Local Guidance Research Articles

Selective serotonin reuptake inhibitors (SSRIs) in women of reproductive age: a systematic review of local formularies.

Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice. To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding. A systematic review of prescribing formularies in England and Wales. A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs. Seventy-four prescribing formularies were reviewed. Of these, 14.9% (n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (n = 21/74) provided links to guidance on PPH risk, and 1.4% (n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (n = 9/74), 23.0% (n = 17/74), and 21.6% (n = 16/74) of formularies, respectively. Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.

“It felt a bit wartime”: Teacher perspectives of social and emotional well‐being support in primary schools during Covid‐19

AbstractAlthough primary schools in the UK were required to provide access to remote learning for pupils during Covid‐19 mandated school closures, there was less clarity for teachers and school leaders about expectations and priorities relating to the provision of social and emotional well‐being support for children at home during this period. Using an existing whole‐school approaches (WSA) framework we aimed to understand the extent to which well‐being support was a priority for primary schools during closures, what structures were in place to support well‐being, what factors facilitated or inhibited provision of remote pastoral care, and how schools supported pupil reintegration following school reopening. Twenty semi‐structured qualitative interviews were conducted with teachers and school leaders in primary schools in three counties of southern England during February and March 2020. A hybrid inductive‐deductive thematic analysis approach was used with a critical realist approach. Findings indicate that school closures were associated with radically disrupted home–school partnerships. Lack of national and local policy guidance limited the extent to which schools adapted remote well‐being provision and maintained contact with families. This disruption contributed to a decline in children's emotional well‐being, particularly for those children from disadvantaged backgrounds. Covid recovery recommendations center on a renewed emphasis on universal, ethos‐focused interventions and a strength‐based focus on curriculum change.

The role of overnight pulse oximetry in risk stratification of paediatric sleep disordered breathing in a district general hospital

ObjectivesAdenoidectomy and tonsillectomy are common surgical interventions in paediatric patients with sleep disordered breathing. Post operative respiratory complications are a recognised risk, and pre-operative risk stratification of patients is important to enable safe delivery of peri-operative care. Due to easy accessibility, overnight pulse oximetry is commonly used for this purpose. However, its limitations have been widely reported and recent national guidance recommends limiting use to patients with significant risk factors. We reviewed the use of overnight pulse oximetry in our local unit to determine if local guidelines should be adapted in line with these national recommendations. MethodsRetrospective analysis of all paediatric patients referred for overnight pulse oximetry over an eighteen month period between August 2020 to February 2022. Data collection included patient age, weight, and relevant co-morbidities. The McGill score was used to risk stratify patients and determine the need for an overnight bed. This was then correlated with the occurrence of post operative respiratory complications. Results200 patients were referred for overnight pulse oximetry, with a mean age of 7.5 years. 7.5 % (15/200) had significant comorbidities. 64 % (128/200) of patients were subsequently listed for surgery. 20.3 % (26/128) were deemed at risk of post-operative complications due to McGill scores of 3 and 4 and planned for overnight ward observation. Of these, 15 % (4/26) were subsequently discharged the same day. None of our patients developed major respiratory complications in the post operative period. ConclusionOur findings support national recommendations that overnight pulse oximetry is not an accurate predictor of post-operative respiratory complications and resulted in unnecessary inpatient stays. Following discussion with the trust paediatric anaesthetist lead, our local guidance was tightened, limiting overnight pulse oximetry to children with relevant identifiable co-morbidities.

Making plans findable, accessible, interoperable, and reusable with data infrastructure: A search engine for constructing, analyzing, and visualizing planning documents

Local land-use plans help guide future development, but it is often difficult to compare content across jurisdictions, making regional coordination and plan evaluation challenging. This research reviews federal, state, and local data infrastructure guidance for land-use plans and compares such guidance to compliance with a California use-case. Findings indicate a number of obstacles to fostering data sharing and comparative analysis of plans: there is currently no central repository of land-use plans; plans are not uniform in format and are often out of date; many plans are not machine-readable thereby inhibiting text extraction, and planning language varies so greatly that there are numerous synonyms for terms of interest. Nonetheless, we demonstrate that the creation of digital platforms for archiving and searching across plans is currently feasible and enables large-scale quantitative analysis. Based on currently available metadata in existing land-use plans, we designed and piloted a structured database to enable users to search for terms and phrases across over 500 land-use plans. To center issues of social equity, the open access platform was developed in collaboration with state agencies and community organizations focused on environmental justice. Based on the pilot, we conclude with a framework for both developing plan data infrastructure given current constraints in standardized plan metadata and availability as well as guidance for plan formatting using FAIR standards (Findable, Accessible, Interoperable, and Reusable).

Insights From a Community-Based Strategy to Assess Tobacco and Vape Shop Retailers' Implementation of Tobacco 21 Law in El Paso, Texas.

In 2019, the United States Congress passed Tobacco 21 (T21) legislation that raised the minimum legal sales age for tobacco products from 18 to 21. However, although the federal legislation superseded weaker state laws that were already in place in some states, including Texas, local guidance for retailers was inconsistent. Given that retailers are ultimately responsible for policy implementation, the American Heart Association (AHA) initiated a process of assessing retailers knowledge and perceptions of the law through a survey targeting all tobacco retailers and accompanying ethnography of a subset of vape shops in El Paso, Texas. The process yielded lessons learned for assessment of community-based policy implementation including key considerations for personnel and process that are applicable to other community-based assessment processes. While AHA considered an in-person approach ideal, having an alternate online response option was necessary. In addition, a focused approach and in-depth understanding of the purpose was key to responsiveness of the retailers.

Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach.

A new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation. We conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences. A total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω), p = 0.004) and relative LI drops (-23.3 ± 4.9% vs. -18.3 ± 5.6%, p = 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω, p < 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω, p = 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g, p = 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up. LI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.

A Novel Lightweight Underwater Fish Individual Recognition Method Based on Local Feature Guidance Training for Precision Aquaculture

Highlights This article proposed a novel lightweight underwater fish individual recognition method. The proposed method can fully learn the characteristic information of fish. This method can guide training through local features. During prediction, only the global branch is utilized, resulting in a small number of parameters. Abstract. Individual recognition of fish within aquaculture fish groups is crucial for monitoring the growth status of each fish and is a key technology for precision and green aquaculture. However, accurately recognizing fish faces challenges due to the significant variations in fish postures and the influence of complex environments. This article aims to present a highly accurate method for underwater fish individual recognition, offering technical support for intelligent fish farming. To achieve this goal, a novel lightweight underwater fish individual recognition method based on local feature guidance training was proposed for precision aquaculture in this study. The method designs a multi-scale network based on deep learning and utilizes SE_ResNext for feature extraction. This network consists of a branch representing the global feature and a branch representing the local feature. During training, the full image of the fish individual is inputted as a coarse scale to the global branch (G-branch) to learn the global feature and calculate the ID loss. The image of each part formed after segmenting the fish individual is inputted as a fine-scale input to the partial branch (P-branch) to learn the local feature. Subsequently, the global feature and local feature are combined to form the fusion feature, and the Triplet loss and ID loss are calculated on the fusion feature. Finally, the loss calculated in the global feature and the loss calculated in the fusion feature are weighted and summed to obtain the total loss. Through the design of the loss function, the global feature is consistently influenced by the local feature, and the local feature serves to guide the global feature. During prediction, the global feature, having learned the information from the local feature, allows for the sole utilization of the G-branch to recognize fish individuals. This approach significantly reduces the number of parameters and computational requirements, resulting in a lightweight network. The method achieves high accuracy, with both Rank-1 and Rank-5 accuracy rates surpassing 95%. Remarkably, even with low image resolution and slight obscuration of the fish body, the Rank-1 accuracy remains above 90%. Keywords: Deep learning, Multi-scale network, Object detection, Recognition of fish individual.

Bipartite Graph-Based Projected Clustering With Local Region Guidance for Hyperspectral Imagery

Bipartite Graph-Based Projected Clustering With Local Region Guidance for Hyperspectral Imagery

The genotypic antibiogram: using gram-negative antimicrobial resistance genes identified via rapid blood culture identification tests to optimize treatment of Enterobacterales bloodstream infections

Abstract The negative predictive value of blaCTX-M on BCID2 for ceftriaxone resistance in E. coli and K. pneumoniae group was 97% and 94%, respectively. Creation of a genotypic antibiogram led to updated local guidance for clinicians to utilize for empiric treatment of Enterobacterales bloodstream infections identified via rapid diagnostics.

A virtual restoration network of ancient murals via global–local feature extraction and structural information guidance

Ancient murals are precious cultural heritages. They suffer from various damages due to man-made destruction and long-time exposure to the environment. It is urgent to protect and restore the damaged ancient murals. Virtual restoration of ancient murals aims to fill damaged mural regions by using modern computer techniques. Most existing restoration approaches fail to fill the loss mural regions with rich details and complex structures. In this paper, we propose a virtual restoration network of ancient murals based on global–local feature extraction and structural information guidance (GLSI). The proposed network consists of two major sub-networks: the structural information generator (SIG) and the image content generator (ICG). In the first sub-network, SIG can predict the structural information and the coarse contents for the missing mural regions. In the second sub-network, ICG utilizes the predicted structural information and the coarse contents to generate the refined image contents for the missing mural regions. Moreover, we design an innovative BranchBlock module that can effectively extract and integrate the local and global features. We introduce a Fast Fourier Convolution (FFC) to improve the color restoration for the missing mural regions. We conduct experiments over simulated and real damaged murals. Experimental results show that our proposed method outperforms other three comparative state-of-the-art approaches in terms of structural continuity, color harmony and visual rationality of the restored mural images. In addition, the mural restoration results of our method can achieve comparatively high quantitative evaluation metrics.

PP146 Seeing Eye-To-Eye on Real-World Evidence: Are Guidance from Japan and China Consistent with Recommendations from REALISE in Asia?

IntroductionThe REAL World Data (RWD) In Asia for Health Technology Assessment (HTA) guidance was developed by a regional working group to facilitate the increasing acceptance of real-world evidence (RWE) in Asia. We compared the consistency of REALISE against guidance from Japan and China.MethodsCountry-specific guidance for RWE/RWD use in pharmaceutical development were identified in May 2022 through governmental websites, with validation searches via Google. Sections from local guidance were mapped onto REALISE and categorized as “agree”, “mixed”, “disagree” or “missing” based on coverage and consistency.ResultsFive Japanese and three Chinese documents were mapped. Most sections in Chinese guidance (77%) and 36 percent of sections in Japanese guidance were tagged “agree” or “mixed”, with general alignment on definitions and good practice considerations (study design, accountability); however, 63 percent of Japanese sections were tagged “missing” from REALISE. As local documents took the regulatory perspective, they lacked REALISE’s discussion of translating RWD to RWE for HTA/economic evaluations specifically. Local guidance focused on practicalities of RWD collection in local contexts, including descriptions of specific actions (e.g., evaluating RWD sources, ensuring data security) rather than overarching principles described in REALISE; specifically, Japanese guidance described how to access and analyze databases/registries, reflecting Japan’s landscape of robust sources of national healthcare data, but lacked discussion of other RWE study types, data sources and specialized analytical methods. While Chinese guidance had a broader view of RWD types (more similar to REALISE), they also contained discussions on pharmacovigilance and omics data, communication with regulatory bodies, and incorporation of RWE into the approval pathway for traditional Chinese medicines.ConclusionsDespite differing purposes (with no RWE guidance from local HTA bodies), local and regional guidance align on general principles/good practice in generating/using RWE, providing common ground for increasing usage of RWE in HTA in Asia.

PP21 Are We Ready For It? Developing Criteria To Include Artificial Intelligence Medical Devices (AI-MDs) For Health Technology Assessment

IntroductionThe increasing pace at which artificial intelligence medical devices (AI-MDs) or digital health technologies (DHTs) have been introduced and integrated in healthcare has not been matched with appropriate selection criteria for health technology assessment (HTA) to inform funding decision-making. To align with international best practice and local regulatory guidance, the Agency for Care Effectiveness (ACE) developed criteria to include AI-MDs as part of its 2022 topic prioritization process for medical technologies. This abstract describes ACE’s approach to develop the inclusion criteria.MethodsTo develop key principles for including AI-MDs in ACE’s topic prioritization process, relevant information from overseas HTA agencies, local regulatory guidelines, and ACE’s existing topic selection criteria were reviewed. A search of international HTA agency websites was conducted in September 2022 to identify relevant information on inclusion of AI-MDs in healthcare for reimbursement recommendations.Additionally, local regulatory guidelines for AI-MDs in healthcare were also identified. The inclusion criteria were then piloted with AI-MDs identified from ACE’s horizon scanning workstream to examine their feasibility for HTA topic selection.ResultsOne overseas framework on DHTs from the National Institute for Health and Care Excellence (NICE) and two local regulatory guidelines were identified. Based on the key finding that the purpose of AI-MD use in guiding clinical management and its associated risks were important considerations, the following criteria were developed: (i) full registration with the regulatory body;(ii) device characteristics should be interventional, have direct impact on patient safety, or support accurate diagnosis or treatment which is critical to avoid death and serious health deterioration; and (iii) the AI algorithm should be fixed as opposed to adaptable as per regulatory requirements. Using this inclusion criteria, eight AI-MDs surfaced from horizon scanning were screened with the above criteria and deemed suitable for HTA topic selection.ConclusionsAs AI technologies are increasingly used to replace or supplement current clinical practice, continuous adaptation of HTA method is needed to ensure appropriate topic selection.

HPB P53 Readmission rate after laparoscopic cholecystectomy in a tertiary HPB Unit

Abstract Background Laparoscopic cholecystectomy comprises a large portion of benign biliary surgery, and is increasingly performed safely as a daycase. The aim of our study was to determine the rate of unplanned readmission to hospital or unscheduled contact with medical services following discharge after laparoscopic cholecystectomy, along with the reasons for seeking medical advice. Methods Patients were identified retrospectively from our HPB Unit's operative database. All patients were included (daycases and inpatients) who underwent laparoscopic cholecystectomy in our unit in the calendar year 2019. Patients were excluded if they also had a CBD Exploration, or if their operation was converted to an open procedure. All patients' records were reviewed in detail on the Northern Ireland Electronic Care Record to capture readmissions, A&amp;E attendances and contact with Out of Hours GP service within 30 days of discharge from hospital following operation. Results 273 patients were admitted for planned cholecystectomy under 7 Consultant Surgeons. 257 had their operation completed laparoscopically (5.86% conversion rate). The overall daycase rate was 66%. 39 patients (15%) sought unplanned medical advice within 30 days of discharge. 15 patients (5.8%) contacted Out of Hours. A further 9 patients (3.5%) went to A&amp;E. Most of these had pain or wound problems. There were 15 (5.8%) readmissions to hospital: 3 within 48 hours; with abdominal wall haematoma, constipation and pneumonia. The remainder (day 4-29) had mostly pain, vomiting or umbilical wound infection. Median length of stay was 3 days. Conclusions Our early readmission rate was low and in line with local guidance of &amp;lt;10%. Most patients seeking unplanned advice had pain or wound problems. Further work looking at counselling patients regarding postoperative pain and wound care may reduce the total readmission rate and unscheduled contact after discharge. Readmission was not dependent on the age or size of the patient, or on whether the operation was carried out as a daycase or inpatient.

A systematic review of Australian hospitals' policies on the deactivation of implantable cardioverter defibrillators

Abstract Introduction Increasing numbers of older adults are living with implantable cardioverter defibrillators (ICD), reflecting expanded indications and increased insertion rates (1). Deactivation rates for those approaching end of life are low, risking undue distress and an undignified death (2). International guidelines recommend discussions regarding deactivation be part of pre-implantation consent (3). Local health service policies, procedures and guidelines regarding deactivation are crucial for best-practice end-of-life care. Objective This systematic review aimed to determine the availability and content of hospital policies, procedures and guidelines regarding ICD deactivation towards end of life. Methods Victorian (PROMPT) and South Australian hospital guidelines databases were systematically searched (September 2022 - February 2023) to identify all documents regarding ICD deactivation at end-of-life. Eligible documents were analysed using a data extraction tool. Results Of 4001 documents identified from 93 health services (population 8.45 million Australians), 11 were included, with 10 (91%) from public, and 8 (73%) from metropolitan, health services. Two (18%) documents provided recommendations for subacute healthcare settings and 1 (9%) for community-based patients. Guidance for prompting ICD deactivation discussions was limited. Only 2 (18%) documents advised at time of insertion, 1 (9%) at generator change and 6 (55%) during advance care planning discussions (Figure 1). Recommended indications for ICD deactivation varied and included: patients with a palliative condition (2, 18%) or receiving end-of-life care (11, 100%), patient’s request (7, 64%) and with an active do not resuscitate order (5, 45%). Nine (82%) documents provided key points for informed consent discussions including that deactivation does not cause/hasten death (8, 73%), does not deactivate pacing (8, 73%), aims to promote a peaceful death (8, 73%) and that reactivation is possible (8, 73%). Instructions for temporary deactivation using a magnet were provided in 10 (91%) documents (8 (73%) included manufacturer-specific instructions, 2 (18%) including correct magnet placement diagram). Most (10, 91%) gave non-urgent deactivation instructions. Advice for managing ICDs after death was detailed in 4 (36%) documents. Conclusion There is a paucity of local health service guidance to support Australian clinicians navigate the challenges of ICD deactivation at end of life. Consistent, detailed, high-quality local health service guidance is required to facilitate active recognition of people with whom timely discussion and action regarding ICD deactivation is appropriate. This may contribute to improved end of life care. Additionally, given the geographical size and population spread of Australia and implications for cardiologist access, logistical caveats that allow adaptation for local health service should be highlighted.Figure 1

Construction and optimization of ecological security pattern based on landscape ecological risk assessment in the affected area of the Lower Yellow River

In the context of urban expansion and climate change, the world is under pressure from multiple ecological risks. Key ecological protection areas play a pivotal role in preserving ecological stability and promoting development. Due to its unique geographical conditions, the Yellow River basin has been facing huge ecological risk pressure. In the affected area of the Lower Yellow River (AALYR) as an agricultural hub, ecological protection has gradually become a key factor restricting the development of cities and agriculture. Taking AALYR as an example, the landscape ecological risk assessment (LERA) system is established based on three aspects “natural environment—human society—landscape pattern”. We construct a comprehensive cumulative resistance surface based on the risk assessment results as the basis for the future study. Ecological corridors are identified by minimum cumulative resistance (MCR) models to establish and optimize Ecological security pattern (ESP) in the AALYR. We found that the landscape ecological risks (LER) in the study area show a uniform spatial distribution, with a slightly higher distribution in the northeast than the southwest. The ecological risk levels are generally high in AALYR, indicating a more severe risk problem in this area. A total of 56 ecological sources were identified, with a total area of 21176 km2. The ecological sensitivity of AALYR was high, and 99 ecological corridors and 59 ecological nodes were extracted. Ecological corridors and nodes were consistently and densely distributed throughout the study area. The network analysis method improves the stability of the network structure after optimization. Based on the key components of the ESP, with the combination of geographical characteristics and local policy planning guidance, we constructed the “One Belt and One Axis, Two Cores and Two Corridors, Four zones” ESP. The study results may offer guidance and suggestions for the construction of ESP and ecological environment protection system in the world’s major river basins, and may also provide information for ecological planning of other similar river basins in the world.

How can surgeons help transgender patients and colleagues feel welcome?

Estimates suggest that around 0.5% of the UK population are transgender. This paper offers some useful information and advice to help surgeons be transgender inclusive. This includes: understanding terminology; recognising that transgender people are a diverse group; treating transgender patients with dignity and respect; respecting gender diverse people’s identities; avoiding inappropriately ‘outing’ transgender patients and colleagues; discretion regarding personal questions; and awareness of barriers to care, differing healthcare needs and ‘trans broken arm syndrome’. The paper ends with signposting to local and national guidance and consultancy services.

Exploring associations between built environment and crash risk of children in school commuting

Understanding how built environment are associated with crash risk (CR) in school commuting is essential to improving travel safety through land use and transportation policies. Scholars often assume that this relationship is consistent across space, but this may lead to inconsistent estimates. To address this issue, using data in Shenzhen, China, the data covers traffic accident data of children taken from police incident reports and supplemented with local land use, transportation network and specific school information. The measurement model of crash scale was conducted to represent crash severity, and the CR was further quantified. The study applies three models, spatial dubin model (SDM), geographically weighted regression (GWR), and mixed GWR (MGWR), to explore spatio-temporal heterogeneity relationships between built environment attributes and CR of children in school commuting. The findings reveal that the crash scale can better represent crash severity of school commuting than a single indicator. Policy interventions should be targeted at specific spatial scales, school types, and time windows to effectively improve travel safety. However, there are some common findings. It is recommended to use a scale of 200 m to explain the relationship between the variables. The MGWR model outperforms the other two models. To reduce CR, it is important to consider lower road network density, a reasonable layout of educational facilities, fewer bus routes, and more on-street parking spaces. Our findings can help to enrich the understanding of associations between land use and CR of children, as well as offer local planning and operating guidance for creating child-friendly environment.

Chronic lymphocytic leukaemia Australasian consensus practice statement.

Chronic lymphocytic leukaemia (CLL) is the most common haematological malignancy in Australia and New Zealand (ANZ). Considerable changes to diagnostic and management algorithms have occurred within the last decade. The availability of next-generation sequencing and measurable residual disease assessment by flow cytometry allow for advanced prognostication and response assessments. Novel therapies, including inhibitors of Bruton's tyrosine kinase (BTKi) and B-cell lymphoma 2 (BCL2) inhibitors, have transformed the treatment landscape for both treatment-naïve and relapsed/refractory disease, particularly for patients with high-risk genetic aberrations. Recommendations regarding appropriate supportive management continue to evolve, and special considerations are required for patients with CLL with respect to the global SARS-CoV-2 pandemic. The unique funding and treatment environments in Australasia highlight the need for specific local guidance with respect to the investigation and management of CLL. This consensus practice statement was developed by a broadly representative group of ANZ experts in CLL with endorsement by peak haematology bodies, with a view to providing this standardised guidance.

A Study to Assess the Attitude and Acceptance toward COVID-19 Vaccine among General Public

Background and Aim: COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. While most people experience mild-to-moderate respiratory illness and recover without special treatment, some, especially older people and those with underlying medical conditions, may become seriously ill. To prevent transmission, it is important to be informed about the disease and how it spreads. This includes staying at least 1 m apart from others, wearing a properly fitted mask, washing your hands frequently, getting vaccinated, and following local guidance. The virus spreads through small liquid particles from an infected person’s mouth or nose when they cough, sneeze, speak, sing, or breathe. Practicing respiratory etiquette and self-isolating when feeling unwell are important measures to take. SARS-CoV-1 and SARS-CoV-2 are genetically similar viruses responsible for global epidemics of different scales. They diverged due to differences in transmission dynamics and clinical presentations. COVID-19 management has evolved with new knowledge, therapeutics, and vaccines. The impact on health care and public health systems has been profound, with lessons learned for future pandemics. A globally fair vaccine distribution system must prevail over vaccine nationalism for the world to return to its prepandemic status. Materials and Methods: A quantitative cross-sectional study conducted in a tertiary care hospital among 272 participants who were selected conveniently. The attitude was assessed using self-structured five-point Likert scale, and acceptance was assessed using self-structured dichotomous questionnaire. Results: About 64.0% of the general public had good attitude, 31.3% of the general public had moderate attitude, and 4.8% of the general public had excellent attitude, none of them had poor attitude. The majority 95.6% of the general public expressed acceptance toward the COVID-19 vaccine and 4.4% of them not. Correlation of attitude and acceptance toward COVID-19 the r = 0.15 was significant at the level of P &lt; 0.01. The association between attitude and demographic variables of the public revealed such as occupation, family monthly income, and any of the family members vaccinated had significant association at the level of P &lt;0.01. Association between acceptance and demographic variables of the public revealed such as, age, vaccinated participants, and any of the family members vaccinated had significant association with acceptance at the level of P &lt; 0.01. Conclusion: This study provides valuable insights into the attitude and acceptance toward COVID-19 vaccine among general public. These findings can help to inform strategies for increasing vaccination rates and ultimately protecting public health.

Minimum spanning tree niching-based differential evolution with knowledge-driven update strategy for multimodal optimization problems

Multimodal optimization problems (MMOPs) aim to simultaneously locate as many global optima as possible with high accuracy. Recently, many niching strategies have been wildly used in evolutionary algorithms to solve MMOPs due to the advantage of maintaining the diversity of population. However, most multimodal algorithms are sensitive to the niching parameters and lack effective methods to update the “stagnant individuals”, including individuals that have trapped into local optima or converged to the same optima. In this paper, a minimum spanning tree niching-based differential evolution (TNDE) with knowledge-driven update (KDU) strategy is proposed to better solve the above challenges, where the “knowledge” includes historical evolutionary information, fitness distribution information, and individual distribution information. In TNDE, a minimum spanning tree niching (MSTN) strategy is proposed to adaptively divide the population, which can adjust the number of niches dynamically. Besides, the KDU strategy is proposed to utilize the knowledge to locate and update stagnant individuals. Lastly, an improved differential evolution with local stage-based mutation (LSM) and directional guidance selection (DGS) strategies is proposed to accelerate convergence and refine the accuracy of solutions, respectively. The comparison results with 16 state-of-the-art algorithms on CEC’2013 show that TNDE achieves significant advantages on high-dimensional problems or problems with many global optima.