Key Actions Research Articles

EFFORTS OF THE TRANSPORT AND ENERGY SECTORS TOWARD RENEWABLE ENERGY FOR CLIMATE NEUTRALITY

The integration and utilization of renewable energy sources in the energy and transport sectors are the main actions undertaken to attain climate neutrality by 2050. The connection and indication of the relations occurring in these two sectors constitute the novelty of the current research. Key actions include increasing the share of low- and zero-emission transport, such as electric cars, bicycles, trains, and buses; reducing emissions from aviation and shipping; and improving energy efficiency and transport safety by modernizing the vehicle fleet, introducing intelligent transport systems, applying emission and fuel quality standards, and promoting technological and digital innovation. A novel and significant aspect of the research is its comprehensive approach to key economic sectors that exert a profound influence on climate change. Through the conducted studies, it has been demonstrated what essential actions must be undertaken to transition towards a low or zero-emission economy. This paper points to a strong nexus between the transport sector, the energy sector, and climate change, underscoring the imperative for collaborative efforts and strategic initiatives among these sectors to address the pressing challenges associated with achieving climate neutrality.

The ‘Wellbeing Wardrobe’ as a tool to promote just transitions in the fashion and textile industry

ABSTRACT In this paper we discuss the pressing need for a just transition in one of our most environmentally and socially problematic contemporary industries: the fashion and textiles industry. We detail the current injustices in the industry, from both environmental and socio-economic standpoints, and then move on to providing some suggestions as to how these entrenched problems with the industry could be addressed. Specifically, we identify five key action areas that could take us towards a just transition for the fashion and textiles industry: establishing limits, developing new indicators, promoting fairness, implementing just modes of governance, and creating new exchange systems. We propose policy interventions in each of these five action areas and discuss how they could practically be put into practice. In doing so, we develop a novel theoretical concept for a more just version of the global fashion industry: the ‘Wellbeing Wardrobe’, which draws on wellbeing economics and de-growth thinking applied to the contemporary fashion industry.

Population recovery of a migratory anadromous fish in a small forest stream following restoration of longitudinal connectivity

Restoration of movement corridors is a key management action used to address threats to migratory and other mobile species. Yet, we lack restoration effectiveness studies that allow for species to reestablish naturally (i.e. without supplementation) following habitat reconnection that capture all phases (dispersal, growth, and regulation) of recovery, and that takes an ecosystems approach. We investigated the natural recovery of migratory anadromous Coho salmon following habitat reconnection across a 5‐km section of Rock Creek, a forested tributary of the Cedar River, Washington, United States, 3 km upstream of Landsburg Dam. The dam blocked upstream fish movement for 102 years until the completion of a fish ladder in 2003. We also evaluated the response of non‐migratory trout, which are closely related to Coho salmon. Juvenile Coho salmon natal to the Cedar River dispersed into Rock Creek for rearing until spawning there in 2007. After restoration, juvenile Coho salmon density (fish/m2) increased 18‐fold, approaching an asymptote (i.e. regulation phase) a decade later. Coho salmon recovery in Rock Creek was spatially variable, however, slowing with distance from the site of restoration. Trout density was also higher after restoration relative to before, likely due to several mechanisms, including increased capacity resulting from the reestablishment of marine organic matter subsidies delivered by spawning anadromous fish. Our study demonstrates that migratory species can recover naturally after the restoration of habitat connectivity and associated movement corridors. Furthermore, our results suggest that such actions can also benefit nontarget species by reestablishing key ecosystem links driven by the target species.

The Role of Medical Societies and the Relevance of Clinical Perspective in the Evolving EU HTA Process: Insights Generated at the 2023 Fall Convention and Survey of the European Access Academy.

This work aimed to determine the role and action points for the involvement of medical societies in the European Health Technology Assessment (EU HTA) Methods: An online pre-convention survey was developed addressing four areas related to the EU HTA: (i) medical societies' role; (ii) role of clinical guidelines; (iii) interface with the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS); and (iv) approaching 'best-available evidence' (BAE). A descriptive analysis of questionnaire outcomes was conducted to inform the European Access Academy (EAA) Fall Convention 2023. Within the working groups (WGs), action points were identified and prioritised. A total of 57 experts from 15 countries responded to the survey. The WGs were attended by (i) 11, (ii) 10, (iii) 12, and (iv) 12 experts, respectively, representing a variety of national backgrounds and stakeholder profiles. The most relevant action points identified were as follows: (i) incorporation of clinical context into population, intervention, comparator, outcomes (PICO) schemes, (ii) timely provision of up-to-date therapeutic guidelines, (iii) ensuring the inclusion of MCBS insights into the EU HTA process, and (iv) considering randomized controlled trials (RCTs) as the gold standard and leveraging regulatory insights if development programs only include single-arm trials. The involvement of medical societies is a critical success factor for the EU HTA. The identified key action points foster the involvement of patient associations and medical societies.

Key Actions to Enable Automation for Mobile Network Security Operations

Over time, the landscape of Cyberspace surrounding Internet Service Providers (ISPs) has undergone enduring transformations. Notably, mobile networks, integral to contemporary societal infrastructure, consistently encounter evolving cybersecurity threats and risks. ISP processes have adapted with a persistent focus on optimizing network performance and availability, yet the challenges emerge from a laborious and protracted network change management process, hindering the practical automation of network security. Addressing the rightful demand for the highest level of security from mobile network users, our research question probes: "How can we intensify the emphasis on network security and facilitate the automation of network security operations?" To delve into this, we conducted extensive interviews with ISPs globally, affirming the inherent difficulty in automating security operations. The findings categorize challenges into three domains: Security Culture, Operational Processes, and Tools. Cultivating a security culture demands a pivotal commitment to change from top management, coupled with dedicated time and resources. Essential to this is the enhancement of security competence, extending beyond specialists to encompass network engineering staff. Robust network security not only safeguards against threats but significantly influences various business processes. Initiating a secure network requires ISPs to articulate explicit security requirements during the network procurement process, exerting pressure on vendors to fortify systems with a security-by-design approach at the factory. Critical to this is the secure deployment of networks, integrating comprehensive network hardening during the build phase. However, findings indicate a prevalent oversight where network security configuration changes are often neglected or deprioritized in favor of network performance. Achieving a harmonious balance between security and performance necessitates a predefined agreement on a network security configuration baseline. This collaborative effort involves network security specialists and competent network engineers. To effectively monitor and enforce network security configuration, ISPs require automation-enabled tools with the predefined baseline, offering capabilities for monitoring and enforcing network assets. In conclusion, our research emphasizes the imperative need for a paradigm shift in organizational culture, operational processes, and tool utilization to enhance the focus on network security and enable the critical automation of network security operations within the ever-evolving landscape of Cyberspace.

Collaborative governance arrangements: what makes nature-based solutions endure?

ABSTRACT ‘Nature-based Solutions’ (NbSs) are considered key actions to address urban regeneration and foster greener cities. Such actions are based on collaborative governance arrangements, where public administration, private companies, research and citizens cooperate to test and manage innovative solutions. Reflecting a quadruple helix logic, these arrangements display different actors leading responsibility for maintenance while cultivating collaborative relations. Hence, collaborative governance arrangements can assume the shape of public-led, private-led, research-led or community-led types, addressing specific maintenance challenges. Yet, the conditions that allow different types of collaborative governance arrangements to make NbSs endure are still poorly investigated. Through an in-depth analysis of the proGIreg Urban Living Laboratory in Turin (Italy), this paper analyses different types of collaborative governance arrangements, exploring which challenges, risks and potentials characterise them. Particularly, the paper investigates conditions that make NbSs endure over time. The results outline how legitimacy, institutional leadership and administrative commitment, networking capacities, integration of resources, competencies, co-responsibility, knowledge transfer and empowerment play a pivotal role in making NbSs endure. Overall, this article contributes to contemporary research and practices on urban experimentation, NbSs and maintenance.

The Impact of the Sharing Economy on Traditional Hospitality Models

Purpose: The general objective of the study was to examine the impact of the sharing economy on traditional hospitality models. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the sharing economy on traditional hospitality models. Preliminary empirical review revealed that the sharing economy, exemplified by platforms like Airbnb, significantly disrupted traditional hospitality models, particularly affecting mid-tier and budget hotels with declines in revenue and occupancy. Luxury hotels, however, maintained resilience through brand reputation and superior services. It highlighted the importance of adaptive regulatory frameworks to ensure fair competition and consumer protection. The study recommended that traditional hotels innovate by embracing digital transformation and enhancing personalized experiences. These insights were deemed crucial for industry stakeholders to navigate the evolving hospitality landscape influenced by the sharing economy. Unique Contribution to Theory, Practice and Policy: The Disruptive Innovation Theory, Resource-Based View (RBV) Theory and Institutional Theory may be used to anchor future studies on sharing economy on traditional hospitality models. The study recommended several key actions for theory, practice, and policy to address the impact of the sharing economy on traditional hospitality models. Theoretically, it suggested expanding Disruptive Innovation and Institutional Theories to better understand market dynamics and regulatory influences. Practically, it advised traditional hotels to leverage their unique strengths, embrace digital transformation, form strategic partnerships, and innovate their service offerings to remain competitive. For policymakers, the study emphasized the need for adaptive regulatory frameworks to ensure fair competition and consumer protection. It also highlighted the importance of consumer education on the benefits and risks of different accommodation options. Future research directions included long-term impact studies, regional comparisons, and investigations into socio-cultural effects. Keywords: Sharing Economy, Traditional Hospitality Models, Disruptive Innovation Theory, Institutional Theory, Airbnb, Hotel Industry

Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan.

This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan. This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023). Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place. This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.

Emergent Management of Spontaneous Subarachnoid Hemorrhage.

Spontaneous subarachnoid hemorrhage (SAH) carries high morbidity and mortality rates, and the emergent management of this disease can make a large impact on patient outcome. The purpose of this article is to provide a pragmatic overview of the emergent management of SAH. Recent trials have influenced practice around the use of antifibrinolytics, the timing of aneurysm securement, the recognition of cerebral edema and focus on avoiding a lower limit of perfusion, and the detection and prevention of delayed cerebral ischemia. Much of the acute management of SAH can be protocolized, as demonstrated by two updated guidelines published by the American Heart Association/American Stroke Association and the Neurocritical Care Society in 2023. However, the gaps in evidence lead to clinical equipoise in some aspects of critical care management. In acute management, there is an urgency to differentiate the etiology of SAH and take key emergent actions including blood pressure management and coagulopathy reversal. The critical care management of SAH is similar to that of other acute brain injuries, with the addition of detecting and treating delayed cerebral ischemia. Strategies for the detection and treatment of delayed cerebral ischemia are limited by disordered consciousness and may be augmented by monitoring and imaging technology.

Обострение отношений Польши и ЕС: возможные варианты развития и решения дезинтеграционных процессов

The aim of this study is to analyze the aggravation of relations between Poland and the European Union from 2016 to 2023 and to identify potential development scenarios. The study identifies several forms of disintegration processes within Poland-EU relations, including challenges to the primacy of EU law, erosion of democratic norms, and disputes over national sovereignty. Key actions by both parties aimed at mitigating these processes include dialogue, negotiation, and institutional reform. However, the underlying issue of conflicting national values poses a significant obstacle to resolution. The tensions between Poland and the EU are rooted in divergent interpretations of democracy, the rule of law, and national sovereignty. The EU’s insistence on adherence to its legal and democratic standards clashes with Poland’s perceived defense of traditional national values. Resolving these tensions requires a delicate balance between respecting national sovereignty and upholding EU principles. The effective implementation of these reforms should be deemed satisfactory by the European Commission. Only after aligning Poland’s judicial system with EU standards will the country receive the majority of subsidies, grants, and funds from the European Union, which can then be directed towards supporting national agricultural producers. In conclusion, the aggravation of relations between Poland and the EU underscores the challenges facing European integration. Addressing disintegration processes within the union requires a concerted effort by both parties to reconcile conflicting interests and values. Poland’s commitment to aligning its judicial system with EU standards is essential for restoring trust and cooperation within the union.

#325 Prescribing patterns in older people with advanced chronic kidney disease approaching the end of life

Abstract Background and Aims Advancing age and chronic kidney disease (CKD) are risk factors for polypharmacy—the regular daily intake of >5 medications. Polypharmacy is a key action area for the World Health Organization in its effort to reduce global medication-related harm. Deprescribing, the systematic review and rationalisation of potentially inappropriate medications, is a proposed way of addressing polypharmacy. Deprescribing is particularly relevant near the end of life, when preventative treatments provide less benefit. Prescribing practices for elderly people with advanced CKD in the last years of life are currently unknown. The aim of this study was to describe prescribing and deprescribing patterns in such a cohort. Method The EQUAL study [1] is an international, prospective cohort study of people ≥65 years with an incident estimated glomerular filtration rate (eGFR) of ≤20 ml/min/1.73 m2. We analysed data from participants who died during follow up, including 3-6 monthly study-visit-collected prescribed oral medications (POMs). Generalized additive models were used to explore trends leading up to death in the total number of POMs, and the proportion of participants taking specific medications. Data are presented for medications: a) identified as targets for deprescribing in the elderly with CKD (statins, proton-pump inhibitors (PPIs) and antihypertensives—alpha-blockers, beta-blockers, calcium-channel blockers (CCBs), diuretics and renin-angiotensin-aldosterone inhibitors (RAASis)); b) used for symptom control in kidney failure (opioids and gabapentinoids); and c) prescribed to >30% of the cohort (allopurinol, aspirin, vitamin D). Results Data from 563 participants were analysed, comprising 2793 study visits (median follow-up time 2.2 years (interquartile range (IQR) 1.1-3.8) pre-death), and 22,200 POMs. At baseline, mean age was 77.8 years (standard deviation (SD) 6.7), median eGFR 18.1 mls/min/1.73 m2 (IQR 15.0-21.2), and 87.2% were experiencing polypharmacy. The number of POMs increased over the time approaching death (Fig. 1)—7.3 (95% confidence interval (CI) 6.9-7.7) at 5 years pre-death, 8.3 (95% CI 8.0-8.6) at 2.5 years pre-death, and 8.7 (95% CI 8.4-9.1) at death. At their final study visit 90.1% were experiencing polypharmacy. Trends in the proportion of individuals prescribed specific medications differed by POM class (Fig. 2). Opioids, diuretics and PPIs increased in the last years of life; statins, RAASis, alpha-blockers and CCBs decreased; and allopurinol, beta-blockers and gabapentinoids remained stable. Aspirin and vitamin D showed phasic patterns, increasing then decreasing. Conclusion Elderly people with advanced CKD experience increasing levels of polypharmacy as they approach the end of life. Although there is evidence that certain medication classes are being deprescribed, this is outweighed by increased prescribing of other agents. Previous analyses of EQUAL decedents have shown that blood pressure decreases pre-death—we show this is despite reductions in most classes of antihypertensives. Our work suggests a high reliance upon pharmacological interventions (both symptom-directed and preventative) for older people with CKD who are approaching death. We cannot ascertain whether this reflects personalised prescribing, aligned with individuals’ preferences and prognoses; however, high levels of polypharmacy potentiate risks of side effects, medication burden and drug-drug interactions, and indicate a role for enhanced medication review in this setting.

The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies.

Background: Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative complications and promote earlier recovery. Although it is well established in noncardiac surgery fields, the ERAS approach has only recently been adopted in cardiac surgery. The aim of this review is to evaluate the status and implementation of ERAS protocols in patients undergoing heart valve surgery and to summarise associated clinical results. Methods: A literature search for the period January 2015 and January 2024 was performed through online databases. Clinical studies (randomised controlled trials and cohort studies) on patients undergoing heart valve surgical procedures and comparing ERAS and conventional approaches were included. The data extracted covered studies and populations characteristics, early outcomes and the features of each ERAS protocol. Results: There were 14 studies that fulfilled the final search criteria and were ultimately included in the review. Overall, 5142 patients were identified in the 14 studies, with 2501 in ERAS groups and 2641 patients who were representative of control groups. Seven experiences exclusively included patients who underwent heart valve surgery. Twelve out of fourteen protocols involved multiple interventions from the preoperative to postoperative phase, while two studies reported actions limited to intraoperative and postoperative care. We found high heterogeneity among the included protocols regarding key actions targeted for improvement and measured outcomes. All the studies showed that ERAS pathways can be safely adopted in cardiac surgery and in most of the experiences were associated with shorter mechanical ventilation time, reduced postoperative opioid use and reduced ICU and hospital stays. Conclusions: As demonstrated in noncardiac surgery, the adoption of structured ERAS protocols has the potential to improve results in patients undergoing heart valve surgery. Further evidence based on larger populations is needed, including more homogenous pathways and reporting further outcomes in terms of patient satisfaction, recovery and quality of life after surgery.

Triple Helix for Sustainable Development Goals: An Impact Assessment of Shared Service Facility for Micro, Small, and Medium Enterprises Competitiveness in the Philippines

This study investigates the impact and operational challenges of the Shared Service Facility (SSF) for Micro, Small, and Medium Enterprises (MSMEs) in the Philippines, focusing on enhancing MSME competitiveness and sustainability. Through a mixed-methods approach, including surveys, interviews, and data analysis, the study assesses the SSF’s effectiveness in supporting MSMEs and identifies key challenges hindering its operation. The findings reveal significant improvements in MSMEs’ access to resources, innovation capacity, and market competitiveness following SSF assistance. However, logistical, managerial, and resource-related challenges pose significant hurdles to the SSF’s operational efficiency and effectiveness. To address these challenges, a comprehensive Strategic Plan is formulated, outlining key actions to improve logistical efficiency, enhance managerial effectiveness, strengthen financial sustainability, upgrade technological infrastructure, and foster collaboration and partnerships. Implementation of these strategic initiatives is crucial for optimizing the SSF’s operation, enhancing its impact on MSME competitiveness, and ensuring long-term sustainability. Overall, this study contributes valuable insights into the role of the SSF in fostering MSME development and economic growth in the Philippines, highlighting the importance of targeted interventions and collaborative efforts to support inclusive and sustainable development.

Good Practices and Initiatives for the Control and Elimination of Hepatitis B in the World: A Scoping Review.

Hepatitis B virus (HBV) infection remains a significant global public health challenge, leading to considerable morbidity and mortality. Implementationof effective strategies and novel initiatives is necessary to control and eliminate HBV. To identify the key approaches and actions used worldwide for HBV control and elimination, we conducted a comprehensive scoping review. We searched various sources, including PubMed, Scopus, Web of Science, Google Scholar, the official websites of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), and relevant articles and reports published in the past decade. Our inclusion criteria focused on studies that reported on strategies for HBV control and elimination, provided evidence of their effectiveness, and assessed their impact on public health outcomes. We included 16 articles in our review, which highlighted a range of strategies, such as universal HBV vaccination, prevention of mother-to-child transmission, mass screening programs, and treatment of chronically infected individuals. These strategies have shown promising results in reducing HBV transmission rate, improving health outcomes, and making progress towardHBV elimination. Moreover, several challenges, including limited access to care, low awareness, stigma, and funding constraints, hinder the effectiveness of elimination programs. The findings underscore the importance of sustained efforts and investment in comprehensive strategies for HBV control and elimination. It is crucial to address barriers to care and enhance public awareness to achieve the goal of eliminating HBV as a public health threat by 2030.

A roadmap to reduce the risk of overexploiting EU marine living resources in a changing ocean

We provide a balanced overview of how risk assessment and management is being tackled in the European Union (EU) and beyond to address the challenges of overexploiting marine living resources in EU waters. We aim to guide EU fisheries and aquaculture policymakers towards key actions to foster the transition to responsible, sustainable, clean energy, and resilient fisheries and aquaculture sectors, aligning with EU environmental objectives under the European Green Deal and the Common Fisheries Policy. Despite progress in reducing fishing pressure on some stocks in recent years, most of the stated (single-stock) sustainability objectives still need to be met. The risk of overexploiting marine resources remains high, especially when combined with other pressures such as pollution and climate change. Risk is defined as the probability of an adverse event arising from natural or human activities and excessive pressures. Scientists have documented these pressures, proposing regional risk assessments to support adequate risk-based management of human activities impacting marine and coastal regions. As a next step, we recall actionable short- to long-term recommendations to reduce the risks associated with exploiting these natural resources and ensure their sustainability and resilience. This includes actions the EU can take to improve and implement fisheries policy while prioritising less harmful alternatives among current fishing methods and considering the three pillars of sustainability i.e. environmental, economic and social. Such actions include capturing in scientific advice the strong, causal links between pressures induced by human activities, natural disturbances and ecosystem states; such understanding can be used in an uncertain and changing environment, with ocean productivity possibly trending towards new levels. Finally, we restate that conserving by reducing pressures and restoring the integrity of marine ecosystems is crucial for minimising the risk of overexploitation and ensuring future fishing and farming opportunities. This is the aim of an Ecosystem Approach to fisheries and aquaculture – it should safeguard the long-term economic and social capital already invested by the public and private sectors in exploiting marine living resources to continue delivering healthy, low-carbon, low-impact seafood to EU citizens and beyond.

Systematic review and research gaps on wildfire evacuations: infrastructure, transportation modes, networks, and planning

ABSTRACT Wildfires pose significant threats to communities, requiring robust pre-event planning for efficient evacuations. Transportation systems are crucial for these efforts, yet global research gaps persist, especially those related to transportation assets and transportation modes beyond privately owned automobiles. This study conducts a systematic review of four under-researched areas – infrastructure, modality, networks, and planning – to build a more comprehensive understanding of wildfire evacuations. Initial research is emerging in these domains, related to post-fire debris flows, air and transit evacuations, network analysis, and shelter planning. However, systematic analyses, evidence, and recommendations remain lacking. This includes wildfire's direct impact on transportation infrastructure, multi-modal evacuations, routing strategies, and community-driven evacuation plans. We underscore the need for empirical evacuation strategies to foster resilience for wildfire-threatened communities, offering valuable context-specific insights, identifying key actions, and highlighting ongoing research gaps.

Strategic Approaches to Reducing the Burden of Atopic Dermatitis in the Middle East and Africa Region

ObjectivesAtopic dermatitis (AD) creates a significant burden on patients and society. This study proposes a set of health policy interventions that can reduce the burden of AD in the Middle East and Africa. MethodsWe conducted a scoping review to find relevant actions that have been implemented or recommended to decrease AD burden globally. An expert panel was conducted to discuss the review findings, then experts were surveyed to suggest the most efficient actions. Finally, survey results and recommendations were formulated into key actions to reduce the burden in the Middle East and Africa region. ResultsRecommended actions were related to 5 domains; capacity building, guidelines, research, public awareness, and patient support and education. Several actions related to each domain can help reduce the burden. One of the most advocated recommendations was investing in patient education through trained healthcare professionals. Understanding the disease and learning how to control it is a key cornerstone to treatment optimization and reducing the burden. Multidisciplinary care, publishing defined therapeutic guidelines, and investing in research were the most recommended actions based on the experts’ discussion and survey results. ConclusionsAlthough the burden of AD is the highest among dermatological diseases, a well-grounded action plan has the potential to reduce the disease burden. Decision makers may develop a national AD action plan by selecting the most relevant items of this study based on their potential impact, feasibility, timeliness, and affordability.

First detailed calculation of atmospheric neutrino foregrounds to the diffuse supernova neutrino background in Super-Kamiokande

The diffuse supernova neutrino background (DSNB)—a probe of the core-collapse mechanism and the cosmic star-formation history—has not been detected, but its discovery may be imminent. A significant obstacle for DSNB detection in Super-Kamiokande (Super-K) is detector backgrounds, especially due to atmospheric neutrinos (more precisely, these are foregrounds), which are not sufficiently understood. We perform the first detailed theoretical calculations of these foregrounds in the range 16–90 MeV in detected electron energy, taking into account several physical and detector effects, quantifying uncertainties, and comparing our predictions to the 15.9 live time years of pre-gadolinium data from Super-K stages I–IV. We show that our modeling reasonably reproduces this low-energy data as well as the usual high-energy atmospheric-neutrino data. To accelerate progress on detecting the DSNB, we outline key actions to be taken in future theoretical and experimental work. In a forthcoming paper, we use our modeling to detail how low-energy atmospheric-neutrino events register in Super-K and suggest new cuts to reduce their impact. Published by the American Physical Society 2024

The experiences of patients not conveyed after evaluation by emergency medical services in Southwest Finland – A qualitative survey study

BackgroundThe amount of non-critical Emergency Medical Services missions has been increasing. After examination and treatment, paramedics can decide, based on guidelines, not to convey the patient to a healthcare facility. This study aimed to investigate patients’ experiences in non-conveyance situations in Southwest Finland. Our research questions were: 1) Which patient concerns were not addressed? 2) What key actions improved patient comfort? and 3) What possible enhancements could make the patient experience more positive? MethodsThis was a qualitative survey study. In March 2023, all the patients who met the inclusion criteria (N = 1017) received a survey via mail. The data from three open-ended questions were analyzed using inductive content analysis. ResultsThe response rate was 22.2 % (n = 226). The unaddressed patient concerns were related to inadequate immediate care and guidance and non-clinical factors causing concern. Key actions for improved patient comfort were related to immediate treatment and guidance, as well as non-clinical factors that impact the patient experience. More thorough treatment processes and more attentive encounters would have enhanced the patient experience. ConclusionsPredominantly, patients reported having received excellent services. Utilizing paramedics’ soft skills and keeping the patient as the central focus is key to improving the non-conveyance process and experience.

Tracking the Cognitive Band in an Open-Ended Task.

Open-ended tasks can be decomposed into the three levels of Newell's Cognitive Band: the Unit-Task level, the Operation level, and the Deliberate-Act level. We analyzed the video game Co-op Space Fortress at these levels, reporting both the match of a cognitive model to subject behavior and the use of electroencephalogram (EEG) to track subject cognition. The Unit Task level in this game involves coordinating with a partner to kill a fortress. At this highest level of the Cognitive Band, there is a good match between subject behavior and the model. The EEG signals were also strong enough to track when Unit Tasks succeeded or failed. The intermediate Operation level in this task involves legs of flight to achieve a kill. The EEG signals associated with these operations are much weaker than the signals associated with the Unit Tasks. Still, it was possible to reconstruct subject play with much better than chance success. There were significant differences in the leg behavior of subjects and models. Model behavior did not provide a good basis for interpreting a subject's behavior at this level. At the lowest Deliberate-Act level, we observed overlapping key actions, which the model did not display. Such overlapping key actions also frustrated efforts to identify EEG signals of motor actions. We conclude that the Unit-task level is the appropriate level both for understanding open-ended tasks and for using EEG to track the performance of open-ended tasks.