Level Of Expertise Research Articles

The possibilities and advantages of conducting multicenter clinical trials on the basis of outpatient clinics in Moscow

The article presents the special role of the outpatient unit (urban polyclinics) in the system of urban medical organizations, which has significant development potential in the field of clinical research. This activity became possible due to the systematic work on equipping outpatient clinics with the most modern diagnostic equipment, the availability of specialists trained in the organization and conduct of clinical trials according to the international rules of good clinical practice. A special value lies in the fact that the polyclinic network has an extensive database that includes millions of patients and provides the opportunity to perform the highest level of medical expertise and research.

Predicting preschool moral development with school climate: Fuzzy Delphi approach

Education is vital for a person’s development, especially from an Islamic perspective, where the first goal is to foster a servant attitude, talent, personality, and outlook on life. Preschool education is crucial in nurturing a child's nature, emotions, and cognitive and social skills in the first five years. However, the significance of a good school environment, particularly in moral formation, varies among institutions. Therefore, this article aims to build consensus among experts on the role of school environment and classroom management in preschoolers’ moral development. Eleven-panel members validated the survey instrument with items and analyzed it using the Fuzzy Delphi method (FDM). According to the study, the experts agree that the physical school environment and classroom management are essential for promoting healthy moral development. Expert consensus was obtained on 19 out of 20 items in the physical school environment and classroom management dimension with an expert agreement level greater than 75% with an average (d) value less than 0.2. The undeniable consensus is that the school environment and classroom management play a crucial role in fostering the moral development of preschool children.

Laparoscopic antegrade spleen-preserving distal pancreatectomy with conservation of the splenic vessels: a prospective multi-centre case series (with video)

Introduction: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with conservation of the splenic artery and vein (Kimura’ technique) is considered a technically challenging procedure that requires a high level of expertise in laparoscopic and pancreatic surgery. Methods: A prospective descriptive study on 18 patients with laparoscopic “antegrade” spleen-preserving distal pancreatectomy with Kimura’ technique from 2018 to 2023. The perioperative indications, clinical data, intraoperative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results: The mean age was 39.4±13.3. Only 2 male patients accounted for 11.1%. The average operating time is 171±23 min. The average blood loss is 65.7±43 ml. The average tumor size is 4.1 cm. The average hospitalization is 9.4 days. The rate of pancreatic fistula is 66.7%. There is no case of transferring open surgery or blood transfusion during surgery. The results of pathological after surgery there were eight cases of solid pseudopapillary tumors, four cases of mucinous cystadenoma, six cases of neuroendocrine tumors. Conclusion: Kimura’s technique for laparoscopic spleen-preserving distal pancreatectomy is safe and feasible, which can be applied to benign tumors in the body and tail of the pancreas. However, this is a difficult technique in laparoscopic surgery that requires surgeons to have a lot of experience and equipment need to be adequate.

Trained to cut? A literature review of veterinary surgical resident training.

A surgical residency trains veterinary graduates to a higher level of expertise in surgical procedures than is possible during veterinary school and prepares a resident to pursue board certification in surgery. The education of veterinary surgical residents has changed minimally since its inception in the twentieth century, and there are insufficient studies to determine if residency programs are producing surgeons with competence in each of the necessary procedural categories. The aims of this review were to report the current theory and methods used to provide surgical education to residents, to discuss the training most likely to create a competent, board-certified surgeon and to review assessment methods used during training. Several literature searches using broad terms such as "veterinary surgery residency," "veterinary surgery resident," and "veterinary surgical training" were performed using PubMed, CAB abstracts, and Google Scholar. Literature pertinent to theory, methods, training, and assessment of veterinary surgical residents was included. The reviewed literature demonstrated the need for research-based learning curves for specific procedures. Simulation training is known to facilitate deliberate practice and should be leveraged where possible to reach competency. The creation of validated assessment methods should be pursued as it enables assessment of competency instead of inferring its development from case logs. Understanding and supporting learner cognition and providing sufficient feedback remain important issues in the field. Surgical educators are urged to continue to search for innovative and evidence-based ways to train competent surgical residents.

Качественные методы социологического исследования в рамках сенситивных тематик

The aim of this work is to describe the existing qualitative sociological research methods with a focus on maximizing their potential within the context of sensitive topics. The article explores the functions of qualitative methods, the historical background of their development and implementation in sociology. Furthermore, it delves into the concept of sensitive topics and their specifics, providing a list of suitable methodologies for studying such sociological issues. The study involves the processing of theoretical concepts from a range of authors – both domestic and foreign – who have contributed to the development of qualitative sociological methods in the context of sensitive topics. It is noted that the method of in-depth interviewing has gained recognition as the most effective when applied to sensitive topics. However, it is emphasized that its use is fraught with difficulties not only for respondents but also for researchers, as it exerts significant emotional pressure on both parties. It is concluded that qualitative methods of sociological research demand a high level of expertise from the researcher-practitioner, particularly within sensitive topics. While in-depth interviewing remains a cornerstone approach, its implementation requires sensitivity and skill to navigate complex emotional dynamics. Understanding the nuances of qualitative methods is essential for effectively addressing sensitive sociological issues.

Developing professional capital through technology-enabled university-school-enterprise collaboration: an innovative model for C-STEAM preservice teacher education in the Greater Bay area

Purpose Preservice teacher (PST) professional development programs are crucial for cultivating high-quality STEAM teachers of the future, significantly impacting the quality of regional STEAM education. The Guangdong-Hong Kong-Macao Greater Bay Area, as a region of cross-border cooperation, integrates the resources and advantages of Guangdong, Hong Kong, and Macao, possessing rich cultural heritage and innovative capabilities. Transdisciplinary Education for Cultural Inheritance (C-STEAM) is an effective approach to promoting educational collaboration within the Greater Bay Area, facilitating the integration of both technological and humanities education. This study aims to develop a Technology-Enabled University-School-Enterprise (T-USE) collaborative education model and implement it in the Greater Bay Area, to explore its role as a support mechanism in professional development and its impact on C-STEAM PSTs' professional capital. Design/methodology/approach Adopting a qualitative methodology, the study interviewed PSTs who participated in a C-STEAM teacher education course under the T-USE model. Thematic coding is used to analyze their knowledge acquisition, interaction benefits with community members, and autonomous thinking and decision-making in theoretical learning and teaching practice. Findings The findings show that the T-USE model significantly enhanced the PSTs' human capital, including teaching beliefs, knowledge, and skills. In terms of social capital, PSTs benefited from collaboration with PST groups, university teaching teams, in-service teachers, and enterprises, though challenges such as varying levels of expertise among in-service teachers and occasional technical instability emerged. For decisional capital, the T-USE model provided opportunities for autonomous thinking and promoted teaching judgment skills through real teaching challenges and scenarios. Reflective practice activities also supported PSTs' professional growth. Originality/value This study reveals the effectiveness and internal mechanism of the T-USE model in C-STEAM PST training, offering significant theoretical and practical references for future PST education.

Clinical Nurse Leader Practice Development: An Integrative Review of the Literature.

The Clinical Nurse Leader (CNL) is a skilled clinician qualified in outcomes-based practice and quality improvement. Publications describe the CNL training, integration, and outcomes. However, CNL practice development and its impact has not been fully explored. This review aimed to synthesize existing literature related to CNL practice development and identify what influences on the care environment and nursing care outcomes. An integrative literature review was conducted in 5 bibliographic databases for sources published in English from January 2012 to March 2023. Fifteen publications identified 3 interrelated themes of CNL practice, outcomes, and practice development. Staff development needs were identified across various levels of expertise. There is a need to further explore CNL practice development and how it can impact the care environment and care outcomes.

Unveiling the Mental Toughness and Performance Resilience of Table Tennis Athletes

This study examined the psychological resilience and mental fortitude of Chinese table tennis athletes, specifically analyzing their demographic characteristics. The sample comprised predominantly of athletes aged 18 to 24, with a majority of female participants and a notable proportion having less than one year of expertise in the sport. Athletes assessed their mental toughness dimensions, such as commitment, control, confidence, and challenge, as being of average level. Noticeable disparities in mental resilience evaluations were noted among various age cohorts, genders, and levels of professional expertise. In terms of age, athletes between the ages of 18 and 24 demonstrated greater dedication and self-regulation, whereas female athletes had higher levels of confidence and dedication. The performance resilience tests indicated that the scores were moderate to slightly above average in many categories, indicating a well-balanced impression of their skills to withstand challenges. Significantly, the components of performance resilience, including awareness, physiology, emotions, and mastery, exhibited notable variations depending on age, gender, and years of experience. Moreover, a significant correlation was discovered between the characteristics of mental toughness and the ability to bounce back from setbacks, underscoring the significance of mental conditioning in improving athletes' capacity to surmount challenges and attain peak performance. These findings highlight the necessity of customized mental training programs to improve psychological resilience and performance among Chinese table tennis athletes. When developing interventions, coaches and sports psychologists should take into account the age, gender, and level of experience of players.

Analysis of the Motion Postures in Equestrian Sports Based on Multi-Sensor Data Fusion

Horse riding, in its essence, is both an art and a captivating sport. In these events, riders showcase their refined skills and deep bond with their horses, most notably through changes in physical positioning. This research aims to accurately capture and analyze the spatial postures of riders in equestrian sports, exploring the dynamic differences between professional and amateur riders. To achieve this, we employed a multi-sensor data fusion approach based on human kinetics theories, enhanced by an extended Kalman filter. This method, combined with an optical tracking system, enabled us to intricately compare and analyze the 3D postures of riders during walking and trotting phases. Our research captured these nuanced postural shifts using an inertial sensor network, yielding nine-axis motion data of riders during their performance. The accuracy of our fusion technique was validated using the optical tracking system. By analyzing the motion data, we discerned posture variations among the riders of differing expertise levels, even when executing the same riding technique. The insights from this research offer a quantifiable metric for refining equestrian training and contribute to understanding the complex dynamics of rider–horse interaction.

Translation, cultural adaptation, and validation of Numerical Pain Rating Scale and Global Rating of Change in Tibetan musculoskeletal trauma patients

Tibetan-speaking patients seeking care in predominantly Mandarin-speaking healthcare settings frequently face communication barriers, leading to potential disparities and difficulties in accessing care. To address this issue, we translated, culturally adapted, and validated the Numerical Pain Rating Scale (NPRS) and the Global Rating of Change (GRoC) into Tibetan (NPRS-Tib and GRoC-Tib), aiming to facilitate cross-linguistic and cross-cultural interactions while examining potential challenges in the adaptation process. Using standard translation-backward translation methods, expert review, pilot testing, and validation through a cross-sectional study with a short-term longitudinal component, we engaged 100 Tibetan patients with musculoskeletal trauma for psychometric validation, including 37 women (aged 22–60 years, mean age 39.1 years). The NPRS-Tib and GRoC-Tib exhibited outstanding psychometric properties, with an Intraclass Correlation Coefficient (ICC) of 0.983 for NPRS-Tib indicating superb test–retest reliability, and expert review confirming good content validity for both instruments. A Spearman's correlation coefficient (Rho) of -0.261 (P = 0.0087) revealed a significant, albeit weak, correlation between changes in NPRS-Tib scores and GRoC-Tib scores. The adaptation process also presented notable challenges, including translation discrepancies from translators' diverse backgrounds and levels of expertise, ambiguity in scale options, and the lack of established tools for criterion validity assessment in Tibetan.

Development of a 3D-printed nuchal translucency model: a pilot study for prenatal ultrasound training

BackgroundWe used two 3D ultrasound volumes of fetal heads at 13 weeks to create live-size 3D-printed phantoms with a view to training or assessment of diagnostic abilities for normal and abnormal nuchal translucency measurements. The phantoms are suitable for use in a water bath, imitating a real-life exam. They were then used to study measurement accuracy and reproducibility in examiners of different skill levels.MethodsUltrasound scans of a 13 + 0-week fetus were processed using 3D Slicer software, producing a stereolithography file for 3D printing. The model, crafted in Autodesk Fusion360™, adhered to FMF guidelines for NT dimensions (NT 2.3 mm). Additionally, a model with pathologic NT was designed (NT 4.2 mm). Printing was performed via Formlabs Form 3® printer using High Temp Resin V2. The externally identical looking 3D models were embedded in water-filled condoms for ultrasound examination. Eight specialists of varying expertise levels conducted five NT measurements for each model, classifying them in physiological and abnormal models.ResultsClassification of the models in physiological or abnormal NT resulted in a detection rate of 100%. Average measurements for the normal NT model and the increased NT model were 2.27 mm (SD ± 0.38) and 4.165 mm (SD ± 0.51), respectively. The interrater reliability was calculated via the intraclass correlation coefficient (ICC) which yielded a result of 0.883, indicating robust agreement between the raters. Cost-effectiveness analysis demonstrated the economical nature of the 3D printing process.DiscussionThis study underscores the potential of 3D printed fetal models for enhancing ultrasound training through high inter-rater reliability, consistency across different expert levels, and cost-effectiveness. Limitations, including population variability and direct translation to clinical outcomes, warrant further exploration. The study contributes to ongoing discussions on integrating innovative technologies into medical education, offering a practical and economical method to acquire, refine and revise diagnostic skills in prenatal ultrasound. Future research should explore broader applications and long-term economic implications, paving the way for transformative advancements in medical training and practice.

Development of a Biosafety Level 1 Cellular Assay for Identifying Small-Molecule Antivirals Targeting the Main Protease of SARS-CoV-2: Evaluation of Cellular Activity of GC376, Boceprevir, Carmofur, Ebselen, and Selenoneine.

While research has identified several inhibitors of the main protease (Mpro) of SARS-CoV-2, a significant portion of these compounds exhibit reduced activity in the presence of reducing agents, raising concerns about their effectiveness in vivo. Furthermore, the conventional biosafety level 3 (BSL-3) for cellular assays using viral particles poses a limitation for the widespread evaluation of Mpro inhibitor efficacy in a cell-based assay. Here, we established a BSL-1 compatible cellular assay to evaluate the in vivo potential of Mpro inhibitors. This assay utilizes mammalian cells expressing a tagged Mpro construct containing N-terminal glutathione S-transferase (GST) and C-terminal hemagglutinin (HA) tags and monitors Mpro autodigestion. Using this method, GC376 and boceprevir effectively inhibited Mpro autodigestion, suggesting their potential in vivo activity. Conversely, carmofur and ebselen did not exhibit significant inhibitory effects in this assay. We further investigated the inhibitory potential of selenoneine on Mpro using this approach. Computational analyses of binding energies suggest that noncovalent interactions play a critical role in facilitating the covalent modification of the C145 residue, leading to Mpro inhibition. Our method is straightforward, cost-effective, and readily applicable in standard laboratories, making it accessible to researchers with varying levels of expertise in infectious diseases.

Predictive machine learning model for mechanical dilatation in transvenous lead extraction procedures

Abstract Background Transvenous lead extraction (TLE) remains a procedure that requires a high level of expertise, with a doubled risk of death and clinical failure when performed in low-volume centers compared to high-volume ones (1). Purpose The aim of this study was to create a machine learning (ML)-based risk stratification system for predicting the need for mechanical dilatation in patients undergoing TLE due to infection. Methods We designed a ML-based risk stratification system trained with data from our registry to predict the need for mechanical dilatation in patients undergoing TLE for infection. An extensive evaluation of 5 different ML models (k-nearest neighbors, support vector machine, decision tree, and decision tree ensembles, such as random forest and gradient boosting machine) was conducted to identify a classifier with the highest potential to correctly predict previously unseen patients. Results Data to train the model was extracted from our 25-year registry of patients undergoing TLE (June 1998 – March 2023), for a total of 491 patients (77.8% male; age 69.7 ± 12.8 years) and 938 leads (ICD 21.2%; pacing 78.8%; indwelling time 61 ± 60 months) removed with success in 100% of cases. Each patient was represented by a set of 21 attributes (14 clinical, 7 device-related). Manual traction (MT) was used in 27.5% of cases, and mechanical dilatation (MD) was employed in the remaining 72.5% of cases. 5-fold nested cross validation was used to estimate performances: in turn, 393 patients were used for training and model selection, and 98 patients were used for independent testing. According to the evaluation, Gradient Boosting Machine performed best, achieving test accuracy of 89% (+/- 2% std. dev.), test sensitivity of 95% (+/- 3% std. dev.), test specificity of 73% (+/- 8% std. dev.), test AUROC of 92% (+/- 1% std. dev.). A further interpretability analysis on the best performing decision tree was conducted, showing remarkable adherence between the internal decisions taken by the model to make predictions and the current clinical practice for TLE. Conclusion ML models have enhanced the prediction of MD requirements in TLE procedures. This data may support the referral of patients to specialized and high-volume centers, thereby improving preoperative risk assessment.Feature importanceROC Curves

#2168 Lupus nephritis histopathological classification system: a questionnaire-based survey of the Renal Pathology Society (RPS)

Abstract Background and Aims Kidney biopsy is the gold standard for lupus nephritis diagnosis, defining histologic class, disease activity and chronicity in detail and providing guidance for treatment. The updated 2018 ISN/RPS histopathological classification in lupus nephritis is widely used for prognosis and treatment decisions. Given the evolving phenotypes of lupus nephritis and the success of new targeted agents in clinical trials, there is ongoing discussion about the need for updating existing classification systems. A survey to assess the current use of the lupus nephritis histopathological classification systems in everyday practice was conducted on behalf of the RPS. Method An online survey was sent between September 27th and October 24th, 2023 to active members of the RPS. The survey used an internet platform and contained both multiple-choice and open-ended questions; results were analyzed anonymously. Results 185 of 562 RPS members replied to the questionnaire. 179 (97%) were pathologists and the level of expertise in lupus nephritis was good: 120 (65%) participants indicated they encounter more than 20 biopsies with lupus nephritis per year, while only 13% encounter fewer than 10. Almost 90% of responders discuss kidney biopsy results in a multidisciplinary meeting involving both clinicians and pathologists, on a weekly or monthly basis. The 2018 ISN/RPS lupus nephritis classification is used in most cases (92%), while 7% of participants prefer the earlier 2004 version. The average grade on the utility of the 2018 ISN/RPS classification was 8 (IQR 7-9) on a scale from 0 (not useful) to 10 (extremely useful). Almost 90% of the pathologist responders indicated they include the NIH activity/chronicity indices in biopsy reports. Reasons for not adding the activity/chronicity indices were given as responses to open-ended questions: (1) clinicians usually do not ask for activity/chronicity indices—(2) the extra workload outweighs the perceived clinical benefit—(3) a quantitative description of the degree of activity/chronicity is less time-consuming and more understandable than the indices—(4) reproducibility is not guaranteed. The average grade on the utility of the activity/chronicity indices was 7 (IQR 7-9) on a scale from 0 (not useful) to 10 (extremely useful). Pathologists rated treating clinicians' understanding of kidney biopsy reports and lupus classification at light microscopy with an average score of 8 (IQR 7-9) on a scale from 0 (no understanding) to 10 (complete understanding). Suggested improvements of the 2018 ISN/RPS lupus nephritis classification were further standardization and simplicity. Clearer definitions were requested for: class III vs class IV; segmental sclerosis vs fibrotic crescents; the role of globally sclerosed glomeruli; lupus-like entities; and lupus podocytopathy. Furthermore, there was a request on guidelines for new parameters: e.g., focus on extraglomerular involvement, laboratory and clinical features and biomarkers; CD68+ staining to detect endocapillary hypercellularity; and EXT1/2 immunostaining. Conclusion Our survey shows the 2018 ISN/RPS lupus nephritis classification is widely used in everyday practice by pathologists, and well known by clinicians. The results obtained by the RPS survey serve as a starting point for the new Working Group of lupus nephritis classification. We will consider the ideas and suggestions of the international community to evaluate biopsies from extensively phenotyped cohorts, to modify the classification and to facilitate improved targeted treatment decisions—a current unmet need.

#464 Survey results on the utility of the Renal Risk Score and Histopathological Classification of ANCA-glomerulonephritis

Abstract Background and Aims The importance of kidney biopsy in ANCA-associated glomerulonephritis (AAV) is widely recognized: both the Berden classification and the ANCA renal risk score (ARRS) are widely used and reliable predictors of prognosis. AAV phenotypes, outcomes and treatment have changed over the last decades: whether and how the existing classification and ARRS need to be updated is a matter of discussion. A survey to assess the current use of the classification and ARRS in clinical practice was conducted on behalf of the newly formed “Working Group on classifications and risk scores”. Method An online survey was sent to the active members of the European Vasculitis Society (EUVAS) between September 13th and September 27th, 2023. The survey used an internet platform, contained 12 multiple-choice and 2 open questions and results were analyzed anonymously. Results 76 of 295 EUVAS members replied to the questionnaire: 40 (52.6%) were nephrologists, 25 (32.9%) rheumatologists, 4 (5.3%) pathologists and 7 (9.3%) “others”. Their level of expertise was high, with 61 (80.3%) physicians encountering more than 10 new-diagnosed AAV patients per year. A total of 64 (84.2%) responders usually performed a kidney biopsy in suspected AAV patients, considering the pathological examination a useful tool for prognosis (89.5%), diagnosis (85.5%) and treatment (81.6%). More than 90% of responders indicated they discuss kidney biopsy results in a multidisciplinary meeting involving both clinicians and pathologists. Both the Berden classification and the ARRS are known by around 70% of experts in the field; the first being commonly used by clinicians in everyday practice (70.1% vs 52.5%, p = 0.08). Both systems were considered useful on a scale from 0 to 10, with a median grade of 7 [(IQR 5-8) vs (IQR 6-8), p = 0.21]. Suggested improvements were further standardizations and simplicity. New parameters (e.g., extraglomerular involvement, laboratory and clinical features) and biomarkers should be considered for future inclusion. Conclusion A survey assessing the current use of the Berden classification and ARRS in clinical practice showed that both systems are widely used among vasculitis clinicians and that the ideal system should be able to guide treatment decisions. The validation of pathological systems for targeted treatment decisions is an unmet need.

#1357 Regional and national hospitalization burden of lupus nephritis and systemic lupus erythematous in Spain

Abstract Background and Aims The regional epidemiology of Systemic lupus erythematosus (SLE) and lupus nephritis (LN) within the same country is poorly understood. Being a rare disease, its severity may be influenced by local expertise and treatment protocols, especially when healthcare systems are fragmented, like in Spain (17 different healthcare systems in 17 Autonomous Community (AACC), population range 319.796 to 8.472.407), resulting in potentially different levels of expertise in regional referral centers. Additional heterogeneity may derive from different specialists (rheumatology, internal medicine, nephrology) caring for SLE and LN. We aim to investigate the disease burden of SLE and LN in Spain and its AACC between 2019 and 2021, and to characterize factors that may influence this burden. Method The primary diagnostic data and average cost of SLE and NL hospitalization were extracted from the Minimum Basic Data Set (MBDS, Ministry of Health) that contains data from private and public hospitals. Sociodemographic data were obtained from the National Statistics Institute. Results From 2019 to 2021, there were 872 LN and 3612 SLE nationwide hospitalizations. Over 60% occurred in Andalucia, Catalonia, and Madrid, which account for 48% of Spanish population. Nationwide, the incidence of LN and SLE hospitalization was 1.44 and 4.59 per 100 000, respectively. However, regional variability was large, with a 3.7-fold difference for LN and a 7.3-fold difference for SLE between Madrid and Valencia, 2 of the more populated AACC. The median LN/SLE hospitalization ratio was 0.33. Relative risk for hospitalization, compared to the national mean, ranged in AACC from 0.37 (Baleares) to 2.55 (La Rioja) for LN and from 0.22 (Baleares) to 3.67 (Ceuta and Melilla) for SLE (Fig. 1A). Heterogeneity was larger at the provincial level where 10/50 provinces had significantly higher or lower relative risk than the national mean (Fig. 1B). The length of SLE/LN hospitalizations was very variable across specialties and AACC. There was a trend for shorter duration in Nephrology and longer in Internal Medicine for both LN and SLE. Nephrology was mainly responsible (76%) for LN hospitalization, with regional differences. For SLE hospitalization, Nephrology was also most commonly in charge. Heterogeneity was larger at the province level within the same AACC. The average All-Patient-Related (APR) cost per LN and SLE hospitalization episodes was €5254 and €4376, respectively, with significant geographical variability. Total annual hospitalization costs varied significantly among AACC, ranging from €8683 (Ceuta and Melilla) to €682512 (Catalonia) for LN and from €68361 (Ceuta and Melilla) to €2229456 (Madrid) for SLE. Adjusted per million population, total LN hospitalization cost ranged from €27920 (Baleares) to €179248 (La Rioja), and SLE cost from €91563 (Baleares) to €399693 (Ceuta and Melilla). When adjusted by €1000 of average household net income, the budget burden of LN hospitalization was highest in La Rioja (€5812 per €1000 of average household net income) and lowest in Baleares (€809 per €1000), while for SLE was highest in Murcia (€11186 per €1000) and lowest in Baleares (€2652 per €1000) (Fig. 2A,B). Conclusion In conclusion, the burden of LN and SLE hospitalization is heterogeneous across and within Spanish AACC, with large regional differences in the distribution of cases, costs and specialists who care for these patients. The analysis of these differences may contribute to benchmarking of best practices, decreasing clinical practice heterogeneity, optimizing care for SLE and LN and improving outcomes.

Cross-border data sharing through the lens of research ethics committee members in sub-Saharan Africa.

Several factors thwart successful data sharing-ambiguous or fragmented regulatory landscapes, conflicting institutional/researcher interests and varying levels of data science-related expertise are among these. Traditional ethics oversight mechanisms and practices may not be well placed to guarantee adequate research oversight given the unique challenges presented by digital technologies and artificial intelligence (AI). Data-intensive research has raised new, contextual ethics and legal challenges that are particularly relevant in an African research setting. Yet, no empirical research has been conducted to explore these challenges. We explored REC members' views and experiences on data sharing by conducting 20 semi-structured interviews online between June 2022 and February 2023. Using purposive sampling and snowballing, we recruited representatives across sub-Saharan Africa (SSA). We transcribed verbatim and thematically analysed the data with Atlas.ti V22. Three dominant themes were identified: (i) experiences in reviewing data sharing protocols, (ii) perceptions of data transfer tools and (iii) ethical, legal and social challenges of data sharing. Several sub-themes emerged as: (i.a) frequency of and approaches used in reviewing data sharing protocols, (i.b) practical/technical challenges, (i.c) training, (ii.a) ideal structure of data transfer tools, (ii.b) key elements of data transfer tools, (ii.c) implementation level, (ii.d) key stakeholders in developing and reviewing a data transfer agreement (DTA), (iii.a) confidentiality and anonymity, (iii.b) consent, (iii.c) regulatory frameworks, and (iii.d) stigmatisation and discrimination. Our results indicated variability in REC members' perceptions, suboptimal awareness of the existence of data protection laws and a unanimously expressed need for REC member training. To promote efficient data sharing within and across SSA, guidelines that incorporate ethical, legal and social elements need to be developed in consultation with relevant stakeholders and field experts, along with the training accreditation of REC members in the review of data-intensive protocols.

A framework for creating an IoT system specification with ChatGPT

The Internet of Things (IoT) is a core concern for the digital transformation of the industry. However, the development of IoT systems, starting from creating specifications, is a serious and time-consuming effort, which requires high levels of expertise. This paper introduces a novel approach leveraging large language models, specifically ChatGPT, to streamline the generation of IoT system specifications from initial, unstructured customer requirements. A framework, adapting the ISO IEC/IEEE 12,207:2017 standard, is developed for this purpose. The utility of this framework is validated through the development and expert evaluation of a specification for a campus laboratory IoT use case. The findings demonstrate ChatGPT's effectiveness in producing specifications that are understandable, complete, and unambiguous, thus offering a substantial aid to the industry in overcoming the complexities of IoT system specification development. At the same time, the study identified specific tasks within the requirements engineering process for IoT systems that ChatGPT could not effectively perform, such as verification, obtaining agreements, and maintaining traceability of requirements between stakeholders. The findings offer valuable insights into the practical applications of AI in the domain of IoT development, particularly in automating the specification generation process. These contributions not only advance the understanding of AI's role in IoT development but also open pathways for further research on refining AI-assisted methodologies for system specification and beyond.

A machine learning based approach for generating point sketch maps from qualitative directional information

People often use qualitative relations to describe locations or directional information, especially in written communication, such as ‘the restaurant is located at the southeast corner of the square’. However, when a large number of spatial entities are involved, qualitative relations alone are not intuitive enough for people to understand a spatial configuration. In fact, many applications, e.g. pertaining to sharing travel experiences, use sketch maps, i.e. maps focusing on the main features of an area whilst abstracting exact scale measurements, to help demonstrate abstract qualitative relations with more intuitive geometric points. Current approaches for generating point sketch maps from qualitative spatial relations require a high level of expertise, face inherent difficulties with efficiently processing large-scale data in bulk, and are vulnerable to inaccurate or conflicting information contained in qualitative data. To address these limitations, by incorporating machine learning techniques, we propose to translate the problem into an optimization problem of data reconstruction, enabling a novel end-to-end approach for generating point sketch maps from qualitative directional relations in bulk. Experiments on real-world datasets show that the proposed approach has very high accuracy and is robust even with a large portion of inaccurate or incomplete information.

Five-Year Treatment Outcomes of Resident-Performed Ahmed Valve Implantation for Glaucoma.

Ahmed glaucoma valve implantation by residents showed similar complications, success, and failure rates, regardless of their level of expertise. Training programs must encourage ophthalmologists to perform this surgery to enhance competence in their future practices. To describe outcomes of resident-performed Ahmed valve implantation over a 5-year period. In this cross-sectional observational study we retrospectively reviewed the medical records of patients who underwent resident-performed Ahmed glaucoma valve implantation over a 5-year period. The main outcomes were the number of surgeries performed by first-year, second-year, and third-year residents, intraoperative, and postoperative complications, and the association of level of training with outcomes and complications. Totally, 160 eyes were included, with a mean age of 53.8±15.4 years, 63% were men. The most frequent type of glaucoma was neovascular glaucoma (67.5%). Mean follow-up was 23.2±19.6 months. Residents of higher years performed more surgeries and no relationship was found between the surgeon's level of training and type of glaucoma operated on. After the surgical procedure, significant changes in best-corrected visual acuity were noted in surgeries performed by third-year residents ( P =0.04). Intraocular pressure and number of medications were significantly reduced in all groups ( P =0.01). Complications were registered in 60 eyes; the most frequent being the presence of a transient flat anterior chamber (27.45%). There were no significant differences in terms of IOP control and the number of complications in the 3 groups. There was no significant association between the resident's experience and the outcomes of the surgery. The Ahmed valve implant is a procedure that appears to have similar results in surgeons with different levels of training.