Multidisciplinary Perspective Research Articles

The Evolution in Non-Alcoholic Fatty Liver Disease Patients’ Profile and the Associated Sustainable Challenges: A Multidisciplinary Perspective

The prevalence and incidence of NAFLD is rising due to the obesity pandemic, caused by the widespread availability of ultra-processed foods and the decrease of physical activity. Factors such as socioeconomic status (SES), ethnicity and geographical location are associated with NAFLD, with lower SES correlating with higher incidence, particularly in regions like America or Europe. Beside the quality of food, the quantity also plays a crucial role. The World Health Organization (WHO) recommends a Mediterranean diet with a balanced energy intake. Since no hard medical treatment is available for NAFLD, lifestyle adjustments are key. Patient empowerment by providing relevant information and co-ownership of the therapy will increase the implementation rate and enhance the quality of medical follow-up and medication adherence, as studies report a good adherence to medication among patients who are well-aware of the severity of their disease. Regarding sustainability, patients with NAFLD have a high load of ambulatory follow-up, which, since the COVID-19 pandemic, can be partially provided by teleconsulting. Both patients’ lifestyle modifications and healthcare practitioners’ therapeutical strategy can decrease the carbon footprint.

Cybersecurity for Sustainable Smart Healthcare: State of the Art, Taxonomy, Mechanisms, and Essential Roles

Cutting-edge technologies have been widely employed in healthcare delivery, resulting in transformative advances and promising enhanced patient care, operational efficiency, and resource usage. However, the proliferation of networked devices and data-driven systems has created new cybersecurity threats that jeopardize the integrity, confidentiality, and availability of critical healthcare data. This review paper offers a comprehensive evaluation of the current state of cybersecurity in the context of smart healthcare, presenting a structured taxonomy of its existing cyber threats, mechanisms and essential roles. This study explored cybersecurity and smart healthcare systems (SHSs). It identified and discussed the most pressing cyber threats and attacks that SHSs face, including fake base stations, medjacking, and Sybil attacks. This study examined the security measures deployed to combat cyber threats and attacks in SHSs. These measures include cryptographic-based techniques, digital watermarking, digital steganography, and many others. Patient data protection, the prevention of data breaches, and the maintenance of SHS integrity and availability are some of the roles of cybersecurity in ensuring sustainable smart healthcare. The long-term viability of smart healthcare depends on the constant assessment of cyber risks that harm healthcare providers, patients, and professionals. This review aims to inform policymakers, healthcare practitioners, and technology stakeholders about the critical imperatives and best practices for fostering a secure and resilient smart healthcare ecosystem by synthesizing insights from multidisciplinary perspectives, such as cybersecurity, healthcare management, and sustainability research. Understanding the most recent cybersecurity measures is critical for controlling escalating cyber threats and attacks on SHSs and networks and encouraging intelligent healthcare delivery.

Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies.

Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies. In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated. The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p: .001), while xerosis cutis was significantly more prevalent in patients remitted (p: .001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidismand galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values: .024, .034and .027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p: .035). Cutaneous androgenization findings such as skin tag, seborrhoea, acneand acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier.

The framing of authority in the ACRL framework on information literacy: multidisciplinary perspectives on truth, authority, expertise and belief

PurposeThis paper engages multidisciplinary perspectives on truth, authority, expertise and belief to unpack and better understand the underlying epistemology and implications of the ACRL Frame “authority is constructed and contextual.”Design/methodology/approachFollowing an overview of the issues confronting us in a “post-truth world,” the paper reviews critiques of the ACRL Frame “authority is constructed and contextual” and examines the related concepts of truth, authority, expertise and belief from multidisciplinary perspectives.FindingsWhile the Frame acknowledges the limitations and biases of current scholarly publishing and implicitly supports social justice, it runs the danger of promoting relativism and is ambiguous regarding the relationships between expertise and authority. The critical concepts of truth and belief are conspicuously absent. Engaging a critical discussion and understanding of these concepts is a valuable contribution to information literacy.Originality/valueThis paper offers an important and accessible analysis of the frame “authority is constructed and contextual” and its underlying concepts. It moves beyond the library literature to include multidisciplinary perspectives and will require the engagement of the wider library community to promote discussion of the underlying epistemology and links between the construction of authority and truth, expertise and belief. In particular, the discussion of the construction of belief and the difference between judgments of fact and judgments of value offers important additions to the library literature.

Comment on ‘A Systematic Review of Non-Invasive Ventilation (NIV) and Cranio-Facial Fractures: A Multi-Disciplinary Perspective and Recommendations for Management’

Comment on ‘A Systematic Review of Non-Invasive Ventilation (NIV) and Cranio-Facial Fractures: A Multi-Disciplinary Perspective and Recommendations for Management’

In reply to the Letter to Editor regarding “A Systematic Review of Non-Invasive Ventilation (NIV) and Cranio-Facial Fractures: A Multi-Disciplinary Perspective and Recommendations for Management”

In reply to the Letter to Editor regarding “A Systematic Review of Non-Invasive Ventilation (NIV) and Cranio-Facial Fractures: A Multi-Disciplinary Perspective and Recommendations for Management”

Exposomics in practice: Multidisciplinary perspectives on environmental health and risk assessment.

Exposomics in practice: Multidisciplinary perspectives on environmental health and risk assessment.

Multi-Disciplinary Expert Perspective on the Management of Type 2 Inflammation-Driven Severe CRSwNP: A Brief Overview of Pathophysiology and Recent Clinical Insights.

Severe chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disabling airway disease that significantly impacts patients' lives through the severity of symptoms, the need for long-term medical treatment and the high risk of recurrence post-surgery. Biological agents targeting type 2 immune responses underlying the pathogenesis of CRSwNP have shown effectiveness in reducing polyp size and eosinophilic infiltrate, and in decreasing the need for additional sinus surgeries. However, despite recent progress in understanding and treating the disease, type 2 inflammation-driven severe CRSwNP continues to pose challenges to clinical management due to several factors such as persistent inflammation, polyp recurrence, heterogeneity of disease, and comorbidities. This article presents the findings of a scientific discussion involving a panel of ear, nose and throat (ENT) specialists and pulmonologists across Sweden and Finland. The discussion aimed to explore current management practices for type 2 inflammation-driven severe CRSwNP in the Nordic region. The main topics examined encompassed screening and referral, measurements of disease control, treatment goals, and future perspectives. The experts emphasized the importance of a collaborative approach in the management of this challenging patient population. The discussion also revealed a need to broaden treatment options for patients with type 2 inflammation-driven CRSwNP and comorbid conditions with shared type 2 pathophysiology. In light of the supporting evidence, a shift in the disease model from the presence of polyps to that of type 2 inflammation may be warranted. Overall, this discussion provides valuable insights for the scientific community and can potentially guide the future management of CRSwNP.

Gender mainstreaming in sweetpotato breeding and dissemination in Ghana and Malawi.

Gender responsiveness in breeding programs to meet client and end user preferences for crops is essential. This case study analyzes the implementation experience of gender-responsive breeding and variety dissemination in Malawi and Ghana, focusing on good practices and challenges encountered. In Malawi, a training-of-trainers approach was employed to share knowledge among trained farmers. In Ghana, a research study was conducted to identify gender-based preferences for sweetpotato to define breeding objectives. The participation of social scientists, food scientists, and sweetpotato breeders in the GREAT (Gender Researchers Equipped for Agricultural Transformation) team provided a multidisciplinary perspective, addressing questions and responses in the field. Research efforts were strengthened by focusing on food quality through the establishment of an analytical laboratory for rapid evaluation of nutrition and food quality, including sugars. This helped develop sensory analytical capacity to better understand quality attributes and market segments, guiding breeding and improving market opportunities for women. Breeding outcomes resulting from gender inclusion led to the release of some sweetpotato varieties meeting end user and consumer preferences, as well as adoption of OFSP varieties by men and women. Other good practices for gender inclusion and responsiveness include providing funds for gender-based research and activities, engaging gender specialists and social scientists in trans-disciplinary teams, designing program activities with gender considerations, and incorporating traits in seed multiplication and dissemination decisions. Application of these gender inclusion practices resulted in adoption and development of acceptable sweetpotato varieties.

The data economy

This article analyzes the evolution of capitalism under the logic of the data economy, the result of the transition to a paradigm dominated by knowledge, technology and design. The data economy, driven by Artificial Intelligence technologies, opens up possibilities for digital businesses. The impact of digitalization, technology on business models and global socioeconomic dynamics are discussed, with special emphasis on the role of Big Techs. A broad bibliographical review, from a multidisciplinary perspective, allows us to analyze how hyperconnectivity and emerging technologies are restructuring interactions and production processes, transferring the centrality of capital from the physical to the immaterial. The article also addresses the ethical and regulatory implications of this scenario, highlighting the need for effective techno-regulation. In the context of Brazil, a fertile environment for startups and fintechs can be identified, although limited by structural challenges, highlighting the importance of public policies that promote innovation and technological education. It concludes with a reflection on the need for more solid and equitable data governance, aligning technological advancement with the protection of rights.

Non-invasive methodology for the ecotoxicological sampling of anatids in urban and peri-urban areas

Urban waterbirds serve as crucial bioindicators for evaluating environmental pollution in urban areas, necessitating a focus on tailored non-invasive ecotoxicological biomonitoring methods. This paper adopts a multidisciplinary perspective to underscore the pivotal role of biomonitoring in gauging environmental quality and identifying threats. Emphasizing the versatility and ease of sampling urban birds, we highlight their correlation with human exposure to pollutants, alongside the significant role of wetlands, particularly Ramsar sites, in conservation endeavors and as habitats for migratory birds. Additionally, the paper delves into the relevance of urban birds in monitoring pollutants, showcasing their efficacy in reflecting urbanization or pollution gradients. Proposed non-invasive biomonitoring techniques, including feather and feces analysis, offer practical means to assess heavy metal, microplastics, and other pollutant concentrations without harming the avian species. A comprehensive methodology proposal for waterbird sampling, encompassing pre-sampling activities, basic and specialized laboratory characterization, and data collection in a Central Mexican Ramsar site, is detailed as examples and experiences into these considerations. Concluding insights underscore the impact of emerging pollutants, such as microplastics, on waterbird health and nutritional status, advocating for multivariate statistical analysis to elucidate correlations between morphological characteristics, elemental composition, and pollutant presence.

Primary Cardiac Intimal Sarcoma: Multi-Layered Strategy and Core Role of MDM2 Amplification/Co-Amplification and MDM2 Immunostaining.

Primary cardiac tumours are relatively uncommon (75% are benign). Across the other 25%, representing malignant neoplasia, sarcomas account for 75-95%, and primary cardiac intimal sarcoma (PCIS) is one of the rarest findings. We aimed to present a comprehensive review and practical considerations from a multidisciplinary perspective with regard to the most recent published data in the specific domain of PCIS. We covered the issues of awareness amid daily practice clinical presentation to ultra-qualified management in order to achieve an adequate diagnosis and prompt intervention, also emphasizing the core role of MDM2 immunostaining and MDM2 genetic analysis. An additional base for practical points was provided by a novel on-point clinical vignette with MDM2-positive status. According to our methods (PubMed database search of full-length, English publications from January 2021 to March 2023), we identified three studies and 23 single case reports represented by 22 adults (male-to-female ratio of 1.2; male population with an average age of 53.75 years, range: 35-81; woman mean age of 55.5 years, range: 34-70) and a 4-year-old child. The tumour-related clinical picture was recognized in a matter of one day to ten months on first admission. These non-specific data (with a very low index of suspicion) included heart failure at least NYHA class II, mitral regurgitation and pulmonary hypertension, acute myocardial infarction, ischemic stroke, obstructive shock, and paroxysmal atrial fibrillation. Awareness might come from other complaints such as (most common) dyspnoea, palpitation, chest pressure, cough, asthenia, sudden fatigue, weakness, malaise, anorexia, weight loss, headache, hyperhidrosis, night sweats, and epigastric pain. Two individuals were initially misdiagnosed as having endocarditis. A history of prior treated non-cardiac malignancy was registered in 3/23 subjects. Distant metastasis as the first step of detection (n = 2/23; specifically, brain and intestinal) or during follow-up (n = 6/23; namely, intestinal, brain and bone, in two cases for each, and adrenal) required additional imagery tools (26% of the patients had distant metastasis). Transoesophageal echocardiography, computed tomography (CT), magnetic resonance imagery, and even 18F-FDG positronic emission tomography-CT (which shows hypermetabolic lesions in PCIS) represent the basis of multimodal tools of investigation. Tumour size varied from 3 cm to ≥9 cm (average largest diameter of 5.5 cm). The most frequent sites were the left atrium followed by the right ventricle and the right atrium. Post-operatory histological confirmation was provided in 20/23 cases and, upon tumour biopsy, in 3/23 of them. The post-surgery maximum free-disease interval was 8 years, the fatal outcome was at the earliest two weeks since initial admission. MDM2 analysis was provided in 7/23 subjects in terms of MDM2-positive status (two out of three subjects) at immunohistochemistry and MDM2 amplification (four out of five subjects) at genetic analysis. Additionally, another three studies addressed PCISs, and two of them offered specific MDM2/MDM2 assays (n = 35 patients with PCISs); among the provided data, we mention that one cohort (n = 20) identified a rate of 55% with regard to MDM2 amplification in intimal sarcomas, and this correlated with a myxoid pattern; another cohort (n = 15) showed that MDM2-positive had a better prognostic than MDM2-negative immunostaining. To summarize, MDM2 amplification and co-amplification, for example, with MDM4, CDK4, HMGA3, CCND3, PDGFRA, TERT, KIT, CCND3, and HDAC9, might improve the diagnosis of PCIS in addition to MDM2 immunostaining since 10-20% of these tumours are MDM2-negative. Further studies are necessary to highlight MDM2 applicability as a prognostic factor and as an element to be taken into account amid multi-layered management in an otherwise very aggressive malignancy.

A bibliometric analysis of two-decade research efforts in turning natural gas hydrates into energy

As a promising energy source, natural gas hydrate production has ignited scientific research in multidisciplinary fields globally, generating a vast amount of literature. A review in multidisciplinary and international perspectives will contribute to a comprehensive understanding about this field. This paper maps the two-decade spatiotemporal landscapes of scientific research on natural gas hydrate (NGH) production with a bibliometric analysis. The landscapes suggested that the study on gas hydrate production covers multiple research fields and international collaboration. Research topics on NGH production experienced three stages involving resource exploration, productivity enhancement, and environmental issues. An analysis of the research with the most activity showed that Energy & Fuel, Chemical Engineering, and Multidisciplinary Geoscience were the most active, with Thermodynamics, Geological Engineering, Ocean Engineering, and Civil Engineering experiencing fast growth. In terms of the landscape of international collaboration, the United States and European countries were the main contributors in the early stage, followed by China after 2008. The breakthrough of the commercial production threshold relies on the international collaboration and the multidisciplinary research among Thermodynamics, Geological Engineering, Ocean Engineering and Civil Engineering to characterize the energy consumption, gas production rate, and reservoir stability.

Assessment and treatment of reflux-like symptoms in the community: a multidisciplinary perspective.

Assessment and treatment of reflux-like symptoms in the community: a multidisciplinary perspective.

Historical, cultural, and social significance of ancient hydraulic wheat mills: A multidisciplinary approach in the municipality of Matanza (Colombia)

This work focuses on the historical, cultural, and social significance of ancient hydraulic wheat mills in the Municipality of Matanza (Colombia) from a multidisciplinary perspective. It begins by providing historical context about wheat and its introduction to the Americas, particularly in Colombia, as well as discussing the relevance of mills in wheat flour production and their role in rural and urban society. We emphasize the historical and technological significance of the ancient hydraulic mills in Matanza, which harnessed the power of water to grind grains and produce wheat flour. Additionally, the document explores the general characteristics of the millstones used in these devices, including their shape, dimensions, and function in the milling process. Next, it is proposed that the millstones were made from intrusive igneous rocks from the Triassic-Jurassic magmatism and biotitic and possibly amphibolic gneisses belonging to the Proterozoic Bucaramanga Gneiss. Finally, this article addresses the importance of preserving the cultural heritage related to wheat production and artisanal milling in Matanza. It underscores the need to conserve this cultural legacy, revitalize wheat production in the region, and promote tourism and environmental education related to the geological and cultural heritage of the area.

Perspectives in the validation of DEFASE: a paradigm shift in food allergy management.

To explore the groundbreaking international consensus on the DEFASE (DEfinition of Food Allergy Severity) project as a revolutionary grading system for IgE-mediated food allergy severity. Against the backdrop of the growing public health challenge posed by food allergy, this article delves into the importance of validating and implementing DEFASE in real-world clinical settings. With new therapeutic options available for food allergy, including biologics alongside immunotherapy, it is urgent to properly support clinical decision-making in the management of the disease. The DEFASE score is the first international consensus-based grading system of severity associated with food allergy as a whole disease embracing multidisciplinary perspectives from different stakeholders involved. In its current version, this comprehensive scoring system has been developed to be used in research settings. The review emphasizes the potential impact of DEFASE on patient outcomes, healthcare management, and resource allocation, underscoring its significance for the allergy scientific community. Future research should focus on internal and external validation of the scoring system, targeting these models to various food allergenic sources, populations, and settings.

Wild birds and the ecology of antimicrobial resistance: an approach to monitoring

AbstractTackling the global threat of antimicrobial resistance (AMR) requires joint efforts according to the principles of the One Health approach. In this context, wildlife, and especially wild birds, are recognized as an important bridge between environment, humans and livestock in perpetuating AMR. Over the last decades, important progress has been made in understanding the role of wild birds as carriers of antibiotic‐resistant bacteria and their genes (ARGs) within ecosystems; however, there are still many knowledge gaps regarding transmission sources and routes. This commentary summarizes studies from recent years focusing on AMR in wild birds, highlighting the most frequently found zoonotic bacteria harboring ARGs and the possible exchange scenarios between humans, livestock, and wild birds. We emphasize the need to standardize and optimize a wild bird monitoring approach for AMR surveillance that includes non‐invasive sampling methods, culture‐independent techniques for identification of ARGs, database integration and implementation, and machine learning technology. This multidisciplinary perspective, which could involve veterinarians, biologists, ornithologists, conservationists, and managers, may represent part of the solution, not only for wildlife conservation but also for global health, considering that the goal is to reverse the route of AMR.

China's criminal justice reforms against youth violence: punishment with leniency?

ABSTRACT The issue of addressing youth violence through criminal justice reform has been extensively studied in the Western world, particularly the United States. However, research investigating similar efforts in China has been relatively limited, with few normative studies being the exception. This paper presents China's approach to tackling youth violence by examining the nation's criminal justice reform initiatives in recent years. Specifically, this study examines China's implementation of a lower age of criminal responsibility and the Supreme People's Procuratorate's system for approving the prosecution of juvenile offenders. These measures do not necessarily contravene the best interests of children. Rather, they are implemented to address public concerns and to prevent unjust outcomes in individual cases. Furthermore, China's criminal justice system continues to emphasize the importance of forgiveness and care for young offenders. Thus, it is crucial to approach the issue of youth violence from a multidisciplinary perspective, incorporating considerations of pedagogy, criminology, and psychology, in addition to legal measures.

Resources to Support Decision-Making Regarding End-of-Life Nutrition Care in Long-Term Care: A Scoping Review.

Resources are needed to aid healthcare providers and families in making end-of-life nutrition care decisions for residents living in long-term care settings. This scoping review aimed to explore what is reported in the literature about resources to support decision-making at the end of life in long-term care. Four databases were searched for research published from 2003 to June 2023. Articles included peer-reviewed human studies published in the English language that reported resources to support decision-making about end-of-life nutrition in long-term care settings. In total, 15 articles were included. Thematic analysis of the articles generated five themes: conversations about care, evidence-based decision-making, a need for multidisciplinary perspectives, honouring residents' goals of care, and cultural considerations for adapting resources. Multidisciplinary care teams supporting residents and their families during the end of life can benefit from resources to support discussion and facilitate decision-making.

Research on Pathology Information Management of Educational Architectural Heritage Based on Digital Technology: The Case of James Jackson Gymnasium

Rapid advances in technology have led to an increasing demand for this type of information in the field of cultural heritage and architectural conservation. The article aims to use digital technology to obtain, record, store, and display accurate and intuitive information about architectural heritage for daily management and repair of that heritage. This article conducts a comprehensive and in-depth study of the pathology information from the James Jackson Gymnasium, a typical case of the modern educational architectural heritage of Wuhan. Research contents include obtaining point cloud data through 3D scanning, constructing Building Information Modeling (BIM) 3D models and pathological information models to visualize the affected parts, using the Monument Damage Diagnostic System (MDDS) to establish a pathological information map management system, using virtual simulation technology and digital repair technology to diagnose and repair the affected parts, and establishing a systematic architectural pathology information database to explore the causes of architectural pathology from a multidisciplinary perspective. The authors aim to gradually promote this method and build a systematic pathological information database of architectural heritage. This utilizes the sharing characteristics of information technology to transcend the barriers of time and space and provide important support for heritage protection and pathology management. The Architectural Pathology Information Management System is proposed as an innovative solution to promote the sustainable conservation of architectural heritage through digital technology.