Initial Registration Research Articles

Place de la cranioplastie dans la prise en charge des crâniectomies décompressives : étude de la cohorte de l’Hôpital Fondation Adolphe de Rothschild sur 7 ans

The objective of our study is to take stock of the cranioplasty implants used within our establishment. We analyzed the patients files who underwent craniectomy followed by cranioplasty between 2017 and 2023, with at least 1 year of follow-up after cranioplasty (n=75). The data were extracted from the computerized patient file (DxCare®, Dédalus) and the pharmaceutical management tool for drugs and sterile medical devices (Pharma®, Computer Engineering). The sex ratio, indication for craniectomy, operating time, time between craniectomy and cranioplasty, complications and aesthetic result were statistically analyzed. The main indications are stroke (n=59; 78.5%) and aneurysms (n=7; 9.5%). Among the 75 patients, 52 benefited from the placement of a custom implant (PolyEtherEtherCetone/PEEK or Hydroxyapatite) and 23 from cementoplasty. The operating time was significantly shorter (p < 0.05) for custom cranioplasty (1.93 ± 0.61 h vs 1.62 ± 0.53). Only 4 patients (5.3%) were not satisfied with the aesthetic result following the placement of a custom implant. A greater risk of infection was found in the context of cementoplasty (43% for cementoplasties vs 25% for the custom implant, so χ2(p = 0.1095), this difference not being statistically significant. This collaborative work between the pharmacy and the adult neurosurgery department served to establish an initial register for monitoring patients who have undergone cranioplasty for whom the ideal implant remains to be determined.

The Crucial Role of Breeder and Dog Owners Associations in Safeguarding Genetic Heritage of Endangered Balearic Dog Breeds: Gender Preference and Registry Adscription.

This study delves into the complex relationships between indigenous dog breeds in the Balearic Isles and their human counterparts, specifically breeders and owners. Using Canonical Correlation Analysis, the research examines variables such as breed registries and the number of breeders/owners, uncovering significant correlations within registries. For example, an increase in female auxiliary registrations corresponds to a decline in foundational registrations, indicating shifts in breed documentation dynamics. Similarly, a rise in definitive female registrations coincides with a decrease in foundational female registrations, suggesting increased pedigree awareness across generations. Beyond registries, the study explores the correlation between breeders/owners and various initial records, highlighting that a notable increase in breeders positively influences initial registrations, definitive totals, and overall counts, underscoring their crucial role in early breed stages. Gender preferences in registrations are noted, with a historical bias towards female entries during foundational stages gradually shifting in favor of males in definitive registrations. In conclusion, the research underscores the interconnected roles of breeders, owners, and comprehensive registries in preserving genetic diversity among Balearic dog breeds, emphasizing the need for ongoing efforts to address gaps in genealogical data for a more accurate understanding of breed dynamics.

Optimizing graphics for understanding real-scene using 3D image registration and tracking and mapping

A satisfactory graphic design and good-looking 3D models and environments are the backbones of a positive user experience, especially in Augmented Reality (AR) / Virtual Reality (VR) app development. Where these technologies is seen as the an excellent realm of human-computer interaction. The purpose is to fool the viewer by the seamless incorporation of simulated features. Every AR system relies on true interaction and three-dimensional registration to function properly. In this research, we present a strategy for real-world 3D image registration and tracking. The primary foci of this study are the first three stages: initial registrations and matrix acquisitions, road scene feature extraction, and virtual information registration. At initial registration, a rough virtual plane is estimated onto which the objects will be projected. To this, we propose YoloV3 for transferring features from a virtual to a real-world setting. The projection process concludes with a guess at the camera’s posture matrix. This tech is used in the vehicle’s head-up display to augment reality. The average time required to register a virtual item is 43 seconds. The final step in making augmented reality content is to merge the computer-generated images of virtual objects with real-world photographs in full colour. Our results indicate that this method is effective and precise for 3D photo registration but has the potential to dramatically increase the verisimilitude of AR systems.

“It is because the treatment of this lady is a cascade”: Accumulation of delays and the occurrence of obstetric emergencies in an urban maternity unit in Tanzania

ObjectiveTo explore healthcare workers’ and women's experiences of providing and seeking childbirth care in a busy urban maternity facility in Tanzania. DesignA qualitative study with observations, in-depth interviews, and informal conversations, using thematic network analysis. SettingThis study was conducted in a busy urban maternity unit in Dar es Salaam, Tanzania which is a low-resource setting with a need to improve childbirth care. ParticipantsSix frontline healthcare providers and four hospital managers from the facility, along with six postpartum women who gave birth at the facility. FindingsDelays were observed throughout the childbirth care cascade, encompassing various stages. During antenatal care, timely provision of care was hindered by a high patientto-provider ratio, resulting in inadequate monitoring of risk factors. At the onset of labor, women delayed seeking care, sometimes, attempting a trial of labor after a previous Caesarean section. Within the facility, delays in care decision-making and patient management were evident due to insufficient resources. The accumulation of these delays over time influenced the quality of care provided and challenged the management of obstetric emergencies at the study facility. Key conclusionsThe study findings show that delays are prevalent throughout the entire childbirth care cascade. The accumulation of these delays over time has influenced the quality of care provided at the facility and increased the vulnerability of women experiencing obstetric emergencies. To effectively address the imperative of reducing maternal mortality in low-resource settings, it is essential to develop appropriate interventions that span the entire spectrum of childbirth care. Additionally, further research is needed to delve into the complexities of care decision-making and the quality of care delivered within urban maternal facilities. Implications for practiceOur findings stress the need for comprehensive childbirth interventions and contextspecific guidelines to address challenges across the care cascade, particularly in lowresource settings. Urgent attention is required to prioritize care during patient triage and address systemic challenges within the healthcare system to improve birth outcomes and ensure effective facility-based care provision.Trial registration number: NCT04685668Date of initial trial registration: December 28th, 2020

An accurate and robust visual-inertial positioning method

The human–machine integrated coordinate measurement is a promising coordinate measurement method with high flexibility and efficiency for the complex working environments. The cameras installed on the head-mounted measurement device achieves accurate global positioning by observing the uncoded LED landmarks, and then combines with the local measuring to obtain 3D coordinates. However, limited by the frame rate of the camera, the fast movements of the operator’s head may cause landmark misidentification and visual positioning failure. In order to improve the robustness, a visual-inertial positioning method is proposed in this paper. An inertial measurement unit (IMU) is added to compensate for the deficiency of the visual positioning and enhance the dynamic performance. An adaptive extended Kalman filter (EKF), which adjusts the measurement noise covariance matrix based on the visual positioning uncertainty, is established to obtain the optimal state estimation. And an efficient initialization procedure is presented to implement the initial registration of uncoded landmarks based on the normal distribution transform algorithm and to determine the initial state of the IMU. Furthermore, the residual chi-square test is employed to detect false pose estimate in real time and to avoid positioning failure. The experiments demonstrate that the proposed method has high static positioning accuracy (0.681 mm) and high dynamic positioning robustness. The adaptive EKF realizes reliable landmark identification under fast movements and provides a higher accuracy than the common EKF.

Improving Lean Clinics (Lean Healthcare): A Voice of Employee Approach to Reduce Waiting Times

This study presents a solution-focused strategy for reducing patient waiting times at an aesthetic clinic in Ankara, Turkiye. Focused on the dynamic intersection of operational efficiency and patient satisfaction, this study employs a "Voice of Employee" approach to glean insights from frontline staff, acknowledging their pivotal role in service delivery. Quality circles, Pareto, and fishbone diagram analyses discern the root causes of prolonged waiting times, identifying factors such as deficient initial registration processes, inadequacies in ERP and CRM applications, and suboptimal waiting area facilities. This investigative process yields pragmatic solutions, positioning the study as a strategic guide for enhancing service quality and ensuring patient contentment in aesthetic clinics. Beyond its immediate implications, the research contributes to the broader academic discourse on sustainable healthcare solutions, championing the integral role of employee perspectives in shaping operational strategies. The refined conclusions drawn from this study propel healthcare institutions toward a future marked by continual improvement, attuned to patient needs while navigating the complexities of an ever-evolving healthcare landscape.

ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range

Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (≤ 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique Identifier: NCT02725853; Initial registration date: 01/04/2016.

A virtual consultation system for very rare tumors in children and adolescents – an initiative of the European Cooperative Study Group in Rare Tumors in Children (EXPeRT)

BackgroundVery rare tumors (VRTs) in children and adolescents are orphan diseases defined by an annual incidence of <2/1000,000. For a long time, VRTs have been outside of clinical and research groups in the field of pediatric oncology. As a result, exchange of experience and development of therapeutic standards have not been promoted. After the foundation of several national VRT working groups and the European Cooperative Study Group on Pediatric Rare Tumors (EXPeRT), a virtual consultation system (VCS) has been established, which specifically aimed at facilitating access to clinical consultation in complicated cases of VRTs. MethodsThe VCS has been open to physicians. After initial registration, they can present VRT patients free of charge. Patient consent and data pseudonymization were mandatory. Within the VCS, disease specific interdisciplinary panel discussions with at least three experts from the EXPeRT group and partners have been opened, and at the end of the discussion, a written summary and recommendation was provided. ResultsBetween Mai 2017 and March 2023, 160 cases from 27 countries (20 European, 7 non-European) have been discussed in the VCS. The most common diagnoses were adrenocortical carcinoma, malignant skin tumors and malignant ovarian tumors. In a survey three months after panel discussion, more than 90% of requesting physicians evaluated the VCS to be easy to use, helpful and to have a significant impact on patient management. ConclusionA VCS may provide significant assistance in the management of children and adolescents with VRTs. Furthermore, it may help to overcome inequalities in access to adequate treatment in countries with lower health care system resources or without established VRT study groups. Therefore, EXPeRT will continue to support the VCS. For this purpose, the VRT panels have been integrated into the Clinical Patient Management System (CPMS) within the European Reference Network Initiative (ERN PAedCan).

L’efficacité des semelles posturales dans la gestion de la posture chez les personnes atteintes de paralysie cérébrale : une revue de portée

BackgroundChildren with cerebral palsy often have gait abnormalities that can affect their daily activities. Insoles have been used as a treatment option to improve walking in children with cerebral palsy, but their efficacy remains uncertain. The aim of this study was to investigate the effects of postural insoles with corrective elements on gait parameters in children with cerebral palsy. MethodsChildren with cerebral palsy often have gait abnormalities that can affect their daily activities. Insoles have been used as a treatment option to improve walking in children with cerebral palsy, but their efficacy remains uncertain. The aim of this study was to investigate the effects of postural insoles with corrective elements on gait parameters in children with cerebral palsy. ResultsOf 35 initial registrations, three studies met the inclusion criteria. Results showed that postural insoles are effective in improving foot biomechanics and posture. However, the quality of the evidence was generally low, and further high-quality studies are needed to confirm these results. ConclusionsPostural insoles with corrective elements may be an effective treatment option for improving gait parameters in children with cerebral palsy. The use of these semelles can lead to an increase in cadence and speed, as well as an improvement in the range of motion of ankle dorsiflexion and a decrease in the range of motion of knee flexion and hip internal rotation.

PP104 Impact Of New Permbrolizumab Indications After Initial Registration By Brazilian Health Regulatory Agency (ANVISA)

IntroductionMost new drugs have only clinical studies focused on a single population at the time of first registration, hence their indications for use are restricted to this population. For clinical conditions when there are no other treatments available, new drugs have higher costs in Brazil. There is no review of prices when these medications broaden their therapeutic areas, and this can have a significant financial impact. This study’s objective is to assess the financial implications of pembrolizumab’s incremental indication after its initial registration.MethodsWe calculated the annual cost to treat all Brazilian patients with indications for use in the first registration and all incremental indications of pembrolizumb. Populations were estimated by epidemiological data from the pembrolizumab clinical trials called, KEYNOTE studies, and the INCA 2023 cancer estimate for the Brazilian population. Costs were calculated by CMED-ANVISA price value and considering the dosing of 200mg every 3 weeks.ResultsIn 2016, pembrolizumab was granted registration in Brazil was restricted to patients with advanced melanoma. In 2022 the indication was expanded to more than 20 new indications, with several studies in progress that potentially will lead to further inclusions. The estimate of patients eligible for indications increase of 1,796 to 99,544 patients with an increased total cost from BRL625,802,837 to BRL34,685,366,192 (USD121,185,677.4 to USD6,716,763,399.04).ConclusionsThe financial burden of pembrolizumab’s expanded uses after it was first approved could significantly rise, endangering the long-term viability of healthcare systems. In Brazil, where medicine costs are not regularly monitored, the annual inflation adjustment is the only factor that causes prices to change. In order to lower medicine prices in response to the addition of new indications, the expansion of therapeutic options for the same condition, or even obsolescence, regulations are required.

Perinatal health effects of herbicides exposures in the United States: the Heartland Study, a Midwestern birth cohort study

BackgroundThe objective of the Heartland Study is to address major knowledge gaps concerning the health effects of herbicides on maternal and infant health. To achieve this goal, a two-phased, prospective longitudinal cohort study is being conducted. Phase 1 is designed to evaluate associations between biomarkers of herbicide concentration and pregnancy/childbirth outcomes. Phase 2 is designed to evaluate potential associations between herbicide biomarkers and early childhood neurological development.MethodsPeople (target enrollment of 2,000) who are seeking prenatal care, are ages 18 or older, and are ≤ 20 + 6 weeks gestation will be eligible for recruitment. The Heartland Study will utilize a combination of questionnaire data and biospecimen collections to meet the study objectives. One prenatal urine and buccal sample will be collected per trimester to assess the impact of herbicide concentration levels on pregnancy outcomes. Infant buccal specimens will be collected post-delivery. All questionnaires will be collected by trained study staff and clinic staff will remain blinded to all individual level research data. All data will be stored in a secure REDCap database.Hospitals in the agriculturally intensive states in the Midwestern region will be recruited as study sites. Currently participating clinical sites include Indiana University School of Medicine- affiliated Hospitals in Indianapolis, Indiana; Franciscan Health Center in Indianapolis, Indiana; Gundersen Lutheran Medical Center in La Crosse, Wisconsin, and University of Iowa in Iowa City, Iowa. An anticipated 30% of the total enrollment will be recruited from rural areas to evaluate herbicide concentrations among those pregnant people residing in the rural Midwest.Perinatal outcomes (e.g. birth outcomes, preterm birth, preeclampsia, etc.) will be extracted by trained study teams and analyzed for their relationship to herbicide concentration levels using appropriate multivariable models.DiscussionThough decades of study have shown that environmental chemicals may have important impacts on the health of parents and infants, there is a paucity of prospective longitudinal data on reproductive impacts of herbicides. The recent, rapid increases in herbicide use across agricultural regions of the United States necessitate further research into the human health effects of these chemicals, particularly in pregnant people. The Heartland Study provides an invaluable opportunity to evaluate health impacts of herbicides during pregnancy and beyond.Trial registrationThe study is registered at clinicaltrials.gov, NCT05492708 with initial registration and release 05 August, 2022.

Exploring recent patterns of migration of doctors to the United Kingdom: a mixed-methods study

IntroductionA shortage of doctors is currently one of the biggest challenges faced by the healthcare workforce in the United Kingdom (UK). While plans are in place to increase the number of medical school places, in the short-term this gap will need to continue to be filled by the international recruitment of doctors. The aim of this study is to identify key factors that explain the patterns of migration of doctors to the UK, in order to aid the development of policies to recruit and retain a sustainable workforce.MethodsWe analysed General Medical Council (GMC) secondary data on the patterns of migration of internationally trained doctors (2009–2019). Qualitative interviews were conducted with 17 stakeholders by videoconferencing which were audio-recorded, transcribed and thematically analysed using NVivo.ResultsIn 2019, 34.5% of UK doctors were trained internationally mainly in India, Pakistan, Italy, Nigeria, Greece, Romania and Egypt. Most new registrations by internationally trained doctors from 2009–2019 did not have a specialty at the time of initial registration (96.2% in 2019). Only a relatively small number of these doctors go on to gain specialist or GP registration (11.6% within 5 years and 27.2% within 10 years of registration). The stakeholder interviews highlighted training opportunities and career progression as the main drivers of migration. The barriers internationally trained doctors face regarding specialty training included differences between UK and destination health systems, systematic bias, bureaucracy and selection processes not being accessible.ConclusionThis study makes a contribution to the literature by identifying recent patterns in the migration of doctors to the UK. The UK’s dependence on internationally trained doctors has important global implications as source countries are losing skilled health workers which is undermining their health systems. In keeping with the WHO Global Code on the International Recruitment of Healthcare Personnel, policymakers need to consider how to reduce the UK’s reliance on internationally trained doctors, particularly from countries on the safeguard list whilst continuing the drive to increase medical school places. Additional support is required for internationally trained doctors, to ensure that they get on the training programmes they seek, enabling their career progression.

A 3D/2D registration method based on reconstruction of orthogonal-view Xray images

To establish a 3D/2D registration method for preoperative CT and intra-operative X-ray images in imageguided spine surgery. We propose a 3D/2D registration algorithm based on 3D image reconstruction. The algorithm performs 3D image reconstruction of 2D orthogonal view X-ray images, thus converting the problem into 3D/3D registration. By constructing an end-to-end framework that combines the two tasks of reconstruction and registration, the geodesic distance is measured in the 3D manifold space to complete the registration. We conducted experiments on the public dataset CTSpine1k. The tests on two test sets with different initial registration errors showed that for data with small initial errors, the proposed algorithm achieved a rotation estimation error of 0.115±0.095° and a translation estimation error of 0.144±0.124 mm; for data with larger initial errors, a rotation estimation error of 0.792±0.659° and a translation estimation error of 0.867±0.701 mm were achieved. The proposed method can achieve robust and accurate 3D/2D registration at a speed that meets real-time requirements to improve the performance of spine surgery navigation.

Citizenship of the agricultural transfer population and property income‐‐empirical evidence from the Chinese region

AbstractIn urbanization, achieving common prosperity is a common complication faced by human society in the process of development. The citizenship of the agricultural transfer population (CRM) is a vital urbanization goal in developing countries. However, there is rare empirical evidence on the citizenship of agricultural migrants and property income. The relaxation of household registration restrictions and property policy changes under China's new urbanization plan provide crucial material for the test of their causal effects. The results of this study suggest that the citizenship of the agricultural transfer population can be divided into two stages: identity conversion and service sharing. Both the initial household registration conversion and the later service sharing are conducive to the growth of property income of the residents who have switched from agriculture to non‐agriculture. Besides, the increase in transfer length of the “rural‐to‐non‐native” residents further strengthens the positive effect of service parity on property income. This implies that governments and relevant authorities in developing countries should emphasize the construction of a policy system for equalizing basic public services to facilitate the reduction of income disparity while stimulating economic growth. Additionally, the mechanism analysis reveals that the underlying logic of the citizenship of agricultural migrants lies in the ability to enrich total property, adjust asset allocation behavior, reinforce the efficiency of financial asset allocation, and achieve an increase in property income. The quantitative results of this study provide effective information for future sustainable urban development, especially for rational urbanization in developing countries.

Value of gym-based group exercise versus usual care for young adults receiving antipsychotic medication: study protocol for the multicenter randomized controlled Vega trial

Background Exercise is recommended to protect physical health among people with severe mental illness and holds the potential to facilitate long-term recovery. An inclusive exercise community provides an opportunity for life skill training and social connectedness and may reduce the experience of loneliness and internalized stigmatization which together may improve personal recovery. Using a pragmatic randomized design, we aim to examine the effectiveness of a gym-based exercise intervention tailored to young adults in antipsychotic treatment (i.e., Vega Exercise Community) compared to usual care. It is hypothesized that the Vega Exercise Community will be superior to usual care for personal recovery at four months.Methods The trial will be conducted at four sites in Denmark from which 400 participants, aged 18 to 35 years, who are in current treatment with antipsychotic medications for the management of schizophrenia spectrum or affective disorders, will be recruited. Participants will be randomized (2:1) to Vega Exercise Community or usual care. Vega Exercise Community includes three weekly group-based exercise sessions hosted in commercial functional training centers delivered by certified Vega instructors. After four months, participants in Vega Exercise Community will be randomized (1:1) to minimal versus extended support with regards to sustained physical activity. Data will be collected at baseline, four, six and 12 months. The primary outcome is personal recovery assessed by Questionnaire about the Process of Recovery at four months. Behavioral symptoms, health-related quality of life, metabolic health, and program costs will be evaluated to further determine the effectiveness and cost-effectiveness of the Vega Exercise Community. Finally, the quality of life and physical and mental health of the participants’ primary relative will be evaluated.DiscussionThe results of this trial may have important implications for health, sustained physical activity, and recovery for individuals in treatment with antipsychotics. Given the pragmatic design, positive results may readily be implemented by mental health care professionals to promote exercise as an integrated part of treatment of severe mental illness.Trial registrationClinical Trials.gov (NCT05461885, initial registration June 29th, 2022). WHO Universal Trial Number (UTN): U1111-1271–9928.

Land Registration Derived from Customary Land According to Government Regulation Number 24 of 1997

The purpose of this study is to determine the procedure for registering land derived from customary land according to Government Regulation Number 24 of 1997. The results show that the procedure for registering land derived from customary land includes the activity of initial registration, which is the registration of land objects that have not been registered based on Government Regulation Number 10 of 1961, as amended by Government Regulation Number 24 of 1997. This registration is carried out systematically and sporadically with certain requirements that must be fulfilled by the applicant. These requirements include a letter of application, a photocopy of the applicant's identification card, a photocopy of the Land and Building Tax, written evidence of the original land accompanied by a certificate of physical possession and a certificate from the village head. Once all the required data is complete and meets the criteria, a certificate of rights over customary land is issued.

Budgetary impact of new label indications after initial drug registration in Brazil: A case study of pembrolizumab and trastuzumab deruxtecan

The pharmaceutical landscape has undergone a transformative shift due to emerging technologies, leading to a projected value of USD 405.52 billion for the global pharmaceutical manufacturing market in 2020. Brazil, representing 2% of the global pharmaceutical market, boasts a comprehensive public health system called Sistema &amp;Uacute;nico de Sa&amp;uacute;de (SUS), ensuring universal health coverage. However, the public and private health sectors in Brazil operate independently, with 23% of Brazilians possessing private health insurance plans. Regulated by the Brazilian Drug Market Regulation Chamber (CMED), which controls drug prices based on international retail prices and other factors, the pharmaceutical market in Brazil faces significant challenges in maintaining the sustainability of the Brazilian health-care system, particularly due to the high costs of cancer medications, such as pembrolizumab and trastuzumab deruxtecan. This study aims to assess the budgetary impact of expanding indications for pembrolizumab and trastuzumab deruxtecan in Brazil after their initial registration by the Brazilian Health Regulatory Agency. Utilizing epidemiological data from the National Cancer Institute (INCA) and clinical trial data, we estimated the eligible patient populations and associated costs for these medications. Trastuzumab deruxtecan&amp;rsquo;s eligible patient population increased from 383 to 23,000 across various indications, resulting in a total cost increase from USD 90.6 million to USD 5.0 billion. Similarly, pembrolizumab&amp;rsquo;s eligible patient population expanded from 1796 to 99,544 for multiple indications, causing the total cost increase from USD 121.1 million to USD 6.7 billion. The study highlights the substantial expansions in indications and patient eligibility for trastuzumab deruxtecan and pembrolizumab in Brazil, with significant budgetary implications potentially jeopardizing the health-care system&amp;rsquo;s sustainability. To ensure the long-term sustainability of health-care systems and to provide equitable access to optimal treatments, it is crucial for policymakers to monitor and adjust drug prices following their initial registration. Policymakers must be aware of these challenges and consider them in health-care policy development and decision-making processes.

Tokopedia E-Commerce Retail Business Innovation in the Transformation Retail Industrial Era 4.0

Tokopedia's strategy in the world of retail 4.0 will be explained in this paper. The transformation of the retail world occurred from the 1.0 era to the 4.0 era and each has its characteristics. Tokopedia was born when it was in the retail 3.0 era and began to grow in the 4.0 era. A business model innovation strategy is very necessary for the business to survive in the online marketplace. Many innovations have been carried out, including (1) store management facilities (2) Shopping by type category of goods sold and business processes are very easy to learn (3) For easy access to online shops, sellers receive their accounts created during initial registration (4) Collaboration with various transportation services facilitates delivery of goods to consumers (5) simple payments and safe. The method used is to collect some literature to further identify whether it is by the topic to be discussed and make important points related to Tokopedia's strategy in the 4.0 era.

Three-Dimensional Measurement of Full Profile of Steel Rail Cross-Section Based on Line-Structured Light

The wear condition of steel rails directly affects the safety of railway operations. Line-structured-light visual measurement technology is used for online measurement of rail wear due to its ability to achieve high-precision dynamic measurements. However, in dynamic measurements, the random deviation of the measurement plane caused by the vibration of the railcar results in changes in the actual measured rail profile relative to its cross-sectional profile, ultimately leading to measurement deviations. To address these issues, this paper proposes a method for three-dimensional measurement of steel rail cross-sectional profiles based on binocular line-structured light. Firstly, calibrated dual cameras are used to simultaneously capture the profiles of both sides of the steel rail in the same world coordinate system, forming the complete rail profile. Then, considering that the wear at the rail waist is zero in actual operation, the coordinate of the circle center on both sides of the rail waist are connected to form feature vectors. The measured steel rail profile is aligned with the corresponding feature vectors of the standard steel rail model to achieve initial registration; next, the rail profile that has completed the preliminary matching is accurately matched with the target model based on the iterative closest point (ICP) algorithm. Finally, by comparing the projected complete rail profile onto the rail cross-sectional plane with the standard 3D rail model, the amount of wear on the railhead can be obtained. The experimental results indicate that the proposed line-structured-light measurement method for the complete rail profile, when compared to the measurements obtained from the rail wear gauge, exhibits smaller mean absolute deviation (MAD) and root mean square error (RMSE) for both the vertical and lateral dimensions. The MAD values for the vertical and lateral measurements are 0.009 mm and 0.039 mm, respectively, while the RMSE values are 0.011 mm and 0.048 mm. The MAD and RMSE values for the vertical and lateral wear measurements are lower than those obtained using the standard two-dimensional rail profile measurement method. Furthermore, it effectively eliminates the impact of vibrations during the dynamic measurement process, showcasing its practical engineering application value.

Homeownership While Aging-How Health and Economic Factors Incentivize or Disincentivize Relocation: Protocol for a Mixed Methods Project.

Many factors influence housing choices among older adults, but far from all have been identified. There is little systematic analysis that has included economic factors and virtually no knowledge about the interplay among perceived costs of moving, health status, and the mobility rate of older homeowners. It is currently unclear whether economic factors influence older adults' willingness to move, and the effects of economic policies on their actual behavior in the housing market are largely unknown. The overarching objective of the AGE-HERE project is to develop knowledge of the relationship between health and economic factors that incentivize or disincentivize relocation during the process of aging. This project uses a mixed methods convergent design across 4 studies. The initial quantitative register study and subsequent qualitative focus group study will nurture the evidence base and the development of a national survey. The final study will synthesize and integrate the results of the entire project. Ethical approval for the register study (DNR 2022-04626-01) and focus group study (DNR 2023-01887-01) has been obtained. As of July 2023, data analyses (register study) and data collection (focus group study) are currently being conducted. The first paper based on the register data is expected to be submitted after the summer of 2023. Three meetings have been held with the nonacademic reference group. The qualitative data will be analyzed in the autumn. Based on the results of these studies, a survey questionnaire will be developed and distributed nationally during the spring of 2024, followed by data analyses in the autumn. Finally, the results from all studies will be synthesized in 2025. Results from AGE-HERE will add to the knowledge base for research on aging, health, and housing and can play a critical role in guiding future policy decisions aiming to balance the housing market. Such developments may lower related social costs and support older adults to maintain active, independent, and healthy lives. DERR1-10.2196/47568.