Additional Measures Research Articles

Repeatability and agreement of multispectral refraction topography in school children before and after cycloplegia

BackgroundThe purpose of this study was to evaluate the repeatability and agreement of multispectral refraction topography (MRT) in measuring retinal refraction before and after cycloplegia in children. The results of this study will provide valuable insights into the accuracy and reliability of MRT as a tool for assessing retinal refraction in pediatric patients.MethodsChildren aged 7 to 18 years old were recruited for this prospective research. The central and peripheral retinal refraction was measured three times using multispectral refraction topography (MRT) before and after cycloplegia. The retinal deviation value (RDV) was used to describe the average peripheral refractive error of the retina. In addition, objective refraction (OR) and subjective refraction (SR) measurements were also performed.ResultsA total of 60 children with a mean age of 10.50 ± 1.81 years were enrolled. Before cycloplegia, all the central and peripheral retinal refraction parameters showed good repeatability with the lowest intraclass correlation coefficient (ICC) being 0.78 in the retinal deviation value from 45° eccentricity to 53° of the retina (RDV 45–53). After cycloplegia, the repeatability of MRT was significantly enhanced (lowest ICC = 0.91 in RDV-I). The 95% limits of agreement (LoA) of the central refraction and OR ranged from − 2.1 to 1.8 D before cycloplegia, and from − 1.69 to 0.27 D after cycloplegia. The 95% LoA of the central refraction and SR ranged from − 1.57 to 0.36 D after cycloplegia. All the 95% LoA demonstrated high agreement.ConclusionsThe MRT shows high agreement with autorefractometry and experienced optometrist in measuring central refraction. Additionally, the MRT provides good repeatable measurements of retinal peripheral refraction before and after cycloplegia in schoolchildren.

Tumor Necrosis Alpha (TNF-α) Antagonists Used in Chronic Inflammatory Rheumatic Diseases: Risks and their Minimization Measures.

Tumor necrosis factor alpha (TNF- α) inhibitors are widely employed for the management of chronic inflammatory rheumatism. However, their usage carries significant risks, including site and infusion reactions, serious infections, malignancy, heart failure autoimmune and demyelinating disorders. These risks are comprehensively outlined in risk management plans (RMPs) associated with these molecules. RMP provides information on the safety profile of a medicinal product as well as the measures that will be taken to minimize risks; these are known as risk minimization measures. These measures are divided into routine measures related to elements, such as the summary of product characteristics, labeling, pack size, package leaflet, or legal supply status of the product, while additional measures may include educational programs, including tools for healthcare providers and patients, controlled access or pregnancy prevention programs, among others. Additional measures can consist of one or more interventions that need to be implemented in a sustainable way in a defined target group, while respecting the timing and frequency of any intervention and procedures to reach the target population. An evaluation of the effectiveness of these measures is required to determine whether or not an intervention has been effective. This comprehensive review offers an in-depth exploration of the current treatment, uses, and associated risks of TNF-α inhibitors. Additionally, it provides a detailed account of risk minimization measures and risk management practices while shedding light on their real-world implementation and effectiveness.

6.M. Scientific session: Risk And Resilience Factors Of Mental Health During COVID: European Multi-country Data Findings

Abstract The COVID-19 pandemic significantly affected mental health. It worsened the mental health and well-being of those already vulnerable or exposed to excess pandemic-related stress. In addition, lockdowns and other measures created additional obstacles to mental health support access. In response, the European Commission funded the RESPOND project in 2020, aimed at enhancing the preparedness of mental health systems for pandemics and global crises. As part of the RESPOND project, (meta-)analyses were conducted on prospective cohort datasets, national health register data, and multi-country individual participant data (IPD). The aim was to examine whether there was a change in prevalence rates of mental health conditions (e.g., anxiety and depression) in the general adult population of the EU during, compared to before and in between, the COVID-19 pandemic waves. Analyses on risk factors (e.g. sociodemographic- and economic factors, severity of COVID-19 infection, (lack of) social activity and support, and loneliness) associated with psychological distress and mental disorders as well as resilience and well-being (coping strategies and core value orientations) in the general population or specific vulnerable groups were conducted as well. This workshop will feature five talks covering various aspects of the RESPOND epidemiological analyses. First, an introduction and rationale of the RESPOND study on short- and long-term impacts of the COVID-19 pandemic and outbreak response, will be provided. Subsequently, findings from the multi-country longitudinal COvid MEntal healTh Survey (COMET) on forecasting psychological distress throughout the pandemic will be presented. Second, findings from the French TEMPO (Trajectoires EpideMiologiques en POpulation) cohort and merged datasets will be presented indicating associations and interactions between socioeconomic factors, mental health, and public health behaviours during the pandemic. Third, using data of a large Belgian prospective cohort, fluctuations in risk of psychological distress across study waves and the factors associated with individual trajectories of psychological distress during the COVID-19 pandemic will be presented. Fourth, the risk of SARS-CoV-2 infection, severe COVID-19 outcomes, and death among individuals with various mental disorders, based on Spanish health records, will be presented with specific attention to sex differences. Finally, based on the IPD meta-analyses of 9 European cohorts, findings on stressor reactivity, resilience trajectories, and factors associated with resilient outcomes and vulnerability are presented. By presenting a selection of findings from large datasets together, we aim to facilitate discussions on critical topics such as vulnerability and resilience to mitigate mental health impacts in future public health crises. Key messages • Targeting specific individual vulnerabilities appears to be more effective in reducing the pandemics’ mental health impact than solely responding to pandemic-related fluctuations. • Research and harmonised data on vulnerability and resilience factors are essential for guiding the development of targeted interventions and support systems for vulnerable populations during crises.

A compact machine perfusion device for whole blood perfusion in isolated rat liver.

We established a compact machine perfusion system for whole blood perfusion of rat liver by making use of oxygenation filters as an artificial lung. Livers removed from rats were divided into Krebs-Henseleit (control), 50% blood (hemoglobin: 7g/dL), and whole blood (hemoglobin: 14g/dL) groups, then perfused (total perfusate volume: 25ml) with a small oxygenation filter at 37°C for 120min. Blood or perfusate was collected over time, and blood gas and blood cell were measured. In addition, bile volume and portal venous pressure measurements were taken. In all groups, the partial pressure of oxygen was controlled to approximately 400mmHg. Flow rates were maintained at approximately about 20-30ml/min according to liver size. Portal venous pressure was normal in the 50% blood and whole blood groups, while lower than the reference value in the Krebs-Henseleit group. Twice as much bile was produced in the 50% blood and whole blood groups relative with the Krebs-Henseleit group. We observed no differences in hemoglobin and red blood cell levels. Lactate levels were normal in the 50% blood and whole blood groups, but were elevated in the Krebs-Henseleit group. Our compact perfusion system using oxygenation filters was able to maintain rat liver function by perfusing a small amount of extracorporeal blood. This system is simple and stable, and may contribute to the future development of machine perfusion systems.

VBO3/V2O3@C heterogeneous anode material with high-specific-capacity and high-stability for lithium-ion batteries

The design and synthesis of high-performance anode materials is the key to further improve the performance of lithium-ion batteries. In this study, VBO3/V2O3 heterogeneous material with high crystallinity was prepared in vacuum quartz tubes by a facile high-temperature solid-phase method, and the electron transport capacity of VBO3/V2O3 was further improved by ball-milling with conductive carbon. As a result, the obtained VBO3/V2O3@C heterogeneous anode material delivers an initial discharge specific capacity of 927 mAh·g−1 and good cycling stability. Even at −20 °C, VBO3/V2O3@C still presents a discharge specific capacity of 432 mAh·g−1. In addition, ex-situ XRD and ex-situ XPS measurements reveal the conversion reaction and (de)intercalation reaction mechanism during charge/discharge. This work deepens the understanding of the structure-activity relationship of borate/oxide heterogeneous anode materials.

A "suicide" BCG strain provides enhanced immunogenicity and robust protection against Mycobacterium tuberculosis in macaques.

Intravenous (IV) BCG delivery provides robust protection against Mycobacterium tuberculosis (Mtb) in macaques but poses safety challenges. Here, we constructed two BCG strains (BCG-TetON-DL and BCG-TetOFF-DL) in which tetracyclines regulate two phage lysin operons. Once the lysins are expressed, these strains are killed in immunocompetent and immunocompromised mice yet induced similar immune responses and provided similar protection against Mtb challenge as wild type BCG. Lysin induction resulted in release of intracellular BCG antigens and enhanced cytokine production by macrophages. In macaques, cessation of doxycycline administration resulted in rapid elimination of BCG-TetOFF-DL. However, IV BCG-TetOFF-DL induced increased pulmonary CD4 T cell responses compared to WT BCG and provided robust protection against Mtb challenge, with sterilizing immunity in 6 of 8 macaques, compared to 2 of 8 macaques immunized with WT BCG. Thus, a "suicide" BCG strain provides an additional measure of safety when delivered intravenously and robust protection against Mtb infection.

Evaluation of the conformity of intensity-modulated radiation therapy and volumetric modulated arc therapy using AAPM TG 119 protocol.

The aim of this work was to evaluate the conformity of intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), and verify the accuracy of the planning and delivery system used in this work based on the AAPM TG-119 protocol. The Eclipse 13.6 treatment planning system (TPS) was used to plan the TG-119 test suite, which included four test cases: MultiTarget, Prostate, Head/Neck, and C-Shape for IMRT and VMAT techniques with 6 MV and 10 MV acceleration voltages. The results were assessed and discussed in terms of the TG-119 protocol and the results of previous studies. In addition, point dose and planar dose measurements were done using a semiflex ion chamber and an electronic portal imaging device (EPID), respectively. The planned doses of all test cases met the criteria of the TG-119 protocol, except those for the spinal cord of the C-Shape hard case. There were no significant differences between the treatment planning doses and the doses given in the TG-119 report, with p-values ranging from 0.974 to 1 (p > 0.05). Doses to the target volumes were similar in the IMRT and VMAT plans, but the organs at risk (OARs) doses were different depending on the test case. The planning results showed that IMRT is more conformal than VMAT in certain cases. For the point dose measurements, the confidence limit (CLpoint) of 0.030 and 0.021 were better than the corresponding values of 0.045 and 0.047 given in the TG-119 report for high-dose and low-dose areas, respectively. Regarding the planar dose measurements, the CLplanar value of 0.38 obtained in this work was lower than that given in the TG-119 report (12.4). It is concluded that the dosimetry measurements performed in this study showed better confidence limits than those provided in the TG 119 report. IMRT remains more conformal in certain circumstances than the more progressive VMAT. When selecting the method of delivering a dose to the patient, several factors must be considered, including the radiotherapy technique, energy, treatment site, and tumour geometry.

Accurate and Robust Wide‐Range Luminescent Microthermometer Based on ALD‐Encapsulated Ga2O3:Cr DBR Microcavities

AbstractThe high spatial resolution and contactless optical readout capabilities of luminescence thermometry offer significant advantages in numerous fields, including biomedicine, space exploration and optoelectronics. In addition, robust, reproducible, and accurate temperature measurements are essential in these areas. The ultra‐wide band gap semiconductor material Ga2O3 is a suitable host for optical sensing in harsh environments due to its high stability. In this work, the thermometric operation of Ga2O3:Cr‐based microcavities are evaluated. They are designed as follows: Ga2O3:Cr microwires are encapsulated in multilayers fabricated by atomic layer deposition (ALD), which act as both Bragg reflectors and protective layers for the thermometric sensor. Prior to the ALD encapsulation step, focused ion beam carved trenches at the microwire ends are necessary to accommodate the multilayer coating. The structural and optical properties of the devices are assessed experimentally, analytically and by simulations. The developed microthermometers can be easily calibrated using a cubic polynomial for the temperature‐dependent resonant peak position shift. A better than 0.5 °C temperature resolution and accuracy for temperatures above −80 °C is demonstrated. Additionally, the devices show robustness against excitation laser densities of at least 34 W mm−2, can operate at temperatures up to 600 °C and remain functional in liquids.

Ground-based MAX-DOAS observations of tropospheric formaldehyde and nitrogen dioxide: Insights into ozone formation sensitivity

Tropospheric profiles of HCHO, NO2, and O3 are important for analyzing ozone formation mechanism. In this study, ground-based multi-axis differential optical absorption spectroscopy (MAX-DOAS), light detection and ranging (LIDAR), and in-situ measurements were simultaneously performed to diagnose ozone formation sensitivity at the Heshan Observatory in the Pearl River Delta (PRD) region from September to end October 2019. The profiles of tropospheric HCHO and NO2 were retrieved from MAX-DOAS measurements using an optimal estimation method. The retrieved surface HCHO and NO2 results were validated with 2,4-dinitrophenylhydrazine (DNPH) and Thermo 42i measurements, and the correlation coefficients (R) were 0.78 and 0.81, respectively. The retrieved tropospheric vertical column densities (VCDs) of HCHO and NO2 were compared with TROPOMI measurements, and the correlation coefficients (R) were 0.68 and 0.87, respectively. In addition, MAX-DOAS and LIDAR measurements were combined to diagnose a typical planetary boundary layer (PBL) ozone pollution episode from September 28 to October 10, 2019; this episode was analyzed using HCHO/NO2 ratio as an indicator and was found to be dominated by the VOC-sensitive regime. Moreover, the regime transition of ozone formation sensitivity was calculated using the surface HCHO/NO2 ratio and increased O3 from the MAX-DOAS and Thermo 49i measurements, with transition thresholds of 1.43 and 1.78, respectively. Based on this definition, the ozone formation sensitivity at Heshan Observatory varied from VOC-sensitive (< 0.2 km and > 0.8 km) to NOx-sensitive (0.3–0.7 km) to VOC-NOx-sensitive (0.2–0.3 km and 0.7–0.8 km). The results improve our understanding of ozone formation sensitivity in the PRD region.

Effect of COVID-19 on paediatric TB service delivery and patients’ comfort receiving TB services in Cameroon and Kenya during COVID: a qualitative assessment

BackgroundThe outbreak of COVID-19 has caused a setback to the gains achieved in tuberculosis (TB) control by impairing TB diagnosis, delaying treatment initiation and aggravating TB deaths. This study explored...

Synthesis, Physical, and Magnetocaloric Properties of MgZn2-Type Gd2Al3Rh.

Gd2Al3Rh was synthesized from the elements using arc-melting techniques, along with subsequent annealing. The title compound adopts the hexagonal MgZn2 type structure (space group P63/mmc, hP12, Wyckoff sequence hfa) with the Gd atoms found on the Mg positions (4f), the Rh (2a) and Al (6h) atoms occupying the two Zn sites of the prototype. In addition, mixing of Rh and Al on both crystallographic positions is observed. The magnetic susceptibility and magnetization experiments were conducted indicating ferromagnetic ordering below the Curie temperature of TC = 51.3(1) K and very high magnetization of 6.96(1) μB at 3 K and 70 kOe. In addition, heat capacity and electrical resistivity measurements were conducted. The magnetocaloric properties of ferromagnetic Gd2Al3Rh have been determined by means of magnetization measurements. For a field change of ΔH = 0 → 50 kOe the magnetic entropy change equals ΔSMmax = -4.8 J kg-1 K-1, leading to a relative cooling power of RCP = 283 J kg-1 for the same field change. The adiabatic temperature change was estimated to be ΔTadmax = 2.1 K using the heat capacity data.

Body composition of extreme performers in the US Marine Corps

BackgroundThe creation of highly muscled and strong fighters is a recurring theme in human performance enhancement concepts. Physical readiness standards, intended to prevent obesity in the military, produce contradictory objectives,...

The likelihood of detecting abnormal karyotypes in fetuses with a single major anomaly or "soft" marker on ultrasonographic scanning.

Fetuses with abnormal karyotypes often exhibit distinctive ultrasonographic markers, including major anomalies and "soft" markers, indicating potential chromosomal issues. A crucial consideration arises when a single fetal anomaly is detected, raising the question of whether karyotyping is warranted, given the associated procedural risks. Our objective was to establish correlations between single fetal anomalies identified through ultrasound and chromosomal abnormalities. A cross-sectional study analyzed the karyotype of 1493 fetuses and detected a single ultrasonographic anomaly over a 16-year period. Karyotyping was performed using the standard karyotype technique. Moreover, data regarding the type of anomaly detected ultrasonographically, karyotype results, and outcomes following interventions were collected. Among other methods, the use of positive likelihood ratios (LR+) was used to evaluate the diagnostic accuracy of ultrasound compared to karyotyping. In total, an aberrant karyotype was identified in 99 fetuses (6.6%). This was most commonly observed in cases involving a "soft" marker, occurring in 27 out of 218 fetuses (12.4%). The most frequently detected aberrant karyotype resulted from aneuploidies (80.6% of cases), notably trisomy 21 (50.5%). "Soft" markers predicted chromosomal issues (LR+ = 1.9; OR = 2.4), and isolated polyhydramnios (LR+ = 1.54; OR = 1.6) showed significance in predicting fetal chromosomal aberrations. When assessing the necessity for karyotyping in fetuses with single major anomalies or "soft" markers, it is crucial to consider individual risks for chromosomopathies, including the LR+ of the detected marker. In cases where fetuses exhibit isolated anomalies with a normal karyotype, additional diagnostic measures, such as molecular cytogenetic and molecular genetics techniques, may become necessary.

Novel CoFe2O4/Bi2WO6 S-scheme heterostructure photocatalyst for effective and rapid visible-light-driven reduction of toxic nitrobenzene into industrially valuable aniline

Photocatalytic transformation of toxic nitrobenzene (NB) into highly industrially valuable aniline (AN) has emerged as a promising and prospective strategy. In this work, mesoporous S-scheme CoFe2O4/Bi2WO6 (CFO/BWO) heterostructure photocatalysts were constructed using a simple surfactant-aided sol–gel technique for visible-light-induced reduction of NB into AN. The characterization findings demonstrated the successful loading of p-type CFO nanoparticles (NPs) on a 2D n-type BWO framework, forming a p-n heterostructure. The as-synthesized heterostructure exhibited enhanced visible light absorbance, with superior photosensitivity up to 564.43 nm, which surpassed the optical absorbance of bare BWO by ∼ 1.26 times. In addition, PL and photoelectrical measurements demonstrated significantly enhanced separation and kinetics for light-generated charge carriers for the constructed CFO/BWO heterostructures compared to bare specimens. Therefore, the CFO/BWO heterostructure photocatalysts exhibited superior efficacy compared to pristine CFO and BWO. The NB was reduced into AN with a conversion efficacy of 100.0 % within 40.0 min on the 12.0 % CFO/BWO with a reaction rate constant of ca. 0.07616 min−1, which outperformed the pure CFO and BWO by more than 3.5- and 4.2-folds, separately. This optimized heterojunction exhibited excellent repeatability (98 %) during five cycles. This superb photocatalytic effectiveness can be pinned to the effective growth of the S-scheme heterostructure between CFO and BWO, substantially accelerating the transmission of carriers and their spatial separation by forming an inherent electric field and band curving at the interface. Our contribution offers novel and distinct hot points for the design of scalable and highly effective S-scheme heterostructures for multiple promising photocatalytic purposes.

Lateral extra-articular tenodesis does not enhance ACL graft healing, however, does reduce graft tunnel widening.

The study hypothesized that the addition of lateral extra-articular tenodesis (LEAT) in anterior cruciate ligament reconstruction (ACLR) had a significant effect on ACL graft healing. A total of 80 patients were divided into two cohorts matched for gender, age, body mass index, time from surgery to post-operative MRI and graft diameter. Forty patients underwent ACL reconstruction alone, while 40 underwent ACLR in addition to LEAT. Patients underwent a magnetic resonance imaging scan at 12 months post-surgery; tunnel apertures were measured using multiplanar reformation, graft healing was assessed using signal-to-noise quotient (SNQ) in three regions of interest and finally graft maturity and integration were classified using the Howell and Ge scale, respectively. In addition, clinical evaluation and patient-reported outcome measures were collected. The mean femoral tunnel widening at 12 months post-surgery was 39.8 ± 14.0% in the ACLR + LEAT group and 55.2 ± 12.7% in the ACLR alone group (p < 0.05). The mean tibial tunnel widening was 29.3 ± 12.7% in the ACLR + LEAT group and 44.4 ± 12.1% in the ACLR group (p < 0.05). The mean adjusted graft SNQ was 9.0 ± 14.9 in the ACLR + LEAT group and 9.5 ± 11.4 in the ACLR group (n.s.). At 1 year post-operatively, we noted significantly less femoral and tibial tunnel widening in the ACLR + LEAT group. LEAT did not result in a statistically significant effect on graft healing. Level III.

Type of pectin affects the functionality of potato protein-pectin conjugates in emulsions

This study investigated the effect of the molecular structure of pectin on conjugate formation and its functionality in plant protein-based emulsions. For this purpose, high-methoxylated, low-methoxylated, amidated citrus pectin and their mixtures with potato protein were vacuum-dried at defined process conditions. The change in free amino groups, colour and molecular weight distribution assessed conjugation. The side reaction, such as pectin degradation, was monitored by the degree of methoxylation, galacturonic acid content and intrinsic viscosity. In addition, FT-IR and hydrophobicity measurements were performed to determine the changes in chemical structure due to the occurring reactions. The ζ-potential, solubility and oil droplet size reflected the functionality of the conjugated samples.The results confirm that, apart from the conjugation of protein and pectin, where the most significant decrease in free amino groups was obtained with an increasing degree of methoxylation or presence of amide groups, undesirable degradation of pectin occurring, resulting in a broad molecular weight distribution of the conjugate samples. The conjugate formation was the highest with amidated pectin. The FT-IR measurements confirmed the formation of Maillard conjugates. The FT-IR spectra showed a decrease in the intensity signals of amide I and amide II and the formation of new C–N bond maxima. In addition, the conjugation caused the shift of the protein's isoelectric point to the acidic environment, resulting in higher solubility and improved emulsion stability at the isoelectric point of the protein.Regarding emulsion stability, the conjugates with amidated pectin performed best and achieved the narrowest oil droplet size distribution over a wider pH range. Emulsion-stabilising properties of conjugates with high- and low-methoxylated pectin differed only slightly. To better understand the underlying mechanisms for emulsion stabilisation, future research will focus on the interfacial properties of the conjugates as determined by interfacial shear rheology and pendant drop analysis.

Photoelectrical performances of semiconductor-based devices having CoFe and CoFeNi magnetic interlayers

This study was designed to examine the photoelectric device performances of cobalt-iron (CoFe) and cobalt-iron-nickel (CoFeNi) materials with good magnetic properties, specifically to investigate the effect of the Ni element on the electrical properties. In this context, Al/CoFe/p-Si and Al/CoFeNi/p-Si devices were produced by coating both materials between the semiconductor and the metal using the radio frequency (RF) sputtering method. First of all, to investigate the structural properties of the coated films, the content analysis was carried out by x-ray diffraction (XRD) analysis. To determine the photoelectrical properties of the produced devices, current–voltage and transient photocurrent measurements were performed and analyzed under different light intensities. While the ideality factor (barrier height) values of the devices produced using CoFe and CoFeNi materials were found to be 11.45 (0.487 eV) and 9.86 (0.513 eV), respectively, in the dark, they were obtained as 13.29 (0.446 eV) and 11.02 (0.484 eV) under 100 mW cm−2 illumination. It was determined that both devices are sensitive to light, with the sensitivity of the device with the CoFeNi interlayer being much higher. In addition, photocapacitance and photoconductivity measurements were carried out to examine the photocapacitor performance of the devices. As a result of the investigations, both current–voltage, photocurrent, and photo-capacitance/conductivity measurements showed that the device with the CoFeNi interface layer showed better performance than the device with the CoFe interface. Therefore, it has been determined that the Ni element has a positive effect on electrical properties. The results obtained show that the prepared materials and produced devices can be used in photovoltaic applications.

Power generation characteristics and optimum alcohol concentration in bio-direct alcohol fuel cell using chitin family electrolyte

Direct alcohol fuel cells (DAFCs) have the potential to become the next-generation portable energy device. However, the development of DAFC requires the explore new electrolytes without fuel crossover. In this study, DAFC with bio-electrolyte have been fabricated and their characteristics have been investigated. Ethanol impermeability measurements revealed that the crossover of ethanol in the chitin and chitosan electrolytes is extremely low. This result indicates that the chitin family electrolyte has the potential of DEFC electrolytes. Furthermore, DAFCs using the chitin electrolyte have been investigated for various alcohol fuels (methanol, ethanol, 1-propanol, and 1-butanol fuels), and the optimum fuel concentrations to achieve the maximum power density in these DAFCs have been determined. In addition, these results and viscosity measurements clarify the optimum alcohol fuel concentration can be obtained by adding the water molecules required for the proton generating reaction to the water molecules required to stabilize alcohol in water.

Implementation of the electronic health record in the German healthcare system: an assessment of the current status and future development perspectives considering the potentials of health data utilisation by representatives of different stakeholder groups.

The digitalisation of the German healthcare system enables a wide range of opportunities to utilize healthcare data. The implementation of the EHR in January 2021 was a significant step, but compared to other European countries, the implementation of the EHR in the German healthcare system is still at an early stage. The aim of this paper is to characterise the structural factors relating to the adoption of the EHR in more detail from the perspective of representatives of stakeholders working in the German healthcare system and to identify existing barriers to implementation and the need for change. Qualitative expert interviews were conducted with one representative from each of the stakeholder groups health insurance, pharmacies, healthcare research, EHR development and panel doctors. The interviews with the various stakeholders revealed that the implementation process of the EHR is being delayed by a lack of a viable basis for decision-making, existing conflicts of interest and insufficient consideration of the needs of patients and service providers, among other things. The current status of EHR implementation is due to deficiency in legal regulations as well as structural problems and the timing of the introduction. For instance, the access rights of various stakeholders to the EHR data and the procedure in the event of a technical failure of the telematics infrastructure are remain unclear. In addition, insufficient information and communication measures have not led to the desired acceptance of EHR use among patients and service providers.

Development of Trade-Econimic Relations between Azerbaijan-EU Countries in the Field of Natural Gas Supply

The research work is devoted to the analysis of mutual relations between the European Union and the Republic of Azerbaijan in the field of gas supply. In addition, the short-term and long-term measures implemented by the European Union countries in response to the changes in the political arena in recent times were reviewed. The relevance of the topic is related to the opening of economic and transport communications after the Second Karabakh war. The region is an important link between Asia and Europe, and Azerbaijan is an important energy partner of the EU as an exporter of oil and natural gas. In addition, considering the existing gas production potential of the Republic of Azerbaijan, the development of this field is a very important field for the country’s economy. The article focuses on the directions of cooperation of the parties in the matter of production and transit of energy resources. The main result is that it is designed as a framework that allows the two parties to develop their relations in the form of mutually beneficial projects based on market principles.