Number Of Medical Physicists Research Articles

Analysis of human errors in the operation of various treatment planning systems over a 10-year period.

The present study aimed to summarize and report data on errors related to treatment planning, which were collected by medical physicists. The following analyses were performed based on the 10-year error report data: (1) listing of high-risk errors that occurred and (2) the relationship between the number of treatments and error rates, (3) usefulness of the Automated Plan Checking System (APCS) with the Eclipse Scripting Application Programming Interface and (4) the relationship between human factors and error rates. Differences in error rates were observed before and after the use of APCS. APCS reduced the error rate by ~1% for high-risk errors and 3% for low-risk errors. The number of treatments was negatively correlated with error rates. Therefore, we examined the relationship between the workload of medical physicists and error occurrence and revealed that a very large workload may contribute to overlooking errors. Meanwhile, an increase in the number of medical physicists may lead to the detection of more errors. The number of errors was correlated with the number of physicians with less clinical experience; the error rates were higher when there were more physicians with less experience. This is likely due to the lack of training among clinically inexperienced physicians. An environment to provide adequate training is important, as inexperience in clinical practice can easily and directly lead to the occurrence of errors. In any environment, the need for additional plan checkers is an essential factor for eliminating errors.

Trends and distribution of external radiation therapy facilities in Japan based on Survey of Medical Institutions from the Ministry of Health, Labour and Welfare.

This study aimed to explore the distribution of external radiation therapy (RT) facilities, the status of related device installations and the adoption of high-precision RT using Survey of Medical Institutions from the Ministry of Health, Labour and Welfare in Japan. Analysis, categorized by the hospital size and prefecture, provides specific insights into the trends in treatment facility healthcare capabilities. Data on the number of RT facilities, high-precision RT facilities, RT devices and treatment planning systems (TPS) categorized by the number of beds and prefecture from 1996 to 2020 were analyzed. In addition, the study examined the correlation between the high-precision implementation rate and the number of TPSs or radiation oncologists and other medical staff. High-precision RT exceeded 95% in large facilities (800+ beds) but remained <50% in medium-sized facilities (300-499 beds). In a prefecture-by-prefecture analysis, calculation of the maximum-minimum ratio of RT facilities per million population and per 30km2 revealed a disparity of 3.7 and 73.1 times in the population ratio and the density ratio, respectively. Although a correlation was found between the number of TPSs per RT device or the number of medical physicists per million population and the rate of high-precision RT implementation, no correlation was found among other professions. Detailed analysis based on the hospital size and prefecture provided more specific information on the medical functions of RT facilities in Japan. These findings can potentially contribute to the future development of RT, including the standardization of treatment techniques and optimal resource allocation.

Global status of medical physics human resource – The IOMP survey report

PurposeRealizing the need for periodic surveys about global medical physics human resource, the International Organization for Medical Physics (IOMP) performed a third survey following the previous two (2015 and 2018). The objective was to collect information about the current numbers of medical physicists (MPs) in individual countries, about their MP training, and accreditation pathways. MethodsThe survey was designed using Google Forms. Forms were distributed to national MP associations around the world. The data was collected during May-Nov 2022. MS Excel and SPSS software were used to perform descriptive statistics. Results64 valid responses were received covering all continents. The largest numbers of MPs are in high income countries of Europe, Australia and North America, while the lowest numbers of MPs are seen in middle and low-income countries of Asia, Latin America and Africa. Among the respondents, 73% reported MP shortages in their countries. 69% reported the existence of an official MP training program which comprises university courses and in-service training. Furthermore, 85% of the respondents indicated the availability of MP university courses, primarily at the Master’s degree level. Participation in research was between 10 and 30% of allocated work time for 42% and below 10% for 33% respondents. ConclusionsThere are new findings on number of MPs per million population in different countries, with some expressing adequacy in the total number of MPs, but the data breakdown indicates a shortage in diagnostic X-ray physicists. Future surveys should also investigate in more detail data on outsourcing, and involvement in research.

The role of medical physicists in clinical trials across Europe

IntroductionThe roles and responsibilities of medical physicists (MPs) are growing together with the evolving science and technology. The complexity of today’s clinical trials requires the skills and knowledge of MPs for their safe and efficient implementation. However, it is unclear to what extent the skillsets offered by MPs are being exploited in clinical trials across Europe. MethodsThe EFOMP Working Group on the role of Medical Physics Experts in Clinical Trials has designed a survey that targeted all 36 current National Member Organisations, receiving a response from 31 countries. The survey included both quantitative and qualitative queries regarding the involvement of MPs in trial design, setup, and coordination, either as trial team members or principal investigators. ResultsThe extent of MPs involvement in clinical trials greatly varies across European countries.The results showed disparities between the roles played by MPs in trial design, conduct or data processing. Similarly, differences among the 31 European countries that responded to the survey were found regarding the existence of national bodies responsible for trials or the available training offered to MPs. The role of principal investigator or co-investigator was reported by 12 countries (39%), a sign of efficient collaboration with medical doctors in designing and implementing clinical studies. ConclusionOrganisation of specific training courses and guideline development for clinical trial design and conduct would encourage the involvement of a larger number of MPs in all stages of trials across Europe, leading to a better standardisation of clinical practice.

Collaborative networking and support for medical physics development in low and middle income (LMI) countries.

Medical physics is one of the key aspects of contemporary medicine, primarily focused on the safe and effective use of medical imaging and radiotherapy equipment. The number of medical physicists and their activities are directly related to the national/regional healthcare provision. The distribution of the medical physics workforce however is still very uneven—more than 70% of all medical physicists are in North America and Europe, serving the healthcare provision of about 1 billion people. The remaining 30% of medical physicists serve the healthcare provision of the rest of the world—serving about 6.5 billion people. A number of activities were taken by various teams and organisations to address this issue. The increase of quality of healthcare and the effectiveness of medical technology usage, lie in adequate education and training for medical physicists and engineers, who are the front-liners when it comes to dealing with technology in healthcare. To help LMI countries professional growth in the field of medical physics and technology, we developed an education and capacity building strategy, based on the revolutionary application of digital resources combined with experience sharing through large international network.

Radiotherapy in the Caribbean: a spotlight on the human resource and equipment challenges among CARICOM nations

BackgroundThere is limited data on access to radiotherapy services for CARICOM nations.MethodsThis was a descriptive mixed-methods observational study which used data collected via survey from staff working in Radiation Oncology in 14 CARICOM countries. Benchmark recommendations from the International Atomic Energy Agency were compared to existing numbers. The Directory of Radiotherapy Centers, World Bank, and Global Cancer Observatory databases were all accessed to provide information on radiotherapy machines in the region, population statistics, and cancer incidence data respectively. Both population and cancer incidence-based analyses were undertaken to facilitate an exhaustive review.ResultsRadiotherapy machines were present in only 50% of the countries. Brachytherapy services were performed in only six countries (42.9%).There were a total of 15 external beam machines, 22 radiation oncologists, 22 medical physicists, and 60 radiation therapists across all nations.Utilizing patient-based data, the requirement for machines, radiation oncologists, medical physicists, and radiation therapists was 40, 66, 44, and 106, respectively. Only four (28.6%) countries had sufficient radiation oncologists. Five (35.7%) countries had enough medical physicists and radiation therapists.Utilizing population-based data, the necessary number of machines, radiation oncologists, and medical physicists was 105, 186, and 96 respectively. Only one county (7.1%) had an adequate number of radiation oncologists. The number of medical physicists was sufficient in just three countries (21.4%). There were no International Atomic Energy Agency population guidelines for assessing radiation therapists.A lower economic index was associated with a larger patient/population to machine ratio. Consequentially, Haiti had the most significant challenge with staffing and equipment requirements, when compared to all other countries, regardless of the evaluative criteria. Depending on the mode of assessment, Haiti’s individual needs accounted for 37.5% (patient-based) to 59.0% (population-based) of required machines, 40.1% (patient-based) to 59.7% (population-based) of needed radiation oncologists, 38.6% (patient-based) to 58.3% (population-based) of medical physicists, and 42.5% (patient-based) of radiation therapists.ConclusionThere are severe deficiencies in radiotherapy services among CARICOM nations. Regardless of the method of comparative analysis, the current allocation of equipment and staffing scarcely meets 50% of regional requirements.

Medical physics graduate education in Mexico and its relation to the advances in radiation oncology.

To evaluate the state of graduate education in medical physics and progress in radiation oncology (RO) equipment in Mexico since 2000, when conferring degrees from two master's-degree programs in Medical Physics began. Medical physics is a Health Profession and there are international recommendations for education, training, and certification. Both programs follow these education guidelines. The most common clinical occupation of graduates is in RO services. Techniques in Mexican RO include traditional and high-precision procedures. Academic and occupational information about the programs and their graduates were obtained from official websites. Graduates were invited to respond to a survey that requested information about their present job. We obtained data on RO equipment and human resources from public databases and estimated staffing requirements of medical physicists (MPs). Medical physics programs have graduated a total of 225 MPs. Half of them work in a clinical environment and, of these, about 90 work in RO services. MPs with M.Sc. degrees constitute 36% of the current MP workforce in RO, estimated to be 250 individuals. Survey responses pointed out the main merits and limitations of the programs. The number of MPs in RO has increased fivefold and the number of linacs sixfold in 15 years. The present number of MPs is insufficient, according to published guidelines. All MPs in RO services with advanced modalities must be trained following international recommendations for graduate education and post-graduation clinical training. Education and health institutions must find incentives to create more graduate programs and clinical residencies.

Medical physicists in Malaysia: A national workforce survey 2019

ObjectiveMedical physics in Malaysia is still considered a young profession. This workforce survey aims to understand the status, aspirations, motivation and experiences of medical physicists (MPs) in the country. A subsection of this survey also aims to understand the role of women. MethodA survey was carried out between April 20 and May 30, 2018 by a working group under the Medical Physics Division of the Malaysian Institute of Physics (IFM). The survey form was designed using Google Form and sent to various public and private institutions nationwide that employed MPs registered with IFM. ResultsA total of 106 responses (28% men and 72% women) were analysed. This represented 30% of the medical physics workforce. Majority of them had postgraduate degrees, but their clinical training is mostly obtained on the job with no certification. The number of low-ranking female MPs was disproportionately high. MPs worked long hours and achieving work-life balance (WLB) was a challenge. Factors that improved their WLB included working close to home, having a supportive manager and flexible working hours. Most MPs aspired to become professional and mentor younger compatriots, besides contributing to patient care and research. Gender discrimination was reportedly low. ConclusionMedical physics in Malaysia is growing and has a strong representation of women. In future, they would probably take over the top management from their male counterparts, whose number had stagnated. A united effort was essential to set up a proper clinical training system to train clinically qualified MPs.

Medical physics workforce: A global perspective

PurposeThe International Organization for Medical Physics (IOMP) performed a detailed study following the first survey published in 2015 with the particular objectives: 1) gather data on global medical physicists (MPs) workforce, 2) identify differences between geographical regions and, 3) investigate whether there is a gender dimension in higher hierarchy positions. MethodsAn online questionnaire was send to IOMP members and contact points in countries where no professional MPs society existed. Information requested: total number (N) of MPs (men and women), N of current elected executive board (EB) of societies and women proportion in the board, president gender and number of women presidents for the last 10 years. IOMP archives were also investigated for data on gender composition related to chairs of committees, officers and IOMP awardees. ResultsNinety three countries reported 29,179 MPs, from which 8702 were women (29.8%) and 20,477 men. The most dense MPs population was in Europe (34%), followed by North America (33%) and Asia/Oceania (24%). Societies EB women members constitute 21–40%, but rarely reach the presidential position. The IOMP archived data show that women MP representation decreases in higher hierarchy positions. ConclusionsGlobal MPs production does not meet clinical needs especially in Latin America/Caribbean and Africa (6% of total MPs workforce and small number of MPs/million of population). Rough estimations showed that approximately 58,950 MPs will be required by 2035. Women representation is away from the United Nations and European Commissions goals. Women representation in higher hierarchy position is low.

P066] History of medical physics – A project tracing the development of the profession

Purpose The International Organization for Medical Physics (IOMP) exists over 50 years. It collects information from all medical physics societies, thus collating a picture of the professional global development. While during the mid-1960 there were c.6000 medical physicists in the world, in 2017 these are c.26,000. However there is a huge challenge in front of the profession. The recently published report of the Global Task Force on Radiotherapy for Cancer Control predicts that by 2035 the existing number of medical physicists has to triple in order to support the needs of the global healthcare provision. The lessons from the past 20 years show that to achieve such goal the profession has to firmly invest in education and training activities, with special emphasis on e-learning and international collaboration. In order to support this global effort of the profession, IOMP launched a new project “History of Medical Physics”, which will trace the professional development in various countries, showing specific models which could be useful for other countries. Methods This large international project will not only focus on the medical physics professional development. It will also show the development of the various branches in our profession. This way the project will create a Compendium of independent Volumes/Parts, which will reflect the main areas of development of medical physics, including: Diagnostic Radiology (X-ray) Imaging; Computed Tomography; Radiotherapy (External beam); Radiotherapy (Brachytherapy); Nuclear Medicine Imaging; Ultrasound Imaging; Magnetic Resonance Imaging; Optical Systems and NIR in Medicine; Medical Informatics; Radiation Measurement and Protection in Medicine; Professional Development; EducationT EducationT Diagnostic Radiology (X-ray) Imaging. These will be presented at ECMP together with their outcomes, aiming to expand the project and invite more colleagues from EFOMP to take part in this unique international activity. Conclusions The project results will be a very useful source of information for future new developments and will provide a canvas for future updates. Very importantly, the project results will be a written proof of the significant role played by medical physicists in contemporary medicine.

Reducing total education and training time without loss of quality: The education and training model in Malta

The number of Medical Physicists in Malta was until recently much lower than that recommended by the European Guidelines on the Medical Physics Expert. This was impacting the extent, effectiveness, safety and efficiency of clinical services. The Maltese Ministry of Health and University of Malta together partnered a project the objective of which was to produce an Education and Training scheme for the Clinically Qualified Medical Physicist which followed the recommendations of the ‘European Guidelines on the Medical Physics Expert’ project, EFOMP Policy Statement 12.1 and IAEA Training Course Series 37, 47 and 50 whilst optimizing costs and ensuring future-proofing. We present the innovative scheme as a model of academic and public administration cooperation in the service of patients. The project was part financed by the European Social Fund. It is hoped that the model will help other countries in Europe where Medical Physics Education and Training is not yet developed to set up similar cost-effective schemes.

Surveying trends in radiation oncology medical physics in the Asia Pacific Region

ObjectiveOur study aims to assess and track work load, working conditions and professional recognition of radiation oncology medical physicists (ROMPs) in the Asia Pacific Region over time. MethodsA structured questionnaire was mailed in 2008, 2011 and 2014 to senior medical physicists representing 23 countries. The questionnaire covers 7 themes: education and training including certification; staffing; typical tasks; professional organisations; resources; research and teaching; job satisfaction. ResultsAcross all surveys the response rate was >85% with the replies representing practice affecting more than half of the world’s population. The expectation of ROMP qualifications (MSc and between 1 and 3years of clinical experience) has not changed much over the years.However, compared to 2008, the number of medical physicists in many countries has doubled. Formal professional certification is only available in a small number of countries. The number of experienced ROMPs is small in particular in low and middle income countries. The increase in staff numbers from 2008 to 2014 is matched by a similar increase in the number of treatment units which is accompanied by an increase in treatment complexity. Many ROMPs are required to work overtime and not many find time for research. Resource availability has only improved marginally and ROMPs still feel generally overworked, but professional recognition, while varying widely, appears to be improving slowly. ConclusionWhile number of physicists and complexity of treatment techniques and technologies have increased significantly, ROMP practice remains essentially unchanged over the last 6years in the Asia Pacific Region.

Medical physics aspects of cancer care in the Asia Pacific region: 2014 survey results.

It was the aim of this work to assess and track the workload, working conditions and professional recognition of radiation oncology medical physicists (ROMPs) in the Asia Pacific region over time. In this third survey since 2008, a structured questionnaire was mailed in 2014 to 22 senior medical physicists representing 23 countries. As in previous surveys the questionnaire covered seven themes: 1 education, training and professional certification, 2 staffing, 3 typical tasks, 4 professional organisations, 5 resources, 6 research and teaching, and 7 job satisfaction. The response rate of 100% is a result of performing a survey through a network, which allows easy follow-up. The replies cover 4841 ROMPs in 23 countries. Compared to 2008, the number of medical physicists in many countries has doubled. However, the number of experienced ROMPs compared to the overall workforce is still small, especially in low and middle income countries. The increase in staff is matched by a similar increase in the number of treatment units over the years. Furthermore, the number of countries using complex techniques (IMRT, IGRT) or installing high end equipment (tomotherapy, robotic linear accelerators) is increasing. Overall, ROMPs still feel generally overworked and the professional recognition, while varying widely, appears to be improving only slightly. Radiation oncology medical physics practice has not changed significantly over the last 6 years in the Asia Pacific Region even if the number of physicists and the number and complexity of treatment techniques and technologies have increased dramatically.

Female medical physicists: The results of a survey carried out by the International Organization for Medical Physics

IntroductionThe gender composition of the existing medical physicist (MP) workforce around the world is basically unknown. The International Organization for Medical Physics (IOMP) performed a survey in order to investigate the number of MPs in countries around the world and the percentage of women MPs compared to total number of MPs. Materials and methodsA simple online questionnaire prepared as a Google Forms survey asking the country, the total number of MPs, the number of female MPs and finally the gender of the person providing the data was sent in mid-March 2013 to six regional member organizations of IOMP, as well as contact points in many member countries. ResultsSixty-six countries responded to the survey by mid-July 2013. Fifty two percent of those who filled the form were females, the rest males. The total number of MPs was 17,024, of which 28% were female (4807). The median values of percentages of females were 21% in the USA, 47% in Europe, 35% in Asia, 33% in Africa and 24% in Latin America. ConclusionThis is the first international survey that investigates the number and percentage of female MPs around the world. There are European countries that are far away from the target set by European Commission (40%) whereas in countries in the Middle East and Asia, female MPs actually outnumber males. This study is the first step in a more in-depth study that needs to be taken in near future.

Approaches to aspects of optimisation of protection in diagnostic radiology in six continents

There has been an expansion in the use of x-ray imaging during the last 20 years. Effective arrangements for justification of exposures as well as for optimisation of protection are crucial. The amount of effort put into the latter, the way in which it is organised and the groups carrying this out vary across the globe. A simple survey of organisational arrangements relating to performance testing of x-ray equipment, management of patient dose and other aspects of implementing optimisation has been undertaken. A total of 137 completed survey forms were received from medical physicists in 48 countries. Results for individual countries from which more responses were received, or for groups of neighbouring ones, are compared to portray variations. Some performance testing of x-ray equipment was mandated in most countries (more than 90%), with the tests being performed primarily by hospital or private medical physicists, although other groups are involved. Testing of equipment prior to clinical use was generally high for most regions, but the frequency was lower in Latin America. There was considerable variation in the frequency and regularity of subsequent testing. The prevalence of patient dose surveys was high in Europe, but lower in other continents. Organisational arrangements for testing performance of x-ray equipment, patient dose surveys and implementing optimisation of protection in medical exposures across the globe can be divided into five main groups. Hospital medical physicists take the lead in western Europe and Australia with the involvement of radiographers. Private medical physicists test equipment in Brazil, the USA and New Zealand, and have some responsibility for optimisation in Brazil. University personnel have significant involvement, together with medical physicists in eastern Europe, but the extent of the coverage is uncertain. Government personnel and service engineers carry out equipment testing in many countries of Africa and Asia, while radiographers have a significant role in Thailand and other countries where the number of medical physicists is limited. In order for dose surveys to have an impact, action must be taken upon the findings, but there must be an effective link between surveyors and radiology facility staff to ensure that this is done.

Status of Medical Physics in Asia Pacific Region

According to a large scale surveys conducted in year 2011 by an ad hoc medical physics working group, the Asia and Pacific region has about 3864 radiation oncology medical physicists. This is a significant increase from about 2410 found in a 2008 survey. The number of imaging medical physicists in the region is rather uncertain as the two surveys did not cover specifically medical physicists engaged in imaging physics work. It is estimated that about 10% of the medical physicists in AFOMP are engaged in imaging work. This number is expected to increase as imaging physics is gaining momentum due to increasing application of imaging techniques in radiation therapy. Despite of the significant increase in the number of medical physicists in radiation oncology over the past three years, the mean ratio of the number of radiation oncology medical physicist to MV treatment machine in the region remained basically unchanged due to a corresponding increase in the number of treatment machines in the region. The regional mean ratio was 1.04 in 2008 against 1.14 in 2011. The national ratio varied significantly between countries from 0.64 in a developing country to 2.13 in a developed country. The survey data indicated that there were much shortage in both radiotherapy treatment equipment and medical physicists in the developing countries in the region. According to a large scale global survey conducted by IAEA during late 2009 to early 2010 on education, training and professional development of medical physicists, most of the countries in the region demanded a master degree as the entry requirement for the medical physics profession. However, formal clinical training was available in only 9 countries with duration of training varied between 1 to 4 years. Four of these countries adapted the IAEA clinical training programs in radiation oncology physics and imaging physics. In countries where formal clinical trainings were not available, informal on the job trainings were given to newly appointed medical physicists. National systems for professional certification of medical physicist were established in countries where formal clinical trainings are available. Voluntary CPD systems were also established in these countries. The survey data indicated a large variation in the clinical training and professional development of medical physicists in the region. Such degree of disparity in qualification and competency is considered as unsatisfactory and can have negative impact on the standard of practice and professional status of medical physicists. External audit of training and professional certification systems is considered by some countries as useful in improving the professional status of certified medical physicists and also in getting supports for training resources. Medical physicists in the region are looking into standardization of training and professional competence and are exploring the possibility of achieving this through independent accreditation. With this objective, six medical physics organizations in the region have become chartered members of the International Medical Physicist Certification Board (IMPCB) and are enthusiastically working to have their national certification systems accredited by IMPCB or other accreditation bodies.

Medical physics aspects of cancer care in the Asia Pacific region: 2011 survey results.

Background:Medical physicists are essential members of the radiation oncology team. Given the increasing complexity of radiotherapy delivery, it is important to ensure adequate training and staffing. The aim of the present study was to update a similar survey from 2008 and assess the situation of medical physicists in the large and diverse Asia Pacific region.Methods:Between March and July 2011, a survey on profession and practice of radiation oncology medical physicists (ROMPs) in the Asia Pacific region was performed. The survey was sent to senior physicists in 22 countries. Replies were received from countries that collectively represent more than half of the world’s population. The survey questions explored five areas: education, staffing, work patterns including research and teaching, resources available, and job satisfaction.Results and discussion:Compared to a data from a similar survey conducted three years ago, the number of medical physicists in participating countries increased by 29% on average. This increase is similar to the increase in the number of linear accelerators, showing that previously identified staff shortages have yet to be substantially addressed. This is also highlighted by the fact that most ROMPs are expected to work overtime often and without adequate compensation. While job satisfaction has stayed similar compared to the previous survey, expectations for education and training have increased somewhat. This is in line with a trend towards certification of ROMPs.Conclusion:As organisations such as the International Labour Organization (ILO) start to recognise medical physics as a profession, it is evident that despite some encouraging signs there is still a lot of work required towards establishing an adequately trained and resourced medical physics workforce in the Asia Pacific region.

SU-GG-P-01: The Medical Physics Specialization System in Poland

The aim of this paper is to presents the situation of the profession of medical physicists in Poland. The official recognition of the profession of medical physicist in Polish legislation was done in 2002. In recent years, more and more Universities which have Physics Faculties introduce the medical physics specialty. At present there are about 15 Universities which offer such programs in medical physics. These Universities can graduate about 150 medical physicists per year. In 2002, the Ministry of Health introduced a program of postgraduate specialization in medical physics along the same rules used in specialization of physicians in various branches of medicine. Seven institutions were selected as teaching institutions, based on their experience, quality of the medical physics professionals, staffing levels, equipment availability, lecture halls, etc. The first cycle of specialization programme started in 2005 and the first candidates completed their training at the end of 2008 and passed their official state exams in May 2009, becoming medical physics experts. In 2006, the Ministry of Health issued a regulation specifying the required number of physicists and medical physics experts employed in radiotherapy and nuclear medicine departments. In radiotherapy, every department has to employ 3 physicists (including 2 medical physics experts) per 1000 new patients treated per year. At present, there are about 220 medical physicists employed in radiotherapy facilities. So far the overall number of medical physicist is sufficient, but the number of medical physics experts is too small. At present, the formation of medical physics professionals in Poland is well established. The principles of postgraduate training and specialization are well established and the curriculum of the training is very comprehensive and demanding. However, the system of specialization should be further strengthened and supported financially to meet the requirements established by the Polish Ministry of Health.

The international scope of Medical Physics: An editorial

The international scope of Medical Physics: An editorial