Effective Exchanges Research Articles

The medicinal cognition of grapes between the Western Regions and the Central Plains: a comparative study

Grapes originated from the eastern coast of the Mediterranean, as well as Asia Minor, the South Caucasus and other regions. Grapes were introduced to the Xinjiang area of China around 600 BC through the Iranian Plateau and Central Asia. Grapes were spread from the Western Regions (a term in Han Dynasty for the area out of Yu Men Guan) to the Central Plains (Birthplace of Chinese civilisation) with the opening of the Silk Road in the Han Dynasty. The medicinal and edible features of grapes had been recorded in ancient western medical books. The medical cognition of grapes were further developed and were incorporated into the local medical system through absorbing foreign experience and integrating them with local medical practice by physicians from both the Western Regions and the Central Plains. The medical cognition of grapes from the physicians of the civilisations was identical though with minor differences. This indicates the multidimentional specialties of different medical systems and the history of the effective exchanges and mutual learning between the two medical systems.

Diplomatic webs: the influential figures shaping U.S. policy in Israel, Qatar, and Iraq

Abstract Purpose This study examines the Twitter/X networks of U.S. ambassadors in Israel, Iraq, and Qatar from 2017 to 2024, aiming to assess how digital diplomacy is conducted through these platforms. Utilizing Sprinklr, we gathered 586,736 mentions involving the ambassadors’ Twitter handles, with a focus on evaluating the influence and communication strategies within these networks. Design/methodology/approach We analyzed a random sample of 30,000 tweets from the collected data using network analysis techniques. This approach enabled the examination of centrality metrics within the ambassadors’ digital networks, providing insights into the influence patterns and communicative interactions via Gephi. Findings The analysis revealed a significant influence of state actors and established political elites who predominantly engage in unidirectional communication, despite the platforms’ capabilities for interactive and reciprocal dialogues. We identified elected officials and specific non-governmental organizations as key actors shaping the diplomatic narratives, highlighting the diverse yet controlled actor interplay in digital diplomacy. Practical implications This research underscores the need for strategic adjustments in digital diplomacy practices to enhance interaction and inclusivity. Our work provides policymakers with insights into leveraging digital platforms for more effective and dynamic diplomatic exchanges. Social implications The study illuminates the role of digital platforms as critical venues for shaping diplomatic narratives by both state and non-state actors. Notably, our findings highlight the use of hashtags in advancing human rights movements and in discussions surrounding the Israel–Palestine conflict, demonstrating hashtags’ impact on global and regional advocacy efforts. Originality/value This research offers a unique perspective on the integration of traditional diplomatic roles with contemporary digital strategies, particularly highlighting the constraints and potentials within Middle Eastern contexts. We suggest ways to enhance the inclusivity and effectiveness of diplomatic engagements through improved social media utilization, thereby contributing to the evolving field of international relations and public diplomacy.

Rethinking inter-firm dynamics from a small firm perspective: the case for inter-organizational bullying

PurposeThis paper aims to explain how the dynamics of inter-firm relations between small and large firms can, in the case of some behaviours, be interpreted as inter-organizational bullying.Design/methodology/approachThis paper draws on a qualitative approach adopting the critical incident method to explore the subjective experiences of 13 individual managers and owners of small service businesses in dealing with the representatives/executives of the large corporations they serviced. The method facilitated an investigation of the significant occurrences identified by the small-firm respondents about the undue advantage taken by the large firms. This was found to be more than simple occasional opportunistic or unfair business practices perpetrated by representatives of the large firms but, instead, involved bullying.FindingsThe results revealed that large corporations actively, though covertly, sought to take advantage of their small service providers by resorting to bullying practices. Intimidation, opportunism, use of deceitful or unfair business practices, as well as abuse of power, were manifestations of inter-organizational bullying committed by the large and powerful corporations. The contrasting characteristics of size, access to resources, economic and market power were identified as strong impediments against building effective ethical relational exchanges between the large corporations and their small service providers.Research limitations/implicationsThe study's findings provide valuable insights into the root causes and consequences of inter-organizational bullying. However, it is crucial to interpret these results in the context of this specific study. It is worth nothing that these findings primarily represent the self-perception of inter-organizational bullying among small service providers and may not capture other viewpoints or aspects of the industrial sector. Replicating this study in different sectors could enhance the generalizability of the conclusions drawn.Practical implicationsThis analysis is valuable in understanding what constitutes the phenomenon referred to as inter-organizational bullying. It also assists to understand the conditions when large firms exhibit such behaviours and their implications on the well-being of relevant stakeholders.Social implicationsFirstly, the business partners should maintain a healthy relationship if they want to avoid incidents of bullying, which can harm the performance of the relationship. In doing so, they need to reduce the level of uncertainty in their business relationships through the transparent information exchange, formulating commonly agreeable contracts and enhancing communication procedures. They also need to put aside their self-interest, but rather strive for achieving results that will be beneficial to both parties.Originality/valueThis exploratory study offers a novel and unexplored way of theorizing inter-organizational bullying, as well as uncovering its antecedents and impacts on the welfare of small businesses, particularly small service providers.

Традиционная педагогическая культура в современном мире: гуманистический феномен татарской семьи

The article actualizes the problem of socio-cultural and ethnic identity of the Tatar people and the need to cherish and preserve the traditions of the Tatar family. The authors propose to discuss the practical aspects of the development of ethnic processes and the main directions of increasing the importance of ethnic characteristics in the humanization of social relations and the mission of ethnic positions in human life. Analysis of the literature on the problems of ethnic identity, detailing the characteristic desire of different peoples to support and preserve their own identity, determine both the possibility and the need to emphasize the inimitability and uniqueness of social and humanistic practices of their ethnoculture, taking into account the growth of understanding and comprehension of belonging to their ethnos, i.e. national consciousness and ethnic community. The aim of the research was to study and reveal the dialectical dynamic development of the main directions of the traditional national culture of the Tatar people. In modern conditions of active digital transformations of society, an attempt was made to show creative practices of educating children and adolescents on the basis of careful attitude to the national culture, to the national pedagogical experience, which are represented in family traditions and rituals, in holidays, games and folklore with the help of methods of structured analysis. Based on the interpretation of the research results, the experience of the ethnic system of education in the Tatar family is generalized and its features and socio-cultural humanistic functions are reflected; the essential characteristics of humanization of education in the Tatar ethnos, conveying the phenomenology of traditional pedagogical culture in the conditions of digitalization of socio-cultural processes, are shown; effective cultural and informational exchanges between the educational institution and the family in its ethno-pedagogical space are reflected.

Ecosystem integration: the use of ontologies in integrating knowledge across manufacturing value networks

One of the greatest challenges in creating effective decision-making systems for connected enterprises is the management of cross-domain information. In manufacturing value networks where supply chains are increasingly intertwined, and closed-loop lifecycle management requires traversing several domains, ontologies are proving to be a reliable reference for cross-domain semantic interoperability. However, ontology development, implementation, and management are fragmented and difficult for new users of ontologies to grasp. This is a significant challenge in environments where ontologies are vital for managing effective data exchanges in complex industrial processes. The OntoCommons project has evolved an ontology ecosystem that aims to lower the entry barrier to using ontologies. Building on this ambition, we present a holistic approach to the integration and management of ontologies horizontally across manufacturing ecosystems, including the creation of reference documentation for manufacturing value networks and related standards, available tools for working with ontologies, and examples of vertical integration of knowledge from application level with domain-level and top-level ontology reference documentation. As a novel research direction, we propose a meta-level approach to ontology-driven knowledge management in manufacturing ecosystems. Based on evidence from recent breakthroughs, we present future and emerging research directions.

THE USAGE OF ABBREVIATIONS IN DIFFERENT SPHERES

This article aims to explore the widespread use of abbreviations in various spheres. Abbreviations are employed in fields such as academia, business, healthcare, technology, the military, and scientific research to facilitate efficient communication. Their role in aiding concise and effective exchanges of information is essential. This article will discuss the benefits and potential challenges associated with the use of abbreviations and highlight the need for clear and consistent communication practices. It will also examine how the strategic deployment of abbreviations significantly enhances communication in diverse spheres, contributing to streamlined processes and effective information exchange.

Adaptive squirrel coyote optimization-based secured energy efficient routing technique for large scale WSN with multiple sink nodes

In general, Wireless Sensor Networks (WSNs) require secure routing approaches for delivering the data packets to their sinks or destinations. Most of the WSNs identify particular events in their explicit platforms. However, several WSNs may examine multiple events using numerous sensors in a similar place. Multi-sink and multi-hop WSNs include the ability to offer network efficiency by securing effective data exchanges. The group of nodes in the multi-sink scenario is described through a distance vector. Though, the efficiency of multi-sink WSNs is considerably impacted by the routing of data packets and sink node placement in the cluster. In addition, many WSNs for diverse reasons existed in the similar geographical region. Hence, in this task, a secured energy-efficient routing technique is designed for a Wireless sensor network with Large-scale and multiple sink nodes. Here, the concept of an improved meta-heuristic algorithm termed Adaptive Squirrel Coyote Search Optimization (ASCSO) is implemented for selecting the accurate selection of cluster head. The fitness function regarding residual distance, security risk, energy, delay, trust, and Quality of Service (QoS) is used for rating the optimal solutions. The consumption of energy can be reduced by measuring the mean length along with the cluster head and multiple sink nodes. The latest two heuristic algorithms such as Coyote Optimization Algorithm (COA) and Squirrel Search Algorithm (SSA) are integrated for suggesting a new hybrid heuristic technique. Finally, the offered work is validated and evaluated by comparing it with several optimization algorithms regarding different evaluation metrics between the sensor and sink node.

Pragmatic analysis of verbal attacks in Indonesian courtrooms: Exploring prevalence, nature, and cultural influences

This study investigated the pragmatic aspects of verbal attacks within Indonesian courtrooms, specifically examining speech acts and their alignment with Grice's maxims. While previous research has explored verbal attacks in legal contexts, this study is expected to fill a gap in the literature by focusing on the pragmatic analysis of speech acts and Grice's maxims in Indonesian settings. Using a qualitative research approach and court transcripts, the speech acts contained in this research were systematically analyzed and categorized based on the type and illocutionary force while scrutinizing their adherence to Grice's maxims. The findings reveal a diverse range of speech acts deployed during verbal attacks, including assertive challenges and veiled accusations, often involving deliberate violations of Grice's maxims. Participants strategically flout maxims, utilizing implicatures to contribute to the confrontational nature of verbal attacks. This study is also expected to advance our understanding of the pragmatic dimensions of verbal attacks in Indonesian courtrooms and to describe the strategic use of language in the legal context. It has the potential to inform legal practice, enhancing comprehension of courtroom communication and promoting more effective and respectful exchanges within the Indonesian legal system.

메콩 유역 국가와 한국의 문화교류 및 복수학위제 교류 방향

Both Korea and Vietnam belong to the same traditional Eastern cultural sphere and share common cultural and religious backgrounds, including Confucianism and Buddhism. This results in shared values like family importance, etiquette and education. Their cultures, influenced by China, exhibit a sense of homogeneity. However, differences exist between the two countries, notably in food culture, language, and the habits of lifestyle. It is crucial for effective cultural and human exchanges to recognize these differences. The mutual exchanges between universities in Korea and Vietnam are increasing recently, promoting promote academic exchanges and human resource development. The dual degree program between universities of the two countries notably contributes to cultivating global talented men. This program allows students to acquire academic knowledge from both cultures, enhancing global competence. The study proposes to outline the operation of such a program.

Higher Educational Information Resource Sharing Model Based on Blockchain

Through the sharing of high-quality educational resources in colleges and universities, various colleges and universities have carried out active and effective exchanges in teaching resources, avoiding the duplication of larger educational resources, and improving the academic and career development of teachers and students. The construction of a blockchain-based regional higher education information resource sharing model can solve the problems of scattered teaching resources and duplicate construction of teaching resources, difficulties to ensure the security of digital education resources, high operating costs of platforms, and urgent protection of intellectual property rights of resources. Most of the existing solutions rely on third-party certificate issuing centers or use a single key to encrypt the data flow of education information resources, which has hidden dangers of leakage of privacy information such as intellectual property rights, copyrights, confidential information of resources, other key information, and operation records. Therefore, this paper studies the regional higher education information resource sharing model based on blockchain and designs the data protection protocol of higher education information resources and its resource transaction relationship protection scheme. It introduces the blockchain-based regional higher education information resource sharing model mainly from three aspects: blinding the identity of authorized resource recipients, resource initiators publishing resource transactions, and authorized resource recipients publishing resource transactions. Experimental results verify the effectiveness of the proposed model.

Development and Implementation of an Interprofessional Digital Platform to Increase Therapeutic Adherence: Protocol for a Mixed Design Study.

BackgroundAdherence to care plans is a major issue in health care systems. Improved adherence has several potential benefits such as ensuring treatment effectiveness and control of chronic diseases. There is currently a lack of tools to maximize treatment adherence in an integrated manner, that is, covering multiple aspects of patients’ health continuously throughout their medical care. To ensure better adherence, such tools must meet the needs of patients with chronic conditions as well as those of health care professionals. Acknowledging the health issues associated with nonadherence to treatment, an industry-research-clinical partnership aims to adapt a digital platform—facilitating patient-health care professional interactions—to improve therapeutic adherence in patients with chronic illnesses. The platform allows for exchanges between patients and health care professionals to facilitate the timing of medication use or chronic disease management and maximize patient adherence.ObjectiveThis study aims to (1) identify the needs of patients living with a chronic condition and their health professionals concerning their interactions regarding treatment; (2) codevelop an adaptation of an interactive patient-professional platform that meets the needs identified; and (3) then test the platform and document its effects and acceptability in a clinical setting.MethodsThe study will use a creative design thinking process based on the needs expressed by users (patients and health professionals) concerning treatment adherence for chronic diseases (eg, diabetes, asthma, high blood pressure, depression and anxiety, chronic obstructive pulmonary disease). A mixed method evaluation research design will be used to develop and evaluate the platform. Qualitative data will be used to assess user needs and acceptability of the platform, and quantitative data will provide the necessary insights to document its effects.ResultsTechnological development of the platform has been completed. Recruitment for the first part of Phase 1 started in May 2022. The results of this project to codevelop an interprofessional digital platform to increase therapeutic adherence will be relevant to clinicians and managers seeking contemporary solutions that support patient adherence to treatment for chronic diseases. These results will enable optimal use of the platform and identify areas for improvement in interactive patient-health care professional apps.ConclusionsThe adoption of an interactive digital platform to facilitate effective exchanges between patients and health care professionals in primary care settings could improve adherence to treatment. The platform tested in this project takes a first step in this direction by ensuring that the technological product is developed according to the needs of patients as well as the health professionals who are likely to use it.International Registered Report Identifier (IRRID)DERR1-10.2196/34463

Value-based modeling for mobile health application development.

In this paper is presented the use of value-based modeling, traditionally a business development tool, for the improvement of mobile health app design. The conceptual foundations for this work are design science, which is the scientific study and creation of artifacts, and convergence, which is a research method that in this case combines engineering with medicine. Relevant previous work done by the research team included the modeling of a case management system using process-based and information-based modeling techniques. Value-based modeling represents actors who are exchanging with each other things of economic value, including service outcomes. The focus is on how value objects are offered, accepted, and exchanged in a network. Value-based models do not describe how transactions occur, but rather the net value of those transactions. This technique was applied to the design development of a mobile application system for the improvement of access to health services. Significant value-based modeling was performed. These models highlighted the importance in healthcare delivery of effective value exchanges. The results revealed a limitation on the net value of services delivery. These were related to constraints of time, cost, and responsibility. A design improvement was proposed: The development of an automated decision-making subsystem within the machine learning component of the app system. This subsystem would recommend between-visit micro adjustments to the plan of care based upon protocols established by the healthcare provider. Such would provide an agile response to the patient's changing needs as well as an amelioration to the challenges of access to services.

Desperately Seeking Feedback: a phenomenographic study of medical students’ experiences during a 4-year longitudinal feedback curriculum

Introduction: The focus of feedback in medical education recently shifted to a dialogic partnership between teachers and learners, co-creating effective feedback exchanges. We previously described a prototype, longitudinal 4-year curriculum for medical students to develop feedback-seeking behaviors. We explored the students’ experiences as participants in this novel program. Methods: Beginning in academic year 2017-2018, we assessed the 4-year experiences of 14 medical students with a phenomenographic, qualitative approach. Three waves of semi-structured, individual interviews were conducted during the first 3 years. Focus groups were conducted in the final year of the program. Meaning units were identified, and categories were determined by such units. An outcome space was created based on an ordered set of categories. Results: Based on students’ early experience with the curriculum, 4 categories formed the outcome space: prior or lack of experience, factors impacting experience, learning artifice and techniques, and improving feedback skills. A heavy emphasis was placed on the feedback experience related to the climate of the learning environment and the relationship with the feedback-giver. Learning different feedback techniques was important. As the students progressed through medical school while experiencing the feedback curriculum, the outcome space clearly evolved, with a greater emphasis on refining feedback-seeking skills. Students had a stronger growth mindset in tailoring the feedback they sought. Feedback-seeking became a natural and routine habit. Conclusions: Medical students experienced an evolving emphasis on feedback-seeking. They increasingly recognized the value of effective feedback and confidently embraced feedback-seeking, using a range of techniques and refined approaches.

Greater Social Competence Is Associated With Higher Interpersonal Neural Synchrony in Adolescents With Autism.

Difficulty engaging in reciprocal social interactions is a core characteristic of autism spectrum disorder. The mechanisms supporting effective dynamic real-time social exchanges are not yet well understood. This proof-of-concept hyperscanning electroencephalography study examined neural synchrony as the mechanism supporting interpersonal social interaction in 34 adolescents with autism spectrum disorder (50% female), age 10–16 years, paired with neurotypical confederates of similar age. The degree of brain-to-brain neural synchrony was quantified at temporo-parietal scalp locations as the circular correlation of oscillatory amplitudes in theta, alpha, and beta frequency bands while the participants engaged in a friendly conversation. In line with the hypotheses, interpersonal neural synchrony was significantly greater during the social interaction compared to the baseline. Lower levels of synchrony were associated with increased behavioral symptoms of social difficulties. With regard to sex differences, we found evidence for stronger interpersonal neural synchrony during conversation than baseline in females with autism, but not in male participants, for whom such condition differences did not reach statistical significance. This study established the feasibility of hyperscanning during real-time social interactions as an informative approach to examine social competence in autism, demonstrated that neural coordination of activity between the interacting brains may contribute to social behavior, and offered new insights into sex-related variability in social functioning in individuals with autism spectrum disorders.

Water-land resource carrying capacity in China: Changing trends, main driving forces, and implications

Due to significant resource and environmental pressures resulting from the rapidly developing economy and fast-growing population in recent decades in China, an evaluation of the trends of the water-land resource carrying capacity (W-LRCC) is necessary to promote coordinated and sustainable development. This study proposed a framework for evaluating the trends of the W-LRCC from the perspectives of the water-land resource supporting force (W-LRSF) and pressure (W-LRP) via a decoupling model combined with the ecological footprint concept and an index system. The overall and annual trends of W-LRCC in China from 2006 to 2017 at the provincial level were evaluated, and the main driving forces of the trends were analyzed. The results show that the overall change in the W-LRCC shows a declining trend, and most of the provinces exhibit expansive negative decoupling. Provinces with an increasing W-LRCC trend are mainly located in the middle and downstream portions of the Yangtze River basin. Decreases in the Completed Investment in Solid Waste Treatment Projects/Gross Domestic Product (CISWTP/GDP) and the Completed Investment in Wastewater Treatment Projects/Gross Domestic Product (CIWTP/GDP) have the largest contributions to the decrease in W-LRSF. In contrast, increases in the Domestic Waste Sanitary Landfill Volume/Land Area (DWSL/LA) and Ecological Water Compensation/Total Water Consumption (EWC/TWC) contribute the most to an increase in the W-LRP in most provinces. These are the main driving forces of the overall decline in the W-LRCC in China. Policies that could improve the W-LRCC at the provincial level in China include the systematic implementation of appropriate land resource management measures, soil pollution prevention, promoting effective resource and technology exchanges among the provinces, increasing the investment in wastewater treatment projects, and implementing the most stringent water management system. This study has the potential to deepen our understanding of the W-LRCC trend and its spatial pattern and regional differences in China and provide suggestions for coordinated and sustainable regional water/land resource development plans.

SAR Ship Detection Dataset (SSDD): Official Release and Comprehensive Data Analysis

SAR Ship Detection Dataset (SSDD) is the first open dataset that is widely used to research state-of-the-art technology of ship detection from Synthetic Aperture Radar (SAR) imagery based on deep learning (DL). According to our investigation, up to 46.59% of the total 161 public reports confidently select SSDD to study DL-based SAR ship detection. Undoubtedly, this situation reveals the popularity and great influence of SSDD in the SAR remote sensing community. Nevertheless, the coarse annotations and ambiguous standards of use of its initial version both hinder fair methodological comparisons and effective academic exchanges. Additionally, its single-function horizontal-vertical rectangle bounding box (BBox) labels can no longer satisfy the current research needs of the rotatable bounding box (RBox) task and the pixel-level polygon segmentation task. Therefore, to address the above two dilemmas, in this review, advocated by the publisher of SSDD, we will make an official release of SSDD based on its initial version. SSDD’s official release version will cover three types: (1) a bounding box SSDD (BBox-SSDD), (2) a rotatable bounding box SSDD (RBox-SSDD), and (3) a polygon segmentation SSDD (PSeg-SSDD). We relabel ships in SSDD more carefully and finely, and then explicitly formulate some strict using standards, e.g., (1) the training-test division determination, (2) the inshore-offshore protocol, (3) the ship-size reasonable definition, (4) the determination of the densely distributed small ship samples, and (5) the determination of the densely parallel berthing at ports ship samples. These using standards are all formulated objectively based on the using differences of existing 75 (161 × 46.59%) public reports. They will be beneficial for fair method comparison and effective academic exchanges in the future. Most notably, we conduct a comprehensive data analysis on BBox-SSDD, RBox-SSDD, and PSeg-SSDD. Our analysis results can provide some valuable suggestions for possible future scholars to further elaborately design DL-based SAR ship detectors with higher accuracy and stronger robustness when using SSDD.

CO2 concentration monitoring inside educational buildings as a strategic tool to reduce the risk of Sars-CoV-2 airborne transmission

In order to avoid SARS-CoV-2 transmission inside educational buildings and promote the safe reopening of schools, the Italian Government, in line with the other European countries and in accordance with the WHO recommendations, adopted a contingency plan including actions able to guarantee adequate air ventilation in classrooms. Therefore, in this pilot study, a surveillance activity based on the real-time monitoring of CO2 levels as a proxy of SARS-CoV-2 transmission risk, was conducted inside 9 schools (11 classrooms) located in Apulia Region (South of Italy) during the reopening of schools after the lockdown due to COVID-19 pandemic. More specifically, monitoring activities and data treatment were conducted to evaluate the initial scenario inside the classrooms (first stage of evaluation) and the potential improvements obtained by applying a detailed operating protocol of air ventilation based on specific actions and the simultaneous real time visualization of CO2 levels by non-dispersive infrared (NDIR) sensors (second stage of evaluation). Although, during the first evaluation stage, air ventilation through the opening of windows and doors was guaranteed, 6 (54%) classrooms showed mean values of CO2 higher than 1000 ppm and all classrooms exceeded the recommended CO2 concentration limit value of 700 ppm. The development and implementation of tailored ventilation protocol including the real time visualization of CO2 levels allowed to depict better scenariosAn overall improvement of CO2 levels was indeed registered for all classrooms where teachers were compliant and helpful in the management of the air ventilation strategy. Therefore, this study reports the first evidence-based measures demonstrating that, with the exception of few environments affected by structural limits, the real-time visualization and monitoring of CO2 concentrations allowes effective air exchanges to be implemented and contributes to prevent SARS-CoV-2 transmission. Moreover, on the basis of the monitoring outcomes and in order to ensure adequate air ventilation in educational buildings, a 4 level-risk classification including specific corrective actions for each level was provided.

Northeast America (NEA) Electricity Profile: Proposal of a Free Trade Area

The government of Quebec should formally propose to the governments of neighboring American states (CT, ME, MA, NH, RI, VT, NJ, NY, PA, IL, IN, MI, OH, WI, DE, MD, WV, KY) and the provinces of eastern Canada (NL, NS, NB, ON) an integrated common market in electricity with appropriate commonly owned and shared interconnections and regulatory institutions allowing effective, efficient, transparent and fluid exchanges. The important technological complementarities between the regional production capacities and technologies and the high value added of integration, in particular with the massive arrival of renewable but intermittent energies, are likely to create a win-win situation for all participants. But the game is not only complex, but also demands from the regional leaders, Premiers and Governors, a long-term vision based on strategic complementarities and open competition. Major enabling features revolve around opening the ownership structure of regional producers, integrating the independent system operators (ISO), implementing appropriate mechanisms to adequately face the “not in my backyard (NIMBY)” syndrome.

Initial single centre experiences of a radiographer advanced practitioner led nephrostomy exchange programme

IntroductionTo evaluate the technical success, radiation dose, complications and costs from the introduction of a radiographer-led nephrostomy exchange service. MethodsPost-graduate qualified interventional radiographers with several years' experience in performing other interventional procedures began performing nephrostomy exchanges. Training was provided by an interventional radiologist. Each radiographer performed ten procedures under direct supervision followed by independent practice with remote supervision. Each radiographer was then responsible for the radiological report, discharge, re-referral for further exchange and, where indicated, sending urine samples for culture and sensitivity. Data extraction included the time interval between exchanges, radiation dose/screening time and complications. ResultsThirty-eight long-term nephrostomy patients had their histories interrogated back to the time of the initial insertion. The mean (range) age at nephrostomy insertion was 67 (35–93) years and 65% were male. Indications for nephrostomy were prostatic or gynaecological malignancy, ureteric injury, bulky lymphoma and post-transplant ureteric stricture. A total of 170 nephrostomy exchanges were performed with no statistically significant differences in the radiation dose, fluoroscopy time nor complication rates between consultants and radiographers. There was, however, a statistically significant reduction in the time interval between nephrostomy exchanges for the radiographer group (P = 0.022). ConclusionInterventional radiographers can provide a safe, technically successful nephrostomy exchange program with radiation doses equivalent to radiologists. This is a cost-effective solution to the capacity issues faced in many departments, whilst providing career progression, job satisfaction and possibly improved care. Implications for practiceRadiographer-led interventional services should be considered by other institutions as a means of providing effective nephrostomy exchanges.

Plasma exchange and early thyroidectomy in thyroid storm requiring extracorporeal membrane oxygenation

SummaryThyroid storm with multi-organ failure limits the use of conventional treatment. A 44-year-old male presented with thyroid storm and experienced cardiovascular collapse after beta-blocker administration, with resultant fulminant multi-organ failure requiring inotropic support, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. Hepatic and renal failure precluded the use of conventional thyroid storm treatment and early plasma exchange was instituted. The patient underwent emergency thyroidectomy after four effective exchanges, with subsequent rapid reversal of multi-organ failure. The challenges of institution of plasma exchanges with ongoing ECMO support, dialysis and timing of thyroidectomy are discussed. This case highlights the important role of early therapeutic plasma exchange (TPE) as an effective salvage therapy for lowering circulating hormones and stabilization of patients in preparation for emergency thyroidectomy in patients with thyroid storm and fulminant multi-organ failure.Learning points:Administration of beta-blockers in thyroid storm presenting with congestive cardiac failure may precipitate cardiovascular collapse due to inhibition of thyroid-induced hyperadrenergic compensation which maintains cardiac output.TPE can be an effective bridging therapy to emergency total thyroidectomy when conventional thyroid storm treatment is contraindicated.End-organ support using ECMO and CRRT can be combined with TPE effectively in the management of critically ill cases of thyroid storm.The effectiveness of plasma exchange in lowering thyroid hormones appears to wane after 44–48 h of therapy in this case, highlighting the importance early thyroidectomy.