Consistent Approach Research Articles

A risk-based approach to community illicit drug toxicosurveillance: operationalisation of the Emerging Drugs Network of Australia – Victoria (EDNAV) project

IntroductionThe Emerging Drugs Network of Australia – Victoria (EDNAV) project is a newly established toxicosurveillance network that collates clinical and toxicological data from patients presenting to emergency departments with illicit drug related toxicity in a centralised clinical registry. Data are obtained from a network of sixteen public hospital emergency departments across Victoria, Australia (13 metropolitan and three regional). Comprehensive toxicological analysis of a purposive sample of 22 patients is conducted each week, with reporting of results to key alcohol and other drug stakeholders. This paper describes the overarching framework and risk-based approach developed within Victoria to assess drug intelligence from EDNAV toxicosurveillance. MethodsRisk management principles from other spheres of public health surveillance and healthcare clinical governance have been adapted to the EDNAV framework with the aim of facilitating a consistent and evidence-based approach to assessing weekly drug intelligence. The EDNAV Risk Register was reviewed over the first two years of EDNAV project operation (September 2020 – August 2022), with examples of eight risk assessments detailed to demonstrate the process from signal detection to public health intervention. ResultsA total of 1112 patient presentations were documented in the EDNAV Clinical Registry, with 95 signals of concern entered into the EDNAV Risk Register over the two-year study period. The eight examples examined in further detail included suspected drug adulteration (novel opioid adulterated heroin, para-methoxymethamphetamine adulterated 3,4-methylenedioxymethamphetamine (MDMA)), drug substitution (25B-NBOH sold as lysergic acid diethylamide, five benzodiazepine-type new psychoactive substances in a single tablet, protonitazene sold as ketamine), new drug detection (N,N-dimethylpentylone), contamination (unreported acetylfentanyl) and a fatality subsequent to MDMA use. A total of four public Drug Alerts were issued over this period. ConclusionsContinued toxicosurveillance efforts are paramount to characterising the changing landscape of illicit drug use. This work demonstrates a functional model for risk assessment of illicit drug toxicosurveillance, underpinned by analytical confirmation and evidence-based decision-making.

Limitations on the rights of migrant workers: Is a compliant and consistent approach being followed?

Migration has become a global phenomenon and South Africa, like many other countries, is a recipient of migrant workers. Migrant workers can be classified under five categories: permanent residents, refugees, asylum seekers, temporary residents, and undocumented migrants. This article focuses on documented migrants and their right to engage in work. Integral to the right to work is the right to choose one's trade, occupation or profession freely. This is a constitutionally protected right, but is reserved exclusively for citizens, which implies that migrant workers can be lawfully excluded from working in certain occupations or professions. This ties in with South Africa's obligation to protect employment opportunities for citizens. However, South Africa has immigration laws in place that afford substantial rights to certain categories of migrants. Furthermore, as a member of the UN and International Labour Organisation (ILO), South Africa has certain international law obligations. Against this backdrop, this article engages with the recent Constitutional Court decision of Rafoneke v Minister of Justice and Correctional Services where temporary residents were denied the right to be admitted to practise and be authorised to be enrolled as legal practitioners. The article seeks to establish whether this decision, which has been viewed as disappointing, complies with international law and upholds the legal principles endorsed in preceding cases.

Abstract 13492: Optimal Fluoroscopy Views and Catheter Selection for Coronary Angiography in Porcine Models

Coronary angiography is the gold standard for the diagnosis and treatment of epicardial coronary artery disease. Further, it is an essential tool for conduction of translational cardiac research on large animal models, in the development of novel cardiac therapies. While in humans coronary angiography has an exceedingly low mortality rate; in pigs, procedural mortality has been reported as high as 15%, likely due to unsuitable variations in angiographic techniques. Porcine models are used due to the resemblance of cardiac function and anatomy to humans. However, procedural guidelines delineating proper equipment to be used for angiography in this model has yet to be systematically assessed. Aims: To evaluate clinically common catheters for their utility in the safe engagement of the coronary vessels in pigs. Establish optimal workflow and fluoroscopy views for safe coronary artery engagement and angiography. Method/Results: Percutaneous superficial femoral artery access was acquired via ultrasound guidance and subsequent cardiac catheterization was performed in sus domesticus weighing 35-50 kg. Catheters that were tested included the JL 2.5, JL3.0, JR 3.0, AR1, AL1, MPA1, Champ1, 3DRC, hockey stick and RCB (5-7 french) operated over a standard .035 J tip wire. AP views were optimum to engage both the left and right coronary vessels. Only AR1, 3DRC, and hockey stick catheters successfully engaged the RCA, while all catheters tested could successfully engage the LCA. AR1 was noted to be the best for RCA engagement and AL1 for Left system engagement. AR1 was also the most succesful in engagement of both LM and RCA in same pig. AL1 provided the most stable engagement for Left coronary system. AR1/JL were better for LAD intervensions. AL1 is best for LCX intervensions Conclusion: We present a systematic description of percutaneous coronary angiographic procedures highlighting that AL for the LCA and AR for the RCA are the best choice of catheters for fastest and safest engagement of the coronary arteries limiting both radiation time and contrast use. While variations in anatomy can mandate changes in angiographic angles and catheter techniques, AP visualization and use of AL and AR catheters provided the most consistent and effective approach for porcine angiography.

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient-staff relations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two-way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co-produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. ABSTRACT: Introduction A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method A retrospective phenomenological approach, using semi-structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.

Alternate method to develop ground motion prediction equations: Calibration over Himalayan region

An alternative approach for constructing GMPEs, the Consistent Spectral Shape approach (CSS), is recently proposed to overcome the limitations of the conventional methods. The CSS framework is already implemented using the NGA-West2 database to develop a set of five GMPEs of 5 % damped spectral accelerations (RotD50, RotD100, Geo-mean, GMRotD50, and GMRotD100). In this paper, the performance of the CSS-GMPEs based on the NGA-West2 database is first assessed against those developed in the NGA-West2 project. Two different yardsticks are considered for the comparison: overall root mean square error (RMSE) and similitude of spectral shape. RMSE for CSS-GMPE and five NGA-West2 GMPEs are nearly consistent, but CSS utilizes a significantly smaller number of independent variables. CSS-GMPE also performs better while comparing the similitude of spectral shape. This paper next modifies the existing set of five CSS-GMPEs for the Himalayan region using a generic modification function contingent on intensity measure (RotD50, RotD100, Geo-mean, GMRotD50, and GMRotD100). All five CSS-GMPEs modified for the Himalayan region are observed to be performed satisfactorily for all practical purposes. These modified GMPEs are expected to be a valuable tool for site-specific seismic hazard analysis.

The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know.

Guidelines for brain death/death by neurologic criteria (BD/DNC) determination were revised to provide a consistent and updated approach to BD/DNC evaluation across all ages by the American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine. This article is intended to complement the guidelines and highlight aspects relevant to the critical care community; the actual guidelines should be used to update hospital protocols and dictate clinical practice. Because BD/DNC evaluations are conducted in the ICU, it is essential for members of the critical care community to familiarize themselves with these guidelines. The fundamental concept of BD/DNC has not changed; BD/DNC is permanent loss of function of the brain as a whole, including the brain stem, resulting in coma, brainstem areflexia, and apnea in the setting of an adequate stimulus. The BD/DNC evaluation requires a sufficient observation period to ensure there is no chance of recovery, followed by exclusion of potentially confounding conditions like hypothermia, hypotension, severe metabolic disturbances, or medication effects. Specific guidance is provided for patients who were treated with therapeutic hypothermia or medical or surgical interventions to manage intracranial hypertension. The guidelines outline a structured and meticulous neurologic examination and detail the responses consistent with BD/DNC. A protocol is provided for how to safely perform apnea testing, including modifications needed for patients on extracorporeal membrane oxygenation. Controversial issues such as consent, BD/DNC evaluation in pregnancy, preservation of neuroendocrine function, and primary posterior fossa injuries are addressed. The ultimate goal is to ensure a consistent and accurate approach to BD/DNC evaluation in patients of all ages, fostering public trust in the medical community's ability to determine death. By adhering to these guidelines, critical care clinicians can confidently navigate the challenging aspects of BD/DNC determination.

Comparing frailty prevalence between countries: validation of the Global Burden of Disease study Frailty Index (GBD-FI) in the survey of health, ageing and retirement in Europe.

Accurate comparable prevalence proportions are required to better understand the epidemiology of frailty. Estimates in many countries are missing or incomparable. The Global Burden of Disease Frailty Index (GBD-FI) applies the deficit accumulation model to generate frailty scores from items available in the Global Burden of Disease study. To externally validate the GBD-FI. Data were obtained from the Survey of Health Ageing and Retirement in Europe (SHARE). A 20-item modified GBD-FI was compared with established frailty measures: a 70-item frailty index (FI-70), the Clinical Frailty Scale (CFS), Frailty Phenotype (FP) and SHARE-FI. Area under receiver operating characteristic curves (AUC) were fitted to examine diagnostic accuracy for frailty and predictive validity for 2-year mortality. In total, 31,624 participants aged ≥50years from 15 countries were included. Frailty prevalence was 22% using the GBD-FI (ranging from 8% in Switzerland to 41% in Poland). The GBD-FI had good to excellent diagnostic accuracy for frailty, irrespective of approach; the AUC ranged from 0.86 (95% confidence interval: 0.85-0.87) measuring frailty using the CFS to 0.94 (0.93-0.94) with the FI-70. The GBD-FI had similar accuracy for 2-year mortality (AUC 0.71, 0.69-0.74) compared with the CFS (0.73; P = 0.186), FP (0.73; P = 0.392) and SHARE-FI (0.70; P = 0.255) but lower than the FI-70 (0.76; P < 0.001). The GBD-FI demonstrated concurrent and predictive validity, suggesting it is a valid measure of frailty. It has the potential to be an efficient, replicable and consistent approach to comparing frailty between countries and regions across time using GBD data.

Introducing the Ecosystem and Socioeconomic Profile, a Proving Ground for Next Generation Stock Assessments

Ecosystem-based fishery science is an important component of effective marine conservation and resource management. Implementation has progressed through large-scale comprehensive ecosystem status reports; however, integrating ecosystem research within the stock assessment process remains elusive. Primary obstacles include the lack of a consistent approach to including ecosystem and socioeconomic information into a stock assessment model and how to test its reliability for identifying future change. We introduce a methodology and reporting framework termed the Ecosystem and Socioeconomic Profile (ESP) to overcome these obstacles. The ESP facilitates the integration of ecosystem and socioeconomic factors within the stock assessment process through four steps that culminate in a focused, succinct, and meaningful communication of drivers for a given stock. The first ESP was produced for Alaska sablefish and we provide the general process to implement the ESP framework using results from the sablefish ESP. We conducted a data synthesis that allowed for the framework to be applied across multiple regions and stocks. ESPs are an efficient testing ground for developing ecosystem-linked stock assessments and provide a set of reporting tools that can be tailored to a variety of audiences in order to effectively merge the ecosystem, socioeconomic, and stock assessment disciplines.

Efficacy and Safety of Chemotherapy (DDGP vs VIPD) Followed Radiotherapy Vs Radiotherapy Followed Chemotherapy (DDGP vs VIPD) Vs Radiotherapy Alone for Newly Diagnosed Early Stage Extranodal Natural Killer/T Cell Lymphoma: Final Results of a Prospective, Multicenter, Randomized, Controlled Clinical Trial

Background: Extranodal Natural Killer/T Cell Lymphoma (ENKTL) is a highly aggressive form of non-Hodgkin lymphoma (NHL), primarily found in Asia and commonly linked to Epstein-Barr virus (EBV) infection. Despite the treatment efficacy for early stage ENKTL has been improved in recent years, there is no consistent approach for clinical treatment. Current guidelines includes radiotherapy (RT) alone, concurrent chemoradiation therapy (CCRT), sequential chemoradiation, and sandwich chemoradiation. Here we present the final results of the efficacy and safety of sequential therapies of DDGP (dexamethasone, cisplatin, gemcitabine, and pegaspargase) regimen or VIPD (etoposide, ifosfamide, cisplatin and dexamethasone) regimen combined with RT, and RT alone. M ethods: We conducted a prospective, multicenter, randomized, controlled clinical trial to compare the efficacy and safety of sequential chemotherapy (DDGP vs VIPD regimen) followed by RT, sequential RT followed by chemotherapy, and RT alone in eligible patients with newly diagnosed stage I/II ENKTL. Upon study entry, patients were randomized 1:1:1:1:1 to receive either DDGP regimen followed by RT (DDGP+RT), or VIPD regimen followed by RT (VIPD+RT), or RT followed by DDGP regimen (RT+DDGP), or RT followed by VIPD (RT+VIPD), or RT alone. Patients assigned to the DDGP group were administered cisplatin (20 mg/m 2, intravenous, days 1-4), dexamethasone (15 mg/m 2, intravenous, days 1-5), gemcitabine (800 mg/m 2, intravenous, on days 1 and 8), and pegaspargase (2500 IU/m 2, intramuscular, on day 1). Those in the VIPD group received etoposide (100 mg/m 2, intravenous, days 1-3), ifosfamide (1.2 g/m 2, intravenous, days 1-3), cisplatin (33 mg/m 2, intravenous, days 1-3), and dexamethasone (40mg, intravenous, days 1-4). Both the DDGP and VIPD regimens were repeated every 21 days. For the sequential chemotherapy followed by RT group, patients underwent 3 cycles of either DDGP or VIPD regimen, followed by 50 Gy (2 Gy * 25 times) of intensity modulated radiotherapy (IMRT). In the sequential RT followed by chemotherapy group, patients were first given 50 Gy (2 Gy * 25 times) of IMRT and then sequential either DDGP or VIPD regimen. Meanwhile, the RT alone group received 50 Gy (2 Gy * 25 times) of IMRT only. The primary end point of our study was progression free survival (PFS), with secondary end points including complete remission rate (CRR), objective response rate (ORR), overall survival (OS). R esults: Our study, spanning January 2011 to August 2020, involved 244 patients from 22 centers across China, with 200 randomly assigned to receive treatment (40 in each group). Both the demographic and disease characteristics of the patients at baseline were generally consistent across all treatment groups. During a median follow-up of 72.1 months, the median PFS (mPFS) was not reached in neither the DDGP + RT nor RT + DDGP groups, compared to 36.3 months in the VIPD + RT group, 78.3 months in the RT + VIPD group, and 89.6 months in the RT alone group. The 5-year PFS rates for the DDGP + RT, VIPD + RT, RT + DDGP, RT + VIPD, and RT alone groups were 81.5%, 46.1%, 79.8%, 53.1%, and 57.5% respectively. Similarly, the 10-year PFS rates were 81.5%, 42.8%, 74.1%, 45.9%, and 45.7% respectively. Compared with RT alone, PFS was improved in DDGP + RT group (p = 0.006) and RT + DDGP group (p = 0.024). Compared with VIPD + RT, PFS was improved in DDGP + RT group (p = 0.006) and RT + DDGP group (p = 0.026). Either between DDGP +RT and RT + DDGP group or between VIPD +RT and RT +VIPD group, PFS showed no differences. Median OS was not reached in 5 groups. OS showed no differences in 5 groups (p = 0.27). The patients who failed from either VIPD regimen or RT alone received DDGP regimen. This might be the reason why the OS showed no differences between 5 groups. The CRRs of 5 groups (DDGP + RT, VIPD +RT, RT + DDGP, RT +VIPD, RT alone) were 87.5%, 57.5%, 82.5%, 69.2%, and 67.5%, respectively. Similarly, the ORRs were 97.5%, 77.5%, 90.0%, 74.4%, and 87.5%, respectively. Conclusions: The DDGP regimen exhibited promising outcomes in this randomized clinical trial for newly diagnosed early-stage ENKTL patients. The sequential therapies with DDGP regimen could improve the efficacy compared with RT alone. Patients could also benefit more from therapies with DDGP regimen than those with VIPD regimen. The order in which chemotherapy and RT were applied has no fatal impact on the prognosis of early-stage ENKTL.

3D Genome Organization and Single-Cell Characterization of Pediatric Intrachromosomal Amplification of Chromosome 21 (iAMP21) B-Cell Acute Lymphoblastic Leukemia

B-cell Acute Lymphoblastic Leukemia (B-ALL) is the most frequent childhood cancer, and around 2% of these cases are associated with intrachromosomal amplification of chromosome 21 (iAMP21). The iAMP21 cases represent one of the high-risk but least understood sub-group of B-ALL. The sub-group also has a significantly low survival rate and a higher risk of relapse than non-iAMP21 cases. Recent studies suggest that structural variations in iAMP21 are linked to complex rearrangements such as a chromothripsis event on chromosome 21. The consequences of chromothripsis by which it drives the tumorigenesis are still unclear. Given the limited knowledge of chromothripsis and its impact on the epigenetic landscape in pediatric iAMP21 cases, we aim to systematically provide a critical understanding of the causes and consequences of such complex genomic rearrangements. We conducted an in-depth analysis of 9 iAMP21 and 10 non-iAMP21 pediatric patient samples associated with B-ALL using different sequencing techniques. These included whole genome sequencing (WGS), long-read sequencing, RNA-sequencing, and 3D genome organization. The WGS analysis revealed that iAMP21 cases had more genomic rearrangements compared to the non-iAMP21 group. Interestingly, iAMP21 subtypes displayed a unique feature - the presence or absence of the chromothripsis signature on chromosome 21. However, all patients shared a common characteristic - amplified and frequently deleted regions on chromosome 21, suggesting these genetic changes are a key aspect of the iAMP21 subtype, regardless of chromothripsis. Genomic rearrangements, a crucial element in oncogenesis, also modify the 3D structure of the human genome, and iAMP21 is no exception. Our Hi-C data analysis showed the devastating effect of chromothripsis on the 3D organization of chromosomes in iAMP21 patients. We observed a significant reconfiguration of the genomic compartments, along with changes in cis- and trans-acting regulatory elements such as enhancers and promoters. These changes disrupt the delicate balance of gene expression profile. To better understand the impact of these genomic rearrangements on the transcriptional landscape, we examined global gene expression patterns in iAMP21 subtypes, identifying distinct upregulated and downregulated genes. Our comparison between iAMP21 and non-iAMP21 groups identified a unique set of 186 upregulated and 174 downregulated genes in iAMP21 patients. Further, tumor diversity can greatly influence cancer diagnosis and treatment responses. Therefore, analyzing gene expression at the single-cell level is essential to uncover this diversity and identify unique cellular characteristics. Our analysis provided clear evidence of iAMP21 subclones within individual patient samples, resulting from differences in genomic rearrangements in each cancer cell. The iAMP21 cases with complex chromosomal rearrangement make it a high-risk and poorly characterized subtype of pediatric ALL. We hypothesize that even though related to worse outcomes, investigating the chromosomal rearrangement and the epigenetic landscape in iAMP21 may expose specific vulnerabilities of cancer cells in these patients allowing for targeted therapies and devising new therapeutic strategies. While our findings so far are preliminary, they offer valuable insights that can guide the formulation of hypotheses for further detailed experiments and data analysis. The project has already amassed a wealth of genomic data and a consistent approach to data analysis, addressing the challenging task of identifying relevant prognostic and predictive molecular factors in patients battling aggressive forms of cancer.

Establishing an oncology stewardship committee during the era of drug shortages.

212 Background: Chemotherapy shortages are common, causing rationing when demand exceeds supply. Hospital systems and pharmacies are responsible for chemotherapy ordering - there is no national distribution system. There is risk for inequitable and/or unethical allocation of scarce resources. Prescribing providers are at risk when making individual allocation decisions and leave themselves exposed to medicolegal risk. Given the frequency of supply shortages of antineoplastic, biologic or cellular therapies, we identified a need to create a framework for management of limited supplies and prioritization of allocation decisions. Methods: To ensure a consistent and transparent approach, the Oncology Stewardship Committee (OSC) was established, compromised of multidisciplinary representatives (adult/pediatric physicians, pharmacists, social workers, nurses, and ethicists). The committee based its work on a framework of ethical values and guiding principles, including maximizing benefits (urgency of need, likelihood of benefit, availability of alternatives) and fairness (not upon patient demographics, ability to pay, or financial impact to the health system). A tiered plan for each therapy in shortage was created (table), starting with monitoring and escalating to mitigation through conservation, allocation through a vetted pathway with an appeal process, and up to randomization if all other options were exhausted. Results: The OSC was assembled, agreed upon principles and processes, and launched in 2022. An example for which management escalated to “Tier 3” was fludarabine. During active management of fludarabine, 238 eligible patients were considered, 158 met restriction criteria and 80 were assigned an alternative therapy. Conclusions: The formation of an institutional OSC allowed for improved transparency and equitable allocation of scarce resources. In future, this framework will be used for ongoing drug shortages in addition to management of non-formulary requests.[Table: see text]

A measure to evaluate parenting interventions: Using inclusive research to modify a tool to measure change in parenting self‐efficacy during the antenatal period

AbstractBackgroundWith the right support, people with learning disabilities can be ‘good enough’ parents (Coren et al., 2011; Murphy &amp; Feldman, 2002). Parenting programmes exist to support parents and are made accessible for people with learning disabilities who are expecting a baby, but evaluation of the benefit of these interventions is poor due to a lack of accessible outcome measures (May &amp; Harris, 2020; Wade et al., 2008). The Tool to Measure Parenting Self‐Efficacy in the antenatal period (TOPSE‐ ante‐natal) measures the impact of parenting interventions on an individual's self‐efficacy during the antenatal period. This study aimed to modify the TOPSE ante‐natal tool through a process of inclusive research, to support a consistent approach to evaluating parenting interventions from the perspective of parents‐to‐be with learning disabilities.MethodsA two‐phase study using interviews and discussion groups was conducted in a process of inclusive research to modify the TOPSE ante‐natal tool. Phase one involved conducting eight cognitive interviews (interviews to understand how individuals process and recall information) with parents with learning disabilities. These were conducted remotely via Microsoft Teams, transcribed verbatim and analysed using content analysis (Krippendorff, 2013). Participants were recruited using snowballing techniques through the advisory groups' networks. Phase two included three discussion groups with study collaborators and advisors (n = 14) to assess the accessibility and acceptability of adaptations of the tool, each making further refinements for consideration.FindingsInterviews and discussion groups highlighted how parents‐to‐be with learning disabilities experienced some of the original TOPSE‐ante‐natal negative statements, including negative points on a Likert scale, difficult to comprehend. Figurative statements and unfamiliar words also caused confusion, and statements focussed on the pressures of parenting were experienced as confrontational by people with learning disabilities. Statements were removed or replaced and agreed upon in discussion groups to ensure that the tool was accessible and meaningful to people with learning disabilities.ConclusionsWe have used a process of inclusive research to modify a self‐efficacy tool for parents‐to‐be with learning disabilities that is freely available on the TOPSE website (https://www.topse.org.uk/site/). The next steps are for this tool to be used and validated in future studies evaluating parenting interventions for people with learning disabilities. This will inform a knowledge base of what interventions should be used by practitioners who are supporting people with learning disabilities to prepare for parenthood.

BIT·FTA상 외국인투자심사 실행에 관한 연구

Countries with foreign investment screening mechanism have developed practices to avoid international investment disputes. These practices include using security exceptions, exceptions to dispute settlement provisions, and schedules to Annex regarding non-conforming measures in investment agreements. These practices do not specify specific national security requirements and are subject to full self-judgment. Countries with a long history of foreign investment screening, such as the United States, Canada, and Australia, actively use these practices to exclude foreign investment screening from international agreement obligations. These countries interpret the national security exception jurisprudence as applying to foreign investment screening, meaning that foreign investment screening is entirely self-judged.&#x0D; However, South Korea does not have a consistent approach to foreign investment screening in its Bilateral Investment Treaties (BITs) and Free Trade Agreements (FTAs). The security exception clause in these agreements is different in each agreement, and the contents of the reservations are not uniform. However, it can be interpreted that Korea has decided to treat foreign investment screening as an exception to international law, since it joined the Regional Comprehensive Economic Partnership (RCEP), which stipulates that the screening regime shall not be subject to the dispute settlement provisions.&#x0D; Foreign investment screening is likely to become more important as a policy tool in the era of expanding national security. The concept of national security has evolved from being applied only in exceptional emergencies such as war to encompassing more permanent situations such as economic security, high-tech protection, supply chain crisis response, and climate change. State measures to protect national security have also become more permanent. Given these circumstances, it is important to reconsider whether it is appropriate to treat foreign investment screening as an exception to international law. Allowing foreign investment screening as an exception to international law could lead to a crisis in the international legal system due to potential abuse of this exception. However, from the government's perspective, securing policy space for foreign investment screening can be advantageous in effectively addressing the growing threat to national security. Therefore, it is crucial to contemplate the stance and standards that should be established for the foreign investment screening practice in Korea moving forward.

A new step forward in realistic cluster lens mass modelling: analysis of Hubble Frontier Field Cluster Abell S1063 from joint lensing, X-ray, and galaxy kinematics data

ABSTRACT We present a new method to simultaneously and self-consistently model the mass distribution of galaxy clusters that combines constraints from strong lensing features, X-ray emission, and galaxy kinematics measurements. We are able to successfully decompose clusters into their collisionless and collisional mass components thanks to the X-ray surface brightness, as well as use the dynamics of cluster members, to obtain more accurate masses exploiting the fundamental plane of elliptical galaxies. Knowledge from all observables is included through a consistent Bayesian approach in the likelihood or in physically motivated priors. We apply this method to the galaxy cluster Abell S1063 and produce a mass model that we publicly release with this paper. The resulting mass distribution presents different ellipticities for the intra-cluster gas and the other large-scale mass components as well as deviation from elliptical symmetry in the main halo. We assess the ability of our method to recover the masses of the different elements of the cluster using a mock cluster based on a simplified version of our Abell S1063 model. Thanks to the wealth of mutliwavelength information provided by the mass model and the detected X-ray emission, we also found evidence for an ongoing merger event with gas sloshing from a smaller infalling structure into the main cluster. In agreement with previous findings, the total mass, gas profile, and gas mass fraction are all consistent with small deviations from the hydrostatic equilibrium. This new mass model for Abell S1063 is publicly available, as the lenstool extension used to construct it.

How China Perceives European Strategic Autonomy: Asymmetric Expectations and Pragmatic Engagement

Abstract Intensified strategic competition between China and the US and the outbreak of the Russia–Ukraine conflict have polarised international attention on the promotion and prospects for European strategic autonomy (ESA). This change in the international and regional environment raises an important question: How does ESA affect China–EU relations? Answering it requires clarification of the main impacts of ESA promotion on China–EU relations. These include: the EU’s reduced dependence on key materials and technologies from certain countries, and the formulation and expression, in line with core EU interests, of an independent stance and policies on China; China’s adjustment of its European Strategy; and persistent external pressure from the United States. Starting from its particular interests, the EU has, to some extent, independently assessed and accordingly refined its relations with China, having pursued cooperation in global public welfare governance and other areas of similarly low ideological significance, and pragmatically explored ways of moderating competition and enhancing cooperation with China. Fields highly sensitive to geopolitical influence, or which involve key technologies and globally important supply chains, are those wherein China is treated as a competitor. Upon analysis, it can be concluded that the EU’s most consistent approach to its goals of strategic autonomy is that of maintaining an alliance with the United States while avoiding full dependence on it, and competing with China in key areas that allow leeway for practical cooperation.

Implementasi Kebijakan Pemerintah Tentang Pengurangan Penggunaan Kantong Plastik Pada Bisnis Retail Di Kabupaten Jepara

The purpose of this study was to investigate the execution of measures aimed at lowering the utilization of plastic bags within the retail market of Jepara Regency. The research employs a qualitative methodology, utilizing descriptive analytic techniques. The data-gathering process involved conducting an interview with the Head of Hygiene and Waste Management at the Jepara Regency Environment Office, who served as a key informant. In order to gather comprehensive data, interviews were conducted with both sellers and buyers at retail stores in Welahan, Mayong, and Pecangaan sub-districts. The findings of the study indicate that the implementation of the policy is facilitated by socializing activities, particularly in the context of communication and transmission. The Jepara regency government has conducted socialization efforts throughout nearly all marketplaces, demonstrating a clear and consistent approach. The implementation of policies involves the participation of human resources, namely the Environment Office, as the responsible entity. The necessary financial resources for policy implementation are also obtained through the Regional Revenue and Expenditure Budget. Regarding disposition, policy implementers have a preexisting commitment to effectively executing their responsibilities and exhibit a democratic mindset. In relation to bureaucratic organization, the execution of government policies is already directed by the established Standard Operating Procedure. However, there are still challenges for the government in terms of public response and low understanding of the dangers of using plastic bags.

Risk Factors Affecting Health of Modern Specialists in Vocational and Psychological Training

The health of people in Ukraine has become particularly relevant in recent years, as Ukrainian society is exposed to unprecedented external threats, such as the war with Russia, that negatively affect plans, goals and quality of life, and the increases psychological tensions that lead to the deterioration of people's physical, mental and social health. This also applies eqully to participants in the educational environment.&#x0D; Today, in light of the military actions in Ukraine, it is necessary in higher educational institutions to address new and non-standard tasks challenge students’ health and their personal resources in the process of education.&#x0D; A complex combination of new and unpredictable challenges and risks resulting from challenges to the socio-political situation in the country such as the Covid pandemic, the war with Russia, and the growing presence of digital technologies in the educational space, actualizes the deployment of a series of studies about risk factors affecting students’ health.&#x0D; The purpose of this article is to study the particular risk factors affecting the health status of today’s students distinctive in order to help develop a better system of protective measures to prevent morbidity in the process of their education.&#x0D; The methodology in this article is based on the fundamental methodological principles of consistency and interdisciplinary approach and includes the use of a collection of general scientific (explanation, comparison, classification, generalization, systematization) and empirical (observation, conversation, description, analysis, experiment) methods. Based upon these, we have formulated a set of practical recommendations for providing appropriate conditions for maintaining students’ health in modern learning conditions.&#x0D; Within the framework of our study, the following results were achieved: the views of scientists on the definition of factors affecting the level of youth health were summarized; the risk factors influencing the health indicators of students are considered; the results of a study about the prevalence of diseases among students in a special medical group from the National Technical University "Kharkiv Polytechnic Institute" are given, the recommendations are formulated for the prevention of morbidity among students in higher educational institutions in the process of vocational training in war conditions.&#x0D; The conclusions allow us to state that in order to preserve the health of modern specialists in current conditions, it is necessary to identify the main groups of risk factors, understand the mechanisms of their action to a specialist and apply timely appropriate measures and techniques to prevent them, depending on the current situation.

Survey of the current practices of German football academies towards biological maturation assessment

ABSTRACT Objectives This study aimed to examine the importance assigned to assessing and considering biological maturation in thematic areas of player development and provide an overview of current practices in German football academies regarding its consideration in training and competition. Methods An online survey was sent to 56 elite German football academies. A total of 46 responded to the questionnaire (82% response rate). Six participants provided incomplete information resulting in a total of 40 completed surveys in the period from March to May 2022. Results Only 20 of participants regularly carried out maturation assessments, despite 95% recognizing its importance for load management, 90% for player development, and 85% for injury prevention. There was no consistent approach to modifying training and competition formats based on maturity status, with a primary focus on gym-based sessions for load management. Conclusion The survey results highlight limited implementation of maturation assessment and training modification based on maturity status in German elite youth football academies. Despite recognizing the importance of load monitoring, reporting to parents, and long-term player development in considering biological maturation, practices are not widespread. The predominant use of the maturity offset method suggests an opportunity to improve accuracy by exploring alternative measurement methods and increasing assessment frequency. Moreover, a lack of established procedures for incorporating maturity status into training and competition exists, hindering comprehensive consideration of biological maturation and injury risk prevention. Further research is needed to understand the reasons for inconsistent approaches in maturation assessment and load modification during training and competition.

General population normative data from seven European countries for the K10 and K6 scales for psychological distress

The 10-item Kessler Psychological Distress scale (K10) and its 6-item short-form version (K6) measure psychological distress, particularly anxiety or depressive symptoms. While these questionnaire scales are widely used in various settings and populations, general population normative data are rarely available. To facilitate the interpretation of K10 and K6 scores, we provide normative general population data from seven European countries. We used an online survey to collect K10 data from general population samples in Austria, Italy, Germany, France, the Netherlands, Poland and Spain. We calculated the age- and sex-specific normative values separately for each country. For more specific estimates of K10 and K6 scores for individuals or groups, we also established a multivariable regression model based on socio-demographic and health data. In total, N = 7,087 adults participated in our study (51.6% women; mean age, 49.6 years). The mean K10 score in the total sample was 8.5 points (standard deviation, 7.3) on 0–40 points metric, with mean scores in individual countries ranging from 6.9 (the Netherlands) to 9.9 (Spain). Women showed higher scores than men and younger participants scored higher than older participants. Our study is the first to present normative K10 and K6 data from several European countries using a consistent sampling approach. These reference values will facilitate the interpretation of K10 and K6 scores in clinical research and practice and also highlight the variation in psychological distress levels across countries and groups according to their socio-demographic and health characteristics.

Investigating the Structural and Lithium Storage Properties of High-Entropy Oxides in the Mg-Co-Ni-Cu-Zn-O System

Recently, a new class of materials known as high-entropy oxides (HEOs) has emerged as an alternative electrode material for the next-generation Li-ion batteries. However, the discovery of these materials brings forth a broad range of compositions remained unexplored. This study aimed to investigate the structural and electrochemical characteristics of the non-equiatomic HEOs. Accordingly, ten different samples were synthesized in the Mg-Co-Ni-Cu-Zn-O system at very high (35 mol. %) and very low (5 mol. %) constituent proportions. Our experimental and theoretical results indicated that the thermodynamic stability of the HEOs was affected significantly by the enthalpic contributions arising from the lattice strain. These findings may provide a more consistent design approach in selection of a suitable component for the synthesis of the single-phase HEOs. Furthermore, the specific capacity, cycling stability and lithiation voltage of the electrodes have also been shown to be influenced by each individual constituent of the electrode.