Major Organizations Research Articles

Clinical implications of the SERPINA1 variant, MPalermo, and alpha-1 antitrypsin deficiency in Türkiye

BackgroundAlpha-1 antitrypsin deficiency (AATD) is associated with increased susceptibility to chronic obstructive pulmonary disease (COPD). AATD results from mutations in the SERPINA1 gene and over 500 rare mutations have been identified. Despite these findings and recommendations from major healthcare organizations, testing of COPD patients and their family members for AATD remains inadequate.MethodsWe examined genotypes and clinical characteristics of COPD patients (index cases; n = 14) treated at Recep Tayyip Erdoğan University Chest Diseases Department and their relatives (n = 17).ResultsWhen index cases were compared with screened relatives positive for AATD (n = 14), index cases were older and more predominantly male than screened relatives. Both groups had extensive smoking histories. All of the index cases and one of the screened relatives had been diagnosed with COPD. Clinical characterization of the COPD cases (14 index cases; 1 screened relative) showed that they had moderate to severe COPD with pre-treatment AAT levels of 0.59 ± 0.40 g/L (mean ± SD) and a COPD Assessment Test (CAT) score of 16.0 ± 8.12. The majority of these patients (73.3%) had panlobular emphysema. Five of the patients were treated with AAT augmentation which led to a decrease in the number of COPD exacerbations. Genotyping revealed that the most common rare allele identified in this population was MPalermo (c.227_229delTCT mutation on the M1(Val213) allelic background).ConclusionsMore testing and research need to be done to identify the relative prevalence of rare AATD variants. Earlier identification could lead to more effective treatment of affected individuals and improvement in their quality of life.

From Theory to Practice: The Impact of E-Learning on Student Performance, Trends, and Educational Horizons

BACKGROUND: Following the global outbreak of COVID-19, conventional classrooms have been supplanted by e-learning platforms, which have assumed a critical role in ensur-ing educational continuity. OBJECTIVE: The purpose of this review is to examine the interplay between e-learning platforms and student performance in the age after the COVID-19 pandemic. METHODS: This bibliometric analysis uses PRISMA to summarise studies linking e-learning platforms to student performance. Scopus was selected for its broad coverage and reputation as a scientific article analysis resource. A complete keyword search yielded 8060 publications in the database. Applying inclusion and ex-clusion criteria narrowed the findings to 1420 relevant articles. RESULTS: Since 2019, e-learning and student performance papers have increased, suggesting a greater focus on research. The list of major publications, governments, and organizations that contribute to this issue shows a global effect. The study emphasizes the most prolific authors and main research keywords, reflecting the multidisciplinary nature of e-learning research. CONCLUSION: E-learning is becoming more important in education, as shown by an increasing number of publications, a diverse variety of writers, and a focus on numerous subject areas and keywords. This shows how collaborative and diversified this sector's research is. RECOMMENDATION: The paper recommends greater study to improve digital education and student learning. Understanding and improving the impact of e-learning platforms on student performance requires creating techniques and expanding the corpus of knowledge.

Effects of major trauma care organisation on mortality in a European level 1 trauma centre: A retrospective analysis of 2016-2023.

The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development. To describe the aetiology and evolution of in-hospital mortality in a developing European level 1 trauma centre, to determine the early effect of trauma care reorganisation on mortality and to identify the areas for future investments in trauma care. This retrospective analysis included the calculation of the standardised mortality ratio (SMR), the time to in-hospital death and the cause of in-hospital death of all primary major trauma admissions to the Antwerp University Hospital from 2016 to 2023. A total of 1470 patients was included with a crude mortality of 16.4 %, a median Revised Injury Severity Classification II (RISC II) adjusted mortality of 1.47 %, and a SMR of 1.12. A limitation of care directive was registered for 18.1 % of the patients. The causes of in-hospital death were traumatic brain injury (TBI) in 60 %, haemorrhagic shock in 15 %, organ failure in 10 %, miscellaneous in 14 % and unknown in 1 %. Sixty percent died in the first 48 h of hospital admission (mainly due to TBI and haemorrhagic shock) and 27 % died after more than seven days (mainly due to organ failure and TBI). In 24 % of the deceased patients with severe TBI, a non-TBI related cause of death was found. Overall, the SMR showed a nonsignificant decreasing trend, with a significant decrease of the SMR in the highest risk group (RISCII > 75 %) and a nonsignificant increase in the lowest risk group (RISC II <15 %). The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.

Assessing the impact of radiofrequency radiation from cellular towers on human health: A comprehensive review

The proliferation of cellular communication towers, driven by the rapid advancement of wireless technologies like 4G and 5G, has raised significant public health concerns regarding the potential effects of long-term exposure to radiofrequency (RF) electromagnetic radiation (EMR). This review explores the implications of RF radiation emitted by these towers, which is classified as non-ionizing and typically associated with thermal effects, albeit at levels considered safe by major health organizations such as the World Health Organization (WHO) and the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Key topics addressed include the mechanisms of RF radiation interaction with biological systems, public concerns about health effects including cancer risks, neurological impacts, reproductive health, and the controversial condition known as electromagnetic hypersensitivity (EHS). While numerous studies suggest that RF exposure does not lead to significant adverse health outcomes at permissible levels, evidence regarding potential non-thermal effects, such as oxidative stress and changes in cell signaling, remains inconclusive. The review emphasizes the need for further research into the long-term effects of RF radiation, particularly with the expansion of 5G technology, and considers the regulatory frameworks established to ensure public safety. The conclusion highlights a cautious approach, advocating for ongoing scientific inquiry and the application of the precautionary principle, especially concerning vulnerable populations like children and pregnant women.

Challenges and Opportunities Faced by the United Nations Stabilization Mission in the Democratic Republic of Congo in Fulfilling Its Mandate for Peace and Security in the DRC

The Democratic Republic of Congo (DRC) has been marred by protracted conflict, instability, and human suffering for decades. Studies on or and around United Nations Stabilization Mission in the Democratic Republic of Congo with respect to conflict, peace and security, portray shortcomings bordering on ineffectiveness. This presents a serious paradox and a question on conflict intervention by MONUSCO’s peace and security processes. The study objective was to evaluate challenges and opportunities faced by MONUSCO in fulfilling its mandate on peace and security processes in the DRC. The study explored Liberal Theory, Power Theory and Theory of Functionalism from which a conceptual model was drawn. The target population was 49,871 with a unit of analysis of 21,105 civilians comprising 5052 refugees, 4053 internally displaced persons and 12,000 local traders, 16,161 MONUSCO staff, 7,895 from major none governmental organizations (NGOs), and 4,710 from the political class, the rebel groups, and immigration. The study used random, stratified, snowball, and purposive sampling techniques to select 384 participants. The study was conducted in Eastern DRC. A descriptive survey research design was adopted. The primary and secondary data were collected using questionnaires, focus group discussions, observation guides, and key informant interviews. Content analysis was done for all qualitative data; statistical data was analyzed using descriptive statistics. The findings of the study indicate that, MONUSCO’s key challenges include; persistent violence of attacks by armed groups, mistrust and limited cooperation from government and local authorities, and logistical difficulties in accessing remote areas. The study concluded that mistrust and dearth of cooperation, non-guaranteed protection of the civilian population, and weak governance institutions are the major problems facing MONUSCO in achieving its mandate. The study recommends supporting the establishment of local and international judicial mechanisms to investigate and prosecute war crimes and human rights abuses, by ensuring that perpetrators are held accountable and encourage truth and reconciliation processes to address past injustices and promote healing within communities.

AI-Driven Compliance Training in Finance and Healthcare: A Paradigm Shift in Regulatory Adherence

This article examines the transformative impact of artificial intelligence (AI) on regulatory compliance training in the finance and healthcare sectors. As these industries face increasingly complex regulatory environments, traditional training methods often fall short in ensuring comprehensive and up-to-date compliance. Through a mixed-methods approach, including surveys of 500 professionals and case studies of two major organizations, this article investigates the effectiveness of AI-powered compliance training systems. Key findings reveal that these systems significantly enhance training personalization, regulatory update integration, and risk management. Notably, organizations implementing AI-driven training reported a 37% reduction in compliance violations and a 42% improvement in employee engagement with training materials. The article also identifies challenges in implementation, including data privacy concerns and integration with legacy systems. This article contributes to the growing body of literature on regulatory technology (RegTech) and provides practical insights for organizations seeking to leverage AI in compliance training. The findings suggest that AI-powered systems represent a paradigm shift in regulatory adherence, offering a more adaptive, efficient, and effective approach to compliance training in high-risk industries.

Mastectomy Surgical Recommendations for Female-to-Male Transgender Patients, and a Discussion of Gender-Affirming Care for Gender-Dysphoric Adolescents

Introduction: Subcutaneous mastectomy (top surgery) in female-to-male patients is one of the most common procedures gender-dysphoric patients will undergo in order to live as their desired gender. Procedure: By consistently using the technique described in this article, surgeons can achieve consistent and aesthetically pleasing results. Complications are rare, but it is important to inform the patient that there may be issues related to bleeding, infection, wound healing, nipple necrosis (if using a graft), or dog ears. Discussion: Multiple states in the United States are seeking to ban this type of care and are even attempting to restrict health care for adults. These bans are being enacted despite carefully researched and written guidelines from major international organizations. By following these guidelines, physicians can provide safe and evidence-based care to adolescents. Conclusion: The evidence conclusively demonstrates that providing gender-affirming care to patients of all ages improves their mental health, reduces rates of depression, and decreases the risk of suicide.

Evaluating the Ethical Frameworks of Information Security Professionals: A Comparative Analysis

Information Technology (IT) networks have become a cornerstone of business communication, evolving alongside the Internet, which now facilitates the interconnection of independent IT infrastructures. This interconnectedness has increased the risks of information disclosure and privacy violations, presenting ethical challenges for information security professionals. This study aims to evaluate the ethical codes of four major information security professional organizations in computing sciences to identify critical ethical considerations for these professionals and highlight areas for potential improvement. The study analyzes the ethical frameworks and guidelines provided by these organizations, examining their alignment with the multidimensional aspects of security, including technical, organizational, legal, social, and ecological factors. The analysis reveals that information security extends beyond technical measures, encompassing broader organizational and societal dimensions. Ethical concerns cannot be effectively addressed without engaging all stakeholders. While existing codes of ethics and security policies are valuable, they require updates to address the evolving challenges of the information society. For effective information security, professional codes of ethics must integrate comprehensive stakeholder considerations and adapt to meet the growing demands of a connected digital world. Enhancing these ethical frameworks is crucial for fostering trust and resilience in the information society.

#PorkandPigs: an online media listening analysis of public perception of the U.S. swine industry

Abstract With the majority of the U.S. swine industry being generally bounded by social licensing, there is a growing need to understand social perspectives to better adapt to consumer demands. Online and social media data are rich datasets that researchers are leveraging to tackle economic and societal challenges. The information that can be gleaned from online media regarding public perceptions makes it an important tool for producers to understand driving topics of interest to the public. This study utilized a prominent online and social media listening and data analytics platform to identify and quantify online and social media mentions related to the U.S. swine industry from January 1, 2020, to December 31, 2023. A general search for online media referencing pork and pigs was designed resulting in a total of 41,093,309 mentions. The search was further queried to specific topics of food and cooking (20,580,068 mentions), price (2,866,548 mentions), welfare (1,615,208 mentions), sustainability (771,819 mentions), and top authors/organizations within the U.S. swine industry (1,430 mentions). The study spanned the geographic locations of the overall U.S. (including U.S. Minor Outlying Islands), the top 5 most populous states, and the top 5 pork producing states as of 2024. Of all mentions, X/Twitter was the largest domain for nearly all mentions related to pork and pigs. Major organizations designed to spread information between the general public and pork producers had a minor impact on the overall conversation and no online media presence in the top 5 most populous states. Net sentiment was overall positive across all four years and all geographies except for major events such as the COVID-19 pandemic, the H1N1 Swine Flu, the passing of California Proposition 12, environmental events, and inflation-associated pork prices. Overall, most media presence had positive net sentiments and with most interest surrounding ways to cook pork and how to keep bacon cheap. Understanding public perceptions of the U.S. swine industry provides the opportunity to make informed decisions on marketing strategies and production practices.

Delayed Umbilical Cord Clamping: and Improved Neonatal Outcomes

Delayed cord clamping (DCC) has emerged as a critical practice in modern obstetrics, offering significant benefits to both term and preterm infants. Immediate cord clamping was widely practised to facilitate neonatal care and manage maternal health concerns. However, growing evidence underscores the advantages of delaying cord clamping for 1-3 minutes post-birth. This practice enhances neonatal outcomes by increasing blood volume, improving iron stores, and ensuring a smoother transition to independent physiological function. The physiological benefits of DCC, including better oxygenation and higher haemoglobin levels, contribute to a reduced risk of neonatal anaemia and support long-term health. Additionally, DCC has been associated with improved breastfeeding success and is particularly valuable in low-resource settings where access to comprehensive healthcare may be limited. The practice is endorsed by major health organizations such as the World Health Organization and the American College of Obstetricians and Gynaecologists, reflecting its importance in promoting neonatal health.This article explores the historical context, physiological mechanisms, and global guidelines that inform DCC, highlighting its role as a low-cost, easily implementable intervention with substantial benefits. While there are instances where immediate clamping may still be necessary, particularly in cases of neonatal distress, DCC is increasingly recognized and accepted globally as the standard of care that optimizes neonatal outcomes.

System Complexity, Information &amp; Communication Overload, Work-Family Balance &amp; Social Networking Sites’ Tiredness: A Social and Digital Perspective

The use of Internet for constant connectivity with social networking sites has negative consequences in the form of higher mental pressure, low physical and offline activities, and mental tiredness and fatigue. Using these given phenomena, this research explores how system complexity, information overload, and communication overload are decisive factors of tiredness of social networking sites among Chinese individuals. The study also adds the role of work family balance as a predictor in determining the tiredness levels of the use of social networking sites. A survey questionnaire was conducted over a sample of 507 respondents, drawn through non-probability purposive sampling techniques from employees of major Chinese organizations. The Structural Equation Modelling measurements revealed that, except for system complexity, the impact of information overload, communication overload, and work-family balance is significant in causing tiredness of social networking sites. However, while both overload factors were responsible for greater tiredness, a higher balance between work and family tends to reduce it. The study suggests that policymakers should develop strategies through to reduce such tiredness. It was also felt that a more work-family balance should be a panacea for such tiredness among the Chinese people.

Una metodología de despliegue de mejora continua replicable en escuelas de negocios en México

Continuous improvement fosters adaptability and the ability to respond to changes and challenges in the environment, so in a constantly evolving context, organizations must continuously learn to remain competitive. Continuous improvement provides a structure and mindset that promote innovation and the ability to anticipate the changing needs and expectations of consumers of goods and services, such that the focus on continuous improvement impacts efficiency, adaptability, and innovation within organizations. In this context, the research problem in this paper is to propose a methodology for deploying continuous improvement that is replicable in business schools in Mexico, based on an updated and relevant theoretical framework in line with the guidelines of a major international accrediting organization for higher education, in this case, the Accreditation Council for Business Schools and Programs. The methodology used in this research was documentary and descriptive, collecting, analyzing, and synthesizing existing information on continuous improvement in business schools according to international standards in order to provide a solid foundation for further research in this field of study, and to describe the characteristics and accurate representation of the continuous improvement process in business schools in accordance with the guidelines of leadership, planning, stakeholder listening methods, learning assessment, human capital, and administrative processes.

Balancing Fertility Preservation and Treatment Efficacy in (Neo)adjuvant Therapy for Adolescent and Young Adult Breast Cancer Patients: a Narrative Review.

Adolescent and young adult (AYA) breast cancer survivors face a significant risk of infertility due to the gonadotoxic effects of (neo)adjuvant therapy, which complicates their ability to conceive post-treatment. While (neo)adjuvant therapy primarily aims to improve recurrence-free and overall survival, fertility preservation strategies should also be considered for young patients. This narrative review explores recent advancements in fertility preservation techniques, such as oocyte, embryo, and ovarian tissue cryopreservation, and evaluates the feasibility of modifying breast cancer (neo)adjuvant therapy to preserve fertility without compromising survival outcomes. Our review highlights that clinical trials with co-primary endpoints of oncological safety and fertility preservation are limited, and substituting standard treatment regimens solely for fertility preservation is currently not recommended. Nevertheless, new clinical studies have emerged that either exclude highly ovarian-toxic agents, such as cyclophosphamide, or omit adjuvant therapy altogether, even if fertility preservation is not their primary endpoint. Unfortunately, many of these trials have not evaluated ovarian toxicity. Notably, since 2020, major oncology organizations, including the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO) have advocated for the routine assessment of ovarian toxicity in all clinical trials. The review underscores the importance of incorporating ovarian toxicity as a standard endpoint in future trials involving premenopausal breast cancer patients to identify treatment regimens that can effectively balance fertility preservation with treatment efficacy.

Alcohol consumption-none is better than alittle.

Alcohol is socially accepted and widely consumed as arecreational beverage. Furthermore, it is used as adisinfectant for medicinal purposes and as acultural asset it is also part of religious rituals. However, it is also an intoxicant and an addictive substance. The deleterious side of alcohol is reflected in the fact that around 3million people worldwide die every year as adirect or indirect result of alcohol consumption. For several decades, epidemiological studies suggested that drinking alcohol in moderate quantities was beneficial. This was referred to as the "French paradox," which described differences in mortality between France and Finland mainly, but also other countries, that were found in epidemiological studies. The difference in the levels of alcohol consumption was found to explain the differences in mortality in view of the otherwise similar risk factors. When alcoholic drinks per day were plotted against all-cause mortality this led to aJ-shaped curve. This finding represented awindow of benefit for moderate alcohol consumption. However, the recent publication by Zhao etal. in 2023 revisited the relationship between the quantity of alcohol consumed and mortality risk and led to aparadigm change, which has influenced not only the recommendations of Canada's Guidance on Alcohol and Health but also the recommendations and guidelines of major health organizations: "No alcohol is better than alittle." The J‑shaped curve as an explanation of the French paradox became alinear relationship between the amount of alcohol consumption and the increasing mortality from tumors and cardiovascular diseases. The renewed review of several control groups in previous epidemiological studies revealed arecruitment error due to the inclusion of abstinent ex-drinkers. Taking this bias into account, the alcohol-friendly view of small amounts of alcohol being cardioprotective had to be revised. The combined misuse of alcohol and other risk factors for carcinogenesis and heart diseases still needs further attention. The misuse of both alcohol and cocaine led to the conclusion that when the two risky substances are consumed together, it is even more detrimental than the mere sum of the two.

Complications of vasectomy: results from a prospective audit of 105 393 procedures.

To provide up-to-date complication rates for vasectomy in the UK using 15 years of data collected by the Association of Surgeons in Primary Care (ASPC). Data were collected between 2007 and March 2022. A patient questionnaire was completed on the day of surgery and at 4 months postoperatively. Rates of early and late failure, infection, hospital admission or re-admission, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations. Descriptive statistics were utilised, without formal statistical analysis. Over the 15-year study period, data from 105 393 vasectomies were collected, performed by >150 surgeons. In 2022, 94.4% of surgeons used one test to prove sterility. In all, 65% of patients used a postal sperm test after vasectomy to confirm sterility. Early failure rates were available for 69 500 patients. Early failure occurred in 648 patients (0.93%). Of 99 124 patients, late failure occurred in 41 (0.04%). Of 102 549 vasectomies, postoperative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%), and PVPS was reported in 139 patients (0.14%). Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates that can form the basis for pre-vasectomy counselling.

Experience of Hyperbaric Chamber Usage in Aesthetic Plastic Surgery Practice for Recovery and Complication Prevention.

Hyperbaric oxygen therapy (HBOT) increases oxygen concentration in affected tissues that enhance the cellular hypoxia recovery process, neovascularization, fibroblast proliferation, increased reactive oxygen species, suppression of proinflammatory states, and vascular compression. The aim of this article is to demonstrate the experience in the use of the hyperbaric chamber as an adjunctive management for the prompt recovery of patients who underwent aesthetic plastic surgery. A retrospective descriptive study was conducted between 2021 and 2023, involving 296 patients who received HBOT after aesthetic surgical procedures, to demonstrate the recuperation time rate and the complication incidence in postoperative patients using HBOT. Most participants were women, with a median age of 33.5 years. Surgical procedures were grouped in liposculpture, abdominoplasty, and breast interventions. Complications related to the surgical event were low (10.7%), with occurrences of hematomas (n = 14, 4.72%), anemias (n = 9, 3.04%), and wound dehiscence (n = 8, 2.70%). There were no reports of surgical site infections or necrosis. Recovery times to get back to work were 10 days for liposuction, 3 days for breast interventions, and 21 days for abdominoplasty. This study demonstrated the experience of using a postoperative hyperbaric chamber in aesthetic plastic surgery to promote recovery processes. The patient cohort in this study showed shortened recovery times than the data obtained from the major international plastic surgery organizations. Also, HBOT patients had a low complication rate, without infections, indicating the potential efficacy of this adjunctive therapy. Overall, this study underscores the promising role of hyperbaric chamber therapy in facilitating postoperative recovery and mitigating complications.

Pharmacological profiles of neglected tropical disease drugs

According to the World health Organization there are a group of 20 diverse infectious Neglected Tropical Disease (NTD) conditions that primarily affect populations in low-income and developing regions. Despite the limited attention and funding compared to other health concerns, significant efforts to develop drugs for treating and controlling NTDs have been made. However, there is room for developing NTD drugs with improved safety, efficacy and ecotoxicological profiles. In order to facilitate this, we have adapted our existing validated data-driven workflows for understanding disease comorbidity to systematically evaluate the approved drugs that target the major World Health Organization defined NTDs. The foundation for this work comprised assembling the physicochemical, biological and clinical properties of each NTD drug and identifying patterns that reveal the underlying cause of their efficacy and side-effect profiles. Subsequently, computational methods were employed to identify analogs with potentially improved profiles and validated in a case study focusing on the teratogenic antileishmanial drug miltefosine. The wider impact of NTD drugs with regards to a One Health cross-disciplinary perspective at the human-animal-environment interface are also discussed.

Cybersecurity and the Future of International Relations

This research examines the growing influence of cybersecurity on international relations, focusing on how cyber threats, digital espionage, and cyber warfare are transforming state sovereignty, diplomacy, and global security. With the rise of state-sponsored cyberattacks and the increasing involvement of non-state actors, cybersecurity has become a central issue in the global power dynamics between major nation-states and international organizations. The study analyzes high-profile cyber incidents, such as the SolarWinds and Stuxnet attacks, and investigates their geopolitical implications, including how they have reshaped cyber norms and governance strategies. Through a comparative analysis of national cybersecurity strategies in countries like the U.S., China, and the EU, this research assesses the effectiveness of current international treaties, such as the Budapest Convention on Cybercrime, and multilateral efforts to establish cybersecurity norms. Preliminary findings suggest that cybersecurity has evolved into a strategic tool in global competition, with cyberattacks being used for coercion and disruption. Moreover, the rise of cyber espionage has heightened the stakes in digital diplomacy, leading to the establishment of specialized cyber units within foreign ministries. This study advocates for the development of comprehensive international treaties focused on cyber governance, with an emphasis on conflict prevention, cyber deterrence, and collective defense mechanisms. Additionally, it calls for greater involvement of multilateral organizations, such as the United Nations and NATO, in creating transparent and accountable frameworks for state-sponsored cyber activities. The research underscores the urgent need for cohesive global governance models to address the complex challenges posed by cybersecurity in shaping the future of international relations.

Holy grail or convenient excuse? Stakeholder perspectives on the role of health system strengthening evaluation in global health resource allocation

BackgroundThe role of evaluation evidence in guiding health systems strengthening (HSS) investments at the global-level remains contested. A lack of rigorous impact evaluations is viewed by some as an obstacle to scaling resources. However, others suggest that power dynamics and knowledge hierarchies continue to shape perceptions of rigor and acceptability in HSS evaluations. This debate has had major implications on HSS resource allocation in global-level funding decisions. Yet, few studies have examined the relationship between HSS evaluation evidence and prioritization of HSS. In this paper, we explore the perspectives of key global health stakeholders, specifically around the nature of evidence sought regarding HSS and its potential impact on prioritization, the challenges in securing such evidence, and the drivers of intra- and inter-organizational divergences. We conducted a stakeholder analysis, drawing on 25 interviews with senior representatives of major global health organizations, and utilized inductive approaches to data analysis to develop themes.ResultsOur analysis suggests an intractable challenge at the heart of the relationship between HSS evaluations and prioritization. A lack of evidence was used as a reason for limited investments by some respondents, citing their belief that HSS was an unproven and potentially risky investment which is driven by the philosophy of HSS advocates rather than evidence. The same respondents also noted that the ‘holy grail’ of evaluation evidence that they sought would be rigorous studies that assess the impact of investments on health outcomes and financial accountability, and believed that methodological innovations to deliver this have not occurred. Conversely, others held HSS as a cross-cutting principle across global health investment decisions, and felt that the type of evidence sought by some funders is unachievable and not necessary – an ‘elusive quest’ – given methodological challenges in establishing causality and attribution. In their view, evidence would not change perspectives in favor of HSS investments, and evidence gaps were used as a ‘convenient excuse’. Respondents raised additional concerns regarding the design, dissemination and translation of HSS evaluation evidence.ConclusionsOngoing debates about the need for stronger evidence on HSS are often conducted at cross-purposes. Acknowledging and navigating these differing perspectives on HSS evaluation may help break the gridlock and find a more productive way forward.

HealthChain: A blockchain‐based framework for secure and interoperable electronic health records (EHRs)

AbstractCurrently, there is no unified Electronic Health Record (EHR) system connecting major healthcare organizations such as hospitals, medical centers, and specialists. Blockchain technology, with its unique features, provides an ideal platform for developing a large‐scale electronic health record system. In this article, the authors introduce HealthChain, a novel blockchain‐based secure EHR system that integrates advanced encryption techniques, a robust consent management system, cross‐platform interoperability, and enhanced scalability. Unlike existing EHR systems, HealthChain allows patients to have comprehensive control over their health data, ensuring that access is strictly regulated according to their preferences. The experimental results demonstrate several significant improvements over traditional EHR systems. HealthChain reduces data access times by 30%, and its interoperability rate with various healthcare systems is 40% higher than that of other blockchain‐based EHR solutions. Security is greatly enhanced, with HealthChain experiencing 50% fewer data breaches due to its advanced encryption and smart contract‐based access controls. Moreover, patient satisfaction has increased by 35% as a result of better control and access to their health records. These findings highlight HealthChain as not only a feasible and effective solution for managing health records but also a significant advancement over existing systems.