National Service Research Articles

Stephen Raymond Bicknell.

After completing National Service as a vet in Singapore, he worked in practice before joining the State Veterinary Service. In retirement, he enjoyed many hobbies and helping others.

Systemic anti-cancer therapy in gastroenteropancreatic neuroendocrine carcinoma (GEP-NEC): insights from national cancer registration and analysis service (NCRAS)

Systemic anti-cancer therapy in gastroenteropancreatic neuroendocrine carcinoma (GEP-NEC): insights from national cancer registration and analysis service (NCRAS)

Implementation of a national rapid prenatal exome sequencing service in England: evaluation of service outcomes and factors associated with regional variation

IntroductionPrenatal exome sequencing (pES) can enhance genetic diagnosis of fetuses with structural anomalies and has recently been introduced as a national service in England. We aimed to examine service outcomes such as diagnostic yield (definite final diagnosis), referral rate, and sources of referral, and explore variation in outcomes of pES by individual or service level factors between 01 October 2021 and 30 June 2022.MethodspES testing results from the National Health Service laboratories performing testing were linked to National Congenital Anomaly and Rare Disease Registration Service data and the Maternity Services Data Set and descriptive statistics computed.ResultsThere were 475,089 women who gave birth in England during the study period. The referral rate for pES was 8.6 (95% CI 7.8, 9.4) per 10,000 maternities. About 59% of those referred proceeded with pES testing and 35% of women who proceeded received a definite final diagnosis with a median turnaround time of 15 days. Of those who had pES testing, 64.6% had a live birth, 25.3% underwent termination of pregnancy (median gestational age at termination: 26 weeks), and 9.3% had a stillbirth. Among the 85 women who had a definite final diagnosis, 40% had a termination of pregnancy, 18% had a stillbirth, and 42% had a live birth. The corresponding figures among women without a definite final diagnosis were 18%, 5%, and 78%, respectively. Among women who had a termination of pregnancy, the median gestational age at final report was 24.9 weeks and 26.2 weeks at termination. Variation observed in some of the characteristics and outcomes between regional services were limited by small sample size.ConclusionThis study showed that of those referred, pES testing provided a diagnosis for one in three pregnancies with a fetal anomaly across England during the study period when other tests had been non-informative. Women who opted for a termination of pregnancy underwent the procedure at relatively late gestations. Earlier referral for pES, streamlining pathways, and faster turnaround times may help results to be available at an earlier gestation to allow families more time to make decisions around continuing or terminating their pregnancy. The variation in service outcomes between regional services needs to be investigated further to understand the reasons for these differences.

Gender Incongruence in Danish Youth (GenDa): A Protocol for a Retrospective Cohort Study of Danish Children and Adolescents Referred to a National Gender Identity Service

Background/Objectives In recent years, the national Gender Identity Service for individuals under 18 years of age in Denmark has seen a considerable increase in referrals of youngsters during puberty. Given this development, it is important to deepen our understanding of the characteristics of contemporary youngsters seeking help for gender incongruence. This understanding can serve as the foundation for improving current treatment regimens by ensuring optimal individual assessment and care. In this study, we aim to describe the sociodemographic characteristics, health profiles, and treatment trajectories in detail, as well as any changes in these characteristics, of all transgender and gender-diverse youngsters referred to the Gender Identity Service in Denmark from 2016 through 2022. Methods: This is a retrospective observational study of a national cohort comprising all individuals under 18 years of age referred to the Danish Gender Identity Service from 1 January 2016 to 1 January 2023. We will use data from medical records obtained at routine visits from the first assessment through repeated visits. Data on demographics, physical and mental health profiles, and information regarding gender identity will be collected and analyzed. The characteristics of those individuals who progressed to hormone therapy will be compared to those who did not. Results: This study aims to enhance our understanding of the characteristics and needs of contemporary youngsters with gender identity issues. Conclusions: The scientific evidence for the assessment and treatment of gender incongruence in youngsters is limited. The characteristics of youngsters seeking healthcare for gender incongruence today may differ from earlier.

Validation and implementation of whole-genome sequencing-based analytical methods for molecular surveillance and relatedness analysis of Mycobacterium tuberculosis Complex isolates at a National Reference laboratory

Whole genome sequencing-based methodologies have become extremely relevant for the molecular surveillance of human pathogens and are being increasingly introduced into national reference laboratory services. In this study, we describe the validation and implementation of core-genome Multi-Locus Sequence Typing (cgMLST) and whole genome single-nucleotide polymorphism (wgSNP) analysis at the Irish Mycobacteria Reference Laboratory, as a replacement for Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) typing. Concordance of clustering, discriminatory power, and ease-of-use of both WGS analytical methods were evaluated. Although wgSNP analysis (MTBseq) was the most discriminatory method (p<0,001), we recommend cgMLST (SeqSphere+), as the first-line approach for molecular typing of Mycobacterium tuberculosis isolates in the context of routine surveillance work due to its ease of use and decreased turnaround time, while reserving wgSNP-analysis for a more in-depth cluster analysis of new isolates that show a distance of ≤ 12 alleles to any other isolate(s) in the cgMLST database.

Is Centralisation of Cancer Services Associated With Under-Treatment of Patients With High-Risk Prostate Cancer?-A National Population-Based Study.

Centralising prostate cancer surgical and radiotherapy services, requires some patients to travel longer to access treatment, but its impact on actual treatment utilisation and outcomes is unknown. Using national cancer registry records linked to administrative hospital data, we identified all patients with high risk and locally advanced prostate cancer diagnosed between 1 April 2019 and 31 March 2020 in the English National Health Service (n = 15,971). Estimated travel times from the patient residential areas to the nearest hospital providing surgery or radiotherapy were estimated for journeys by car and by public transport. Multivariable logistic regression was used to model relationships between travel time and receipt of care with adjustment for patient characteristics. 10,693 (67%) men received radical surgery or radiotherapy (RT) within 12 months of diagnosis. Average travel time to the nearest hospital providing prostatectomy or RT was 23.2 min by private car and 58.2 min by public transport. We found no association between travel time, either by car or public transport and the likelihood of receiving curative treatment. Patients living in the most socially deprived areas, those aged over 70, those with two or more comorbidities, and those of black ethnic origin, were less likely to receive curative treatment (p& =& 0.001 for all associations). The current configuration of national prostate cancer services is not associated with the likelihood of receiving curative treatment. Further increases in capacity will unlikely improve utilisation rates beyond addressing sociodemographic barriers.

Posting the nation: Australia’s apprenticeship in letter writing

A national postal service is an essential nation-building institution; it integrates distant regions into a national community and fosters the extension of the public sphere. But in the first decades of colonial Australia, the material conditions of sending letters were precarious and uncertain, the rhythm of exchange was slow and the cost expensive. Australia had to learn how to write letters and how to send them; by the 1890s, it had completed its apprenticeship. Using postmaster-generals’ reports on one hand, and autobiographical sources on the other, I explore the experience and difficulties of epistolary exchanges in the nineteenth century.

Young Bereaved Siblings of Israeli Security Personnel: Challenges, Coping, and Support.

This qualitative study examines the experiences of young bereaved siblings of Israeli security personnel. Through 26 semi-structured interviews with 12- to 21-year-olds who lost a sibling before age 21, the research reveals complex cognitive and emotional challenges within Israel's unique context. Participants struggle with understanding death's finality, managing intense emotions, and navigating altered family dynamics. Coping strategies vary, from maintaining routines to avoiding grief-related interactions. The study highlights a significant contrast between young bereaved siblings' perspectives and those of adults, with siblings describing an ongoing struggle while maintaining hope for the future. They actively manage their identities, often rejecting societal labels and preferring informal support over formal interventions. These findings underscore the importance of recognizing young bereaved siblings' distinct voices and can inform more effective support strategies within a national service context.

A diagnosis of vascular ehlers-danlos syndrome in childhood: clinical and molecular features of 63 individuals

Abstract Background Vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited connective tissue disorder characterised by generalised severe tissue friability and predominantly caused by pathogenic COL3A1 variants. Diagnosis of vEDS in childhood primarily occurs due to a positive family history and/or the occurrence of an early arterial or intestinal event. However, little has been reported on additional clinical characteristics and management in this population. Purpose This study aims to identify critical drivers of a childhood vEDS diagnosis in individuals diagnosed through a national EDS service. Methods 63 individuals (24 index, 31 females) with a clinical and genetic diagnosis of vEDS in childhood (&amp;lt; 18 years) were identified through a national EDS service, and childhood cardiovascular surveillance was conducted through joint inherited cardiovascular disease clinics. Results Diagnosis of vEDS in childhood occurred at a median age of 7 years (IQR 3-12) and was predominantly driven by positive family history of vEDS (55.5%). Clinical investigations were directly initiated by occurrence of a major clinical event in n=13 (20.6%), and a total of 17 major clinical events in childhood were recorded in 13 individuals. First events occurred at a median age of 11 years (IQR 0-13) and vascular events, though infrequent, occurred as early as the first year of life. In individuals who did not have a positive family history or major event, easy and/or excessive bruising was the most frequent cause for referral (60%). Conclusions This cohort provides further details of the clinical and genetic characteristics of children with vEDS and contributes new insight into drivers of vEDS diagnosis in childhood and the importance of long-term management, including paediatric cardiovascular surveillance.

MatSwarm: trusted swarm transfer learning driven materials computation for secure big data sharing

The rapid advancement of Industry 4.0 necessitates close collaboration among material research institutions to accelerate the development of novel materials. However, multi-institutional cooperation faces significant challenges in protecting sensitive data, leading to data silos. Additionally, the heterogeneous and non-independent and identically distributed (non-i.i.d.) nature of material data hinders model accuracy and generalization in collaborative computing. In this paper, we introduce the MatSwarm framework, built on swarm learning, which integrates federated learning with blockchain technology. MatSwarm features two key innovations: a swarm transfer learning method with a regularization term to enhance the alignment of local model parameters, and the use of Trusted Execution Environments (TEE) with Intel SGX for heightened security. These advancements significantly enhance accuracy, generalization, and ensure data confidentiality throughout the model training and aggregation processes. Implemented within the National Material Data Management and Services (NMDMS) platform, MatSwarm has successfully aggregated over 14 million material data entries from more than thirty research institutions across China. The framework has demonstrated superior accuracy and generalization compared to models trained independently by individual institutions.

Lipid-lowering therapy with Inclisiran in the real-world setting: initial data from a national health care service

Abstract Introduction Inclisiran, a first-in-class siRNA enabling long-term inhibition of PCSK9 synthesis, demonstrates good safety and efficacy profile in randomized clinical trials. Challenges for real-life use of inclisiran include limited access to therapy, injections by medical staff, lack of cardiovascular outcome data, and concern from adverse effects considering the novel mechanism and long-term activity. Real-life data on the potential to attain lipid-goals and reduce treatment gaps is lacking. We investigated the implementation of inclisiran in real-world clinical setting in Israel. Methods Data from a nationwide healthcare organization on patients initiating inclisiran therapy during the period of 3/2022-11/2023. Patients’ characteristics, efficacy, use of combination lipid-lowering therapies, and attainment of low-density lipoprotein cholesterol (LDL-C) goals, were evaluated. Results Inclisiran was initiated by 503 patients (57% women; mean age 66±11 years). Atherosclerotic cardiovascular disease was present in 54%, and peak historical LDL-C levels &amp;gt;190 mg/dL documented in 64%. Prior exposure to PCSK9 monoclonal antibodies was evident in 28%. Follow-up lipid profile &amp;gt;2 months after filling first prescription, was available in 397 patients (347 with ≥2 injections). In patients treated by inclisiran only (n=254), median LDL-C reduction from peak historical levels was 57% (IQR, 48%-67%), and from pre-injection levels 40% (19%-54%). In those with concomitant oral lipid-lowering therapies (n=143), median LDL-C reduction from peak levels was 66% (IQR, 55%-73%), and from pre-injection levels 46% (23%-59%) (Figure). LDL-C &amp;lt;70 mg/dL was attained by 39% and LDL-C &amp;lt;55 mg/dL by 21.9%. Of those treated with concomitant statin therapy, 38% attained LDL-C &amp;lt;55 mg/dL. Overall, 6.5% did not persist with inclisiran therapy after initial injection. Conclusions In real-life practice, inclisiran showed good efficacy with positive short-term adherence. However, attainment rates of lipid-goals were suboptimal due to limited use of combination lipid-lowering therapy and high-rates of severe hypercholesterolemia in our patient population cohort.Waterfall Plot of LDL-C (%) Reduction

Cardiovascular emergency in indonesian primary health care (PUSKESMAS): a national multicentre service evaluation study based on ESC guidelines adherence

Abstract Background Early diagnosis and prompt treatment are crucial in reducing cardiovascular (CVD) burden in the global level, especially in Indonesia with more than a half million CVD death annually. As frontliner, more than 10,000 primary healthcare (PUSKESMAS) spreading around Indonesia are pivotal in delivering CVD emergency care. However, due to the scarcity of healthcare resources, significant disparities exist between guideline recommendations and their implementation in Indonesian primary health care. Purpose Our study aims to describe current cardiovascular emergency care, assess guideline adherence, and identify key factors influencing the trend. Methods This multicentre study was conducted in 40 PUSKESMAS across Indonesia from October to December 2023. Data related to cardiovascular emergencies diagnosis, work-ups, treatment, and outcomes were gathered and then evaluated according to the ESC Guidelines. Recommendations, particularly Class I, were converted into points with respect to diagnostic and treatment domains. Guideline adherence scores were then calculated based on the percentage of accomplished points. Linear regression analysis was employed to identify factors that could explain variations in guideline adherence across all PUSKESMAS. Results 215 CVD emergency patients were reported. The most prevalent diagnosis was hypertensive crisis (n=137; 64%) with ECG done in only 26% of cases and none underwent imaging. Oral amlodipine (59%) and captopril (55%) were mostly used as antihypertensive, with none receiving intravenous. The second most common diagnosis was ACS (n=42; 20%), with ECG performed in only 71% of cases. Among 13 patients with STEMI, 69% only received aspirin, and 46% were given DAPT. Malignant arrhythmia occurred in 26 patients, with none receiving cardioversion. The most used anti-arrhythmic are bisoprolol, propranolol, and atropine. Among 23 cases of acute HF, only 39% received oxygen, while IV furosemide was used in only one case. Cardiac arrest occurred in two patients, both received CPR and epinephrine. In terms of guideline adherence, mean diagnostic score (%) was demonstrated highest in Cardiac Arrest at 100 and the lowest in Hypertensive Crisis and Acute HF at 53, while mean treatment score (%) was highest in Hypertensive Crisis at 86 and lowest in arrhythmia at 25. Linear regression suggests that human resources have a positive and significant association with diagnostic adherence scores (R2: 0.3485, p-value: 0.0450), whereas essential medicine has a strong but non-significant correlation with treatment adherence score (R2: 1.0768, p-value: 0.460). Conclusion This study has demonstrated a huge disparity between the current CVD emergency practices and guidelines in Indonesian primary healthcare. These gaps emphasised the need for improved human resources and essential medicine for primary healthcare along with the implementation of data-driven policy making concerning cardiovascular disease in Indonesia.Cardiovascular Emergency Diagnosis in InCardiovascular Emergency Work-up and Tre

NICE guidance in the rapid access chest pain clinic: does it work?

Abstract Background Rapid Access Chest Pain Clinics (RACPC) were developed following the publication of the National Service Framework for Coronary Heart Disease in 2000(1). The National Institute for Health and Care Excellence (NICE) produces guidelines for the management of patients with recent onset chest pain of suspected cardiac origin(2). In 2016 the guidance was updated and recommended the use of CT coronary angiography (CTCA) as the initial investigation for patients with chest pain which was typical or atypical of angina. Adherence to the guideline may be dependent upon factors such as local availability of CT scanners and clinician preference. The RACPC in this tertiary centre is nurse-run with no medical involvement. There is good engagement with the CT department and in July 2017 the NICE guidance was adopted in the clinic. Purpose To evaluate the use of CTCA as the first line investigation for patients with typical or atypical chest pain. Methods Data from all patients reviewed in the clinic between 01/07/2017 and 31/12/2023 were prospectively collected, entered into a database, and then retrospectively analysed. The data were organised into 3 groups: patients with typical chest pain; atypical pain and those with non-cardiac sounding chest pain. The number of patients in each group who underwent a CTCA, and the outcome of the scan were evaluated. The CT scans were categorised as showing significant coronary artery disease (CAD), non-obstructive CAD, no CAD, or as inconclusive. The outcome of patients who had a positive CTCA was also recorded. Results 2986 patients were reviewed in the RACPC in the above period. 14.2% of patients presented with typical pain, 47.4% with atypical pain, and 30.6% had non-cardiac pain. The remaining patients presented with other symptoms such as breathlessness. CTCA was used as the first investigation in the majority of patients with typical or atypical pain, unless alternative investigations or management were deemed to be more clinically appropriate. In 59.5% of typical and 78.5% of atypical presentations, the CT scan showed no CAD, or non-significant CAD. There was a low incidence of positive scans in both groups, however patients with typical pain were more likely to have significant CAD (Table). All patients who had a CTCA indicating significant CAD, were referred for invasive angiography. 88.0% of typical presentations, and 64.0% of those with atypical pain, underwent revascularisation. No patient who underwent invasive angiography was found to have normal coronary arteries. Conclusion Atypical pain is the most frequent presentation in the RACPC, however the majority of these patients, and most of those with typical pain, do not have significant CAD. Careful assessment and the use of CTCA as the initial investigation, enable the identification of those patients who need invasive angiography. This is a cost-effective strategy which also reduces risk and radiation exposure for patients.

Clause-Final Adverbs in Colloquial Singapore English Revisited

Many scholars consider clause-final adverbs (CFAs) like already, also, and only to be a prominent feature of Colloquial Singapore English (CSE), but little is known about their use in present-day CSE. Using data from the Corpus of Singapore English Messages (CoSEM), we investigate patterns of variation involving CFAs and examine whether they are sensitive to factors such as speaker age and gender. We find that clause-final already and only has increased over time, while clause-final also has remained stable. Overall, the results suggest that CFAs are a stable feature of CSE. Variation in the use of CFAs is conditioned by semantic function, age, and gender. Specifically, clause-final already is associated with the inceptive function. Clause-final already and also are more likely to be used by younger speakers, while clause-final also and only are more likely to be used by males and in all-male conversational settings respectively. We suggest that these patterns are due to present-day English-Mandarin bilingualism, increasingly positive attitudes toward CSE, and National Service for males.

Educational management in personnel training of hydrometeorological services: world experience

Introduction. The relevance of the presented study is determined by the fact that the acceleration of climate change on the planet has a significant impact on almost all spheres of economic and social life of mankind, which imposes new requirements both on the information provided by hydrometeorological services and on the personnel of managers and specialists providing it.Purpose setting. The purpose of the presented studies is to summarize the world experience in the development of promising requirements for the skills and competence of managers and specialists of national meteorological services in the interests of forming a system of requirements for staffing and training of managers and specialists of hydrometeorological services of the Roshydromet system.Methodology and methods of the study. The methodological base of the research consists of well-known scientific works devoted to the promising requirements for the skills and competencies of managers and specialists of the hydrometeorological service. Results. The novelty of the obtained results lies in the fact that, based on the generalization of world experience in the development of promising requirements for the skills and competence of managers and specialists of national hydrometeorological services, it was found that when forming personnel management strategies, on the one hand, requirements are put forward for a wide range of competencies of personnel who own both traditional technologies and innovative technologies for processing and interpreting information based on IT. On the other hand, hydrometeorological services impose increased demands on themselves, which is manifested in strategic aspirations to form a holistic motivation system for their employees, covering all levels of human needs, according to substantive theories of motivation – from economic competitiveness to opportunities for training, development and self-expression.Conclusion. The practical significance of the obtained results lies in the possibility of using world experience in developing promising requirements for the skills and competence of managers and specialists of national meteorological services when forming strategies for personnel management of hydrometeorological structures of the Roshydromet system.

Between State Media Use and Democracy: An Investigation into the Role of Botswana Television for Democracy

Although Botswana is commonly heralded as a democratic country, its national television service—Botswana Television (BTV)—has for close to two decades grappled with trying to perform the roles of nurturing democracy and gratifying the despotic instructions of the government. With the limited privately owned media in Botswana, expectations are that BTV offers itself as a platform for civic participation, serves as a conduit between the state and the public, broadcasts content that informs and educates society, and reports impartially on issues that concern members of the public such as politics, questionable government activities, unemployment, and socio-economic inequalities. Instead, BTV has its programming skewed towards the ruling elites. BTV's performance in this regard results from its funding and control by the government. This article argues that for a national media service to nurture democratic ideals in society, the state should introduce policy reforms that serve the interests of all stakeholders and allow media practitioners to exercise professionalism without any unnecessary pressures from the government.

Developing the concept of consequential senior European Union civil servants as sub-political policy entrepreneurs

ABSTRACT In a 2022 article the author described the late Sir Julian Priestley, Secretary-General of the European Parliament, 1997–2007, as being a ‘consequential senior European Union civil servant’, notably because of initiatives Priestley championed to provide simultaneous interpretation for all languages in an enlarged European Union – a facility not guaranteed at the time but which provided the Parliament with continued democratic legitimacy. This article builds on and develops that ‘consequential’ concept, by identifying some further examples of such consequential senior EU civil servants and then by teasing out common aspects of their roles and activities. It posits that they are in effect sub-political policy entrepreneurs (in the Kingdon definition) who can and do have significant effects on the development of their institutions and of the Union more generally. It shows how they share certain characteristics: long service in or with ‘their’ institutions, enabling them to develop reformist visions; political coverage; the determination to see their visions through. The fact that they remain sub-political raises potential questions about political legitimacy. The article concludes by questioning whether the phenomenon is specific to the European Union or can also be observed in national civil services and the secretariats of other international organisations.

ALICENET – an Italian network of automated lidar ceilometers for four-dimensional aerosol monitoring: infrastructure, data processing, and applications

Abstract. ​​​​​​​Vertically resolved information on aerosol particles represents a key aspect in many atmospheric studies, including aerosol–climate interactions and aerosol impacts on air quality and human health. This information is primarily derived by lidar active remote sensing, in particular with extensive networks currently in operation worldwide. In Italy, the Institute of Atmospheric Sciences and Climate (ISAC) of the National Research Council (CNR) established the ALICENET network of automated lidar ceilometers (ALCs) in 2015. Since then, ALICENET has grown as a cooperative effort of Italian institutions dealing with atmospheric science and monitoring, and it currently includes instruments run by regional environmental protection agencies, universities, research centres, and private companies. In the current configuration, the network makes use of both single-channel ALCs and dual-channel, polarisation-sensitive-system ALCs (referred to as PLCs). The systems operate in very different environments (urban, coastal, mountainous, and volcanic areas) from northern to southern Italy, thus allowing the continuous monitoring of the aerosol vertical distribution across the country. ALICENET also contributes to the EUMETNET programme E-PROFILE, filling an Italian observational gap compared to other EU member states, which generally run extended ALC networks through national meteorological services. In this work, we present the ALICENET infrastructure and the specifically developed data processing centralised at CNR-ISAC, converting raw instrumental data into quantitative, quality-controlled information on aerosol properties ranging from attenuated backscatter to aerosol mass and vertical stratifications. This setup allows us to get insights into the 4D aerosol field over Italy with applications from near-real-time monitoring to long-term analyses, examples of which are reported in this work. Specific comparisons of the ALICENET products to independent measurements obtained with different techniques, such as particulate matter (PM) concentrations from in situ samplers and aerosol optical depth (AOD) from sun photometers, are also included here, revealing the good performances of the ALICENET algorithms. Overall, ALICENET represents a valuable resource to extend the current aerosol observational capabilities in Italy and in the Mediterranean area, and it contributes to bridging the gap between atmospheric science and its application to specific sectors, among which are air quality, solar energy, and aviation safety.

Examining the effects of national intellectual capital on economic growth: does digital services trade restrictiveness matter?

Purpose The moderating role of digital services trade restrictiveness to the effects of national intellectual capital on economic growth has been largely ignored in the existing literature. As such, this paper aims to examine how national intellectual capital and digital services trade restrictiveness affect economic growth. In addition, the moderating role of digital services trade restrictiveness in the relationship between national intellectual capital and economic growth is also examined. Design/methodology/approach In this study, a sample comprising 62 countries worldwide is used. The national intellectual capital for each country is computed using the index of national intellectual capital. Data pertaining to digital services trade restrictiveness are extracted from the digital services trade restrictiveness index (OECD Statistics on International Trade in Services database). To ensure the robustness of the findings, the generalized method of moments (GMM) is used in the analysis. Findings The findings of this study confirm that national intellectual capital supports economic growth. Accumulating intellectual capital at the national level plays an essential role in supporting economic growth. The authors also find evidence to confirm that digital services trade restrictiveness negatively affects economic growth, particularly for high-income and lower-middle-income countries. Interestingly, digital services trade restrictiveness deteriorates economic growth across countries globally, except for upper-middle-income countries, with a weak effect. The empirical results also confirm that the joint effects between national intellectual capital and digital services trade restrictiveness are negative and significant. As such, findings from our analysis suggest that digital services trade restrictiveness moderates the relationship between national intellectual capital and economic growth. Practical implications The findings of this study provide valuable implications for policymakers to formulate and implement policies aiming to improve national intellectual capital to support sustainable economic growth. In addition, limiting digital services trade restrictiveness across countries appears to provide both direct and indirect effects in enhancing sustainable economic growth. Originality/value To the best of the authors’ knowledge, this is the first empirical study conducted to examine the moderating role of digital services trade restrictiveness on the national intellectual capital – economic growth nexus.

Cost and resource comparison analysis for THA in Switzerland and Austria.

Total hip arthroplasty (THA) is an orthopedic intervention that generates substantial costs to national healthcare systems due to the number of interventions and the cost per intervention. We performed a cost comparison analysis in Austria and Switzerland. Data from the national joint arthroplasty register in Switzerland and internal information from the national healthcare services in Austria and Switzerland were compared for patient demographics, interventional characteristics, and costs adjusted for inflation and purchasing power from 2015 to 2021. The average age for primary THA in Austria was from 67.4 to 67.8years with 55.9-57.2 percent female patients and from 68.5 to 69.3years with 52.4-53.8 percent female patients in Switzerland. The annual incidence rate for primary THA rose from 210.28/100k to 216.6/100k in Austria and from 212/100k to 250/100k in Switzerland. After correction for inflation, costs were -1.91 percent lower in Austria in 2021 than in 2015 and -2.57 percent lower in Switzerland. After correction for purchasing power, costs were higher in Austria. The average hospital stay after THA in Austria was reduced by 20 percent (11.7days/2015 vs. 9.4days/2021) and 25 percent in Switzerland (8.4days/2015 vs. 6.4days/2021). Revision rate was 2.5-3.2 percent in Austria and 2.8-3.2 percent in Switzerland. The patient population was comparable while patients undergoing primary THA in Austria stay longer in hospital and have relatively higher costs when adjusted for currency, purchasing power, and inflation. The use of standardized registers would be helpful to compare outcomes and costs.