Contact Points Research Articles

Kinematics analysis of planetary roller screw mechanism with misalignment

The misalignment is unavoidable for planetary roller screw mechanism (PRSM) in practical application due to many uncertainties. The misalignment has a strong effect on the kinematic characteristics of PRSM. However, the relevant research has been rarely reported in the past. In order to clearly present the motion characteristics, a novel kinematics model of PRSM with misalignment is established in this article. The rotational tensor theory is introduced to obtain the coordinate transformation equations. The position vectors of PRSM with misalignment are acquired to calculate the position of the contact point. The motion model of PRSM with misalignment is derived by analyzing the velocity of the contact point. Compared with some published literature, the kinematic model of PRSM is verified. Moreover, a relationship between the misalignment variates, which are the misalignment angle, the misalignment azimuth angle, and the offset distance of the nut's ending point, respectively, and the kinematic characteristics of PRSM are investigated. The results indicate that those misalignment variates have a great influence on the kinematics of PRSM and lead to fluctuations in the PRSM's transmission velocity and angular velocity ratio. The fluctuation amplitude of transmission velocity is positively correlated with misalignment angle.

Family Planning and Preconception Care Service Management: The Key Role of Bulgarian GPs.

Assisting women in attaining their reproductive goals is crucial for improving the well-being of families and children. As the first point of contact for healthcare, general practitioners (GPs) are ideal for family planning (FP) and preconception care (PCC). However, primary care interventions' efficacy is unclear. The aim of this study was to examine GPs' knowledge, attitudes, and perspectives on FP and PCC service management. Most GPs were aware of FP and PCC services and held a firm conviction that they should be primarily accountable together with obstetrician-gynaecologists. However, it is worth noting that less than 50% of respondents reported receiving thorough and comprehensive knowledge of their respective specialities. Those with general medicine qualifications demonstrated a high level of commitment to providing such services. The women's GPs and those with training in general medicine prescribed birth control pills and emergency contraception three times more frequently than the other doctors who suggested condoms or traditional methods or referred patients to another specialist (p < 0.05). In conclusion, PCC is of the utmost importance, and its effective implementation demands the collaboration of policymakers, healthcare providers, and individuals. GPs are essential in managing FP and PCC. They must incorporate more in-depth PCC into their clinical practice.

User satisfaction with the National Health Insurance Program: A community-based survey from the Ilam district of Nepal.

The Government of Nepal initiated a family-based National Health Insurance Program (NHIP) in April 2016, aiming to ensure universal health coverage (UHC) by enhancing access to and utilization of quality health services. However, NHIP, in its initial years of implementation, encountered challenges such as low population coverage, a high dropout rate, and concerns among the insured regarding the quality of healthcare services. There is a dearth of information regarding user satisfaction with the NHIP in Nepal. This study aimed to assess user satisfaction with NHIP at the household level in Nepal. We conducted a cross-sectional study among 347 households in the Ilam district using a multi-stage random sampling method. Face-to-face interviews were conducted with household heads enrolled in NHIP. A semi-structured questionnaire was used to collect the data. The multivariable logistic regression analysis was done to identify the predictors of satisfaction level. Overall, 53.6% of the insured were satisfied with the NHIP, while 31.1% had comprehensive knowledge about the NHIP. Factors such as gender (AOR: 1.80, 95% CI: 1.08-3.00), distance to the first point of contact (AOR: 2.15, 95% CI: 1.24-3.74), waiting time (AOR: 2.02, 95% CI: 1.20-3.42), availability of diagnostic services (AOR: 1.90, 95% CI: 1.05-3.45), availability of prescribed medicine (AOR: 3.90, 95% CI: 1.97-7.69), perceived service quality (AOR: 2.20, 95% CI: 1.15-4.20), and the behavior of service providers (AOR: 3.48, 95% CI: 1.04-11.63) were significantly associated with user satisfaction. The satisfaction level among NHIP users was deemed moderate. This study highlighted several factors, such as gender, distance to the first point of contact, waiting time, availability of diagnostic services and prescribed medicine, perceived service quality, and the behavior of service providers, as key determinants impacting user satisfaction. Recognizing the pivotal role of user satisfaction, health insurance stakeholders must prioritize it to ensure higher retention rates and coverage within NHIP.

New angles and long walks: building regional networks through union education

PurposeThis article examines the role the Australian Trade Union Training Authority (TUTA) played in international education through the provision of trade union courses and exchanges. We consider how an investigation of trade union networks contributes to a richer understanding of international education linkages.Design/methodology/approachThis paper is based on research conducted for an Australian Research Council (ARC)-funded project: Trade union training: reshaping the Australian industrial landscape (ARC LP180100500). This research involved a critical analysis of 60 semi-structured oral history interviews and textual archives, including the official records held by the National Archives of Australia and papers held by the Noel Butlin Archives, the Australian Council of Trade Unions and in private collections.FindingsTUTA was established primarily as a national union training organisation, but from its inception, it also acted as a hub for the development of regional and international labour networks. The nature of TUTA’s work placed it at the intersection of international trade union and educational domains. Although there were some points of contact with formal international programs (e.g. Japan–Australia and Kellogg Foundations, the Colombo Plan and US Department of Labour exchanges schemes), the specific contribution of TUTA is overlooked in the educational exchange literature. The role of TUTA is revealed through institutional connections and individual experiences.Research limitations/implicationsFurther research is required to gain a deeper understanding of the impact of TUTA from the perspective of former participants in international TUTA course and current and former trade unionists in the Asia–Pacific.Originality/valueThis article builds new knowledge by examining the connections forged in the Asia–Pacific region at the intersection of trade union and educational networks, an area often overlooked in the literature on educational exchange.

Tibiofemoral articulation and axial tibial rotation of the knee after a cruciate retaining total knee arthroplasty

PurposeNumerous research has reported that total knee arthroplasty (TKA) cannot reproduce axial tibial rotations of normal knees. The objective of this study was to measure the tibiofemoral articular contact motions and axial tibial rotations of TKA knees to investigate the mechanism causing the knee kinematics change of after TKAs.MethodsEleven patients with unilateral cruciate retaining (CR) TKA were tested for measurements of knee motion during a weight-bearing flexion from 0° to 105° using an imaging technique. The tibiofemoral contact kinematics were determined using the contact points on medial and lateral surfaces of the tibia and femoral condyles. Axial tibial rotations were calculated using the differences between the medial and lateral articulation distances on the femoral condyles and tibial surfaces at each flexion interval of 15°.ResultsOn femoral condyles, articular contact distances are consistently longer on the medial than on the lateral sides (p < 0.05) up to 60° of flexion, corresponding to internal tibial rotations (e.g., 1.3° ± 1.0° at 15–30° interval). On tibial surfaces, the articular contact point on the medial side moved more posteriorly than on the lateral side at low flexion angles, corresponding to external tibial rotations (e.g., −1.4° ± 1.8° at 15–30° interval); and more anteriorly than on the lateral sides at mid-range flexion, corresponding to internal tibial rotations (e.g., 0.8° ± 1.7° at 45–60° interval). At higher flexion, articular motions on both femoral condyles and tibial surfaces caused minimal changes in tibial rotations.ConclusionsThese results indicate that the axial tibial rotations of these TKA knees were mainly attributed to asymmetric articulations on the medial and lateral femoral condyles and tibial surfaces. The data can help understand the mechanisms causing axial tibial rotations of TKA knees and help improve implant designs for restoration of normal knee kinematics.

A new kinematic model for revolute clearance joints with noncircular bushing and pin in planar multibody systems

Due to manufacturing error and wear, the profiles of bushing and pin in revolute clearance joints are usually non-circular, while traditional kinematic models for revolute clearance joints generally assume a circular profile for the pin or bushing, which may not be able to accurately capture the kinematic behavior of real revolute joints in multibody systems. To this end, a curvature center method was proposed for the kinematic modeling of revolute clearance joints with noncircular bushing and pin. In the proposed method, both the noncircular bushing and pin were discretized, and the curvature center and radius corresponding to each discrete point were then obtained to detect the point of contact between the bushing and pin based on their kinematic constraints. The number of discrete points was determined based on both accuracy and efficiency of the proposed curvature center method, which was then applied to model a revolute clearance joint between the slider and the link of a slider-crank mechanism. Via comparison to the traditional geometric center method and discrete point method, it was validated that the proposed method can achieve a comparable accuracy in modeling revolute joints with a circular pin. The unique advantage of the proposed curvature center method is its ability in modeling revolute joints with noncircular bushing and noncircular pin, which was also demonstrated via a series of simulations. Simulation results show a significant influence of noncircular bushing and noncircular pin on the dynamic response of the multibody system. This implies the promising value of the proposed method in studying the effect of manufacturing error or wear of both bushing and pin on the system’s dynamic performance and/or service life.

SJCIT Transport Management System

Innovative software developed with great care to maximize transportation inside of educational institution called the SJCIT Transport Management System (TMS). Acting as a single point of contact for all student and faculty transportation-related information, including records, routes, diversions, and more, this system includes sophisticated features like effective database management, user-friendly interfaces, and aesthetically pleasing design elements. Its rapid adaptation minimizes transition times by guaranteeing quick user onboarding. A key instrument in coordinating the smooth movement of people across multiple locations and schedules is the SJCIT TMS, which is centred around the promotion of safe, efficient, dependable, and sustainable transportation practices. Its adaptability makes it possible for it to function seamlessly in both standalone and integrated configurations, which makes it an essential tool for improving transportation management in learning environments

Lock Protocol : a new robust workflow for a very high first pass pulmonary vein isolation during atrial fibrillation ablation

Abstract Introduction Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation. First pass PVI is often demanding when a raw geometry reconstruction is used in combination with an inaccurate automarks annotation, accounting for discontinuous or non-transmural lesions and related AF recurrences. We hypothesized that a magnetic-post processing of left atrial geometry in combination with an LSI-guided high power short duration (HPSD) automarks annotation could improve procedural efficiency. Purpose The aim of this study was to determine the impact on procedural outcomes of the new "Lock PVI protocol" during AF ablation with the new voxel mode EnSite X mapping system. Methods We included in the study consecutive patients with AF scheduled for pulmonary vein isolation (PVI) at our Departement between January 2021 and December 2022. Patients were divided in two Groups, the Lock-PVI Group and the control No Lock-PVI Group. The "Lock PVI" Group was ablated with the new Ensite X System using the new protocol, which consisted in (1) performing a road map with contact-force annotation at potential PVI sites after High Density reconstruction, (2) shaving the magnetic geometry reconstruction to unearth true 3D location of contact points, (3) Use of 3D-Automarks color-coded with a Lesion Index (LSI) target of 5.5 (anterior) and 4.5 (posterior) (4) Inter-lesion distance &amp;lt;6 mm (5) High Power Short Duration Approach (50 W). The No-Lock PVI was represented by patients ablated with and HPSD ablation with the previous version of the EnSite Precision mapping suit as per local standard practice. Groups were compared in term of procedural duration, radiological exposure and "first pass" isolation. Results Forty-four patients (22 "Lock PVI" and 22 controls mean age 63,3±8 years, 65,9% male, 47,7% persistent AF), for a total of 88 PVI circles were enrolled. Procedural duration was similar between approaches (121,1±43,6 vs 125,3±30,1 min; P=0,72) but RF time was shorter in the "Lock PVI" group (19,6±4 vs 29,55±9,1 min; P&amp;lt;0,001), although with with a longer fluoroscopy (19,5±10,1 vs 13,4±4,9 min; P=0,01). Of note, first pass isolation was significantly higher in the "Lock PVI" group: 40/44 (90,9%) vs 28/44 (63,6%) circles (P=0,002). Conclusion The new "Lock PVI" approach resulted in consistently better first-pass isolation (&amp;gt;90%) with less RF time when compared to standard of care PVI.Graphical AbstractLock PVI

Advanced nerve regeneration enabled by neural conformal electronic stimulators enhancing mitochondrial transport

Addressing peripheral nerve defects remains a significant challenge in regenerative neurobiology. Autografts emerged as the gold-standard management, however, are hindered by limited availability and potential neuroma formation. Numerous recent studies report the potential of wireless electronic system for nerve defects repair. Unfortunately, few has met clinical needs for inadequate electrode precision, poor nerve entrapment and insufficient bioactivity of the matrix material. Herein, we present an advanced wireless electrical nerve stimulator, based on water-responsive self-curling silk membrane with excellent bioabsorbable and biocompatible properties. We constructed a unique bilayer structure with an oriented pre-stretched inner layer and a general silk membrane as outer layer. After wetting, the simultaneous contraction of inner layer and expansion of outer layer achieved controllable super-contraction from 2D flat surface to 3D structural reconfiguration. It enables shape-adaptive wrapping to cover around nerves, overcomes the technical obstacle of preparing electrodes on the inner wall of the conduit, and prevents electrode breakage caused by material expansion in water. The use of fork capacitor-like metal interface increases the contact points between the metal and the regenerating nerve, solving the challenge of inefficient and rough electrical stimulation methods in the past. Newly developed electronic stimulator is effective in restoring 10 mm rat sciatic nerve defects comparable to autologous grafts. The underlying mechanism involves that electric stimulation enhances anterograde mitochondrial transport to match energy demands. This newly introduced device thereby demonstrated the potential as a viable and efficacious alternative to autografts for enhancing peripheral nerve repair and functional recovery.

Ultrahigh thermal conductance of the point contact between amorphous nanowires

Amorphous interfaces/contacts are ubiquitous in numerous micro/nanoelectronic devices and functional composite materials. Traditionally, the thermal resistance of interfaces/contacts was believed to be the primary impediment to heat transport. However, in this study, through measuring thermal resistance between crystalline-amorphous core-shell Ge nanowires, we unveil an ultrahigh thermal conductance across the point contact between the amorphous shell of Ge nanowires with a room-temperature value of 892 MW/m2-K. This value surpasses the typical values observed in point contacts between crystalline nanowires/nanoribbons by one to three orders of magnitude and even exceeds that of epitaxial interfaces between well-lattice-matched materials. Molecular and lattice dynamic simulations further reveal that the observed ultrahigh thermal conductance is attributed to the broadened vibrational bandwidths within the amorphous contact, which facilitates the redistribution of phonon energy into a state conductive to more effective interfacial energy transmission, leading to an enhanced overlap of phonon modes and, consequently, a heightened thermal conductance.

A Comprehensive Framework for Hospital@Home Care Models.

To develop a framework of relevant features for describing hospital@home care models. The framework was developed based on a literature review and thematic analysis. We considered 42 papers describing hospital@home care approaches. Extracted features were grouped and aggregated in a framework. The framework consists of nine dimensions: Persons involved, target patient population, service delivery, intended outcome, first point of contact, technology involved, quality, and data collection. The framework provides a comprehensive list of required roles, technologies and service types. The framework can act as a guide for researchers to develop new technologies or interventions to improve hospital@home, particularly in areas such as tele-health, wearable technology, and patient self-management tools. Healthcare providers can use the framework as a guide or blueprint for building or expanding upon their hospital@home services.

Acute Autonomic Nervous System Response to Direct Sacral Nerve Root Stimulation in Lower Urinary Tract Dysfunction: A New Approach to Understand the Mechanism of Action of Sacral Nerve Modulation.

Our goal was to assess acute autonomic nervous system (ANS) response to direct sacral nerve root (SNR) stimulation in the context of lower urinary tract dysfunction. In this retrospective monocentric study, patients undergoing 2-stage sacral nerve modulation for overactive bladder, nonobstructive urinary retention, or chronic bladder pain syndrome between March 2022 and June 2023 were analyzed. A standardized stimulation protocol was applied during the lead implantation, each of the 4 contact points being sequentially stimulated at the amplitude required to elicit anal motor response. Stimulations were labeled as StimA, StimB, StimC, and StimD, ordered by ascending order of minimum amplitude required for anal motor response. Heart rate variability parameters were collected using PhysioDoloris Monitor, and computed through the time-domain (standard deviation of normal-to-normal intervals [SDNN], root mean square of successive differences), the frequency-domain (low frequency, high frequency) and the graphical (Analgesia Nociception Index [ANI]) methods. Fifty patients were analyzed, including 35 females. Twelve patients had an underlying neurological disease. Efficacy was deemed achieved in 54% of patients. SDNN variability significantly increased during StimA to StimC, while maximum SDNN significantly increased only during StimA. ANI variability significantly increased during all 4 stimulations, while maximum ANI significantly increased only during StimA. Direct stimulation of SNR is responsible for a significant increase in ANS and relative parasympathetic nervous system activity, with a greater effect observed when the stimulation was delivered closer to the SNR. These results shed light on potential mechanisms underlying sacral nerve modulation, particularly regarding the treatment of ANS dysregulation in lower urinary tract dysfunction.

Precision Gait Stability Analysis Combining Hardware and Software

Maintaining stable gait and avoiding falls require effective control of the body’s center of mass (CoM) relative to the base of support (BoS), defined by the feet's contact points with the floor. Quadrupeds have an advantage over bipeds but share common spinal neural control mechanisms. Human walking poses stability challenges since the CoM often extends beyond the BoS. This project aims to monitor gait stability by integrating advanced hardware and software solutions. Machine learning algorithms, such as Random Forest, will be employed to predict gait instability by capturing foot positions and sensor data. Inertial measurement sensors will track stability changes, and hardware outputs will be validated against software predictions for accuracy. A mobile app developed using React Native will display predicted parameters and indicate gait instability (yes/no). In case of detected instability, a wearable buzzer will alert the user. This system promises a more accurate solution for monitoring gait stability compared to existing models, by combining real-time data collection and sophisticated algorithms

3D-printed short-span hybrid composite implant-supported restorations fabricated through tilting stereolithography: A retrospective clinical study on 85 patients with 1 year of follow-up

PurposeTo report the clinical results obtained with fixed short-span (single crowns [SCs] and fixed partial prostheses [FPPs]) implant-supported hybrid composite restorations fabricated through tilting stereolithography (TSLA). MethodsThis retrospective clinical study included 85 patients who had been restored with 95 fixed short-span implant-supported hybrid composite (Irix Max®, DWS Systems) restorations (70 SCs and 25 FPPs up to three units) fabricated with TSLA. The full-digital model-free workflow was based on intraoral implant scanning, computer-assisted design (CAD) and 3D printing using TSLA (Dfab®, DWS Systems). The primary outcomes were the marginal adaptation, the quality of the occlusal and interproximal contact points, and the chromatic integration of the restorations, assessed independently by two experienced operators (a prosthodontist and a periodontist). A score from 1 to 5 (with 5 as the highest value, 4 for satisfactory quality, 3 for acceptable quality, and 2 and 1 as the lowest values, expressing unsatisfactory quality) was assigned by each operator to each restoration at delivery. The secondary outcomes were the survival and success of the restorations at the 1-year follow-up. The restoration was defined as successful in the absence of any complications throughout the follow-up period. A statistical analysis was conducted. ResultsFor the quality of the marginal closure and occlusal and interproximal contact points, the 3D-printed hybrid composite restorations scored highly; the aesthetic integration was satisfactory. One year after placement, all restorations survived, with a low incidence (4.2 % overall, 5.7 % SCs) of complications (two abutment screw loosenings, two decementation of the restorations, and one upper portion of the hybrid abutment decemented from the titanium base), for a success rate of 95.8 %. ConclusionsWithin the limits of this study (retrospective design, follow-up limited to 1 year from the delivery, and only cemented restorations included) fixed short-span implant-supported hybrid composite crowns and bridges fabricated through TSLA were clinically precise, presenting a low incidence of complications at 1 year. Statement of clinical relevanceThe use of TSLA printing technology can open new perspectives for the treatment of small edentulous gaps with definitive implant-supported prosthetic restorations.

Implementing dietary counselling in family practice for diabetes control and prevention

The importance of dietary counselling in family practice for managing and preventing diabetes is the focal point of this review, highlighting its integral role in chronic disease management. With diabetes increasingly prevalent worldwide, there is a critical need for effective management strategies, with dietary interventions playing a key role. Family practitioners, often the initial point of contact for patients, have a unique opportunity to implement these dietary changes, which are pivotal in influencing diabetes outcomes and averting long-term complications. Despite facing challenges such as limited time and the need for specialized knowledge, dietary counselling in family practice stands as a proactive measure focused on prevention and early intervention. It adopts a patient-centered approach, where dietary habits and preferences are assessed, and personalized, evidence-based advice is provided. The inclusion of dietitians in primary care teams, utilization of technology for support, and advocacy for policy reforms are recommended to enhance the effectiveness of dietary counselling. Despite various obstacles, integrating dietary counselling into routine care remains a significant advantage, promoting healthier lifestyle choices and effectively managing the increasing burden of chronic diseases.

Attitudes, Beliefs, Barriers, and Facilitators of Emergency Department Nurses Toward Patients with Opioid Use Disorder and Naloxone Distribution.

As opioid overdose deaths continue to rise, the emergency department (ED) remains an important point of contact for many at risk for overdose. In this study our purpose was to better understand the attitudes, beliefs, and knowledge of ED nurses in caring for patients with opioid use disorder (OUD). We hypothesized a difference in training received and attitudes toward caring for patients with OUD between nurses with <5years and ≥6years of clinical experience. We conducted a survey among ED nurses in a large academic medical center from May-July 2022. All ED staff nurses were surveyed. Data entry instruments for the nursing surveys were programmed in Qualtrics, and we analyzed results R using a chi-square test or Fisher exact test to compare nurses with <5years and ≥6years of clinical experience. A P-value of < 0.05 was considered statistically significant. We distributed 74 surveys, and 69 were completed (93%). Attitudes toward naloxone distribution from the ED were positive, with 72% of respondents reporting they were "very" or "extremely" supportive of distributing naloxone kits to individuals at risk of overdose. While attitudes were positive, barriers included limited time, lack of system support, and cost. Level of comfort in caring for patients with OUD was high, with 78% of respondents "very" or "extremely" comfortable. More education is needed on overdose education and naloxone distribution (OEND) with respondents 38% and 45% "a little" or "somewhat" comfortable, respectively. Nurses with <5years of experience reported receiving more training on OEND in nursing school compared to those with ≥6years of experience (P = 0.03). There were no significant differences in reported attitudes, knowledge, or comfort in caring for patients with OUD. In this single-center survey, we found ED nurses were supportive of overdose education and naloxone distribution. There are opportunities for targeted education and addressing systemic barriers to OEND. All interventions should be evaluated to gauge impact on knowledge, attitudes, and behaviors.

Single German centre experience with patient journey and care-relevant needs in amyloidosis: The German AMY-NEEDS research and care program.

Amyloidosis is a rare multi-system disorder associated with frequently delayed diagnosis, enormous disease burden and psychosocial distress. Systematic assessment of needs was performed by a subtype-spanning questionnaire-based survey within the AMY-NEEDS research and care program. 118 patients with proven amyloidosis (62.7% ATTR, 22.0% AL, 15.3% other forms) were included in August 2020 until February 2021 (mean age 71.2 ±11.3 years; 30% women). The median diagnostic delay between onset of symptoms and diagnosis was 9.0 (range: 2.5; 33.0) months. Local health care providers (HCPs) play a central role on the way to diagnosis. Diagnosis itself typically requires a clinical but not necessarily a university setting. In the treatment phase, the focus moves to the amyloidosis centre as primary contact and coordinator, with general practitioners (GPs) acting predominantly as a contact point in crisis and link to additional services. About half of patients reported impaired quality of life and one third suffering from anxiety and depressed mood, respectively. The majority of patients talk about their concerns with close caregivers and local HCPs. Advance care planning is a relevant, yet insufficiently met need. The journey of patients with amyloidotic disease, their contact partners and needs at different stages were characterized in detail within the German health care system. An amyloidosis-specific care concept has to master the multitude of interfaces connecting the numerous treatment providers involved with the amyloidosis centre and GPs as key players. Telemedical approaches could be a promising and well-accepted option allowing optimal coordination and communication.

On Gods, Heroes and Men. A Comparison of Tolstoy and Vico's Philosophies of History

While proceeding toward the end of War and Peace a reader can find itself startling and struggling to understand what kind of work is actually dealing with. The fictional narration is not yet concluded when L. Tolstoy (1828–1910) starts to lose himself in philosophical discussions regarding the nature of history as a science. Suddenly words such as god, heroes and men start to fill the pages recalling in the mind the language of a philosopher with at his back a history of long oblivion, the Italian G. Vico (1668–1744). The common terminology is only the triggering point for approaching a possible comparison between two authors that are so distant for time, context, interests, life and styles. A deep reading of their works however reveals some points of contact especially in a critique of their contemporary historicism, in their common interests on history as an objective science, on the analyses of events recollection and invention of tradition, in their overlapping instances of heterogeneity of ends and their reference to divine providence. A specific and different investigation might be necessary in order to understand whether those concepts somehow traveled along about one century and half from one to the other or whether they are just floating ideas of historical discourse. Nevertheless, starting from their commonalities the paper offers a clue on their inevitable divergences and a possible development of some of their central concepts. Being Tolstoy a writer of the ungraspable and indeterminate, concepts related to complex thinking will emerge during the reading.

The Management of Patients at High Risk of Serious COVID-19 Disease: Optimising the Patient Pathway in the Middle East, Africa, and Eastern Europe.

Introduction For patients at high risk of severe COVID-19 disease, antiviral therapeutic options are available to reduce the risk of hospitalization or death. Although many countries have developed national guidelines for COVID-19 management that include use of antiviral agents, it is unclear how these guidelines are used in daily clinical practice. This study aims to assess the management of high-risk COVID-19 patients in the Middle East, Africa, and Eastern Europe, with a focus on understanding current practices, challenges, and potential strategies for improvement. Methods Healthcare professionals (HCPs) from the Middle East, Africa, and Eastern Europe came together at a regional summit in February 2023 to share perspectives on the therapeutic management of patients at high risk of serious COVID-19 disease in the community. Summit participants represented diverse medical specialties, geographical regions, and healthcare settings. Key insights gathered during the summit were supplemented with evidence from the published literature via a non-systematic literature search of MEDLINE and online sources such as government reports since the start of 2020 to identify articles on disease burden, unmet needs, treatment access, antiviral therapy, guidelines related to individuals with COVID-19 at high-risk for poor outcomes in low- and middle-income countries (LMICs). Together, these sources were used by the authors to generate their recommendations for future priorities and optimal care pathways globally. Results Specific insights gathered from the summit were that participants reported that primary care is the first point of contact for high-risk patients, but the role of primary care physicians (PCPs) in treatment is uncertain. Additionally, participants highlighted that between-country differences in the care pathway for high-risk patients are due to variations in local treatment practices, healthcare system structures, and resourcing. In line with the published literature, participants agreed that HCP education is needed to support the identification, counseling, and appropriate management of high-risk patients and that pharmacists have a critical role to play in identifying clinically important potential interactions with antiviral treatment and recommending appropriate adjustments. Furthermore, patient hesitancy can result in late presentation, delayed treatment, and potential progression of symptoms. HCPs should proactively counsel high-risk patients, so they are aware of their risk and its implications and understand what to do if they experience symptoms of COVID-19. Targeted educational initiatives for patients are needed to mitigate reluctance to undergo COVID-19 testing and counter COVID-19 misinformation. Conclusion Collaboration among stakeholders is essential to optimize COVID-19 management for high-risk patients globally, ensuring effective implementation of guidelines and improving outcomes.

Patient-Reported Experiences of Supportive Cancer Care during the COVID-19 Pandemic

Background. During the COVID-19 pandemic, people affected by cancer were in need of information about the virus and about the (self-) management of cancer symptoms and treatment. It is important to understand how patients with cancer navigated through the pandemic and to explore their experience relating to their supportive care needs. Aim. This study aimed to describe the experience of Swiss oncological patients during the COVID-19 pandemic with additional supportive cancer care. Methods. A single-center study was conducted in 2021. Patients with melanoma, breast, lung, or colon cancer who received active systemic anticancer treatment at the time of the COVID-19 pandemic and who were additionally seeing either oncology clinical nurse specialists, integrative medicine physicians, or both were included. We conducted semistructured interviews alongside the patient-reported quantitative assessment of distress and resilience. Thematic analysis was performed for the qualitative data and descriptive statistics for the quantitative data. Results. Eighteen patients with cancer were interviewed. Patients seeing an integrative medicine physician highlighted that they positively felt being addressed as a whole person during the consultations. The oncology clinical nurse specialists were perceived as the first point of contact for the patients and had more time during the pandemic compared to what the patients normally received. In general, patients did not experience delays or disruptions in their cancer treatment. As immunosuppressed and fatigued patients with cancer, they felt supported by the restrictions and hygienic measures. Access to vaccination reassured patients against the risk of infection. These results were reflected in the quantitative data, as we found moderate distress levels (M = 4.1; SD = 2.5) and high resilience scores (M = 7.5; SD = 0.9) in this patient population. Conclusion. During the COVID-19 pandemic, patients with cancer felt particularly supported by integrative medicine and cancer nurse consultations. Secured resources for nursing consultations and integrative medicine services can help to address the supportive care needs of patients with cancer.