Careful Review Research Articles

Self‐managed abortions in Ghana: A health policy framework analysis

AbstractBackgroundSelf‐managed abortions (SMAs) remain a public health challenge; and are worst in deprived settings. In this policy review, we sought to analyze the legal and policy frameworks within which SMA occurs and look at how these may help improve abortion outcomes in Ghana.MethodsWe searched and reviewed documents on “self‐induced” or “self‐managed” abortion in Ghana from 2015 to 2022. Databases searched included Ghana Digital Attorney, PubMed Central, Google Scholar, and Repositories of Public Universities in Ghana. The key documents reviewed included the abortion law (Act 29) of Ghana, the fourth (2021) edition of the Ghana Health Services’ Comprehensive Abortion Care Standards and Protocols, and the 2017 Maternal Health Survey report. Key documents reviewed included amended Act 29, Comprehensive Abortion Care policy, and standards. We then performed policy analysis using Walt and Gilson's policy triangle framework regarding the context, practice, processes, and key players.ResultsAfter a careful review of the literature, the following key themes emerged in the framework analysis: the policy environment for SMA, the practice of SMAs, key players of SMAs, consequences of induced abortions, the abortion law, and criminal connotations of SMA. We found that SMAs remain criminalized in Ghana but the local practice persists with the use of registered and unregistered abortifacients. We also observed frequent criminal connotations of SMAs in the literature but no evidence of related prosecutions. There was limited empirical evidence on the safety and efficacy of SMAs in Ghana.ConclusionFrom our findings, we contend that there is an unduly high criminal connotation of SMA in Ghana. We, therefore, recommend a multilevel stakeholder engagement to decriminalize SMAs to ensure improved access to safe abortions in Ghana.

P2: Impella Smart Assist Technology and Hemodynamics Management in Cardiogenic Shock Management

Background: Smart Assist Impella pumps provide enhanced hemodynamic metrics via real-time assessment of aortic pressure (AoP), left ventricular pressure (LVP), cardiac output (CO) and cardiac power output (CPO). These data can constitute powerful management tools for clinicians yet information on the Smart Assist Technology algorithms and calculations remains scarce. This case reports illustrates the importance of an in-depth understanding of this newer technology to effectively manage cardiogenic shock patients on Impella support. Method: A 64yo man with cardiogenic shock supported with Impella 5.5 as a bridge to transplant had been on support for 27 days, with stable hemodynamics on P8, flowing 4.5 LPM. On day 28 patient experienced suction alarms and LVDP <-40mmHg prompting the team to reduce P level, administer fluid and attempt Impella repositioning. None of the interventions resolved the issue and consideration was given to reducing support to P2 and weaning or exchanging the Impella. The pump appeared correctly positioned by echo and hemolysis markers were negative. Careful review of patients’ data demonstrated a discrepancy between the transduced radial artery MAP at 73 mmHg and the aortic pressure measured by the Impella fiber optic sensor at 42 mmHg. This prompted a review of the LVP metric. The Impella Left ventricular pressure is calculated in real time by subtracting from the AoP the differential pressure gradient between pump outlet and inlet as derived from the motor current. An erroneous Ao signal input will result in an inaccurate LVP. Furthermore, the Impella suction alarm algorithm utilizes a sustained low LVDP as a trigger and can thus be triggered erroneously if the Ao signal is inaccurate. The suctions alarms and the low LVP were determined to be caused by drifting data feed from the Impella aortic fiber optic sensor. An Impella Ao signal bedside recalibration based on transduced MAP resolved the suction alarms. Result A drifting AoP signal resulted in an erroneous LVP measurements and subsequent suction alarms. Fiber optic technology does not require periodic calibrations once in vivo. Per IFU, the accuracy of the Ao is 1.9mmHg and the accuracy of the LV is 8.8 mmHg. In this case, the recalibration of the AO signal resolved the suction alarms and low LVP. Decision was made to not undertake an invasive pump exchange and continue supporting the patient on the implanted pump managing the metrics with daily manual recalibration. The patient was supported for an additional 17 days demonstrating optimal perfusion pressure and LV unloading and successfully underwent orthotopic heart transplant on Impella day 45. Conclusion: Impella Smart Assist technology is a powerful tool to manage patients’ hemodynamics. An in-depth understanding of the technology and its algorithms is crucial in delivering optimal patient care and preventing erroneous data feed from guiding hemodynamic management.Figure 1. Impella Smart Assist metrics. A. Stable on P8. B. Suction alarm generated by low LVDP. C. Persistent alarms despite fluid bolus and lower P level. D. Suction alarm resolved by Ao recalibrationFigure 2. LVP Calculation

ID: 216141 Successfully Using Peripheral Nerve Stimulation in Treatment-Resistant Pudendal Neuralgia

Pudendal neuralgia has an estimated incidence around 1% of the general population with women affected more often than men.1 It is often an elusive treatment target resistant to common treatment modalities. Here we present a case of successful peripheral nerve stimulation to treatment-refractory pudendal neuralgia with a careful review of the relevant anatomical considerations and pitfalls as it pertains to neuromodulating this difficult target.

Linguistic validation of a questionnaire for the screening of OSAS in a paediatric population with Down Syndrome.

Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. This disorder is present in the paediatric population with a prevalence estimated between 1.2% and 5.8%. Down Syndrome (DS) is the most common chromosomal alteration associated with mental disability and characterised by other clinical manifestations, and its incidence is estimated at 1/800 births worldwide. Most of the craniofacial features typical of DS represent a risk factor for the development of OSAS. Routine screening has been recommended in some countries but it is still not a standard practice. The aim of this study is the Italian linguistic validation of a questionnaire for the diagnosis of OSAS in children with Down Syndrome. After careful review of the existing scientific literature, a specific questionnaire was selected for the diagnosis of OSAS in children with DS. The questionnaire was then translated into Italian and administered to 111 parents of children with Down syndrome, for online completion. The last part of the questionnaire was dedicated to the comprehension of the questionnaire itself, with a specific focus on its clarity, accuracy and difficulty in completing it. The positive feedback registered in the comprehension part of the questionnaire, certified the good quality of the Italian translation and confirmed the questionnaire as a useful screening method to identify the comorbidity of OSAS and DS.

First report of a common dolphin (Delphinus delphis) death following penetration of a biopsy dart

The remote collection of skin and blubber biopsy samples from free-ranging cetaceans is a powerful technique which has been increasingly used by scientists in recent years in a wide range of applications, particularly with respect to genetic and contaminant studies. Biopsy sampling, if carried out responsibly, is known to cause low-level reactions, and is unlikely to produce long-term deleterious effects. However, this technique is not completely devoid of risk for the sampled animals, particularly for smaller odontocetes. This paper reports the death of a common dolphin in the central Mediterranean Sea, following penetration of a biopsy dart and subsequent handling. The dolphin was hit in the dorsal muscle mass below the dorsal fin by a lightweight pneumatic dart fired from a distance of 6m by a variable-power CO2 dart projector. The methods and equipment had been previously successfully used with minimal effect on common dolphins and other species under similar conditions; it was therefore considered to be relatively uninvasive and more likely to reduce disturbance while increasing sample retrieval. However, in the reported event, a dart stuck in the dorsal muscle mass instead of recoiling as expected. Less than 2min after the hit, the dolphin began catatonic head-up sinking, and was recovered by a team member at depth. Basic medical care was given to ensure haemostasis, but the animal died 16min later. Minimal overall bleeding and a small wound in the thick muscle mass were not among the suspected causes of death. This may have been the consequence of either indirect vertebral trauma or stress. Furthermore, the dolphin had a relatively thin (7mm) blubber layer, that may have contributed to the unwanted outcome of the biopsy attempt. The author stresses that scientists should only adopt even mildly intrusive research methods after careful review and risk assessment in the light of the precautionary principle, and that their decisions must be reviewed on a regular basis according to the best available evidence.

법률행위의 해석

The main issue of the Supreme Court's ruling in this case was the recognition of the plaintiff's preliminary claim by reversely applying the legal principles of denial of legal personality to the defendant. The plaintiff's rights were recognized with difficulty. However, the claim for delivery of movable property under the 'Memorandum of Performance' that the Plaintiff had requested was dismissed on the grounds that it was not a title holder in the disposition document. The main basis for the decision to dismiss was the interpretation of legal acts based on indication that the existence and content of the expression of intention should be recognized as the text if the meaning of the text is objectively clear. Past discussions were conducted by dividing the goal of interpreting legal acts into expressing the parties' true intentions and expressing the objective meaning of the indicated text. However, currently, the types of legal acts are subdivided in various ways to set the goal of interpreting legal acts. In a similar way, precedents on the Supreme Court's interpretation of legal acts reveal the contents of legal acts by comprehensively considering the details of specific cases, the circumstances of the parties, and the laws applied to legal acts. The impact of Supreme Court precedents on the law and the people is very significant. In all cases, more careful and careful review is needed for the one-time dispute resolution of specific cases and the relief of the rights of the parties.

경제자유구역의 관리체계에 관한 법적 고찰

As with other planned locations, free economic zones are required to prepare legal and institutional devices facilitating continuous management and operation consistent with the purpose even after development and creation. However, since the legal system for free economic zones is centered on the designation and development of the relevant zones, deregulation, and incentives, it is considerably insufficient in terms of traditional management issues, that is, screening qualifications for occupancy or ex post facto management after sale in lots. Free Economic Zone Authority located throughout the country exists as a management agency for free economic zones. However, it is mainly engaged in tasks focused on investment attraction, support for corporates, and task discovery. On the other hand, the management plans are centered on the land utilization plans determined by the development plans or implementation plans. For occupancy management and ex post facto management, no separate regulations are stipulated other than to dispose of the creation sites according to the implementation plans. Therefore, it is inevitable to encounter limitations in performing efficient and systematic management for free economic zones. Nevertheless, in case where the designation of an industrial complex is under consideration according to the outline of the development plans of the free economic zones, it will be possible to apply the management system for both occupancy management and ex post facto management, which is the method for industrial complexes. In order to systematically manage free economic zones, it is primordial to raise awareness of the importance of management legislation. Furthermore, it is necessary to clarify the management system at the legal level. Fundamentally speaking, it is desirable to have separate regulations regarding management. In order to utilize the management system of industrial complexes as a designation under consideration for these complexes, it is essential to ensure consistency with the management system under the Act on Industrial Cluster Development and Factory Establishment. Furthermore, it will be vital to pay attention to how to establish a distinctive management system in line with the locational characteristics of the free economic zones. When it is judged that some areas require some management upon careful reviews of problems in the operation of free economic zones, active measures such as establishment of management plans must be taken. In addition, since the management system through the sale contract has limitations, it is needed to make serious considerations on the management system by way of the occupancy contract even in cases other than the land for industrial facilities.

경제자유구역의 관리체계에 관한 법적 고찰

As with other planned locations, free economic zones are required to prepare legal and institutional devices facilitating continuous management and operation consistent with the purpose even after development and creation. However, since the legal system for free economic zones is centered on the designation and development of the relevant zones, deregulation, and incentives, it is considerably insufficient in terms of traditional management issues, that is, screening qualifications for occupancy or ex post facto management after sale in lots. Free Economic Zone Authority located throughout the country exists as a management agency for free economic zones. However, it is mainly engaged in tasks focused on investment attraction, support for corporates, and task discovery. On the other hand, the management plans are centered on the land utilization plans determined by the development plans or implementation plans. For occupancy management and ex post facto management, no separate regulations are stipulated other than to dispose of the creation sites according to the implementation plans. Therefore, it is inevitable to encounter limitations in performing efficient and systematic management for free economic zones. Nevertheless, in case where the designation of an industrial complex is under consideration according to the outline of the development plans of the free economic zones, it will be possible to apply the management system for both occupancy management and ex post facto management, which is the method for industrial complexes. In order to systematically manage free economic zones, it is primordial to raise awareness of the importance of management legislation. Furthermore, it is necessary to clarify the management system at the legal level. Fundamentally speaking, it is desirable to have separate regulations regarding management. In order to utilize the management system of industrial complexes as a designation under consideration for these complexes, it is essential to ensure consistency with the management system under the Act on Industrial Cluster Development and Factory Establishment. Furthermore, it will be vital to pay attention to how to establish a distinctive management system in line with the locational characteristics of the free economic zones. When it is judged that some areas require some management upon careful reviews of problems in the operation of free economic zones, active measures such as establishment of management plans must be taken. In addition, since the management system through the sale contract has limitations, it is needed to make serious considerations on the management system by way of the occupancy contract even in cases other than the land for industrial facilities.

A Review of Surgical and Anesthetic Care in Quito, Ecuador

Introduction: Surgical and anesthetic care are critical components of healthcare services in Quito, Ecuador. The region has made significant advancements in technology, training, and infrastructure, which have improved the quality of care and outcomes for patients. However, there are still challenges and opportunities that need to be addressed to ensure that patients have access to high-quality surgical and anesthetic care. Objective: The objective of this review is to examine the developments, challenges, and opportunities in surgical and anesthetic care in Quito, Ecuador. Methods: The review was conducted through a comprehensive search of 20 relevant articles and studies on surgical and anesthetic care. The search was conducted using online databases such as PubMed, Google Scholar, and ScienceDirect. The articles and studies included in the review were selected based on their relevance to the research question and their quality and validity. Results: The results of the review indicate that there have been significant advancements in technology, training, and infrastructure for surgical and anesthetic care in Quito, Ecuador. However, the shortage of medical professionals, limited resources, and other challenges remain to be addressed. Conclusions: the review highlights the developments, challenges, and opportunities in surgical and anesthetic care in Quito, Ecuador. The findings of the review have implications for policymakers, healthcare providers, and medical professionals in the region, highlighting the need for continued investment in these critical medical services to ensure that patients have access to high-quality surgical and anesthetic care.

Associated Risk Factors and Outcomes of Resection Surgery of Colorectal Cancer: A Single Center Study in Bangladesh

Background: One of the most common cancers in the world is c1olorectal cancer. Surgery is the sole curative option, and post-operative morbidity and mortality should be kept to a minimum to enhance results. Of course, the whole surgical and medical team is extremely frustrated when post-operative complications finally result in patient death. Because colon cancer patients tend to be older, it is to be expected that a growing percentage of patients have co-morbidity, making any procedure riskier. Patients may lose their lives even after successful surgery as a result of co-morbidity-related consequences. The main method of therapy for colorectal cancer is still surgery. However, the procedure entails a high risk of morbidity and death and uses a substantial amount of medical resources. Postoperative complications are common in patients who have had colorectal surgery, and they put them at increased risk for morbidity, mortality, poor oncologic outcomes, and a reduced quality of life. Objective: To find out associated risk factors of the patients related to colorectal cancer and the outcome of resection surgery of colorectal cancer. Materials and Methods: After receiving ethical permission, the department of surgery at Rangpur Medical College Hospital carried out this longitudinal form of descriptive study between July 2019 and June 2020. After explaining the nature and goal of the study to the participants, signed informed permission was acquired. A pre-made questionnaire was used to interview a total of 33 patients. Each patient had a complete physical examination, a careful history review, and any necessary investigations. Based on pre-existing co-morbidities, surgical technique, and associated complications, 30-day postoperative mortality and morbidity were assessed. The case questionnaire contained the collected data. ANOVA, Fisher exact, and the appropriate statistical tests (Chi-square) were run. Software called SPSS (version 22.0) was used to examine the data.

Atypical Shoulder Instability Patterns in Adolescents Following Traumatic Anterior Shoulder Dislocation

Background: Traumatic anterior shoulder instability is common in the adolescent athlete, and when it is untreated, the recurrence rate is high. Atypical lesions—such as anterior glenoid periosteal sleeve, humeral glenohumeral ligament, and insertional tendon avulsions—may occur within this population, and accurate diagnosis and appropriate lesion management are key to treatment success. Purpose: To evaluate the age, skeletal immaturity, bone loss, and uncommon soft tissue lesions as correlates of posttraumatic anterior shoulder instability lesion patterns in an adolescent population. Study Design: Cross-sectional study, Level of evidence, 3. Methods: Consecutive patients ≤18 years of age (160 shoulders) treated within a single institution for traumatic anterior shoulder instability between June 2013 and June 2021 were reviewed. Demographics, injury mechanism, radiographic and magnetic resonance imaging of lesions, the presence of any bone loss, operative findings, and physeal status were recorded. An overall 131 shoulders met the inclusion criteria. Instability lesion type was analyzed categorically by age <15 or ≥15 years; individual age was assessed for correlation with any bone loss present. Atypical lesions—anterior labral periosteal sleeve avulsion, humeral avulsion of the glenohumeral ligament, subscapularis avulsion—were assessed for correlations with age, open physeal status, and the presence of any bone loss. Results: An overall 131 shoulders (mean, 15.3 years; range, 10.5-18.3) were identified for this study: 55 in patients <15 years old and 76 in patients ≥15 years old. Bony injuries such as Bankart and Hill-Sachs lesions were more common in the ≥15-year-old group (P = .044 and P = .024, respectively). Bony Bankart injuries were found at a rate of 18.2% in the <15-year-old group, as compared with 34.2% in the ≥15-year-old group (P < .05). Anterior labral periosteal sleeve avulsions were more common in the <15-year-old group (n = 13 [23.6%] vs n = 8 [10.5%]; P < .044), as were all atypical lesions combined (n = 23 [41.8%] vs n = 13 [17.1%]; P < .0018]. Conclusion: In this series of anterior shoulder instability in children and adolescents, instability lesions varied significantly by age. Bone loss was associated with older age at presentation, and atypical lesions were more common in patients <15 years of age. Treatment teams should be aware of less common soft tissue injuries in this young age group and ensure careful review of adequate imaging for proper diagnosis and treatment in these younger patients.

The Impact of Operation Revitalisation Strategies in Power Generation Plants on Customer Satisfaction

Purpose: The purpose of this manuscript is to examine the influence of operation revitalization strategies and management reforms on customer satisfaction in the power plant industry. Theoretical framework: The conceptual model for this study was developed based on previous research in the field of project management in Malaysia and globally. The conceptual model has three operations revitalization variables that affect customer satisfaction. Design/methodology/approach: A survey instrument in the form of a structured questionnaire was designed based on a careful review of pertinent literature. This study collected empirical data from 196 respondents. Multiple regression analysis is used to test the significance of the research model. Findings: The regression results reveals that business process reengineering, agile and lean manufacturing and reconfigurable manufacturing system effects customer satisfaction. Research, Practical &amp; Social implications: The implication drawn from this study aids project managers in providing a focus on the key variables that affect customer satisfaction in the power plant industry. Originality/value: The key value of this research lies in its findings of the key variables influencing customer satisfaction in the power plant industry in Malaysia which is currently under researched.

Marketing Mix Influence on Consumer Buying Behavior: A Case Study on the Cosmetics Industry

Purpose: This purpose of this manuscript is to study the effect of marketing mix on consumer purchasing behaviour in the context of the Malaysian cosmetics sector. Theoretical framework: The conceptual model for this study was developed based on previous research in the field of consumer behaviour and marketing globally. The conceptual model has four variables that affects consumer purchasing behaviour Design/methodology/approach: A survey instrument in the form of a structured questionnaire was designed based on a careful review of pertinent literature. This study collected empirical data from 240 respondents of cosmetic customers. Multiple regression is used to test the significance of the research model. Findings: Promotion and location are significant predictors of consumer behaviour. Promotion and location have a substantial impact on customer purchase behaviour in the local cosmetics business, although goods and price have no significance effect Research, Practical &amp; Social implications:The implication drawn from this study aids marketing managers to focus their resource on the key variables that consumer buying behaviour. Originality/value: This study contributes information to the academia and practitioners on marketing factors that can improve the sales performance and give the organization a competitive advantage in the marketplace.

A Structured Equation Modelling Study on Factors Influencing Students’ Choices of Private Institutions of Higher Education

Purpose: The aim of this study is to examine factors influencing students’ choices of private institutions of higher education Theoretical framework: The conceptual model for this study was developed based on previous research in the field of higher education in Malaysia and globally. The conceptual model has seven variables which can influence students’ choices of private institutions of higher education. Design/methodology/approach: A survey instrument in the form of a structured questionnaire was designed based on a careful review of pertinent literature. This study collected empirical data from 378 respondents. Multiple regression analysis is used to test the significance of the research model. Findings: The research reveals a positive association between the following variables and the university selection decision: programmes offered, employment opportunities and education and campus facilities. Research, Practical &amp; Social Implications: The implication drawn from this study aids the government policy makers and private higher education managers on factors that can affect student enrollement. Originality/value: The key value of this research the outcomes of this study will increase enrolment at private higher education institutions (IPTS).

Factors Affecting Smes Perception of Human Resource Management Practices: A Structural Equation Modeling Approach

Purpose: The purpose of this manuscript is to examine the factors affecting SMEs perception of human resource management practices. Theoretical framework: The conceptual model for this study was developed based on previous research in the field of human resource management globally. The conceptual model has four variables that affects SMEs perception of human resource management practices. Design/methodology/approach: A survey instrument in the form of a structured questionnaire was designed based on a careful review of pertinent literature. This study collected empirical data from 216 Dhaka-based small and medium-sized businesses. PLS-SEM is used to test the significance of the research model. Findings: It is clear from the PLS-SEM that Bangladeshi Small Businesses need training and development, performance measurement, and monetary incentives to succeed. Research, Practical &amp; Social implications: The implication drawn from this study aids human resource managers to focus their resource on the key variables that can afect SMEs perception of their organizations. Originality/value: This study is critical for leadership because it confirms the necessity or desire of business owners to grow human capital to improve corporate performance and give the organization a competitive advantage in the marketplace.

Preface

Preface&#x0D; The 19th International Symposium on Scientific Computing, Computer Arithmetic and Verified Numerical Computation (SCAN) was originally planned to be organized by the Institute of Informatics of the University of Szeged (SZTE) in Szeged, Hungary, in the year 2020. Due to the pandemic situation, the Scientific Committee of SCAN decided to postpone the meeting to September 13–15, 2021 and to have it in a fully online format.The members of the Scientific Committee were the following representatives of the topics of the conference: G. Alefeld (Karlsruhe, Germany), A. Bauer (Ljubljana, Slovenia), J. B. van den Berg (Amsterdam, the Netherlands), G.F. Corliss (Milwaukee, USA), T. Csendes (Szeged, Hungary), R.B. Kearfott (Lafayette, USA), V. Kreinovich (El Paso, USA), J.-P. Lessard (Montreal, Canada), W. Luther (Duisburg, Germany), S. Markov (Sofia, Bulgaria), G. Mayer (Rostock, Germany), J.-M. Muller (Lyon, France), M. Nakao (Tokyo, Japan), T. Ogita (Tokyo, Japan), S. Oishi (Tokyo, Japan), K. Ozaki (Tokyo, Japan), M. Plum (Karlsruhe, Germany), A. Rauh (Brest, France), N. Revol (Lyon, France), J. Rohn (Prague, Czech Republic), S. Rump (Hamburg, Germany/Tokyo, Japan), S. Shary (Novosibirsk, Russia), W. Tucker (Uppsala, Sweden), W. Walter (Dresden, Germany), J. Wolff von Gudenberg (Würzburg, Germany), and N. Yamamoto (Tokyo, Japan). The members of the Organizing Committee were: Balázs Bánhelyi, Tibor Csendes, Boglárka G.-Tóth, Viktor Homolya, Tamás Vinkó, and Dániel Zombori. During SCAN, more than 50 participants were present and 48 talks in several fields of reliable computation and its applications were given, and organized in 18 thematic sessions. The plenary speakers were Fabienne Jézéquel (Sorbonne University, France), Marko Lange (Hamburg University of Technology, Germany), J.D. Mireles James (Florida Atlantic University, USA), together with the Moore Prize winners Marko Lange and Siegfried Rump (Waseda University, Japan).The open-access scientific journal Acta Cybernetica offered to publish paper versions of selected presentations after a careful peer review process. Altogether, 7 papers were accepted for publication in the present special issue of Acta Cybernetica. The full program of the conference, the collection of all abstracts, and further information can be found at https://www.inf.u-szeged.hu/scan2020/.&#x0D; Andreas Rauh, Balázs Bánhelyi Guest Editors

The Enigma of Treating Colorectal Cancer and an Abdominal Aortic Aneurysm

As the average lifespan of individuals increases, malignancies and cardiovascular diseases are becoming a common cause of morbidity and mortality. The treatment of abdominal aortic aneurysms (AAAs) with concomitant diagnosis of colorectal cancer (CRC) is challenging. We aim to review the experience of a single tertiary institution in the management of patients with concurrent diagnosis of AAA and CRC hoping to glean information on how better to treat these patients. This is a retrospective review of all individuals treated between 2009 and 2022 at a large tertiary care center who had a documented diagnosis of CRC and AAA. A careful review of 102 patients resulted in a sample of 89 patients. Of the 89 patients in our cohort, 39 (43.8%) were diagnosed with CRC over 1 year before their AAA diagnosis. Fifteen (16.9%) patients were diagnosed with an AAA over 1 year before their CRC diagnosis and 35 (39.3%) were diagnosed concurrently with both CRC and AAA (Fig). In the concurrent subgroup, AAA was found on cancer staging workup CT scans, and we found the following in regard to their treatment: 12 (34.3%) individuals underwent CRC resection and surveillance of an AAA between 3 and 4 cm, 14 (40.0%) underwent CRC resection and surveillance of an AAA between 4 and 5 cm, and 3 (8.6%) had an AAA of over 5 cm and met criteria for repair; however, they had metastatic CRC and passed on hospice. There were no incidents of aneurysm rupture during surveillance. Ultimately, of the 35 individuals with concomitant AAA and CRC, 6 (17.1%) required treatment for both conditions—3 individuals had an endovascular aneurysm repair (EVAR) 4 to 6 months before CRC surgical resection, 2 had an EVAR after completing chemoradiation, and 1 individual had an EVAR 1.5 weeks after fecal diversion for obstructing CRC. In this group, there were no incidents of operative mortality. The treatment of both CRC and AAA has limited guidelines on how to proceed with the Society of Vascular Surgery level 2C recommendation for concomitant treatment. Our retrospective review of a single tertiary center identified 35 patients who were found to have an AAA during CRC workup. Although the majority had a small AAA that could be surveilled, of those who required repair, we found that EVAR was the sole approach. Further studies are needed to assess long-term outcomes with larger patient volumes from multiple institutions to recommend a definitive treatment algorithm.

The role of the voluntary, community and social enterprise sector in Early Help: Critical reflections from embedded social care research

AbstractThe independent review of children's social care (2022) has proposed a radical reset of England's children's services, shifting a remote, assessment heavy system towards one that works alongside communities to help prevent statutory interventions. However, notions around the harnessing of community resources to deliver Early Help are often underpinned by assumptions regarding the voluntary, community and social enterprise (VCSE) sector and the ease with which such organizations can be integrated into preventative strategies. This paper reports findings from embedded research within a unitary authority in Southwest England during remodelling of its Early Help service to work more collaboratively with local VCSE organizations. The study generated data from ethnographic observations, semi‐structured interviews and focus groups with 95 participants, including local parents, service providers, VCSE organizations and Council leaders. The findings illustrate that families value the compassionate, responsive and flexible support available within many VCSE settings. However, differences in practice cultures, regulatory pressures on statutory providers, the need to (re)build trust in communities and sensitivities around power‐sharing and resourcing meant negotiating VCSE sector integration was fraught with complexities. Few studies have gained such privileged access to a Local Authority's remodelling of Early Help services, and this paper has significant insights for the debates surrounding the independent review of children's social care (2022) and its recommendation to bring services ‘closer to communities’.

SHARING THE CARE: A project to enable prostate cancer care to be delivered in the community

AbstractProstate cancer has become the 2nd most common cancer in men worldwide. An ageing population and treatment improvements are increasing the number of men living with and beyond cancer. In 2013, there was both scant evidence to guide as to when, where or how men with prostate cancer should be followed up and neither, it appears, pointing to agreed pathways. Generally, follow up regimes are based on tradition and expert medical opinion rather than research or patient need. For men to have their follow up with their GP, several factors need to be in place such as a single system, an improved exchange of experiences, as well as information and knowledge sharing. A recent presentation of a randomized control trial has shown that there are no differences between secondary and primary care follow up. Understanding that the current model of follow up was not working and was unsustainable, a review of urological services was undertaken in 2011 in a large National Health Service (NHS) district general hospital in the north of England. The review evaluated current services, noting that some follow up pathways did not necessarily need to be undertaken within a secondary are setting. The process of relocating patients for primary care review, involved creating a shared care process for prostate cancer. A workstream consisting of consultant urologists, nurse specialists, GPs, service managers and clinical commissioners was convened. Protocols containing specific responsibilities for secondary and primary care were devised. The review and workstream, included a shared vision for improving and sustaining services. Whilst safely moving follow up from secondary to primary care, benefits were realized such as care closer to the home. In conclusion a radical approach to follow up was needed and undertaken. Shared care has yielded success for the patient, primary and secondary care.

Versatile Multimodal Biometrics to Prevent ATM Identity Frauds

—Automated Teller Machine (ATM) frauds have increased over the years resulting in the loss of customers and trust in current ATM security measures. In order to fight identity fraud and regain trust and reliability, biometric recognition technologies have become a necessity for ATMs. Using a card and pin is no longer reliable due to the rise of ATM identity fraud over the years. Studies have been carried out to solve this uprising issue, such as replacing the memorized pin with a one-time pin (OTP) and others using biometrics. There are still many gaps and challenges in the systems, with a common challenge being their accuracy rate, dependencies, and reliability. This study is conducted to alleviate the problem by introducing a versatile multimodal biometrics system. After a careful review of different biometric techniques and their differences in human identification inboth accuracy and reliability, physical biometrics isadopted in this study. Unlike behaviouralbiometrics, physical biometric features cannot easily be copied, replicated, or mimicked, and they are unique per individual. The three body features chosen for this study are the face, fingerprint, and iris. A real-time feature quality evaluation method is employed to assess the reliability of the biometric recognition results. The system provides independent anytime ATM access and prevents card-based theft and fraud, it can be relied on to always deliver uninterrupted ATM services to customers. Customers register their fingerprint, face, and iris to be able to use the biometric ATMs. A combination of any two of the registered biometric features can be used to authenticate users with high accuracy and reliability on ATMs with a 0% false acceptance rate. It has been found that allowing multiple options for users reduces false rejections and provides a 100% ATM access guarantee.