Multidisciplinary Survey Research Articles

Evaluating Blinatumomab Treatment Adoption in Varied Resource Settings Using the RE-AIM Framework

Background Blinatumomab is a targeted immunotherapy for B-ALL. Widespread adoption of this evidence-based intervention in varied resource settings has been limited due to cost, commercial access, and barriers including institutional capacity and medication complexity. We used implementation science frameworks to facilitate and study the translation of blinatumomab into hospitals in lower-resource settings in partnership with a drug-donation program. After 2 years of collaboration, we applied the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework to assess implementation processes and effectiveness outcomes in 2 pilot centers. Methods As a component of a larger hybrid effectiveness-implementation type 2 study, we applied RE-AIM methodology retrospectively to examine data for one hospital in India and one in Pakistan. Quantitative and qualitative data were abstracted from meeting notes, readiness assessments, a 54-question implementation survey based on validated measures, and clinical team observations. Local physicians overseeing the patient treatment with blinatumomab collected de-identified clinical data from routine care from 20 patients. Infusion and 6-month follow-up data were available for 18 and 16 patients, respectively. Patient characteristics were summarized using descriptive statistics. Clinical data were analyzed in aggregate to report real-world effectiveness, and other data were integrated to report on the five RE-AIM domains. Results Overall reach was determined by comparing proportion of annual patient requests, predicted number of eligible patients, and characteristics of patients who received blinatumomab. Reach varied by site from 48%-110%. Participants were representative with a median age of 8 years (IQR 6.23) and 55% were female. MRD-positive disease was the primary indication for receiving blinatumomab (60%, n=12). Regarding effectiveness, 73.3% of patients achieved remission after cycle 1, and 9 patients (60%) proceeded to hematopoietic stem cell transplant after receiving blinatumomab. At six months, 81.3% of patients were alive, 1 had died, and 2 were lost to follow-up. Adoption at the staff level was measured based on engagement of provider roles in training and feedback as measured by completion of a multidisciplinary implementation survey. While nursing was engaged in training at both sites, there was a notable lack of nursing-specific input to the implementation survey, identifying a key opportunity to improve engagement strategies. Early-indicator implementation outcomes were assessed by local multidisciplinary teams demonstrated high feasibility (aggregate mean 4.64/5, SD 0.35), acceptability (aggregate mean 4.71/5, SD 0.39), and appropriateness (aggregate mean 4.86/5, SD 0.24) of blinatumomab at their institution. Site-specific modifications to improve implementation included: modifications to the bag change schedule due to the lack of availability of medical supplies (bag sizes, pump cassette), and nursing ratios were temporarily reduced to provide closer monitoring for patients receiving blinatumomab. Thematic analysis revealed that maintenance is supported by the perceived relative advantage of blinatumomab vs. traditional chemotherapy, with physicians appreciating the opportunity for improved quality of life for patients and noting that also “the treating teams and the parents are happy,” highlighting a potentially positive impact on the physician and family wellbeing. One challenge for program maintenance is the cost of associated medical supplies such as medication infusion tubing and filters and the need for prolonged hospitalization due to barriers related to transportation and the availability of outpatient and emergency services. This will inform future strategies, such as implementation mapping, to determine how to address these site and resource-specific barriers. Conclusion Successful implementation and collaboration with local multidisciplinary teams is a critical predecessor to establishing effectiveness and improving future global access to complex, novel therapies such as blinatumomab. Systematic application of established implementation measures, such as RE-AIM, can improve reporting of rich implementation data and inform strategies to improve the long-term adoption and maintenance of these effective therapies in the real world.

Exploring environmental and biological drivers of cetacean occurrence in the cross-border region of the Malin Shelf using data from a European fishery survey

Irish and Scottish waters are important habitats for cetaceans in Europe. Yet, little data is available for the region of the Malin Shelf, north of Ireland. Despite a rich species diversity, relative cetacean abundance appears low compared to hotspots documented west of Scotland and Ireland. Whether this perceived low prevalence accurately portrays an ecological discontinuity or arises from a lack of published results and low survey effort in that transborder area remains unclear. Here, we used sighting records from a multi-disciplinary fisheries survey, the Western European Shelf Pelagic Acoustic Survey (WESPAS), to explore cetacean habitat preferences over the Malin and Hebridean shelves. Northern minke whale and common dolphin occurrence was modelled within a Bayesian Additive Regression Trees (BART) framework, against selected environmental and biological variables. No correlation was observed between cetacean presence and in-situ prey biomass. Minke whales distribution was better explained by oceanography, notably proxies for frontal activity, and primary productivity. Common dolphins similarly showed preferences for shelf waters within 5-25km of fronts, but also affinities for fine substrates. Favourable habitats identified by the models were consistent with literature around the Hebrides and shed light on potentially important areas along the Islay front and north of Donegal, so far unreported due to data deficiency. Results will contribute towards informing future monitoring, strategic management and conservation efforts in this cross-border region.

Management of severe acute pulmonary oedema, from expert guidelines to bedside strategies: multidisciplinary survey involving 1048 physicians

Abstract Introduction Current recommendations regarding the management of severe acute pulmonary oedema (APE) have low levels of recommendation and/or evidence (LOR/E) that may lead to high heterogeneity in clinical practice 1–3. We hypothesized that practice may diverge from guidelines and differ according to medical specialty and level of expertise. The objective of this survey was to evaluate the clinical management of 4 phenotypes of APE by physicians of 3 specialties and their divergence from guidelines. Methods Four vignettes were designed by a scientific committee representing the French scientific societies of cardiology, emergency medicine, and intensive care (Table 1). In addition, 20 experts in the field of APE care were enrolled. Target participants and designated experts were French physicians of the 3 specialties. From 06/2022 to 09/2022, the vignettes were submitted to the physicians and experts using an open online survey. Results Among the 1048 respondents, 781 completed the 4 cases whereas all 20 experts completed the whole survey (Table 1). Accordance with international guidelines was heterogenous (Table 2). Compliance with SpO2<90% threshold for O2 administration (LOE/R: I-C 1): 22% of physicians and 53% of experts were in accordance with the guidelines. Initiation of non-invasive ventilation (NIV) for respiratory distress (LOE/R: IIa-B 1): concordance was 54% and 93%, respectively. Intubation for progressive respiratory failure despite O2 or NIV (LOE/R: I-C 1): in case of pre-hospital NSTEMI worsening despite NIV and medications, compliance was 55% among physicians and 85% among experts. In case of STEMI with worsening respiratory failure, compliance was respectively 44% and 70%. Intravenous (iv) loop diuretics indications and choice of a loop diuretic (LOE/R: I-C 1): 91% of physicians and 95% of experts were in accordance. For the systolic blood pressure>110 mmHg threshold for iv vasodilators (LOE/R: IIb-C 1) and iv nitrates during NSTEMI with signs of APE (LOE/R: I-C 2): concordance was respectively 8% and 96% among physicians, 32% and 100% among experts. For reperfusion strategies, 20% of physicians and experts acted according to the guidelines. For early PCI within 24h of NSTEMI (LOE/R: I-A 2) and immediate strategy (< 2 hours) for very high-risk NSTEMI (LOE/R: I-C 2): concordance was respectively 62% and 12% among physicians, 80% and 10% among experts. Except for indications of mechanical ventilation and NSTEMI early invasive strategy, results were homogenous among medical specialties (Table 2). Conclusion Our data show that therapeutic strategies regarding classical clinical cases of severe APE often diverge from guidelines with expected differences between specialties. The low level of evidence fuelling the Guidelines may explain these heterogeneities 4. There is a need for more clinical investigation to fill the current gap in evidence and strengthen future guidelines that may reduce heterogeneity in care.Table 1Table 2

Confidence of practitioners to support self-management of pain: A multidisciplinary survey.

Supported self-management is an important component of management for persistent pain according to current recommendations and guidelines. However, it is unclear whether staff from differing disciplines who may be in early contact with people with established or developing persistent pain are confident to introduce and support self-management for this patient group. To determine the confidence of staff across professional disciplines to introduce and support self-management. Cross-sectional online survey. Charts were constructed to represent information on professional grouping, prior training in self-management and confidence in supporting key components of self-management for persistent pain. Analysis of variance was used to test for differences between groups. Overall, 165 practitioners reported confidence to support self-management below the midpoint of a ten-point scale and 93 above. There were few differences between different professions apart from in explaining pain (f = 6.879 p < .001), managing activity levels (f = 6.340 p < .001) and supporting healthy habits (f = 4.700, p = .001) in which physiotherapists expressed higher confidence than other professional groups. There was no difference in confidence expressed between staff who had or had not received previous training in self-management (f = 1.357, p = .233). Many front-line staff who might be expected to introduce and deliver self-management support for persistent pain lack the confidence and skills to do so. This is consistent with a known lack of education about pain across disciplinary boundaries in primary and community-based care. In order to meet treatment priorities for persistent pain there is an urgent need to upskill the workforce by providing access to good quality training and resources.

Feasibility and Safety of Implementing Membrane-based Plasma Exchange in a Low-volume Center: Retrospective Single Center Experience Over 3 Years Including Multidisciplinary Survey among Clinicians

Feasibility and Safety of Implementing Membrane-based Plasma Exchange in a Low-volume Center: Retrospective Single Center Experience Over 3 Years Including Multidisciplinary Survey among Clinicians

Methodology and Results of a Joint IFSO-WGO Delphi Survey of 94 Intercontinental, Interdisciplinary Experts in Obesity Management

BackgroundObesity affects 1.5 billion people worldwide, yet few are treated effectively and considerable variability exists in its management. In 2020, a joint International Federation of Surgery for Obesity and Metabolic Diseases (IFSO) and World Gastroenterology Organization (WGO) advisory committee initiated the drafting of consensus guidelines on obesity management, to be based on detailed literature reviews and the results of an extensive multi-disciplinary survey of intercontinental experts. This paper reports on the latter. The objective of this study is to identify areas of consensus and non-consensus among intercontinental, inter-disciplinary experts in obesity management.MethodsGuided by an international consensus-survey expert, a three-round online Delphi survey was conducted in the summer of 2021 of international obesity-management experts spanning the fields of medicine, bariatric endoscopy and surgery, psychology, and nutrition. Issues like epidemiology and risk factors, patient selection for metabolic and bariatric surgery (ASMBS-Clinical-Issues-Committee, Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 8:e27-32, 1), psychological issues, patient preparation for MBS, bariatric endoscopy, and outcomes and follow-up were addressed.ResultsNinety-four experts from six continents voted on 180 statements, with consensus reached on 158, including consensus agreement with 96 and disagreement with 24 statements (38 had other response options besides agree/disagree). Among unanimous opinions were the need for all medical societies to work together to address obesity, for regular regional and national obesity surveillance, for multi-disciplinary management, to recognize the increasing impact of childhood and adolescent obesity, to accept some weight regain as normal after MBS, and for life-long follow-up of MBS patients.ConclusionsObesity is a major health issue that requires aggressive surveillance and thoughtful multidisciplinary management.

The Healthy and Sustainable City—Influences of the Built Environment on Active Travel

The city’s built environment and functionality play a crucial role in shaping individual mobility patterns, impacting the overall health and quality of life of its population. Understanding these influences is an important research topic, making it a central focus of this paper. This study aims to identify the factors responsible for promoting healthy mobility behavior. To address this comprehensively, a multidisciplinary empirical survey was developed based on the “Triad”—a model consisting of the built environment, mobility(-behavior), and public health. In addition to the evaluation of socio-demographic factors and activity radius mapping, statistical analyses like multiple linear regression were used. These statistical analyses allow the assessment of the impact of various independent variables on the promotion of healthy mobility behavior within urban settings. The multiple regression shows that the satisfaction with the accessibility of public transport and the sense of safety as a cyclist contribute to explaining the variation of healthy mobility. Furthermore, the satisfaction with walking in the neighborhood and the inhalation of exhaust fumes while walking also seem to have an impact. The results show the link between the Triad and make it clear that mobility planning and urban planning must take a more integrated approach to promote health and simultaneously protect the climate.

Geophysical and geological exploration of the Aurus clay pan as an archive of the long-term climatic and environmental history of the Namib Desert

The Namib Desert is one of the oldest deserts on Earth. Whilst the history of the desert during the last glacial-interglacial cycle is relatively well understood, information on the older Pleistocene and Neogene history is very scarce, because longer-term records such as those in lakes and caves have not been formed due to the aridity. Here, we investigate the potential of the sedimentary record in the Aurus clay pan in the Sperrgebiet Domain in the southern Namib Desert, Namibia, for longer-term paleoclimate research. For this purpose, we conducted a multi-disciplinary geophysical site survey along with initial sedimentological investigations. We used a combination of transient electromagnetic (TEM), seismic and magnetic data, that allows us to derive information with respect to tectonic features as well as the deeper sedimentary architecture of the Aurus clay pan. TEM and seismics were applied along two perpendicular transects. The data obtained reveal a three- to four-layered subsurface structure with a maximum sedimentary thickness between 31 and 65 m overlaying resistive bedrock. The aeromagnetic data show a fault zone cutting the southwestern corner of the clay pan that correlates with deep conductive anomalies visible in the TEM data. Radiocarbon ages of plant remains from the sediment surface evidence modern deflation, probably due to a particularly dry climate. The composition of a 4-m-long sediment core, which probably reflects the depositional history from 3400 to 23,000 cal. yr BP, however, suggests that most of the Holocene was characterized by a relatively high humidity, whereas the latest Pleistocene again was much dryer. According to an extrapolation of the sedimentation rates in the upper 4 m to the base of the sedimentary infill the record in Aurus clay pan penetrates in the order of 340,000 cal. yr BP. This would be longer than most other paleoclimate records in the Namib, but much less then recently recovered in the Atacama Desert in Chile. A comparison of the geophysical and geological data from Aurus with comparable data and two drill cores from clay pans in the Atacama furthermore shows that the physical parameter in all cases allow to decipher the sediment thickness and general architecture, but alone provides limited information on the sediment composition.

Biomass of Antarctic krill (Euphausia superba) in the eastern Indian sector of the Southern Ocean (80–150°E) in the 2018–19 austral summer

Biomass of Antarctic krill (Euphausia superba) in the eastern Indian sector of the Southern Ocean (80–150°E, corresponding to the longitudinal range of CCAMLR Division 58.4.1) in the austral summer of 2018–19 was estimated using data from a calibrated echosounder and biological sampling. This study was carried out as a part of the multidisciplinary ecosystem survey (KY1804) by Japanese research vessel Kaiyo-maru. The krill biomass was estimated using an up-to-date standard method of CCAMLR, the “swarm-based method”. Biomass of krill in the area had not been estimated since 1996 (BROKE survey). KY1804 covered a total of 4680 km of the surveyed distance in the surveyed area of 0.909 million km2. Krill were mainly distributed between the Southern Antarctic Circumpolar Current Front and the Antarctic Slope Front. The krill biomass during KY1804 was estimated as 4.325 million tonnes (CV = 17.0%), comparable with the 1996 BROKE estimate (4.83 million tonnes, CV = 17.0%); however, direct comparison is difficult because of differences in (1) biomass estimation methods; (2) timing of the surveys (KY1804 commenced about 40 days earlier in the year than BROKE); and (3) areal coverage, primarily because of different positions of the sea ice edge, especially in the western part of the area. There was no noticeable difference of krill biomass between day and night. This study provides a 2018–19 biomass estimate for Antarctic krill in the eastern Indian sector of the Southern Ocean, which is a basis for studies of this species as well as the Southern Ocean ecosystem.

A Structural Model of Organization and Clinician Factors Associated with Standardized Measure Use in a National Survey of Youth Mental Health Providers.

Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making.

Impact of the COVID-19 pandemic on healthcare workers in the frontline

Background: Previous studies have shown that frontline healthcare workers (HCWs) have higher rates of pre-existing mental health problems and may be therefore at risk for worsening of mental health problems during the COVID-19 pandemic. This includes an increased prevalence for anxiety, depression, acute stress and post- traumatic stress disorders. The aim of this study was to assess the subjective and professional burden of the HCWs working in frontline departments of our hospital. Objective: The aim was primarily to identify the psychological and professional impact of the COVID-19 pandemic on HCWs working in the frontline during the first two waves. Design and setting: This was a single-centre multidisciplinary survey. Methods: A printed survey was distributed to all HCWs (N=240) working in the intensive care unit and emergency department during the first and second COVID-19 outbreak. We evaluated the subjective and professional burden using 4-point Likert scale questions. Three-group comparisons based on years of work experience were made using Kruskal-Wallis tests. Comparisons per participant between two successive waves were made using Wilcoxon signed rank tests. Results: A total number of 171 HCWs (71.3%) participated in the survey. Participants mainly feared infecting their family and friends. A majority of the participants showed a high motivation working in the COVID- zone. More than half of the participants reported that their quality of sleep was unaffected by the pandemic. Despite a higher workload, work performance and interactions with colleagues were not negatively affected by the pandemic. No significant difference was found based on years of work experience. Participants had an overall decrease in personal impact during the second wave. However, work motivation decreased (p&lt;0.001). Participants felt better protected by the offered equipment (p=0.004), but felt less appreciated (p=0.01). Conclusions: The pandemic appeared to have affected the subjective and professional burden of our participants. However, they were not as severely impacted as HCWs in some other studies. Acquired knowledge should be utilized in developing preventive and interventional strategies to support HCWs affected by the COVID-19 pandemic and potential pandemics in the future.

Medical care of patients with Wilson disease in Germany: a multidisciplinary survey among university centers

BackgroundWilson disease (WD) is a rare, hereditary disorder of copper metabolism. Due to its variable symptoms and manifestations, diagnosis remains challenging. Affected patients must obtain lifelong medical treatment, as the disease is fatal if untreated. Patients require continuous monitoring, but little is known about the care of these patients in Germany. Therefore, we analyzed the medical care of WD patients at German university centers. We sent a questionnaire containing 20 questions to a total of 108 departments of pediatrics, neurology and gastroenterology in 36 university hospitals. Our questions referred to the characteristics of WD patients at the different sites and internal procedures regarding diagnosis, therapy and follow-up. A descriptive statistical analysis was performed.ResultsSixty-three departments (58%) returned our questionnaire. In total, approximately one-third of the estimated WD patients in Germany are seen annually in the outpatient clinics of these departments (approx. 950 patients). There are only a few departments which treat patients in a multidisciplinary setting (12%). Our survey revealed that for diagnosis, 51% of all departments used an algorithm based on the Leipzig score as recommended by international guidelines. Most departments apply essential parameters recommended by WD guidelines. Routine monitoring is performed at least biannually by 84% of the departments, and standard investigations for monitoring are regularly applied. A routine family screening is performed by 84% of all departments. A reduction in medical therapy during pregnancy is recommended by 46% of the departments. Only 14% suggested that WD patients should not breastfeed. Liver transplantation (LT) due to WD is a rare but repeatedly occurring event. Most departments of gastroenterology (72%) reported at least one patient with LT within the last decade.ConclusionsMedical care of WD patients at German university centers follows the recommendations set forth by international guidelines, but only a few centers treat significant numbers of patients. The surveillance of patients does not follow specified standards, but most departments adhere to the accepted guidelines. The formation of central units and networks in a multidisciplinary setting should be evaluated to improve the care of WD patients.

Euryalida (Echinodermata, Ophiuroidea) from Northwest Africa

From 2004 to 2012, ten multidisciplinary oceanographic surveys were conducted along the coast of Northwest Africa, between the Strait of Gibraltar and the northern border of Sierra Leone. A total of five species of Euryalida Lamarck, 1816 belonging to three families were captured at 29 of the 1298 stations sampled in the area. Among them, Astrodendrum juancarlosi sp. nov. is described and figured in this paper. Ophiocreas oedipus Lyman, 1879 is recorded for the first time on West African continental margin and Gorgonocephalus pustulatum (H.L. Clark, 1916), an Indo-Pacific species only known from South African coast in the Atlantic, is reported off Guinea-Bissau, greatly extending to the North its Atlantic distribution. In addition, Asteroschema inornatum Koehler, 1906, a northeast Atlantic species, is recorded for the first time in African waters, off Western Sahara, extending its range of distribution to the south. Our data also extend the bathymetric distribution of A. inornatum to shallower waters and of G. pustulatum to deeper waters. The association of some euryalids with certain species of pennatulaceans and gorgonians is also described.

‘Sense of place’ and conservation: Toponym diversity helps to maintain vegetation naturalness

Abstract Place names are an important but vanishing part of cultural diversity, and their relevance for environmental sciences is increasingly acknowledged. Still little is known about whether the diversity of toponyms affects human–nature relationships and the decisions of humans on how to use certain parts of the landscape. To investigate this question, we combined approaches from social sciences and ecology in a comprehensive multidisciplinary survey of 1521 cultural landscape features in Hungary. The landscape features studied were ancient millennia‐old burial earthen mounds built by nomadic steppic tribes, that often hold the last remnants of grassland vegetation and provide safe havens for grassland specialist plant and animal species in the intensively used agricultural landscapes of Eurasia. In our research, we (i) compiled a comprehensive database of the mounds in the 5150 km2‐sized study region, (ii) collected all toponyms of the mounds recorded since the 18th century, (iii) derived the height and distance from settlements for each mound and (iv) visited all the mounds in a field survey, and evaluated their vegetation naturalness. We found that despite the intensive landscape transformation in the region, and independently of topographical factors, a higher number of toponyms was associated with a higher degree of naturalness of the vegetation on the landscape features. Independently of the protective effect of the height of the mound against ploughing, and the distance from settlements that reflects to decreasing land use intensity, we found that the vegetation on the mounds with more names had a higher degree of naturalness. Synthesis and applications. Cultural recognition of these places has eroded considerably in the past centuries, but its effect is still noticeable, suggesting an extinction delay of culture‐driven biodiversity patterns. Our results suggest that reestablishment of the lost cultural connections between people and nature can contribute to reversing the deterioration. Read the free Plain Language Summary for this article on the Journal blog.

Multidisciplinary physician survey assessing knowledge of the female athlete triad and relative energy deficiency in sport

BackgroundShort and long-term health consequences surrounding Low Energy Availability can be mitigated by recognizing the risk factors and making early diagnosis of the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). While awareness of the Triad among physicians and allied health professionals has been studied, there are very few studies that assess physician awareness of both the Triad and RED-S.MethodsOur study assesses Low Energy Availability, the Triad, and RED-S knowledge with an electronic survey, educational handout, and follow up survey among physicians across multiple specialties at a single academic institution.ResultsAmong 161 respondents, respective Triad and RED-S awareness among surveyed specialties was highest in Orthopedic surgeons (100%, 100%), followed by Physical Medicine & Rehabilitation (70%, 53%), Family Medicine (67%, 48%), Internal Medicine (54%, 36%), Obstetrics and Gynecology (46%, 32%), Pediatrics (45%, 29%), Endocrinology (33%, 33%), and Other (33%, 33%). Comparing the initial survey results to the follow-up survey results, there was an increase from 37 to 72% of physicians who correctly identified that the presence of low BMI or recent weight loss is not a required component of the Triad or RED-S. Both the initial and follow-up survey revealed a continued misperception surrounding the use of hormonal contraception to resume menstrual cycles, with 33% of physicians on initial survey and 44% of physicians on follow-up survey incorrectly answering that question.ConclusionsMultidisciplinary physicians have various levels of knowledge surrounding the Triad and RED-S, and there is a need for improved physician awareness, diagnosis, and treatment of the Triad and RED-S. Misperceptions exist surrounding the role of hormonal contraception in female athletes with the Triad and RED-S to regain and regulate menses.

InfraRed Thermography and 3D-Data Fusion for Architectural Heritage: A Scoping Review

Comprehensive documentation is the foundation of effective conservation, repair and maintenance (CRM) practices for architectural heritage. In order to diagnose historic buildings and inform decision making, a combination of multi-disciplinary surveys is fundamental to understanding a building’s heritage and performance. Infrared thermography (IRT), a non-contact, non-invasive and non-destructive imaging technique, allows both qualitative and quantitative assessments of temperature to be undertaken. However, the inherent low spatial resolution of thermal imaging has led recent work to fuse thermographic and geometric data for the accurate 3D documentation of architectural heritage. This paper maps the scope of this emerging field to understand the application of IRT and 3D-data fusion (IRT-3DDF) for architectural heritage. A scoping review is undertaken to systematically map the current literature and determine research gaps and future trends. Results indicate that the increasing availability of thermal cameras and advances in photogrammetric software are enabling thermal models to be generated successfully for the diagnosis and holistic management of architectural heritage. In addition, it is evident that IRT-3DDF provides several opportunities for additional data integration, historic building information modelling (H-BIM) and temporal analysis of historic buildings. Future developments are needed to transform IRT-3DDF findings into actionable insights and to apply IRT-3DDF to pressing climate-related challenges, such as energy efficiency, retrofitting and thermal comfort assessments.

Wide variation in pre-procedural blood product transfusion practices in cirrhosis: a national multidisciplinary survey.

Recent guidelines recognize the limitations of standard coagulation tests in predicting bleeding and guiding pre-procedural blood component prophylaxis in cirrhosis. It is unclear whether these recommendations are reflected in clinical practice. We performed a nationwide survey to investigate pre-procedural transfusion practices and opinions of key health care stakeholders involved in managing cirrhosis. We designed a 36-item multiple-choice questionnaire to investigate the international normalized ratio and platelet cutoffs utilized to guide pre-procedural transfusion of fresh frozen plasma and platelets in patients with cirrhosis undergoing a range of low and high-risk invasive procedures. Eighty medical colleagues from all mainland States involved in managing patients with cirrhosis were invited by email to participate. Overall, 48 specialists across Australia completed the questionnaire: 21 gastroenterologists, 22 radiologists, and 5 hepatobiliary surgeons. 50% of respondents reported that their main workplace did not have written guidelines relating to pre-procedural blood component prophylaxis in patients with cirrhosis. There was marked variation in routine prophylactic transfusion practices across institutions for the different procedures and international normalized ratio and platelet cutoffs. This variation was present both within and between specialty groups and held for both low and high-risk procedures. For scenarios where the platelet count was ≤ 50 × 109/L, 61% of respondents stated that prophylactic platelet transfusions would be given before low-risk and 62% before high-risk procedures at their center. For scenarios where the international normalized ratio was ≥2, 46% of respondents stated that prophylactic fresh frozen plasma would be routinely given before low-risk procedures and 74% before high-risk procedures. Our survey reveals significant heterogeneity of pre-procedural prophylactic transfusion practices in patients with cirrhosis and discrepancies between guidelines and clinical practice.

The real-world impact of the COVID-19 pandemic on patients with cancer: a multidisciplinary cross-sectional survey.

The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to cancer care worldwide. We conducted a multidisciplinary survey of the real-world impact of the pandemic, as perceived by patients with cancer. A total of 424 patients with cancer were surveyed using a 64-item questionnaire constructed by a multidisciplinary panel. The questionnaire examined patient perspectives regarding COVID-19-related effects (eg, social distancing measures) on cancer care delivery, resources, and healthcare-seeking behaviour, along with the physical and psychosocial aspects of patient well-being and pandemic-related psychological repercussions. Overall, 82.8% of respondents believed that patients with cancer are more susceptible to COVID-19; 65.6% expected that COVID-19 would delay anti-cancer drug development. Although only 30.9% of respondents felt that hospital attendance was safe, 73.1% expressed unaltered willingness to attend scheduled appointments; 70.3% of respondents preferred to receive chemotherapy as planned, and 46.5% were willing to accept changes in efficacy or side-effect profile to allow an outpatient regimen. A survey of oncologists revealed significant underestimation of patient motivation to avoid treatment interruptions. Most surveyed patients felt that there was an insufficient amount of information available concerning the impact of COVID-19 on cancer care, and most patients reported social distancing-related declines in physical, psychological, and dietary wellness. Sex, age, education level, socio-economic status, and psychological risk were significantly associated with patient perceptions and preferences. This multidisciplinary survey concerning the effects of the COVID-19 pandemic revealed key patient care priorities and unmet needs. These findings should be considered when delivering cancer care during and after the pandemic.

Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group.

Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.

The drifting and spreading mechanism of floating Ulva mass in the waterways of Subei shoal, the Yellow Sea of China – Application for abating the world's largest green tides

The large-scale green tides have been prevailing in the Yellow Sea over a decade. Prevention and control techniques in the source region (Subei Shoal) are urgently needed to minimize its adverse ecological and social impacts. Drifting and spreading mechanism of Ulva mass was investigated in the Subei Shoal in order to develop the early containment measures. The multidisciplinary surveys suggested twelve major waterways transporting the initial Ulva mass which was closely related to the basin topology and water circulation in the shoal. The epiphytic algal mass from the northern and eastern raft regions contributed 82.7 % of the initial floating biomass, and moved out in 4–6 days with an average drifting velocity of 0.28 m s−1. Accordingly, two series of algae-blocking lines were proposed to remove floating mass from the shoal. And the primary field trial in 2018 confirmed the feasibility of this strategy to abate the green tides.