Current Patterns Research Articles

Numerical model of changes in current patterns due to reclamation around the Mireng River estuary, Gresik

Abstract The Mireng River is in Gresik Regency and empties into the Madura Strait. Around the mouth of the Mireng River, two industrial areas require construction facilities through reclamation. The consequences of reclamation will cause phenomena due to the interaction of marine and environmental dynamics, which can change current patterns, wave heights, and sedimentation processes, affecting the surrounding environment. This study explicitly discusses the changes in flow patterns that occur due to reclamation. The investigation was performed using numerical model simulations with Delft 3D software. The model results show the movement pattern and current speed during the highest and lowest low tides. There was a change in the average flow speed to 0.18 m/s around the reclamation area due to flow obstruction due to reclamation. This condition has the potential for sedimentation to occur in the area. Therefore, mitigation efforts are needed to reduce this impact.

Current referral patterns and pitfalls pertaining to the treatment of esophageal perforation

Current referral patterns and pitfalls pertaining to the treatment of esophageal perforation

Characteristics of Patients With Atherosclerotic Cardiovascular Disease in Belgium and Current Treatment Patterns for the Management of Elevated LDL-C Levels.

Dyslipidemia remains the major cause of atherosclerotic cardiovascular disease (ASCVD). Lipid management in patients with increased cardiovascular (CV) risk needs improvement across Europe, and data gaps are noticeable at the country level. We described the current treatment landscape in Belgium, hypothesizing that lipid management in patients with ASCVD remains inadequate and aiming to understand the reasons. Using data from an anonymized primary care database in Belgium derived from 494 750 individuals, we identified those with any CV risk factor between November 2019 and October 2022 and described the clinical features of patients with ASCVD. The main outcomes were the proportion of patients (i) receiving lipid-lowering therapies (LLTs), (ii) per low-density lipoprotein cholesterol (LDL-C) threshold, stratified per LLT, (iii) reaching the 2021 ESC recommended LDL-C goals, and (iv) LDL-C reduction per type of LLT was also determined. Among 40 888 patients with very high CV risk, 24 859 had established ASCVD. Most patients with ASCVD were either receiving monotherapy (59.6%) or had no documented LLT (25.1%). Further, 64.2% of those with no documented LLT exhibited LDL-C levels ≥ 100 mg/dL. Among common treatment options, one of the greatest improvements in LDL-C levels was achieved with combination therapy of statin and ezetimibe, reducing LDL-C levels by 41.5% (p < 0.0001). Yet, in this group, 24.8% of patients had still LDL-C levels ≥ 100 mg/dL and only 20.7% were at goal. Our study emphasizes the importance of developing strategies to help patients achieve their LDL-C goals, with a focus on supporting the implementation of combination LLT in routine clinical practice.

Evaluation and Management of Glenohumeral Instability in Adolescent Patients: An Expert Consensus Statement.

Management of glenohumeral instability in the adolescent population can be both challenging and controversial. There are no current guidelines for optimal management of glenohumeral instability in this population (unidirectional or multidirectional), and the cutoff ages for transition to adult treatment are not known. To develop consensus-based guidelines for the management of glenohumeral instability in adolescents. Consensus statement. A 26-question, multiple-choice survey was developed after 2 rounds of iterations and was submitted to the orthopaedic surgeons of the Pediatric Research in Sports Medicine (PRiSM) Society. The survey comprised 3 sections-demographics, practice setting, and decision-making-and included cutoff ages and management in 5 specific case scenarios. Consensus-based guidelines were generated with 66% response agreement. An indication score was then applied to each response related to more aggressive management to determine if variables related to consensus (or lack thereof) could be identified. A total of 54 responses were returned. Of the respondents, 59% were from academic practice, 84% were pediatric orthopaedic fellowship trained, and 46% performed >25 shoulder instability cases per year. In the setting of first-time anterior shoulder dislocation, nonoperative treatment was preferred for boys aged <14 years and girls aged <13 years. Besides age, proximal humerus physeal status, injury mechanism, sport, and presence of bony injury affected treatment selection. The presence of a Bankart lesion was an indication for stabilization in first-time dislocations for contact athletes with a closing or closed physis, but not in patients with an open physis or noncontact injury mechanisms. For recurrent anterior shoulder dislocation, stabilization was preferred irrespective of physis status. Initial nonoperative treatment was preferred for multidirectional instability. In the setting of first-time anterior shoulder dislocation in patients with open physes, nonoperative treatment was preferred for boys <14 years and girls <13 years. Future multicenter prospective studies focusing on outcomes would help to validate current practice patterns, especially in scenarios for which no consensus was reached.

The Discover In-Hospital Cardiac Arrest (Discover IHCA) Study: An Investigation of Hospital Practices After In-Hospital Cardiac Arrest.

In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the post-resuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover In-Hospital Cardiac Arrest (Discover IHCA) study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort. Our study collects granular data on post-IHCA treatment practices, focusing on temperature control and prognostication, with the objective of describing variation in current post-IHCA practice. This is a multicenter, prospectively collected, observational cohort study of patients who have suffered IHCA and have been successfully resuscitated (achieved ROSC). There are 24 enrolling hospital systems (23 in the United States) with 69 individual enrolling hospitals (39 in the United States). We developed a standardized data dictionary, and data collection began in October 2023, with a projected 1000 total enrollments. Discover IHCA is endorsed by the Society of Critical Care Medicine. The study collects data on patient characteristics including pre-arrest frailty, arrest characteristics, and detailed information on post-arrest practices and outcomes. Data collection on post-IHCA practice was structured around current American Heart Association and European Resuscitation Council guidelines. Among other data elements, the study captures post-arrest temperature control interventions and post-arrest prognostication methods. Analysis will evaluate variations in practice and their association with mortality and neurologic function. We expect this study, Discover IHCA, to identify variability in practice and outcomes following IHCA, and be a vital resource for future investigations into best-practice for managing patients after IHCA.

Harnessing RegTech for Financial Inclusion: Enhancing Compliance and Security in the Modern Financial Landscape

Purpose: The integration of Regulatory Technology (RegTech) into the financial inclusion landscape addresses the complex compliance and security challenges faced by financial institutions in an increasingly ambiguous technological environment. Methodology: The study is conducted through a comprehensive analysis of current patterns, advantages, and disadvantages, supported by real-world case studies, Findings: This study reveals how RegTech, powered by machine learning, artificial intelligence, and blockchain, significantly enhances compliance efficiency, reduces operational costs, and safeguards sensitive financial data. Additionally, a strategic framework for implementing RegTech solutions is presented, offering practical recommendations to ensure compliance while fostering a secure and inclusive financial environment. Unique Contribution to Theory, Practice and Policy: The findings contribute new insights into RegTech's role in advancing financial inclusion, provide guidance for financial institutions on effective adoption strategies, and inform policy by emphasizing the need for regulatory support to fully leverage RegTech for broader financial inclusion goals.

Multidisciplinary Delphi Panel on Rehabilitation Approaches and Unmet Needs for Chronic Stroke Walking Impairment and the Role of Rhythmic Auditory Stimulation.

Walking or gait impairment is a common consequence of stroke that persists into the chronic phase of recovery for many stroke survivors. The goals of this work were to obtain consensus from a multidisciplinary panel on current practice patterns and treatment options for walking impairment after stroke, to better understand the unmet needs for rehabilitation in the chronic phase of recovery and to explore opportunities to address them, and to discuss the potential role of rhythmic auditory stimulation (RAS) in gait rehabilitation. A panel of eight experts specializing in neurology, physical therapy, and physiatry participated in this three-part, modified Delphi study. Survey 1 focused on gathering information to develop statements that were discussed and polled during Survey 2 (interactive session), after which revised and new statements were polled in Survey 3. Consensus was defined as ≥75% (6/8 of panelists) agreement or disagreement with a statement. Consensus agreement was ultimately reached on all 24 statements created and polled during this process. The panelists agreed that individuals with gait or walking impairment in the chronic phase of stroke recovery can achieve meaningful improvement in walking by utilizing various evidence-based interventions. Barriers to treatment included cost, access, participation in long-term treatment, and safety. Consensus was achieved for interventions that have the following features challenging, personalized, accessible, and engaging. Improvement of gait speed and quality, durability of effect, safety, affordability, and ability for home or community use also emerged as important treatment features. In addition to conventional treatments (e.g., physical therapy, including mobility-task training and walking/exercise therapy), RAS was recognized as a potentially valuable treatment modality. Discussion: This panel highlighted limitations of current treatments and opportunities to improve access, participation, and outcomes through a consideration of newer treatment strategies and patient/healthcare provider education and engagement.

EXPLORING TWO DECADES OF PERSONAL FINANCIAL PLANNING: A SYSTEMATIC LITERATURE REVIEW

This research aims to understand current patterns, trends, and gaps in personal finance by conducting a systematic literature review of 20 years. The study collected and analyzed the articles published between 2004 to 2024. The research articles were collected from the Scopus database using the PRISMA framework. The review shows changes in the research area, including behavioural finance, digital financial planning tools, and its impact on individuals' financial literacy and planning.The major limitation of this study is that the literature search for personal financial planning might not have incorporated all publications in this area. Furthermore, there is a possibility of bias in this review concerning the papers selected for review and how the researchers interpreted the results.The findings of this systematic literature review can assist policymakers, financial planners, and practitioners in making more informed financial planning decisions and regulations. Thus, by identifying the trends and gaps in personal financial planning, strategies can be defined to provide individuals and society with the necessary level of support.The research is helpful to existing knowledge in that it presents a critical discussion of the personal financial planning literature evident in the last twenty years. The research is original and provides valuable information for upcoming research and practical application in personal financial planning.

Prescribing Patterns of Intravenous Artesunate for Severe Malaria and Compliance with National Malaria Treatment Protocol, Gezira State, Sudan

Background: Malaria is a major public health problem in Sudan. Severe malaria, due in majority of cases to P. falciparum, poses a real burden on hospitals. This study aims to describe the prescribing pattern of intravenous artesunate (IV-AS) for severe malaria and compliance with national malaria treatment protocol in Gezira State, Sudan. Methods: The study enrolled severe malaria patients who were admitted to the Wad Madani Teaching Hospital during June – August 2022. Patients were verbally consented and followed at hospital level till discharge. Data was recorded on data collection sheet and analyzed using SPSS version 20. Results: Over three months period, 500 patients were diagnosed as having severe malaria based on clinical criteria and the results of thick blood film. The majority were from rural areas and most of them were male. IV-AS was administered for all patients and 71% of patients discharged after administering three doses of artesunate with no serious adverse effects. In 96.4% of patients, the prescription followed the right dosage schedule. The source of the drug was health insurance fund and private sector in 78.4% and 21.6% respectively. The study investigates the prescribing patterns of intravenous artesunate (IV-AS) for severe malaria and compliance with the national malaria treatment protocol in Gezira State, Sudan. A Chi-Square Test of Independence was used to explore associations between gender and the number of IV-AS doses received, as well as between residence (rural vs. urban) and compliance with the dosage schedule. The results showed no significant association between gender and the number of IV-AS doses received (p = 0.915), and no significant association between residence and compliance with the dosage schedule (p = 0.925). These findings suggest that the prescribing patterns and compliance with the treatment protocol are consistent across different genders and between rural and urban patients. Conclusion: Severe malaria patients were treated with IV-AS according to national malaria treatment guidelines with few exceptions. Most patients discharged after administering three doses of artesunate with no serious adverse side effects. Efforts to establish quality assured microscopy and to maintain the current prescription pattern is highly needed.

Between political legitimacy and strategic competitiveness: Overseas corporate social responsibility patterns of Chinese international contractors

This article examines the overseas corporate social responsibility (CSR) patterns of Chinese international contractors (CICs). Adopting an institutional and political economy approach, a unique dataset is constructed with country-specific contents drawn from CSR-related reports and website information of 50 top CICs. This dataset provides a foundation for systematic content analysis of CICs’ overseas CSR practices, revealing that both political legitimacy-seeking and strategic competitiveness-seeking motivations drive CICs’ CSR activities abroad, characterized by the prioritization of customer and community engagement. The findings highlight the coexistence of the exogenous pressures for the national image-building purpose and the endogenous awareness of CSR strategic importance for corporate internationalization. The hybridization of political and economic rationales is presented as the defining feature of CICs’ current overseas CSR patterns, with the balance between them being determined by stakeholder type and internal business needs influenced by corporate internationalization experience.

Movement pattern definitions for resistance training behavior measurement in diabetes.

Type 2 diabetes can result in debilitating vascular complications, and resistance training (RT) is an effective therapy for improving cardiovascular outcomes. However, only 10-30% of adults meet the public health guidance for RT. While current RT guidelines focus on targeting major muscle groups, guidance specific to simplified movement categorization may augment understanding of RT programming and improve uptake and outcomes. Current movement pattern definitions and descriptions lack clarity, accuracy, and consistency. This paper proposes movement definitions and descriptions to be used for RT intervention design and prescription, and includes the following categories: hip, knee, ankle, vertebral column, vertical push, horizontal push, vertical pull, and horizontal pull. These categories are intended to aid clinicians, researchers, and trainers in RT surveillance and RT intervention design for improving vascular complications in type 2 diabetes. Simplified RT program design using these categories may also facilitate greater RT program understanding and adherence for patients.

Addressing EMI and EMF Challenges in EV Wireless Charging with the Alternating Voltage Phase Coil

Wireless charging technologies are widely used in electric vehicles (EVs) due to their advantages of convenience and safety. Conventional wireless charging systems often use planar circular or square spiral windings, which tend to produce strong electric fields (E-fields), leading to electromagnetic interference (EMI) and potential health risks. These standard coil configurations, while efficient in energy transfer, often fail to address the critical balance between E-field emission reduction and power transfer effectiveness. This study presents an “Alternating Voltage Phase Coil” (AVPC), an innovative coil design that can address these limitations. The AVPC retains the standard dimensions of traditional square coils (400 mm in length and width, with a 2.5 mm wire diameter and 22 turns), but introduces a novel current flow pattern called Sequential Inversion Winding (SIW). This configuration of the winding significantly reduces E-field emissions by altering the sequence of current through its loops. Rigorous simulations and experimental evaluations have demonstrated the AVPC’s ability to lower E-field emissions by effectively up to 85% while maintaining charging power. Meeting stringent regulatory standards, this advancement in the proposed coil design method provides a way for WPT systems to meet stringent regulatory standards requirements while maintaining transmission capability.

A snapshot audit of global flexible endoscopy practice among European Association of Endoscopic Surgeons (EAES) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) surgeons from the EAES Flexible Endoscopy Subcommittee survey.

Endoscopy is an essential skill for all surgeons. However, endoscopic competency, training, and practice may vary widelyamong them. The EAES Flexible Endoscopy Subcommittee is working towards a standardized set of fundamental endoscopic knowledge and skills. To best advise on current practice patterns of flexible endoscopy among surgeons worldwide, a snapshot audit was conducted on the training, use, and limitations of flexible endoscopy in practice. An online survey was distributed via email distribution and social media platforms for EAES, SAGES, and WebSurg members. Respondent demographics, training, and practice patterns were assessed. The main outcome measure was theannual endoscopic volume. Multivariate regression and machine learning models analyzed relationships between outcomes and independent variables of age, geographic region, laparoscopic surgery practice, and surgical specialization. A total of1486 surgeons from 195 countries completed the survey. Respondents were mainly general (n = 894/1486, 60.2%), colorectal (n = 189/1486, 12.7%), bariatric (n = 117/1486, 7.9%), upper gastrointestinal (GI)/foregut (n = 108, 7.3%), hepatobiliopancreatic/HPB (n = 59/1486, 4%), and endocrine surgeons (n = 11/1486, 0.7%) in active practice. Eighty-two percent (n = 1,204) mentioned having used endoscopy in theirpractice, and 64.7% (n = 961/1486) received formal flexible endoscopy training. Of those performing endoscopyannually, 64.2% (n = 660/1486) performed between0and20endoscopies, 15.2% (n = 156/1486) performed between20and50endoscopies, 10.1% (n = 104/1486) performed between50and100endoscopies, and 10.5% (n = 108/1486) performed over 100 endoscopies. From the regression analysis, there was no statistical correlation between the annual endoscopy volume and age, geographic region, laparoscopic surgery practice, or surgical specialization. Performing advanced endoscopy was directly related to thebariatric subspecialty and toperforming over 50% of cases in aminimally invasivefashion. This international snapshot audit revealed significant heterogeneity in endoscopic practices among surgeons worldwide. There wasa nonindependent relationship between endoscopy volumes and other variables tested. Barriers to practicing and receiving endoscopy training were common among respondents. The EAES Flexible Endoscopy Subcommittee will consider such results when developing an equitable and effective standardized flexible endoscopy curriculum.

The fentanyl made me feel like I needed more methadone”: changes in the role and use of medication for opioid use disorder (MOUD) due to fentanyl

BackgroundFentanyl and fentanyl analogues have disrupted the illicit drug supply through contamination of other substances (i.e., methamphetamine and cocaine) and replacement of heroin in illicit markets. Increasingly, they are contributing to opioid-overdose related deaths. The rapid and growing presence of fentanyl has led to gaps in research on the impact of this illicit market change on people who use drugs (PWUD). We sought to examine how the changing opioid market and growing fentanyl availability influences the role and use of medication for opioid use disorder (MOUD).MethodsSemi-structured qualitative interviews were conducted with a community recruited sample of PWUD (N = 22) in Los Angeles, California between September 2021 and April 2022. Interviews examined opioid use history, current opioid use behaviors and consumption patterns, and MOUD experiences and perceptions. Thematic analysis was used to systematically code and analyze textual interview data.ResultsThe following themes related to fentanyl use and MOUD emerged: (1) Use of deviated MOUD to address fentanyl contamination, (2) Changing perception of the effectiveness of MOUD on fentanyl, and (3) Regulatory limitations of MOUD for fentanyl use disorder.ConclusionsPWUD described several repertoires for adjusting to changes in the illicit market of opioids. Clinicians treating PWUD should ask about recent fentanyl use prior to starting MOUD to account for increased tolerance to opioids. Harm reduction strategies such as naloxone kits, safe supply, and supervised consumption facilities can all prevent overdose deaths due to fentanyl.

The application of direct ridership models in the evaluation of the expansion of the Porto Light Rail Transit

The main purpose of this paper is to show how a direct demand ride model coupled with a transfer model was able to support the choice of alternative routes for the expansion of the light rail system serving the Porto Metropolitan Area. After an overview of the literature on direct ridership models, emphasizing some key issues such as the need for a systematic assessment of their forecasting performance, the issues related to the definition of the pedestrian catchment area and the limitations of the simultaneous consideration of demand and supply effects, the paper moves into the case study, providing some background information on current occupation densities, land uses and mobility patterns, as well as on the performance of the existing LRT in the Metropolitan Area of Porto. The development of the direct ridership model, measuring the potential attractiveness of each station, and the transfer model, measuring the number of transfers at each station, are presented in detail. A justification is provided why, in this case, a two-step modelling approach was necessary. Further details about the statistical tests for model validation are also provided. After a brief characterization of the alternative routes under analysis for the expansion of the network, the modelling results are presented enabling a comparative assessment of the potential performance of each proposed route. The paper ends with a discussion of the relevance of this modelling results vis a vis the actual final decisions on investment priorities taken jointly by the Metropolitan Council and the Metro Company.

Epidemiological characteristics and clinical antibiotic resistance analysis of Ureaplasma urealyticum infection among women and children in southwest China

BackgroundThe aim of this study was to investigate the epidemiological characteristics and antibiotic resistance patterns of Ureaplasma urealyticum (UU) infection among women and children in southwest China.MethodsA total of 8,934 specimens, including urogenital swabs and throat swabs were analyzed in this study. All samples were tested using RNA-based Simultaneous Amplification and Testing (SAT) methods. Culture and drug susceptibility tests were performed on UU positive patients.ResultsAmong the 8,934 patients, the overall positive rate for UU was 47.92%, with a higher prevalence observed among women of reproductive age and neonates. The majority of UU positive outpatients were women of reproductive age (88.03%), while the majority of UU positive inpatients were neonates (93.99%). Overall, hospitalization rates due to UU infection were significantly higher in neonates than in women. Further analysis among neonatal inpatients revealed a higher incidence of preterm birth and low birth weight in UU positive inpatients (52.75% and 3.65%, respectively) than in UU negative inpatients (44.64% and 2.89%, respectively), especially in very preterm and extremely preterm neonates. Moreover, the incidence rate of bronchopulmonary dysplasia (BPD) among hospitalized neonatal patients was significantly higher in the UU positive group (6.89%) than in the UU negative group (4.18%). The drug susceptibility tests of UU in the neonatology, gynecology and obstetrics departments exhibited consistent sensitivity patterns to antibiotics, with high sensitivity to tetracyclines and macrolides, and low sensitivity to fluoroquinolones. Notably, UU samples collected from the neonatology department exhibited significantly higher sensitivity to azithromycin and erythromycin (93.8% and 92.9%, respectively) than those collected from the gynecology and obstetrics departments.ConclusionsThis study enhances our understanding of the current epidemiological characteristics and antibiotic resistance patterns of UU infection among women and children in southwest China. These findings can aid in the development of more effective intervention, prevention and treatment strategies for UU infection.

Investigating the influence of current trends and behaviours on household structures and housing consumption patterns

As a major contributor to overall carbon emissions and energy consumption, the housing sector has great potential to reduce energy consumption, whether by reducing the number of appliances, heating temperature or floor space. Consumption patterns encompass how people choose and consume products that satisfy their needs and wants. However, wants, and to some extent needs, are influenced by various factors and existing material and non-material (infra)structures, especially in the housing sector. Focusing on the floor area, this article aims to identify potentials towards lower consumption lifestyles by applying the Avoid-Shift-Improve framework in the residential sector. Through a conceptual review, the article explores what shapes current patterns of space use and outlines potential future pathways. Starting from the macro level, the article examines existing and emerging (societal) trends with (potential) impacts on housing consumption. It then looks at the structural development of households affected by the studied trends. At the micro level, the article provides an overview of the potential impact of individual behaviour on space use patterns within different categories of housing behaviour. The article identifies the potential for social and technical change in the housing sector and concludes that promoting non-materialistic narratives (avoid), offering alternative and innovative solutions to satisfy people’s spatial needs (shift) and designing flexible buildings (improve) appear to be effective ways for fostering behavioural change towards more efficient use of space.

Genicular nerve radiofrequency ablation practice patterns: A survey study of the International Pain and Spine Interventional Society

IntroductionChronic knee pain often results from degenerative conditions such as knee osteoarthritis (OA) and can worsen after surgical interventions like total knee arthroplasty (TKA). Knee OA affects approximately 86 million individuals globally, leading to decreased function, mobility limitations, and disability. While TKA is a common surgical treatment for refractory knee OA, though up to 20 % of patients experience chronic post-operative knee pain worse than their pre-operative pain. Genicular nerve radiofrequency ablation (GnRFA) has emerged as a promising intervention for knee OA pain unresponsive to conservative management and for chronic post-TKA pain. GnRFA is an evidence-based technique supported by multiple prospective cohort studies and randomized controlled trials (RCTs). However, practice patterns and GnRFA techniques vary, and no peer-reviewed publication has yet quantified these variations in real-world clinical practice. ObjectiveThis study aims to understand the practice patterns of interventional pain physicians regarding patient selection, use of prognostic blocks, imaging, nerve targets, GnRFA types, and GnRFA techniques in treating knee pain secondary to OA or persistent post-TKA pain. MethodsAn anonymous 29-question survey was distributed via electronic mail to members of the International Pain and Spine Intervention Society (IPSIS) from January 16, 2024, to February 29, 2024. The survey assessed practice patterns related to patient selection, prognostic block use, and GnRFA techniques. Data were collected and stored using REDCap software, with descriptive statistics calculated. ResultsA total of 150 completed surveys were analyzed, representing a completion rate of 2.0 % of surveys sent, 3.5 % of emails opened, and 56.8 % of those who clicked on the survey link. Respondents generally use common selection protocols regarding OA grade (Kelgren-Lawrence 3 and 4), duration of failed conservative care (3–6 months), a single anesthetic block paradigm, and use of fluoroscopic guidance for the GnRFA procedure. More variability was reported between respondents regarding the volume of anesthetic used during prognostic blocks, the threshold to consider a prognostic block “positive,” the technology used, and nerves targeted during the GnRFA procedure. ConclusionThe study provides valuable insights into the current practice patterns of GnRFA among interventional pain physicians. While there is consensus on some aspects of patient selection and procedural techniques, significant variability exists in prognostic block protocols and nerve targets for GnRFA. These findings highlight the need for further research to explore the long-term efficacy and safety of GnRFA and to standardize techniques and protocols across different practice settings, ultimately improving patient outcomes and quality of life. The low response rate may limit generalizability, and the survey did not include data on active tip sizes used for ablation or whether other procedures should be exhausted before resorting to GnRFA. Additionally, a survey to IPSIS membership only may not fully represent a diverse cohort of pain management specialists, potentially introducing sampling bias. Future studies should include members from a broader range of professional organizations to enhance representativeness.

Substance misuse disorder in Saudi Arabia: A comprehensive examination of current demographic patterns, trends, and intervention requirements

IntroductionThis review examines substance misuse disorder (SMD) in Saudi Arabia, drawing insights from 43 prior studies. It explores the prevalence and patterns of SMD across diverse demographics. MethodologyOur analysis integrated data from various studies involving adolescents, university students, psychiatric patients, and the general population as well as postmortem cases. It identifies key risk factors and challenges in managing SMD, underscoring the importance of comprehensive data collection for evidence-based policymaking. ResultsSMD in Saudi Arabia were categorized into two groups: common traditionally abused drugs (such as Captagon, khat, heroin, ethanol, and cannabis) and substances that have emerged in recent years (e.g., methamphetamine “Shabu”, pregabalin, and benzodiazepines). Trends in SMD include early substance initiation and increased amphetamine and polysubstance use. Conclusion and recommendationsDrug-related challenges persist in Saudi Arabia; however, because of limited data from recent epidemiological studies on drug disorders, the full extent is unknown. Saudi Arabia is unique because it as an Islamic country with strict regulations against drug trafficking and a religious prohibition on drugs and alcohol, which contributes to distinct trends in substance misuse disorder (SMD). Although some aspects mirror global patterns, others exhibit regional characteristics specific to the country. Despite data variability, actionable recommendations have emerged for SMD prevention and treatment. During the COVID-19 pandemic, a high number of reports was evident; however, SMD publications often reiterate old findings and overlook emerging psychoactive substances (EPS), such as ‘Shabu”, pregabalin, and benzodiazepines. Further studies are needed, including educational initiatives, national surveys, stricter drug regulations, and an early warning system for traditional SMD and EPS.

Resistance to Anti-HER2 Therapies in Gastrointestinal Malignancies.

Human epidermal growth factor 2 (HER2) is a tyrosine kinase receptor that interacts with multiple signaling pathways related to cellular growth and proliferation. Overexpression or amplification of HER2 is linked to various malignancies, and there have been decades of research dedicated to targeting HER2. Despite the landmark ToGA trial, progress in HER2-positive gastrointestinal malignancies has been hampered by drug resistance. This review examines current HER2 expression patterns and therapies for gastroesophageal, colorectal, biliary tract, and small bowel cancers, while dissecting potential resistance mechanisms that limit treatment effectiveness.