International Collaborative Effort Research Articles

Abstract PO3-23-07: Evaluation of the role of axillary ultrasound to estimate axillary nodal burden to guide de-escalation of upfront axillary surgery in node positive early breast cancer patients

Abstract Background: Axillary surgery is now routinely de-escalated in clinically node negative breast cancer patients with limited axillary nodal burden (up to 2 involved sentinel nodes) based on the results of ACOSOG-Z0011 and AMAROS trials. However, patients with proven axillary metastasis following on ultrasound (AUS) guided core needle biopsy (CNB), undergoing primary surgery are still subjected to an axillary lymph node dissection (ALND) irrespective of the magnitude of the axillary nodal burden. If we could predict axillary nodal burden with a low false negative rate (FNR) for the presence of extensive axillary nodal involvement, we can then hypothesize that axillary surgery could be safely de-escalated in this cohort of patients. We investigated whether pre-operative AUS suggesting limited axillary burden is sensitive enough to rule out gross axillary disease burden. Methods: A single institution retrospective study. We undertook an electronic chart review of all T1 to T3 patients undergoing upfront ALND with either mastectomy or breast conserving surgery between January 2019 and June 2023. Patients with palpable axillary nodes, locally advanced breast cancer or a completion ALND after positive sentinel lymph node biopsy (SLNB) were excluded from the study. Clinical and pathological characteristics associated with nodal burden of disease were evaluated. Limited axillary burden was defined as < 2 involved nodes with ≥3 taken as gross nodal burden for primary analyses. Sensitivity analyses were carried out with limited axillary burden defined as < 3 involved nodes (N1) and ≥4 (N2) taken as gross nodal burden. Subgroup analyses in T1 or T2 tumors were carried out as well. The probabilities of discordant events, defined as limited burden on AUS-CNB but gross burden on final histopathology evaluation (HPE), assuming 10% FNR, were estimated using inverse cumulative binomial distribution function. Results: Data on the exact number of suspicious nodes on AUS were missing for 2 patients, therefore, the final study cohort included 39 patients. The correlation between AUS nodal burden and that on HPE was moderate (Spearman’s rho = 0.48; p = 0.0018). The sensitivity and specificity of AUS in identifying gross nodal burden were 61% and 81% respectively. Observation of 9 discordant events in 22 patients with low burden on AUS ruled out an FNR of < 10% with 99.99% certainty. The sensitivity and specificity in T1/T2 subgroup were 60% and 75% respectively. The sensitivity analyses classifying N1 as limited and N2 as gross axillary burden showed the sensitivity and specificity of 35% and 82% respectively and an FNR of < 10% was ruled out with 99.996% certainty. Conclusion: Pre-operative AUS alone lacks the sensitivity and specificity to accurately predict the true axillary nodal burden to safely guide de-escalation of axillary surgery. AUS followed by targeted axillary dissection (TAD) in conjunction with a dual technique SLNB may provide the desired sensitivity and specificity to guide de-escalation of axillary surgery. A prospective evaluation of this approach is merited. Given the limited number of patients that could be enrolled in such prospective study from individual institutions, an international collaborative effort is needed to address this important research question. Citation Format: Nidhi Garg, Mangesh Thorat, Hisham Hamed, Ashutosh Kothari. Evaluation of the role of axillary ultrasound to estimate axillary nodal burden to guide de-escalation of upfront axillary surgery in node positive early breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-23-07.

Molecular Heterogeneity in Leiomyosarcoma and Implications for Personalised Medicine.

Leiomyosarcoma (LMS) is one of the more common subtypes of soft tissue sarcomas (STS), accounting for about 20% of cases. Differences in anatomical location, risk of recurrence and histomorphological variants contribute to the substantial clinical heterogeneity in survival outcomes and therapy responses observed in patients. There is therefore a need to move away from the current one-size-fits-all treatment approach towards a personalised strategy tailored for individual patients. Over the past decade, tissue profiling studies have revealed key genomic features and an additional layer of molecular heterogeneity among patients, with potential utility for optimal risk stratification and biomarker-matched therapies. Furthermore, recent studies investigating intratumour heterogeneity and tumour evolution patterns in LMS suggest some key features that may need to be taken into consideration when designing treatment strategies and clinical trials. Moving forward, national and international collaborative efforts to aggregate expertise, data, resources and tools are needed to achieve a step change in improving patient survival outcomes in this disease of unmet need.

Changes in the terminology and diagnostic criteria of non-alcoholic fatty liver disease: Implications and opportunities.

Fatty liver disease (FLD) is a highly prevalent pathological liver disorder. It has many and varied etiologies and has heterogeneous clinical course and outcome. Its proper nomenclature and classification have been problematic since its initial recognition. Traditionally, it was divided into two main categories: Alcohol-associated liver disease and nonalcoholic FLD (NAFLD). Among these, the latter condition has been plagued with nomenclature and classification issues. The two main objections to its use have been the use of negative (non-alcoholic) and stigmatizing (fatty) terms in its nomenclature. Numerous attempts were made to address these issues but none achieved universal acceptance. Just recently, NAFLD has received a new nomenclature from an international collaborative effort based on a rigorous scientific methodology. FLD has been renamed steatotic liver disease (SLD), and NAFLD as metabolic dysfunction-associated SLD. Metabolic dysfunction-associated steatohepatitis was chosen as the replacement terminology for non-alcoholic steatohepatitis. This is a significant positive change in the nomenclature and categorization of FLD and will likely have a major impact on research, diagnosis, treatment, and prognosis of the disease in the future.

RECENT ADVANCES IN THE FIELD OF BRIDGE LOAD TESTING

Load testing of bridges is commonly used to verify the performance of a bridge prior to opening as well as for the assessment of existing bridges. This paper reports on recent advances in the field of bridge load testing, based on experimental work carried out in Europe as well as international collaboration efforts. The experimental, numerical and analytical work that has been carried out in these past years is summarized. The main findings are: 1) modern instrumentation techniques (such as acoustic emission measurements and digital image correlation) can be combined with traditional measurements to gain more in-depth insights during and after the test; 2) for load testing to be fully compliant with current codes, a probabilistic substantiation of the methodology is needed; and 3) international collaboration is key in order to successfully update current codes and guidelines and develop recommendations and sets of best practices. The recent advances in North America and Europe have also resulted in improvements to the practice of bridge load testing in Latin America (in particular in Costa Rica and Colombia). To conclude, load testing is an important tool for engineers faced with the task of assessing existing bridges. The aforementioned efforts will result in improved recommendations for the assessment of concrete bridges by load testing to be included in codes and guidelines in Ecuador and other countries in Latin America.

COVID Impacts Cause Critical Gaps in the Indian Ocean Observing System

Abstract Observing and understanding the state of the Indian Ocean and its influence on climate and maritime resources is of critical importance to the populous nations that rim its border. Acute gaps have occurred in the Indian Ocean Observing System, which underpins monitoring and forecasting of regional climate, since the start of the COVID pandemic. The pandemic disrupted the deployment and maintenance cruises for the observational array and also resulted in supply chain issues for procurement and refurbishment of equipment. In particular, the observational platforms that provide key measurements of upper ocean heat variability have experienced serious multiyear declines. There is now record-low data reporting and the platforms that are successfully reporting are old and quickly surpassing their expected period of reliable operation. The overall impact on the observing system will take a few years to fully comprehend. In the meantime, there is a critical need to document the gaps that have appeared over the past few years and how this will impact our ability to improve understanding and model representations of the real world that support regional weather and climate forecasts. The article outlines the expected slow road to recovery for the Indian Ocean Observing System, documents case studies of successful international collaborative efforts that will revive the observing system and provides guidelines for resilience from unexpected external factors in the future.

Athena – The NSF AI Institute for Edge Computing

AbstractThe National Science Foundation (NSF) Artificial Intelligence (AI) Institute for Edge Computing Leveraging Next Generation Networks (Athena) seeks to foment a transformation in modern edge computing by advancing AI foundations, computing paradigms, networked computing systems, and edge services and applications from a completely new computing perspective. Led by Duke University, Athena leverages revolutionary developments in computer systems, machine learning, networked computing systems, cyber‐physical systems, and sensing. Members of Athena form a multidisciplinary team from eight universities. Athena organizes its research activities under four interrelated thrusts supporting edge computing: Foundational AI, Computer Systems, Networked Computing Systems, and Services and Applications, which constitute an ambitious and comprehensive research agenda. The research tasks of Athena will focus on developing AI‐driven next‐generation technologies for edge computing and new algorithmic and practical foundations of AI and evaluating the research outcomes through a combination of analytical, experimental, and empirical instruments, especially with target use‐inspired research. The researchers of Athena demonstrate a cohesive effort by synergistically integrating the research outcomes from the four thrusts into three pillars: Edge Computing AI Systems, Collaborative Extended Reality (XR), and Situational Awareness and Autonomy. Athena is committed to a robust and comprehensive suite of educational and workforce development endeavors alongside its domestic and international collaboration and knowledge transfer efforts with external stakeholders that include both industry and community partnerships.

Meningeal Solitary Fibrous Tumor: A Single-Center Retrospective Cohort Study.

Meningeal solitary fibrous tumors (SFTs) are rare, malignant, mesenchymal tumors of the central nervous system. While surgical gross total resection is widely accepted as a positive prognostic factor for local control (LC), the role of postoperative radiotherapy (PORT) remains controversial. We sought to report our institutional experience with a particular focus on outcomes after PORT. In this single-center, retrospective cohort study, 20 patients with the primary diagnosis of histopathologically confirmed meningeal SFT were analyzed. Data on patient characteristics, imaging, treatment modalities, histopathology, and oncological outcomes were collected. LC and overall survival (OS) were assessed using the Kaplan-Meier estimator. The median follow-up time was 95.8 months. After surgery only, 9 out of 11 patients (81.8%) developed a local recurrence while, after surgery and PORT, 3 out of 9 patients (33.33%) showed local failure. The 5- and 10-year LC rates were 50.5% and 40.4% in the surgery-only group and 80% at both time points in the surgery with the PORT group. In the surgery-only group, 4 out of 11 patients (36.4%) died, and 4 out of 9 patients (44.4%) died in the surgery and PORT group. OS rates after 5 and 10 years were 88.9% and 66.7% in the surgery-only group and 88.9% and 76.2% in the surgery with PORT group. Our findings suggest that PORT may improve LC in patients with meningeal SFT. The low incidence of meningeal SFT impedes prospective studies and requires further international collaborative efforts to exploit retrospective datasets and molecular analysis to improve patient outcomes.

Legal Challenges of Digital Copyright Laws in the Circulation of Digital Content

This academic paper thoroughly explores the multifaceted domain of digital copyright laws in Latin America, unraveling the intricacies and dynamics that have unfolded over the past decade. The study delves deep into the legal landscape, highlighting the region’s adaptive response to the swift evolution of technology. It scrutinizes the subtleties of digital copyright laws in selected Latin American countries, conducting comprehensive analyses of Brazil, Mexico, and Argentina. The paper further investigates the intersection between national and international copyright standards, shedding light on the complexities and divergences that emerge. Enforcement challenges take center stage, dissecting the obstacles encountered in combatting digital piracy and the legal mechanisms employed for copyright infringement. The exploration extends to international collaboration and harmonization efforts, evaluating the effectiveness of regional and global initiatives in addressing cross-border copyright issues. The paper concludes by anticipating future trends and offering recommendations for policymakers, content creators, and technology companies. By navigating the intricate interplay between legal frameworks and technological advancements, this paper contributes to a nuanced understanding of the digital copyright landscape in Latin America.

Delineation of the adult phenotype of Coffin-Siris syndrome in 35 individuals.

Coffin-Siris syndrome (CSS) is a rare multisystemic autosomal dominant disorder. Since 2012, alterations in genes of the SWI/SNF complex were identified as the molecular basis of CSS, studying largely pediatric cohorts. Therefore, there is a lack of information on the phenotype in adulthood, particularly on the clinical outcome in adulthood and associated risks. In an international collaborative effort, data from 35 individuals ≥ 18years with a molecularly ascertained CSS diagnosis (variants in ARID1B, ARID2, SMARCA4, SMARCB1, SMARCC2, SMARCE1, SOX11, BICRA) using a comprehensive questionnaire was collected. Our results indicate that overweight and obesity are frequent in adults with CSS. Visual impairment, scoliosis, and behavioral anomalies are more prevalent than in published pediatric or mixed cohorts. Cognitive outcomes range from profound intellectual disability (ID) to low normal IQ, with most individuals having moderate ID. The present study describes the first exclusively adult cohort of CSS individuals. We were able to delineate some features of CSS that develop over time and have therefore been underrepresented in previously reported largely pediatric cohorts, and provide recommendations for follow-up.

Germline genetic variants in Turkish familial multiple myeloma/monoclonal gammopathy of undetermined significance cases.

Multiple myeloma (MM) is a haematological malignancy primarily affecting the elderly, with a striking male predilection and ethnic disparities in incidence. Familial predisposition to MM has long been recognized, but the genetic underpinnings remain elusive. This study aimed to investigate germline variants in Turkish families with recurrent MM cases. A total of 37 MM-affected families, comprising 77 individuals, were included. Targeted next-generation sequencing analysis yielded no previously reported rare variants. Whole exome sequencing analysis in 11 families identified rare disease-causing variants in various genes, some previously linked to familial MM and others not previously associated. Notably, genes involved in ubiquitination, V(D)J recombination and the PI3K/AKT/mTOR pathway were among those identified. Furthermore, a specific variant in BNIP1 (rs28199) was found in 13 patients across nine families, indicating its potential significance in MM pathogenesis. While this study sheds light on genetic variations in familial MM in Turkey, its limitations include sample size and the absence of invivo investigations. In conclusion, familial MM likely involves a polygenic inheritance pattern with rare, disease-causing variants in various genes, emphasizing the need for international collaborative efforts to unravel the intricate genetic basis of MM and develop targeted therapies.

Challenges and Opportunities in Meeting the Needs of IKN Weapon Systems in the Era of Modern Weaponry Technologies

The relocation of Indonesia's capital city to East Kalimantan has implications for defense and security. This research analyzes the challenges and opportunities of fulfilling the main equipment of the National Capital Integrated Coastal Development (IKN) defense system in the era of modern weaponry technology. Through the Systematic Literature Review (SLR) method, the evolution of warfare from the first generation to the information and cyber era is analyzed in relation to IKN. The research also highlights the development of weaponry technology and its impact on the IKN transition, as well as the urgency of fulfilling modern defense equipment and integrating advanced technology. The results indicate that the relocation of IKN requires strategic adaptation to the evolution of warfare and the use of new technologies in defense. It is crucial to comprehensively fulfill the needs of defense equipment in the air, land, sea, and cyber domains to maintain the sovereignty and security of IKN. With the integration of advanced technology and wise planning, the relocation of IKN can be approached with thorough preparation and an effective defense system. In facing these complex dynamics, international collaboration efforts and adaptation of defense policies become important to respond to global challenges and generate appropriate solutions.

Somatic and Germline Cohesin Genes Alterations in Pediatric Acute Lymphoblastic Leukemia

Leukemia is a complex disease and the molecular mechanisms of malignant transformation are not fully understood yet. Cohesins are essential proteins, forming a complex which plays critical roles in various cellular processes, not only by canonical DNA binding and chromosome segregation but also in non-canonical regulation of gene expression in both proliferating and post-mitotic cells. Mutations or gene expression alterations of genes encoding the components of the cohesins' complex may affect chromosomal stability and potentially contribute to the pathogenesis of leukemia. Somatic cohesins mutations have been already reported to occur in myeloproliferative disorders and pediatric Acute Lymphoblastic Leukemia (ALL), while on the other hand, germline mutations are causative of Cohesinopathies such as Cornelia de Lange Syndrome (CdLS). Our previous first report of a patient affected by both CdLS and ALL suggested a potential involvement of cohesin germline mutations in the pathogenesis of ALL. Moreover, we demonstrated that germline mutations in STAG1 gene could play a crucial role in predisposition to pediatric hematological malignancies, including ALL. These findings suggest that both somatic and germline alterations of cohesin genes may be associated with the development of ALL. This study aims to understand the molecular mechanisms affected by Cohesin genes alterations, that could potentially pave the way for the development of targeted therapies and improved treatment strategies for leukemia patients. By employing a DNA-targeted next-generation sequencing (NGS) screening of a cohort of 120 consecutive pediatric ALL cases (enrolled in the AIEOP-BFM protocol at various Italian centers), we discovered a total of 11 germline cohesin mutations, further categorized as follows: 6 out of 11 were missense, 4 out of 11 were located in the 3' or 5' untranslated regions (UTR) and 1 out of 11 was a splice-acceptor variant. To investigate the functional implications of selected germline mutations in STAG1 gene, we took advantage of the CRISPR/Cas9 technique to generate in vitro models of two Lymphoblastoid Cell Lines (LCLs) harboring specific variants already found in two patients of our cohort. Additionally, we established control LCLs from healthy donors' samples using the same CRISPR/Cas9 approach. Subsequently, we performed RNA sequencing (RNAseq) analysis on these cell lines, and our preliminary findings revealed a total of 619 differentially expressed genes (DEGs) compared to the control group. Many of them are involved in critical intracellular pathways, like ribosomal transcription, suggesting potential disruptions of essential cellular processes caused by germline STAG1 mutations. Moreover, we have successfully developed an advanced computational analysis pipeline with the primary objective of detecting fusion transcripts from RNAseq data. This pipeline was applied to a dataset of 529 consecutive diagnose and 95 relapse samples of pediatric B/T-ALL patients and in five B-ALL cases a fusion transcript involving the STAG1 (n=1), STAG2 (n=3), and NIPBL (n=1) genes was identified. The significance of these findings was further reinforced by additional cases from both pediatric and adult cohorts through an international collaborative effort and five more fusion transcripts of STAG2 (n=2) and NIPBL (n=3) were uncovered. Investigation to clarify the underlying functional consequences of these fusion genes in pediatric ALL are ongoing. Collectively, these observations endeavor to elucidate the role of germline and somatic cohesin events in pediatric ALL. In particular, the investigation seeks to unveil the non-canonical functions of these proteins, thus paving the way for the identification and characterization of a novel and distinct subcategory of leukemia within the pediatric population.

Quantifying Abundance and Mapping Distribution of Loggerhead Turtles in the Mediterranean Sea Using Aerial Surveys: Implications for Conservation

In the Mediterranean, incidental captures in fishing gear contribute to the high mortality of loggerhead turtles (Caretta caretta). Understanding the effects of bycatch is complex and requires robust knowledge of baseline population parameters such as abundance and density, as well as an understanding of animals’ distribution in relation to commercial fishing efforts. Based on data collected during multi-species line transect aerial surveys conducted between 2009 and 2017, we present density and abundance estimates, corrected for availability bias, for a large sector of the central Mediterranean, discuss temporal and spatial patterns and provide Potential Biological Removal (PBR) values for the monitored areas. Sightings data were also used to evaluate the spatial and temporal usage areas. Strong latitudinal and longitudinal gradients in density, abundance and area usage emerged from the analysis, with turtles occurring in higher numbers in the deeper pelagic waters of the Tunisian Plateau, the Ionian Sea and the Gulf of Taranto, irrespective of the season. PBR values derived from this study are likely unsustainable. This paper investigates the implications of commercial fisheries for Mediterranean loggerhead turtles across an area rarely included in sea turtle monitoring and has the potential to be relevant towards informed management and conservation of this species and highlights the necessity of international collaborative efforts in the region.

Diagnosing and Managing Velopharyngeal Insufficiency in Patients With Cleft Palate After Primary Palatoplasty

Velopharyngeal insufficiency (VPI) after palatoplasty is caused by improper anatomy preventing velopharyngeal closure and manifests as a hypernasal resonance, audible nasal emissions, weak pressure consonants, compensatory articulation, reduced speech loudness, and nostril or facial grimacing. A multidisciplinary team using multimodal instruments (speech analysis, nasoendoscopy, videofluoroscopy, nasometry, and magnetic resonance imaging) to evaluate velopharyngeal function should manage these patients. Careful monitoring of velopharyngeal function by a speech pathologist remains paramount for early identification of VPI and the perceptual assessment should follow a standardized protocol. The greatest methodology problem in CLP studies has been the use of highly variable speech samples making comparison of published results impossible. It is hoped that ongoing international collaborative efforts to standardize procedures for collection and analysis of perceptual data will help this issue. Speech therapy is the mainstay treatment for velopharyngeal mislearning and compensatory articulation, but it cannot improve hypernasality, nasal emissions, or weak pressure consonants, and surgery is the definitive treatment for VPI. Although many surgical methods are available, there is no conclusive data to guide procedure choice. The goal of this review article is to present a review of established diagnostic and management techniques of VPI.

Characteristics, primary treatment, and survival of MDS/MPN with neutrophilia: a population-based study

AbstractMyelodysplastic and myeloproliferative neoplasms (MDS/MPN) with neutrophilia, until recently called atypical chronic myeloid leukemia (aCML), being part of the MDS/MPN is a very rare disease with poor prognosis. Although emerging data reveal its cytogenetic and molecular profile, integrated survival and treatment data remain scarce. We analyzed a cohort of 347 adult patients diagnosed with MDS/MPN with neutrophilia, registered in the Netherlands Cancer Registry between 2001 and 2019. Our demographic baseline data align with other cohorts. We observed cytogenetic aberrations exclusively in patients aged >65 years, with trisomy 8 being the most common abnormality. We identified 16 distinct molecular mutations, with some patients (16/101) harboring up to 3 different mutations; ASXL1 being the most frequent one (22%). In a multivariable Cox regression analysis, only age, hemoglobin level and allogeneic hematopoietic stem cell transplant (alloHSCT) were associated with overall survival (aged >65 years; hazard ratio [HR] 1.85; P = .001 and alloHSCT HR, 0.51; P = .039). Because no other treatment modality seemed to affect survival and might cause toxicity, we propose that all patients eligible for alloHSCT should, whenever possible, receive an allogeneic transplant. It is imperative that we strive to improve outcomes for patients who are not eligible for alloHSCT. Tackling this challenge requires international collaborative efforts to conduct prospective intervention studies.

Biomarkers in Duchenne Muscular Dystrophy: Current Status and Future Directions.

Duchenne muscular dystrophy is a severe, X-linked disease characterized by decreased muscle mass and function in children. Genetic and biochemical research over the years has led to the characterization of the cause and the pathophysiology of the disease. Moreover, the elucidation of genetic mechanisms underlining Duchenne muscular dystrophy has allowed for the design of innovative personalized therapies.The identification of specific, accurate, and sensitive biomarkers is becoming crucial for evaluating muscle disease progression and response to therapies, disease monitoring, and the acceleration of drug development and related regulatory processes.This review illustrated the up-to-date progress in the development of candidate biomarkers in DMD at the level of proteins, metabolites, micro-RNAs (miRNAs) and genetic modifiers also highlighting the complexity of translating research results to clinical practice.We highlighted the challenges encountered in translating biomarkers into the clinical context and the existing bottlenecks hampering the adoption of biomarkers as surrogate endpoints. These challenges could be overcome by national and international collaborative efforts, multicenter data sharing, definition of public biobanks and patients' registries, and creation of large cohorts of patients. Novel statistical tools/ models suitable to analyze small patient numbers are also required.Finally, collaborations with pharmaceutical companies would greatly benefit biomarker discovery and their translation in clinical trials.

Saudi Health System and Health Security Structure: A Scope Review Study Addressing the National Need for Governing the Health Security.

Health security has gained significant attention at the national and global levels, "security" is not a simple term; instead, it is "essentially contested" - that is, it induces debates about what it means and how to use it. This study aimed to define three terms frequently used in health security discussions. These terms are national health security, Global Health Security, and public health. The research method was a scoping review performed in three stages. The first stage was electronic searching based on selection criteria among multiple sources at various time points during the year 2023. These sources included online literature searches, websites of non-governmental organizations (NGOs), and other governmental health agencies. The second stage involved determining the relevance of the selected papers to the study's objectives; the selected papers had moderate to high relevance to the study's objectives. The third stage was to evaluate the methodological quality of a study; we selected peer-reviewed published papers and websitesrecognized as trustworthy sources of information.The search yielded 143 articles; five met the inclusion criteria and were subjected to the definition of health security. Despite proposed definitions, agreement has yet to be reached on the content and scope of health security. Another main finding is that health security requires more state and international collaboration efforts to reach Global Health Security. To the best of our knowledge, no known government body or organization is responsible for governing health security in Saudi Arabia. However, the current study presents a definition of health security and differentiates it from the public health approach, in addition to emphasizing the importance of governing the related health sectors within each country in order to improve health security and have a positive impact on overall Global Health Security.

Integration of Art and Humanities in Teaching/Learning in Palliative Care in Undergraduate Medicine: An International Collaborative Effort.

Integration of Art and Humanities in Teaching/Learning in Palliative Care in Undergraduate Medicine: An International Collaborative Effort.

Integration of Renewable-Energy-Based Green Hydrogen into the Energy Future

There is a growing interest in green hydrogen, with researchers, institutions, and countries focusing on its development, efficiency improvement, and cost reduction. This paper explores the concept of green hydrogen and its production process using renewable energy sources in several leading countries, including Australia, the European Union, India, Canada, China, Russia, the United States, South Korea, South Africa, Japan, and other nations in North Africa. These regions possess significant potential for “green” hydrogen production, supporting the transition from fossil fuels to clean energy and promoting environmental sustainability through the electrolysis process, a common method of production. The paper also examines the benefits of green hydrogen as a future alternative to fossil fuels, highlighting its superior environmental properties with zero net greenhouse gas emissions. Moreover, it explores the potential advantages of green hydrogen utilization across various industrial, commercial, and transportation sectors. The research suggests that green hydrogen can be the fuel of the future when applied correctly in suitable applications, with improvements in production and storage techniques, as well as enhanced efficiency across multiple domains. Optimization strategies can be employed to maximize efficiency, minimize costs, and reduce environmental impact in the design and operation of green hydrogen production systems. International cooperation and collaborative efforts are crucial for the development of this technology and the realization of its full benefits.

Combating Dark Web Terrorism: Strategies for Disruption and Prevention

Abstract: Dark web platforms have emerged as a significant concern in the context of global security, with the potential to facilitate and amplify terrorism activities. This paper presents an analysis of the evolving landscape of dark web terrorism and proposes strategies for combating this emerging threat. The study begins by examining the characteristics and functionalities of the dark web that make it attractive to terrorist organizations, including anonymity, encrypted communications, and illicit marketplaces. It further explores the methods employed by terrorists to exploit the dark web for recruitment, propaganda dissemination, and coordination of attacks. To counteract this growing menace, a comprehensive framework for combating dark web terrorism is introduced. The proposed strategies encompass various dimensions, such as technological advancements, international collaboration, legislative measures, and law enforcement efforts. Technological approaches focus on enhancing digital surveillance capabilities, developing advanced data analytics tools, and improving cybersecurity measures to disrupt terrorist networks operating in the dark web. International cooperation is emphasized to foster information sharing, intelligence coordination, and joint operations among nations to counter the cross-border nature of dark web terrorism. By implementing these multifaceted strategies, governments, law enforcement agencies, and technology providers can collectively mitigate the threats posed by dark web terrorism