Formal Guidelines Research Articles

A systematic literature review of attitudes, intentions and behaviours of teaching academics pertaining to AI and generative AI (GenAI) in higher education: An analysis of GenAI adoption using the UTAUT framework

The rapid advancement of artificial intelligence (AI) has outpaced existing research and regulatory frameworks in higher education, leading to varied institutional responses. Although some educators and institutions have embraced AI and generative AI (GenAI), other individuals remain cautious. This systematic literature review explored teaching academics' attitudes, perceptions and intentions towards AI and GenAI, identifying perceived benefits and obstacles. Utilising the unified theory of acceptance and use of technology framework, this study reveals positive attitudes towards AI's efficiency and teaching enhancement, but also significant concerns about academic integrity, accuracy, reliability, skill development and the need for comprehensive training and policies. These findings underscore the necessity for institutional support to navigate the integration of AI and GenAI in tertiary education. Implications for practice or policy: Attitudes towards AI and GenAI integration are diverse with educators recognising benefits but raising ethical and practical concerns. These concerns indicate a need for a more comprehensive understanding and dialogue within academic communities. Academics' intentions to use these technologies are contingent upon the development of robust ethical guidelines and supportive institutional policies. Institutional support and training shape behaviours. The scarcity of formal training, systematic guidelines and policy frameworks currently limits effective integration.

Scale-Up and Postapproval Changes in Orally Inhaled Drug Products: Scientific and Regulatory Considerations.

Approved drug products may be subject to change(s) for a variety of reasons. The changes may include, but are not limited to, increase in batch size, alteration of the drug product constituent(s), improvement in the manufacturing process, and shift in manufacturing sites. The extent of pharmaceutical testing and the regulatory pathway for timely implementation of any change in the approved product and/or process depends upon the nature and extent of change. The U.S. Food and Drug Administration (FDA) has published guidelines that outline its expectations for the Scale-Up and Postapproval Changes (SUPAC) in the solid oral immediate and modified release (MR) products, and semisolid formulations. However, to date, no such guidelines have been issued to address SUPAC in the orally inhaled drug products (OIDPs), and this article represents a seminal contribution in this direction. It is hoped that it will inspire contributions from the relevant multidisciplinary experts from the pharmaceutical industry and the agency in accomplishing formal regulatory guidelines relevant to the OIDP SUPAC. The OIDPs are complex drug-device combination products. Therefore, a conceptualization of SUPAC guidelines for these products warrants consideration of contributions of effect of change(s) in individual components (drug substance, formulation, device) as well as a compound effect that a single or multiple changes may have on product performance, and its safety and efficacy. This article provides a discussion of scientific aspects and regulatory bases relevant to the development of SUPAC for OIDPs, and it attempts to outline considerations that may be applicable in addressing issues related to the OIDP SUPAC in the context of human drugs. The authors' statements should not be viewed as recommendations from any regulatory agency, as the applicable guidelines would be determined on case-by-case evaluation by the relevant authorities.

The challenges of being imperfect: how do judges and prosecutors deal with sentencing disparity

Legal decision-making aspires to be objective, a principle regarded as foundational to justice, public trust, and the legitimacy of legal outcomes. However, this ideal is often challenged by the reality of human judgment, which is influenced by subjective factors such as emotions, biases, and varying cognitive strategies. This paper investigates the psychological challenges faced by legal professionals in the context of sentencing, drawing on data from studies involving judges and prosecutors in Slovenia. Through workshops, interviews, and focus groups, the research highlights substantial inconsistencies in sentencing practices, even for similar offences. These disparities reveal the limits of objectivity within the judicial process, prompting legal professionals to reflect on the systemic and individual factors driving variability. The analysis focuses on how judges and prosecutors react to these discrepancies, examining a range of emotional and psychological responses—including the rationalization of decisions, the pursuit of consistency through personal “sentencing codes,” and reliance on collegial input to cope with the absence of formal guidelines. The analysis draws on concepts from cognitive dissonance theory, deliberate ignorance, emotional labour, and personality types to explore how professionals reconcile the ideal of objectivity with the imperfections of human judgment. It highlights the profound emotional toll that discrepancies in sentencing can take on decision-makers and how these emotional reactions influence their professional identity and approach to justice. By contextualising these findings within the sociology of emotions, this paper emphasises how the emotional realities of legal professionals shape their responses to perceived failures and impact their capacity to deliver justice. Ultimately, this study aims to foster a deeper understanding of the human aspects of judicial decision-making, underscoring the need for systemic reforms to mitigate disparities, provide support, and promote consistency in sentencing practices.

Electroconvulsive therapy research in BRICS and G7 countries: A bibliometric analysis from 2005 to 2024

Abstract Objectives: Over the last two decades, global mental health challenges have significantly increased, drawing attention to electroconvulsive therapy (ECT) as a potential remedy for serious mental conditions. This article aimed to examine the patterns of collaboration networks, publication dynamics, and key areas of ECT research in BRICS and G7 nations. Methods: Through bibliometric evaluation, this study analyzed publication volume, collaboration networks, keyword burst detection, and citation patterns of 3,595 articles published between 2005 and 2024, from the Web of Science Core Collection database, published between 2005 and 2024. The analysis focused on outputs from BRICS and G7 countries and limited to publications in English. The descriptive analytics, network visualization, and burst detection techniques were used. Results: Findings showed a notable surge in ECT-focused publications post-2015, signaling a heightened worldwide interest in mental health. Analysis of keyword trends identified three pivotal stages in ECT research evolution: initial concerns over ECT’s efficacy and safety, broadening of its application scope, and the recent refinement of treatment methodologies alongside the formulation of international guidelines. Examination of collaborative networks underscored dense interconnections among G7 nations, in stark contrast to the more localized collaborations within BRICS. Conclusions: This study provides critical insights into the global research landscape of electroconvulsive therapy (ECT) among BRICS and G7 nations. The findings emphasize the growing importance of ECT as a treatment for severe mental disorders, particularly in light of the ongoing global mental health crisis. Future studies is needed to compare ECT with emerging therapies, personalize treatment outcomes, and expand to underrepresented populations to further enhance the efficacy and accessibility of ECT worldwide.

Universal Design and Accessibility as an Act or a State - A Comparison of Policies in Norway, Sweden, and Denmark.

186 countries have ratified The Convention on Rights of People with Disabilities (CRPD) since 2006. Sweden ratified the CRPD in 2008, Denmark in 2009, and Norway in 2013. In the context of the United Nations, the concept of Universal Design (UD) introduced in the CRPD is new. Previously, accessibility was the dominant concept. By ratifying the CRPD, these three countries have agreed to initiate or advocate for research and development aimed at utilising UD when designing goods, services, equipment, and facilities. Additionally, they have committed to encouraging the integration of UD in the formulation of standards and guidelines. As a starting point for a future debate about the research part, this paper studies the uptake of UD in national policy in the three countries. The findings show that the approach in each country differs. Norway quickly developed their own version of UD (that has been critisised by scholars), thus choosing a top-down approach. By contrast, Denmark has been reluctant and is still using the concept of accessibility, waiting for the different sectors to adopt the concept of UD in their own way - as a kind of bottom-up strategy. While Sweden, has chosen another approach between these two strategies focusing on UD as a guiding principle, accessibility, and a third concept: usability. Finally, the paper discusses these approaches in relation to the built environment, using a framework that distinguishes between and act (like a process) and a state (as a result). All three counties are characterised by a dual focus on both act and state in line with the literature; however, the state dominates. The paper argues that we must acknowledge this duality but focus more on the process-related aspect to further develop UD as a human right concept.

Lymph node yield independently predicts local recurrence in papillary thyroid cancer.

Lymph node yield (LNY) is a validated quality control parameter in colorectal cancer surgery, with >12 nodes reflecting an adequate oncological resection. No formal guidelines exist in the context of central and lateral compartment lymph node dissection for papillary thyroid cancer (PTC). This study aimed to investigate the association between LNY and regional recurrence in PTC patients, and to define a threshold LNY that indicates adequate compartmental lymphadenectomy. A retrospective analysis of patient data (1992-2022) was conducted using "The University of Sydney Endocrine Surgery Unit" database. Patients undergoing either prophylactic or therapeutic dissection of the central compartment or therapeutic dissection of the lateral compartment for PTC were included. Multivariate logistic regression analysis was performed to examine the relationship between nodal yield and local recurrence. On multivariate analysis, a central LNY ≤3 was an independent adverse prognostic factor for central recurrence (odds ratios [OR] 2.19, 95% confidence intervals [CI] 1.15-4.17, and p=0.018) and a lateral LNY ≤20 was independently predictive of lateral recurrence (OR 2.45, 95% CI 1.24-5.31, and p=0.007). This study highlights the association between LNY and local recurrence in PTC. Our findings suggest that minimum LNY thresholds (>3 for central and >20 for lateral) may serve as indicators of adequate dissection. Further research should validate these findings across healthcare centers.

A guide for planning triangulation studies to investigate complex causal questions in behavioural and psychiatric research.

At the basis of many important research questions is causality - does X causally impact Y? For behavioural and psychiatric traits, answering such questions can be particularly challenging, as they are highly complex and multifactorial. 'Triangulation' refers to prospectively choosing, conducting and integrating several methods to investigate a specific causal question. If different methods, with different sources of bias, all indicate a causal effect, the finding is much less likely to be spurious. While triangulation can be a powerful approach, its interpretation differs across (sub)fields and there are no formal guidelines. Here, we aim to provide clarity and guidance around the process of triangulation for behavioural and psychiatric epidemiology, so that results of existing triangulation studies can be better interpreted, and new triangulation studies better designed. We first introduce the concept of triangulation and how it is applied in epidemiological investigations of behavioural and psychiatric traits. Next, we put forth a systematic step-by-step guide, that can be used to design a triangulation study (accompanied by a worked example). Finally, we provide important general recommendations for future studies. While the literature contains varying interpretations, triangulation generally refers to an investigation that assesses the robustness of a potential causal finding by explicitly combining different approaches. This may include multiple types of statistical methods, the same method applied in multiple samples, or multiple different measurements of the variable(s) of interest. In behavioural and psychiatric epidemiology, triangulation commonly includes prospective cohort studies, natural experiments and/or genetically informative designs (including the increasingly popular method of Mendelian randomization). The guide that we propose aids the planning and interpreting of triangulation by prompting crucial considerations. Broadly, its steps are as follows: determine your causal question, draw a directed acyclic graph, identify available resources and samples, identify suitable methodological approaches, further specify the causal question for each method, explicate the effects of potential biases and, pre-specify expected results. We illustrated the guide's use by considering the question: 'Does maternal tobacco smoking during pregnancy cause offspring depression?'. In the current era of big data, and with increasing (public) availability of large-scale datasets, triangulation will become increasingly relevant in identifying robust risk factors for adverse mental health outcomes. Our hope is that this review and guide will provide clarity and direction, as well as stimulate more researchers to apply triangulation to causal questions around behavioural and psychiatric traits.

Disaster-Related Wound Care: A Scoping Review.

To better understand the research status and demand of society on disaster-related wound care. Scoping review. A systematic search and screening was conducted in PubMed, CINAHL, Embase, WHO Guidelines, Cochrane Library, ISI Web of Science, MEDLINE and China National Knowledge Infrastructure (CNKI) Database, and 31 articles were selected from 244 articles for critique and synthesis. Existing disaster-related wound care research lacks a systematic review. In numerous nations, the technology and administration of disaster-related wound care for Emergency Medical Teams (EMT) are still nascent, the responsibilities are ambiguous, and there is a shortage of wound professionals. Current critical issues include the following: (1) inadequate strategies for enhanced orderly management of disaster-related wounds, particularly in an emergency setting and (2) lack of associations and organisations responsible for promoting research and development of catastrophe-related wound care proliferation strategies in disaster wound care. There is still a lack of understanding regarding effective organisation and scientific implementation of disaster-related wound care. More research should be carried out, focusing on the formulation of guidelines and continuous training, so as to promote the standardisation of disaster-related wound care in the future.

Screening and Following Up Harmful Alcohol Use "… is Not Necessarily Your Primary Focus": A Qualitative Study Exploring Health Professionals' Experiences Addressing Harmful Alcohol Use in a Norwegian Hospital.

Alcohol use remains a leading cause of excess mortality and morbidity worldwide, and identifying and following up harmful alcohol use represents a key component of alcohol harm reduction policies. This article explores health professionals' experiences implementing these policies in a Norwegian hospital. To explore health professionals' views and experiences of systematic screening and tailored follow-up of harmful and hazardous alcohol use in a Norwegian hospital. We conducted semi-structured interviews with 13 specialty registrars and nurses working in the emergency department and observation ward of a hospital in Oslo, Norway. Interviews were carried out between May and December 2022, coded using NVivo v.14 and analyzed thematically. We identified three themes: (i) standardized and clinical assessment, referring to tensions between standardized and clinical alcohol risk assessment; (ii) formal and informal treatment guidelines, encompassing the informal patient care practices enacted in the emergency department and on the wards, and; (iii) training delivery and barriers to implementation, referring to the training penetration rate and identified need for "clear and simple" alcohol treatment guidelines. This study highlights tensions between alcohol-related harm and alcohol-related norms as these pertain to screening and following up harmful and hazardous alcohol use in a Norwegian hospital. Results suggest training should focus on zero alcohol recommendations, the use of assessment tools, the acceptability of screening to patients and "clear and simple" patient follow-up procedures.

Clinical implications of atrial fibrillation recurrence vs. burden following catheter ablation: outcome data from 3 contemporary clinical trials using an insertable cardiac monitor

Abstract Background Recurrence of atrial fibrillation (AF) following catheter ablation is typically defined in clinical trials in a binary fashion, e.g. > 30 seconds or none. However, the clinical implications of this endpoint, adopted from formal guidelines, have been questioned. Purpose We hypothesized that assessment of AF burden can provide incremental clinical and management implications to the dichotomous definition of AF recurrence following ablation. Methods The study population comprised 147 patients enrolled in 3 ongoing multicenter randomized clinical trials (ICM REDUCE-AF [N=67]); HYBRID-AF (N=55] and DAPA-AF [N=25]), each employing an insertable cardiac monitor (ICM) to assess post-ablation AF recurrence and burden. The rate of cardiovascular (CV)-related healthcare utilization (CV-HCU, defined as the total number CV admissions, ED visits, cardioversions, procedures, and unplanned office visits) was compared based on AF recurrence (defined as >2 minutes of ICM-detected AF) vs. based on AF burden post-ablation (defined as time in AF divided by total monitoring time). Results Among the 147 study patients, mean age was 65 years; 53 (36%) were women; and 78 (53%) had persistent AF. At 12-months post-ablation (excluding blanking), the cumulative probability of AF recurrence was 60% (Figure 1A). However, 27% of AF recurrences were associated with a very low AF burden (≤0.1%) and low CV-HCU (10 events per 100 patient-months), similar to patients without AF recurrence (11 events per 100 patient-months). In contrast, recurrences with a higher AF burden (>0.1%; mean 17% ± 25%) were associated with a 3-fold higher rate of CV-HCU (31 events per 100 patient-months, p<0.001; Figure 1B). Findings were consistent regardless of AF-type, comorbidities or LVEF. Conclusions A substantial proportion of AF recurrences following contemporary AF ablation are associated with a very low AF burden without apparent effect on CV outcomes, whereas higher AF burden is associated with increased CV-HCU. These findings stress the need to move beyond a dichotomous definition of AF recurrence and to monitor AF burden post-ablation to guide management decisions in contemporary clinical practice.Figure 1

It’s ‘Gut Feeling’ Mostly: Online Hate, Uncivil Comments and Content Moderation in Australian Sports Media

There is evidence that online hate speech is increasing significantly on social media pages related to sport, but less research on how sport and media organisations are managing it. This research explored the management of content moderation in Australian sport media through qualitative interviews (16) with social media and communications staff in Australian sport and media organisations. It found that content moderation, or the moderating and removal of comments under social media posts, happened mostly as an addition to content creation work. Strategies for dealing with online hate and incivility were mostly the same between media and sport organisations, interviewees used some automated filters, but mostly manually hid, deleted and blocked comments and users to ‘clean’ their spaces. Overall there was a lack of formal guidelines and policies to direct moderation. Instead the work of content moderation was reliant on the actions of individuals, who took it on with a significant level of personal responsibility, and developed individual coping mechanisms to deal with the work. With its focus on communication staff in sport and media organisations this research contributes a different and important perspective to the growing field of research of online hate in sport.

A study of professional practices, attitudes and barriers to blended tube feeding in Australia and New Zealand.

This study investigates the utilisation of blended tube feeding by health professionals in Australia and New Zealand, assessing factors influencing its implementation following the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding consensus statement. A cross-sectional survey was conducted targeting health professionals across Australia and New Zealand. The survey comprised 35-questions including multiple choice, Likert scales and open-ended responses, to gain insights into blended tube feeding practices and perspectives. The effect of the health professional factors on outcomes was explored in pairs with a series of Chi-squared tests. Odds ratios (ORs) were calculated using standard univariate logistic regression. An exploratory content analysis was used to code the open-ended text responses to the survey questions which were then categorised and further synthesised into overarching themes. Out of 89 health professionals who completed the survey, the majority were dietitians, 63% reported managing fewer than five patients using blended tube feeding within their services. Parental request was the leading reason for adoption. Notable barriers included clinician time constraints, resource limitations and a lack of formal guidelines. Some health professionals considered the primary risk associated with blended tube feeding to be poor growth and/or weight loss. Professional development was pivotal in increasing confidence and advocating for blended tube feeding, with significant correlations observed between blended tube feeding training and clinical practice. This study emphasises the essential role of education, resource availability and institutional policy in promoting blended tube feeding practices for health professionals. Findings suggest that focusing on professional development and standardised resources could significantly enhance knowledge, confidence and competence of health professionals in blended tube feeding application. The outcomes point towards the need for a coordinated approach to support evidence-based blended tube feeding practices, aligning with the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding resources and recommendations.

Novel use of Siltuximab in a patient with VEXAS Syndrome.

VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is an increasingly recognized disorder that occurs due to somatic mutations of a ubiquitin-activating enzyme encoded by ubiquitin-like modifier activating enzyme 1 gene, UBA1. Clinical findings associated with VEXAS syndrome include recurrent fevers, polychondritis, periorbital edema, pleural effusions, myocarditis and/or pericarditis, hepatosplenomegaly, myelodysplastic syndrome, cytopenias, inflammatory arthritis, neutrophilic dermatosis, and deep venous thrombosis. Novel renal manifestations like interstitial nephritis are infrequent, and to our knowledge, acute renal failure due to C3 glomerulonephritis (C3GN) has not yet been reported. Overwhelming systemic inflammation can result in morbid end-organ damage and death. While there is no formal guideline or established protocol for its management, treatment of VEXAS syndrome with tocilizumab, an interleukin-6 (IL-6)-directed therapy, has been described in the literature. Here, we report a case of a 71-year-old male patient presenting with C3GN as an initial manifestation of VEXAS syndrome and explore the rationale for our approach to treatment with IL-6 blockade. Our patient was initially treated with two inpatient doses of tocilizumab with successful transition to siltuximab in the outpatient setting. He continues to benefit from ongoing siltuximab treatment for more than one year to date without any safety issues or relapse of VEXAS syndrome.

Interpretation of WFAS Clinical practice guideline on acupuncture and moxibustion: smoking cessation

The paper interprets the formulation, main content and characteristics of Clinical practice guideline on acupuncture and moxibustion: smoking cessation issued by World Federation of Acupuncture Societies (WFAS 007.2-2023, short for Guideline). The Guideline focuses on the clinical value of acupuncture regimen for smoking cessation and its abstinence rate, and attaches the importance to the actual needs of patients, the counseling and management of smoking cessation. The Guideline is characterized by its international orientation, the integration of Chinese and Western medicine, and the advantages of acupuncture for smoking cessation. It is formulated concisely in content and highlights the clinical practicability. During the guideline development for smoking cessation in future, the consideration should be paid on improving the evidence quality of acupuncture, preserving the characteristics of acupuncture and emphasizing patients' demand, the counseling and management of smoking cessation, as well as the scenarios of implementation so as to improve the quality and applicability of the guidelines.

6429 An Unusual Gene Mutation and Clinical Manifestation of MODY 10

Abstract Disclosure: J. Ambalavanan: None. O. Abdulhussein: None. J. Ferri-Guerra: None. G. Madrigal Loria: None. K. Alkwatli: None. A. Iqbal: None. R.R. Correa: None. Introduction: Maturity-Onset Diabetes of the Young (MODY) is a rare monogenic form of diabetes characterized by impaired beta cell function accounting for < 5% of all people with diabetes. About 14 different subtypes of MODY have been described in the. MODY 10 is an extremely rare form with mutation in the INS (insulin) gene. We present a previously unreported genetic mutation in the INS gene, its clinical course and subsequent management. Case: A 23-year-old female presented to us for consultation regarding new diagnosis of diabetes. She came to medical attention for pre-diabetes at the age of 16 years and was managed with diet control. She was officially diagnosed with diabetes by PCP in October 2022 after onset of polyuria and nocturia, and HbA1c of 8.7%. During initial evaluation, we suspected type 1 diabetes due to her age, low BMI of 17.61 kg/m2 and prescribed a CGM while we awaited extensive antibody evaluation. Within a week she reported average blood sugars in the 200-300 mg/dl range. As a result, she was on insulin glargine 5 units at bedtime. Within 3 months, her HbA1c dropped to 6.5% but she started experiencing frequent symptomatic hypoglycemia at work. At this point we suspected MODY due to age at diagnosis; antibody negative status for GAD-65, IA-2, ZnT8 and insulin; detectable C-peptide 1.7 ng/ml (0.81-3.85); low BMI and good glycemic control and frequent hypoglycemia on insulin. On evaluation of family history, she had a history of diabetes in maternal grandmother, paternal grandfather and paternal great uncle. Her parents did not have diabetes. We stopped glargine and started glipizide XL 2.5mg once daily. She was also referred to our clinical genetics team. On genetic evaluation she was found to have one heterozygous variant of uncertain significance in the INS gene. On further evaluation, this was found to be guanine to adenine substitution at c:139 in exon 2 of the INS gene on chromosome 11:2182063 resulting in a variant protein p.Gly47Ser which is a missense change that occurs when glycine (Gly) is replaced by serine (Ser) at position 47. This mutation has not been previously reported to be pathogenic or benign and has not been reported in significant frequency anywhere based on our literature search. Furthermore, in silico analysis supported that this missense variant had a deleterious effect on the insulin structure/function. Given the rarity of this condition, there are no formal guidelines or consensus regarding the management. During a subsequent follow up visit, we discussed that she fit the diagnosis clinically and suggested possible medications. In the end, we decided to change her from glipizide to sitagliptin 50mg daily as she was continuing to have lows at work. This helped avoid hypoglycemia and maintained time in rage at 98%. Conclusion: We present a patient with rare form of MODY 10 with a new mutation in c139:G>A at exon 2 of INS gene managed with sulfonylurea and eventually DPP4 inhibitor. Presentation: 6/2/2024

8077 Use of Lovaza for Management of Hypertriglyceridemia in Pregnancy

Abstract Disclosure: J. Segarra-Villafane: None. L.R. Sepulveda-Garcia: None. L. El Musa Penna: None. I.C. Arroyo: None. Z. Maisonet -Feliciano: None. W. Medina-Torres: None. M. Alvarado: None. M. Ramirez: None. L.A. Gonzalez-Rodriguez: None. Severe hypertriglyceridemia in pregnancy increases the risk of health complications to both mother and fetus, including preeclampsia, hyperviscosity syndrome and life-threatening pancreatitis. Several case reports include management of hypertriglyceridemia in pregnancy with medical nutrition therapy, omega fatty acids and gemfibrozil but is controversial. There are no formal clinical guidelines for management of severe hypertriglyceridemia in pregnancy which presents a challenge for physicians. Lovaza is a combination of ethyl esters of omega 3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) indicated as an adjunct to diet to reduce triglycerides (TG) levels in adult patients with severe hypertriglyceridemia. Lovaza is Category C (risk cannot be ruled out) and should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Case of a 40 years old female G3P1A1 with IUP 25 WGA with history of hypothyroidism, dyslipidemia and episode of acute pancreatitis in 2016 due to hypertriglyceridemia, who was referred to clinics due to uncontrolled lipids and thyroid disease. Laboratories included fasting serum triglycerides (TG) 4357mg/dL (40-150mg/dL), total cholesterol 525mg/dL (120-200), HDL 56mg/dL, LDL invalid due to elevated TG. Thyroid function test revealed TSH of 161uIU/mL (0.43-2.91) and FT4 of 0.24ng/dL (0.8-1.8). HbA1c, lipase and amylase within range. Vital signs were normal. Patient was asymptomatic, no abdominal complaints or hypothyroidism-related symptoms, but hospital admission was recommended due to high risk of pancreatitis and uncontrolled hypothyroidism. She was started on Synthroid 220 mcg IV daily for hypothyroidism and was placed NPO until nutritionist evaluation. Triglycerides levels improved with conservative interventions and low-fat diet. However, TG persisted above 2000mg/dL and, after discussing risks and benefits with patient, pharmacological therapy with Lovaza was started to reach goal of TG less than 1000 mg/dL and reduce potential risk of pancreatitis. Patient agreed to start Lovaza 2gm AM and 2gm PM. After initiation of Lovaza, in addition to dietary modifications and hypothyroidism management, laboratories showed significant improvement in TG levels from 3569 down to 1778 mg/dL. Patient was discharged on Lovaza 2gm oral BID and Synthroid 200mcg oral daily. One month later, TG had decreased to 557mg/dL (0-150) and thyroid tests showed TSH at 0.305mIU/mL and FT4 at 1.71ng/dL. Patient tolerated medications well without side effects and had an uncomplicated pregnancy and delivery. This case demonstrates that severe hypertriglyceridemia during pregnancy can be managed effectively and, more importantly, in a safe manner with Lovaza, in addition to dietary fat restriction. However, additional research is needed if its use is to be included in future pregnancy management guidelines. Presentation: 6/2/2024

Development of international guidelines by Tuina practitioners for specific acupoints of paediatrics Tuina (2022 version).

To establish a standardized framework encompassing the precise locations, manipulations, functions and indications of specific acupoints in the field of paediatric Tuina. The development of consensus involved three distinct stages. Initially, a list of paediatric Tuina specific acupoints was compiled based on an extensive literature review, which was subsequently supplemented through expert interviews. In the second stage, the Delphi method was employed to assess the significance of acupoint locations, manipulations, functions, and indications. In situations where the questionnaire survey failed to yield agreement or when the experts held reservations, the nominal group approach was utilized during the expert consensus meeting. The final version of the technical standardized material was ultimately determined during an expert consensus conference. After undergoing external peer review and evaluation, the completed draft was prepared for public dissemination RESULTS: The comprehensive list identified a total of 66 specific acupoints. The location and manipulation questionnaire consisted of 156 items based on the literature database, while the function and indication questionnaire contained 116 items. Two rounds of Delphi surveys were conducted for the location and manipulation category, and another two rounds of Delphi surveys were conducted for the function and indication category. During the experts consensus meeting The panel of experts conducted in-depth discussions on 61 questions, resulting in the formulation of technical guidelines for the locations, manipulations, functions, and indications of 64 paediatric Tuina acupoints. Subsequently, the research team compiled and edited the draft of the technical guidelines for acupoints of paediatric Tuina, which was finalized after external review and feedback. This study successfully established the recognized technical standards for practitioners of paediatric Tuina, thereby standardizing clinical practices and providing a foundation setting the framework for future research. The guidelines offer theoretical insights and recommendations for conducting clinical studies comparing different acupoint sites, as well as modifying or enhancing treatment regimens.

Ocular Manifestations in Children with Special Needs Presenting in a Tertiary Eye Hospital of Central Nepal

Background Children with special needs are at a substantially higher risk of visual impairment (VI) (10.5% compared with 0.16%) but also of ocular disorders of all types, including refractive errors and strabismus. VI and other potentially correctable ocular disorders are frequently unidentified in children with complex needs. Although assessment may be more challenging, identifying these potential additional barriers to learning and development may be critical.MethodsDetailed ophthalmic examination was carried out in all children with special needs presenting to the Pediatric OPD of Bharatpur Eye Hospital over 6 months (January to June 2023). Ophthalmic examination included case history, presenting distance visual acuity, cycloplegic refraction, binocular vision examination, anterior and posterior segment evaluation.ResultsOut of the total of 55 participants, mean age was 9.74 ± 5.07 years, majority were male 32 (58.18%). Quantitative visual acuity could be assessed only in 19 (34.55%) children, using picture chart 9 (16.36%) and Snellen chart 10 (18.18%). Strabismus 21 (38.18%) and refractive error 14 (25.45%) were the commonest visual disorders in our study children.Conclusions With patience, suitably adapted methods, visual assessment is feasible in the majority of children with special needs. It is hoped that the formulation of proper vision care guidelines at a national level may help in early detection and management of visual disorders in this special population and enhance their quality of life.

Investigation of colonial-era architecture style on modern architecture design style in Aden city

This study investigated the lasting influence of British colonial architecture (129 years) on contemporary building design in Aden, Yemen. The initial focus was on the perception of British Neo-Classical architecture as a symbol of superiority, overshadowing Aden's rich architectural history. This research explored Aden's architectural transformation from pre-colonial to colonial periods, analyzing the impact of colonial-era building facades on modern design practices. Through observation and interviews with built environment professionals, the study examined the broader social, political, and economic effects of British colonialism. The findings reveal a significant influence of British colonial architecture on the design of building facades in Aden. This influence is evident in structures like the repurposed church on Crater Mountain, which now serves as a government building. The influx of British administrators, soldiers, and workers from diverse backgrounds (Indian, Somali, Jewish) during the colonial period contributed to Aden's architectural diversity by constructing churches, temples, and government buildings. Unfortunately, the ongoing war in Yemen has damaged or destroyed many of these structures. This study also found that classical architectural elements from British colonial buildings like the Military Museum in Crater, the Heritage Museum, and the Tax Office continue to influence modern design. These elements and the miniature Big Ben clock in Al-Tawahi stand as prominent symbols of British influence in Aden. However, the Yemeni government's restoration efforts for these colonial-era buildings have been slow and largely ineffective. The research further explored the enduring influence of Neo-classical architectural ideals in Aden. The study highlights the formal guidelines, specific modules, and proportions used in designing arches and columns, particularly in residential buildings. These elements contribute to the aesthetic qualities of these structures. While the British incorporated classical elements during their rule, architectural advancements and new materials have led to the incorporation of novel elements in contemporary design.

The management of Pseudomonas aeruginosa respiratory infection in children with cerebral palsy: A narrative review.

Children with cerebral palsy have increased respiratory morbidity and mortality. Infection with Pseudomonas aeruginosa (PA) is associated with poorer outcomes, yet there are no formal guidelines to inform treatment of respiratory infection in children with cerebral palsy. This review explores the existing literature regarding management of PA-infection in children with cerebral palsy, with the aim of synthesising clinical recommendations and identifying gaps in current understanding. Medline (Ovid), PubMed and Embase were searched using keywords. Full-text articles involving the paediatric population and antimicrobial therapy were included. There was no limit on date of publication. Four retrospective case series were identified. Respiratory microbiology, in samples collected from a range of sites along the respiratory tract, was reported in three studies. Patients who received PA-specific antibiotics clinically improved. Two studies suggest that the use of suppressive inhaled anti-pseudomonal therapy may improve respiratory morbidity in the chronic setting. There is minimal evidence to guide management of PA respiratory infection in children with cerebral palsy. Children with cerebral palsy are at risk of developing bronchiectasis, so in the absence of high-quality evidence, management should be informed by extrapolating from the non-cystic fibrosis bronchiectasis guidelines. Further research examining surveillance and management of PA-infection in this population is required given that early intervention may prevent irreversible lung damage.