care of children with COVID-19 infection, including availability of vaccines and therapeutics approved for children, and pediatric emergency medicine workforce innovations and/or strategies. Furthermore, it provides guidance to emergency preparedness for optimal delivery of care in future health-related crises.

Rethinking Tako-tsubo Cardiomyopathy: The Contribution of Myocardial Pathology and Molecular Imaging.

Despite substantial research, the mechanisms behind stress Tako-tsubo cardiomyopathy (TTC) remain rather elusive. The purpose of this paper was to provide a detailed review of the mainstream factors underlying the pathophysiology of TTC, highlighting the novel contributions of molecular pathology and in-vivo molecular imaging. A careful literature review selected all papers discussing TTC, specifically those providing novel insights from myocardial pathology and cardiac molecular imaging. Results concerning myocardial pathology, defect extension, sites and relationships between functional parameters underline the existence of a causal relationship between a determinant (e.g., the release of catecholamines induced by stress) and an outcome for TTC, which is not limited to a reversible contractile cardiomyopathy, but it includes reversible changes in myocardial perfusion and a long-lasting residual deficit in sympathetic function. Besides, they reinforce the hypothesis that sympathetic nerves may exert a complex control on cardiac contractile function, which is likely to be direct or indirect through metabolism and microvascular perfusion changes during anaerobic and aerobic conditions. TTC is characterized by acute transient left ventricular systolic dysfunction, which can be challenging to distinguish from myocardial infarction at presentation. Catecholamineinduced myocardial injury is the most established theory, but other factors, including myocardial metabolism and perfusion, should be considered of utmost importance. Each effort to clarify the numerous pathways and emerging abnormalities may provide novel approaches to treat the acute episode, avoid recurrences, and prevent major adverse cardiovascular events.

Exploring the Use of Blockchain Technology to Create Transparent and Efficient Platforms for Managing Agricultural Processes

The focus of this study is on the impact and degree to which blockchain can transform existing agricultural procedures, also taking into consideration but not necessarily emphasizing its effects in other areas. It attempts firstly to add transparency; secondly traceability or authenticity (the ability for consumers at marketplaces everywhere-wherever they may be-to understand clearly who grew what); and finally economic empowerment Based on a careful review of case studies and stakeholder perspectives, the study stresses that blockchain is an effective tamper-proof log to record all information from farmers right down to consumers. Its permanent, traceable nature becomes of vital significance in improving traceability. Moreover, it allows for rapid location and recovery of contaminated products; this is a big boost to food safety. According to the proposed conceptual framework, industry standards related to collaboration are included; scalable solutions and stakeholder education on transparency and traceability as well as economic empowerment will be added. It gives a viable orientation and reference for industry professionals, policymakers, and technologists who want to apply the transformative control of blockchain in agribusiness. Not as it does the coming of blockchain in agriculture alter supply chain connections, but it too exchanges control from buyers to vendors and guarantees customers almost item realness. This investigation envisions a future in which blockchain can be a portion of making the worldwide nourishment framework versatile and maintainable.. KEYWORDS :Agriculture, Blockchain, Traceability, Economic Empowerment, Transparency

Identifying and improving the “ground truth” of race in disparities research through improved EMR data reporting. A systematic review

BackgroundStudies about racial disparities in healthcare are increasing in quantity; however, they are subject to vast differences in definition, classification, and utilization of race/ethnicity data. Improved standardization of this information can strengthen conclusions drawn from studies using such data. The objective of this study is to examine how data related to race/ethnicity are recorded in research through examining articles on race/ethnicity health disparities and examine problems and solutions in data reporting that may impact overall data quality. MethodsIn this systematic review, Business Source Complete, Embase.com, IEEE Xplore, PubMed, Scopus and Web of Science Core Collection were searched for relevant articles published from 2000 to 2020. Search terms related to the concepts of electronic medical records, race/ethnicity, and data entry related to race/ethnicity were used. Exclusion criteria included articles not in the English language and those describing pediatric populations. Data were extracted from published articles. This review was organized and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement for systematic reviews. FindingsIn this systematic review, 109 full text articles were reviewed. Weaknesses and possible solutions have been discussed in current literature, with the predominant problem and solution as follows: the electronic medical record (EMR) is vulnerable to inaccuracies and incompleteness in the methods that research staff collect this data; however, improved standardization of the collection and use of race data in patient care may help alleviate these inaccuracies. InterpretationConclusions drawn from large datasets concerning peoples of certain race/ethnic groups should be made cautiously, and a careful review of the methodology of each publication should be considered prior to implementation in patient care.

Evolution of Modern Zoology

Technology has contributed to the development of zoology, and the electron microscope has played an important role in many biological discoveries, as have oscilloscopes Binary isotopes, radiometry, digital photography and satellite images, PCR and DNA, and GPS systems, computers, and many of the technologies that worked on Progress in research fields in various branches of zoology has even contributed to finding solutions to some of the problems facing the environment in order to develop terrestrial and marine resources and preserve biodiversity It was the discovery and identification of Mendelian genetics, the structure of DNA, the code, instinct and animal behaviour Primitive and hybrid species, parthenogenetic forms of life, and new, previously unknown kingdoms of chemomorphology all had a positive impact on the development of zoology This paper discusses the development of zoology in the modern era. What distinguishes zoology is its impact on environmental balance and diversity preservation issues Organisms, ranging from restriction enzymes, the discovery of cloning, genetic engineering, and genetic control of decomposition states. Understanding metabolic pathways supports the need to address these topics with careful review, as we will see in this paper.

Imaging for assessment of cancer treatment response to immune checkpoint inhibitors can be complementary in identifying hypophysitis.

Hypophysitis is reported in 8.5%-14% of patients receiving combination immune checkpoint inhibition (cICI) but can be a diagnostic challenge. This study aimed to assess the role of routine diagnostic imaging performed during therapeutic monitoring of combination anti-CTLA-4/anti-PD-1 treatment in the identification of hypophysitis and the relationship of imaging findings to clinical diagnostic criteria. This retrospective cohort study identified patients treated with cICI between January 2016 and January 2019 at a quaternary melanoma service. Medical records were reviewed to identify patients with a documented diagnosis of hypophysitis based on clinical criteria. Available structural brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT) of the brain and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography with computed tomography (FDG-PET/CT) were assessed retrospectively. The main radiological outcome measures were a relative change in pituitary size or FDG uptake temporally attributed to cICI. There were 162 patients (median age 60 years, 30% female) included. A total of 100 and 134 had serial CT/MRI of the brain and FDG-PET/CT, respectively. There were 31 patients who had a documented diagnosis of hypophysitis and an additional 20 who had isolated pituitary imaging findings. The pituitary gland enlargement was mild, and the largest absolute gland size was 13 mm, with a relative increase of 7 mm from baseline. There were no cases of optic chiasm compression. Pituitary enlargement and increased FDG uptake were universally transient. High-dose glucocorticoid treatment for concurrent irAEs prevented assessment of the pituitary-adrenal axis in 90% of patients with isolated imaging findings. Careful review of changes in pituitary characteristics on imaging performed for assessment of therapeutic response to iICI may lead to increased identification and more prompt management of cICI-induced hypophysitis.

2559. Antibiotic-induced Bartter-like syndrome - A Systematic Review

Abstract Background Bartter syndrome encompasses salt-losing tubulopathies characterized by hypokalemia, hypochloremic metabolic alkalosis, and hyperreninemic hyperaldosteronism with normal blood pressure. Acquired Bartter or Bartter-like syndrome (BLS) is commonly associated with the use of diuretics and antibiotics such as capreomycin, netilmicin, colistin, and amphotericin B. This systematic review was done to understand the time of occurrence of Bartter syndrome post-inciting drug and gain knowledge regarding its progression and management. Methods We searched PubMed, Google Scholar, Embase, medRxiv, and bioRxiv databases for articles published from 1986 to March 2022 using the keywords "Antibiotic," "Bartter Syndrome," "Pseudobartter Syndrome," and "Bartter-like." Studies that reported cases of BLS in adults or children with confirmation of the inciting drug were included. We excluded studies that did not provide sufficient details of the clinical presentation and outcome. Results We identified 31 studies, comprising 43 cases of BLS. The mean age of the patients was 41.1 years (range: 25–57 years), and 65.1% were female. The most common antimicrobial class associated with BLS was aminoglycosides (65.1%), followed by the polymyxin group. The most common antimicrobial was Gentamicin (41.8%), followed by Colistin (32.5%), Streptomycin, and Capreomycin (6.9% each). Hypokalemia(100%), metabolic alkalosis(97.2%), hypocalcemia(92.5%), and hypomagnesemia(100%) were reported in almost all patients. The median time of onset after exposure to the inciting agent was 10 days (range 7–18 days), and the median time for resolution after stopping the drug was 14 days (range 7–31 days). There was a complete resolution of the symptoms following discontinuation in all cases. Demographic and baseline characteristics of the patients Prevalence of electrolyte, acid-base disorder, and urinary electrolyte abnormalities Laboratory parameters among the reported cases Conclusion BLS is a rare but potentially reversible complication of various antimicrobials, most commonly aminoglycosides. The diagnosis requires a high index of suspicion and a careful review of the drug history. The prognosis is favorable, with a complete reversal of the state after drug discontinuation. Disclosures All Authors: No reported disclosures

The views of psychiatrists on proposed changes to the England and Wales Mental Health Act 1983 legislation for people with intellectual disability: A national study.

The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/or autism could not be detained beyond 28 days, in the absence of diagnosed co-occurring mental illness. To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID. A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher's exact tests. Thematic analysis was conducted on free text responses. A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process. Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised.

A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life.

Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute's methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002-2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care.

A study of the clinical and demographic characteristics of adults with an intellectual disability who remain in learning disability assessment and treatment units despite being clinically ready for discharge

AbstractBackgroundThis study investigated differences in the clinical and demographic characteristics of individuals with intellectual disabilities delayed in assessment and treatment hospitals versus individuals who were not delayed. The study further investigated the clinical outcomes of the individuals whose discharge from the hospital was delayed.MethodThis was a cohort study using secondary data collected from patient records. Variables included age, ethnicity, levels of deprivation, areas of origin, diagnoses, and the provision of a care and treatment review. A comparison was made between individuals who became delayed despite being clinically ready for discharge and those who were discharged on time.FindingsIndividuals with severe intellectual disabilities were more likely to experience delayed discharge from hospital (p = 0.001). Similarly, people who were admitted to hospitals away from their home areas were also more likely to experience delayed discharge (p < 0.001). There were no significant differences between the delayed and nondelayed groups for other factors such as age, deprivation or ethnicity. Individuals who experienced a delay in discharge did not experience an increased rate of adverse incidents compared to the period of active treatment and clinical improvements were maintained during the period of delay. There were low rates of completion of care and treatment reviews before admission, although people who were delayed were more likely to have received a review during admission (78.8% vs. 27.1%).ConclusionIt is important for clinicians and service development leads to be aware that people who are admitted away from their home area and people with severe intellectual disabilities may be at higher risk of experiencing significantly delayed discharge from the hospital. More broadly, many people remained in hospital for a substantial length of time after being assessed as clinically ready for discharge. Due to the low rates of completion before admission, the expansion of community‐based care and treatment reviews should also be explored. While people did not suffer increased rates of adverse incidents during their extended stay, their liberty was still restricted, hence there should be a focus on effective community provision. The current model of relying on the willingness of independent providers to support the care of complex individuals requires significant reform.

Frequency and risk factors of atrial fibrillation after acute abdominal surgery: A prospective cohort study.

Scarce data exist on the true incidence of postoperative atrial fibrillation (POAF) after acute abdominal surgery and associated outcomes. The current study aimed to identify the frequencies of clinically recognized POAF and associated complications, along with their risk factors. This study was a prospective, single-center cohort study of unselected adult patients referred for acute abdominal surgery during a 3-month period. Through careful review, demographics, comorbidity, and surgical characteristics were prospectively drawn from medical charts. The primary outcome was clinically recognized POAF occurring in-hospital. Logistic regression was used to determine the risk factors of POAF and associated complications. A subgroup was enrolled in a feasibility study of peri- and postoperative continuous cardiac rhythm monitoring. In total, 450 patients were enrolled. Clinically recognized in-hospital POAF was observed in 22 patients (4.9%). All cases were observed in patients aged ≥60 years, corresponding to 22 of 164 patients (13.4%). Multiple risk factors were observed, such as age, prior atrial fibrillation, heart failure, hypertension, diabetes mellitus, chronic renal disease, and major (vs. minor) surgery. POAF was associated with severe in-hospital complications (POAF group 45.5% vs. non-POAF group 8.6%, p < .001) and in-hospital mortality (POAF group 13.6% vs. non-POAF group 3.0%, p = .043). In total, 295 patients were monitored by continuous cardiac rhythm monitoring for 12,148 h, yielding five patients with asymptomatic AF. In conclusion, this prospective study of POAF in patients undergoing acute abdominal surgery showed that one in 20 patients developed clinically recognized in-hospital POAF. Multiple risk factors of POAF were identified. POAF was associated with severe complications up to 30 days after surgery.

Technology and economics of electric vehicle power transfer: insights for the automotive industry

Battery-based electric vehicles (BEVs) in the United States (U.S.) set a new sales record in 2022, driven by technology, policy, environmental, and economic objectives. However, the rapid deployment of BEVs and charging infrastructure without a careful review of their integration with the electric grid can have negative economic impacts on reliable and resilient electricity supply. Bi-directional power transfer (Bi-Di) vehicle-grid integration technologies and services such as vehicle-to-home or building (V2H/B) and vehicle-to-grid (V2G) can potentially lower local and system peak demand, improve economics for grid operators, and benefit BEV customers. Original equipment manufacturers (OEMs) in the automotive industry are exploring technologies and economics (techno-economics) for Bi-Di services. The study conducted a literature review of eleven case studies in the U.S. and Europe that featured Bi-Di demonstrations from 2005 to 2022 to highlight insights and techno-economic opportunities and challenges for OEMs. The findings should motivate the OEMs to prioritize technology innovation and business models to increase BEV sales and gain continuous revenue from Bi-Di services, which can potentially transition "car makers" to "technology solution" companies.

Investigating the Causality between Corruption and Economic Growth: A Systematic Review

This study aims to establish a systematic examination of the existing literature pertaining to the causal relationship between corruption and its impact on a nation economic growth. In line with established methodological guidelines, particularly the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), this research adopts a structured approach to comprehensively survey the relevant scholarly landscape. To construct a robust foundation for this investigation, a thorough search for scientific papers within the Scopus and Web of Science (WoS) databases, spanning the years from 2012 to 2022 was conducted. Our selection process ultimately led to the identification and analysis of seven publications that offer substantial empirical insights into the chosen domain of inquiry. Through a careful review of these research papers, a compelling pattern that corruption exerts a profound significant influence on various dimensions of economic growth within a nation emerged. Specifically, the synthesis of the extant literature suggests that corruption exhibits a discernible causative effect on critical economic parameters, notably including but not limited to purchasing power, country debt, political stability and foreign direct investment (FDI). In summary, the amalgamation of these scrutinized research findings underscores the substantial and multifaceted role of corruption as a causal factor in influencing economic growth dynamics. This investigation not only contributes to a deeper understanding of this critical relationship but also underscores the importance of anti-corruption measures in promoting sustained economic development and stability on a national scale.

A misleading syllable-based generalization about Japanese SJ+/zu/ compounds

AbstractIn 1910, Ogura Shinpei published a meticulous critique of Benjamin Smith Lyman’s famous 1894 article onrendaku. In the course of a thorough examination of compounds consisting of a single Sino-Japanese morpheme followed by /su/∼/zu/ ‘to do’, Ogura noted that all the examples withrendaku(i.e., with /zu/) have a monosyllabic first element. This observation invites the inference that there is a causal connection between first-element monosyllabicity andrendakuin X+/zu/ compounds, but a careful review of the history of these vocabulary items indicates that the correlation between monosyllabicity andrendakuis just an accident. There is no reason to believe that first-element monosyllabicity has ever been an active phonological constraint, and the pattern that Ogura identified cannot be used to bolster the view that syllables distinct from moras are real units in modern Tokyo Japanese.

Prevalence and prognostic impact of myocardial injury following hypertensive crisis

Abstract Background In patients with acute chest pain, hypertensive crisis is a common possible diagnosis. Severe hypertension may even cause elevated levels of cardiac troponin indicating myocardial injury. Whether this biomarker response is linked to poorer outcome is unknown. Methods We included patients presenting to the emergency department with suspected myocardial infarction. In accordance with the 4th definition of myocardial infarction the final diagnosis and main cause of symptoms was adjudicated by two trained cardiologists based on all available clinical, imaging and laboratory data, including high-sensitive troponin T (hs-TnT). Hypertensive crisis was confirmed by the adjudicators if an elevation of systolic blood pressure (&amp;gt;160 mmHg) was detected and after careful review of all available data other differential diagnoses were less likely. Patients were stratified in those with myocardial injury (acute or chronic) based on sex-specific hs-TnT cutoffs or those without. Kaplan-Meier survival analysis were calculated for all-cause mortality and a composite of death, myocardial infarction, revascularization or cardiac rehospitalization. The event-rates during two-year follow-up were compared using the log-rank test. Cox-proportional hazard ratios were calculated for each patient group with adjustment for age and sex for 2-year all-cause mortality. Results Out of 2,565 patients 446 (17.4%) had a final diagnosis of hypertensive crisis. Of these, 213 (47.8%) developed myocardial injury with a baseline hs-TnT of 15.0 (IQR 10.0-22.0) ng/L. Among the remaining 2,119 patients with other diagnoses than hypertensive crisis, 910 (42.9%) showed myocardial injury with a baseline hs-TnT of 28.5 (IQR 17.0-67.2) ng/L. Patients with hypertensive crisis accompanied by myocardial injury were older (76 (IQR 68-82) vs 60 (IQR 52-71) years, p=0.001) and more often female (61.0% vs 39.5%, p=0.001). Among patients with hypertensive crisis, 2-year mortality rates were higher in patients with myocardial injury compared to non-injury. However, compared to patients with myocardial injury due to other causes, hypertensive patients showed significantly better outcome (p=0.027; Figure 1A). This was consistent for the combined clinical endpoint (Figure 1B). Compared to non-injury/non-hypertensive patients, hazard ratio (HR) for all-cause death after 2 years was not significant for non-injury/hypertensive patients (HR 0.52 (95% CI 0.19-1.48), p=0.22), while patients with myocardial injury and hypertensive crises had significantly increased risk of death after 2 years (HR 1.81 (95% CI 1.02-3.22), p=0.044). In patients with myocardial injury caused by other reasons risk of death was even higher (HR 3.58 (95% CI 2.38-5.39), p=0.001). Conclusion Patients with myocardial injury due to hypertensive crisis are at high risk for adverse outcome within 2 years after presentation. However, compared to other reasons for myocardial injury hypertensive crisis seems less hazardous.Figure 1

Role of community pharmacy and pharmacists in self care in Sweden

BackgroundSelf care is an important concept, which is increasingly being applied by policy makers on a large scale. It is associated with improved health literacy and technological advances. Community pharmacy practitioners are easily accessible for self care counselling, purchase of non-prescription products and for referrals to other healthcare providers. ObjectiveTo describe self care policies and strategies in Swedish healthcare authorities, pharmaceutical organizations and community pharmacy. MethodsA search was conducted to retrieve self care policy documents and strategies in Swedish healthcare authorities, pharmaceutical organizations and community pharmacy on respective websites, as well as personal contacts with key persons in pharmaceutical organizations and community pharmacy practice. ResultsA new law on self care was adopted by the Swedish Parliament becoming effective in 2023. The law defines self care as a healthcare measure that has been assessed by a treating licenced healthcare practitioner to be possible to be performed by the patient him/herself. The law includes a wide range of measures. According to a Government Commission that followed Sweden's the National Pharmaceutical Strategy's Action Plan in 2018, the Medical Products Agency (MPA) was assigned to establish requirements of qualifications in self care counselling. In its report in late 2022, the MPA stated that self care counselling by community pharmacy practitioners plays an important role in society. The new requirements are expected to become effective in mid-2023. None of the four community pharmacy chains operating 97% of Sweden's community pharmacies have developed any specific self care policies, although self care counselling and sales of non-prescription products, as well as provision of some primary healthcare services, constitute important components of their operations. Furthermore, all Swedish pharmacies offer several digital self care solutions, supporting people to manage their own health. Neither the Swedish Pharmacy Association, representing most pharmacies, nor the Swedish Pharmacists Association, the trade union, have developed any self care policies. However, the Swedish Association of the Pharmaceutical Industry is promulgating Swedish self care reform using a systematic review of self care and which medicines should be over-the-counter. ConclusionsSelf care is not currently established as a core pillar of a Swedish national health strategy. There are further opportunities to enable pharmacists to fulfil their potential in supporting individual wellbeing and promoting self care interventions. A new system needs to be created which fully integrates the promotion of everyday wellbeing, self care for self-treatable conditions and the management of long-term conditions.

Increasing Efficiency of Transdermal Drug Delivery Systems Using Some Novel Penetration Enhancement Techniques - A Critical Review

The transdermal route has drawn considerable attention and has emerged as a solid alternative to mimic the drawbacks of drugdelivery through the oral and parenteral routes. However, the effectiveness of TDDS is often limited by the skin's outermost layer, the stratumcorneum (SC), which acts as a barrier to drug diffusion. In addition, the drug molecule's molecular weight, hydrophilicity, and ionic nature canalso impact its transdermal delivery. Various methods have been developed to overcome these limitations to facilitate drug penetration acrossthe SC, including nano-carriers, wearable delivery systems, and combination-based approaches. The use of nano-carriers, such as dendrimers,liposomes, niosomes, and micro sponges, has shown promise in enhancing the efficacy of TDDS. Another emerging innovation for TDDS iswearable delivery systems, which offer non-invasive, convenient, and extended drug administration. Additionally, combination-based approaches,such as ultrasound and microneedle-based systems or ultrasound and electrical-based techniques, are also being investigated and are the centerof attraction in the research of TDDS approaches. This review summarizes a combination of all different novel penetration enhancementtechniques used to enhance the efficacy of transdermal drug delivery systems that were not precisely captured by other review articles. Most ofthe review articles emphasized these penetration enhancement techniques separately. However, a careful review of all the penetrationenhancement techniques in one article is missing. Thus, the purpose of this article is to comprehensively review and summarize the recentlyused penetration enhancement techniques along with the possible mechanism of action in a single article. Our primary aim is to collect relevantreviews and research articles by searching various databases to provide a comprehensive overview of the field. By providing a comprehensiveoverview of the available techniques, this review article will help students and researchers stay up-to-date with the latest developments in thefield of novel penetration enhancement techniques used to increase the efficiency of TDDS.

Introducing a multidisciplinary approach to medication optimization for geriatric oncology inpatients.

455 Background: Drug-related complications have been associated with adverse outcomes in older adults with cancer. This pilot interventional study aimed to assess the feasibility of introducing an inpatient multidisciplinary (MDT) comprehensive medication assessment focussing on the specific needs of older adults with cancer, in addition to standard hospital medication review and reconciliation. Methods: Patients≥70 years with a solid tumour diagnosis, admitted under the medical oncology service, were discussed at a weekly MDT meeting involving geriatric oncology physicians, nurses and pharmacists. Relevant data including age, cancer type and stage, Rockwood clinical frailty scale, comorbidities, medications on admission and initiated during hospitalisation, systemic anti-cancer therapy (SACT), falls history, cognitive screening, and laboratory parameters were prospectively collected. An MDT medication review was conducted including SACT toxicity assessment, drug-drug interactions (DDI), potentially inappropriate medication (PIM) assessment using STOPP/START criteria, and anticholinergic burden (ACB) scoring. A summary of medication review findings and recommendations was provided to the primary inpatient team to support medication optimisation. Results: Sixty patients were included over a 4 month period, with a median age of 76.5 years (range 65-88). Most patients had lung cancer (36.7%), 80% had stage IV disease. Twenty-five patients (42%) were moderately or severely frail. Most patients (61.7%) were on systemic anti-cancer therapy (SACT). Seven patients (11.7%) had a fall in the previous 3 months and 15 patients (25%) experienced acute confusion during the hospitalisation. ADEs were identified in 26 patients (43%), PIMs in 33 (55%), excessive ACB in 43 (72%) and DDIs in 53 (88%). MDT medication optimisation recommendations were made in 59 patients (98%) in addition to standard of care review. Based on review findings, medication interventions included recommendations to deprescribe, start drug, amend drug dose, route or frequency, perform additional laboratory monitoring, and SACT-specific recommendations (Table 1). Conclusions: Implementing an interprofessional geriatric oncology MDT approach to medication review in hospitalised older adults with cancer can result in additional medication recommendations alongside standard of care.[Table: see text]

An empirical study on secure usage of mobile health apps: The attack simulation approach

: Mobile applications (apps) have proven their usefulness in enhancing service provisioning across a multitude of domains that range from smart healthcare, to mobile commerce, and areas of context-sensitive computing. In smart healthcare context, mobile health (mHealth) apps - representing a specific genre of mobile apps that manage health information - face some critical challenges relating to security and privacy of device and user data. In recent years, a number of empirically grounded, survey-based studies have been conducted to investigate secure usage of mHealth apps. However, such studies rely on self-reported behaviors documented via interviews or survey questions that lack practical approaches that can simulate attack scenario for monitoring users’ actions and behaviors while using mHealth apps. : Our objective was to conduct an empirical study - engaging participants with attack simulation scenarios and analyze their actions - for investigating the security awareness of mHealth app users. : We simulated some common security attack scenarios in mHealth context and engaged a total of 105 app users to monitor their actions and analyze their behavior. We analyzed users' data with statistical analysis including correlations test, descriptive analysis, and qualitative data analysis (i.e., thematic analysis method). : Our results indicate that whilst the minority of our participants perceived access permissions positively, the majority had negative views. Users provide their consent, granting permissions, without a careful review of privacy policies that leads to undesired or malicious access to health data. Findings also indicated that 73.3% of our participants had denied at least one access permission, and 36% of our participants preferred no authentication method. : The study complements existing research on secure usage of mHealth apps, simulates security threats to monitor users’ actions, and provides empirically grounded guidelines for secure development and usage of mobile health systems.

Human resource development and management in the Philippines’ national space capacity building program

The Philippines has experienced a shift of interest in space technology development and utilization over the past decade, culminating with the establishment of its national space agency in 2019. In cooperation with different universities in Japan, the Philippines successfully developed and launched two microsatellites, DIWATA-1 and DIWATA-2, and six nanosatellites, MAYA-1 to MAYA-6. By sending personnel to Japan and other space-faring countries, the country was able to rapidly ramp up its satellite development and utilization capabilities. In this paper, we examine and evaluate the complex human resources development efforts conducted by the country to support the creation of a local space ecosystem and ensure its long-term sustainability. Through a careful review, we identify how many people benefited from training programs, studies abroad or other forms of capacity building, and how these skilled individuals were retained in the budding Filipino space sector. Precisely, we looked at the backgrounds of the different people trained by the country, what type of training they received (funding, location, and duration), and how they are supporting the local space ecosystem at the time of writing this paper.