Specialist Opinion Research Articles

Current Practice of Imaging-Guided Interventional Procedures in Rheumatic and Musculoskeletal Diseases: Results of a Multinational Multidisciplinary Survey.

Objectives: To investigate opinion and routine practice of specialists from different disciplines on imaging techniques for interventional procedures related to rheumatic and musculoskeletal diseases (RMDs).Methods: An English-language questionnaire was developed by an international working group and distributed to health care providers of various disciplines involved in the care of people with RMDs via an online survey tool (SoSci Survey®) from December 2019 to May 2020.Results: A total of 1,105 respondents from 56 countries completed the survey, over 60% of participants were rheumatologists. The majority of respondents (88%) performed interventional procedures in RMDs patients and 90% of them used imaging guidance. Ultrasonography was the most frequently used technique, particularly among rheumatologists. X-ray and computed tomography were mainly used by radiologists. A discrepancy emerged between the importance assigned to certain items such as the availability of a second operator and their actual implementation in clinical practice. Local barriers, lack of resources and facilities were mentioned as the most relevant obstacles in this regard. Lack of training on imaging and/or imaging guided procedures did not emerge as a barrier to perform such interventions; in fact, 19% of respondents performing the procedures indicated not to have received adequate training in this field.Conclusions: This is the first multinational multidisciplinary survey exploring in detail the opinions and practice on imaging guidance for interventional procedures in RMDs. A harmonization of protocols based on international guidelines, along with adequate training programmes and interventions on barriers at national/local levels are the main unmet needs requiring attention.

The first case of intracerebral lesions caused by Prototheca wickerhamii

• First case of intracerebral lesions due to Prototheca wickerhamii. • Specialist review of histology helped determine the diagnosis. • The diagnosis was confirmed by both culture and molecular techniques. • Antimicrobial susceptibility testing for Prototheca is challenging to interpret. • There is a lack of evidence for best treatment regimens. This paper describes the first case in the literature of Prototheca wickerhamii infection causing intracerebral lesions. A 55 year old female presented with progressive neurology and multiple lesions on brain MRI scanning. Initial histology from a brain biopsy was reported to show changes compatible with toxoplasmosis. There was no evidence of immunocompromise and this diagnosis was felt to be unlikely. A specialist infectious disease histopathology opinion was requested and results were reported as consistent with protothecosis. Repeat biopsy grew Prototheca wickerhamii confirming the diagnosis. Antimicrobial susceptibility testing was arranged but was challenging to interpret due to lack of clinical break points for this species . A number of treatments were trialled but stopped due to toxicity, antimicrobial resistance on testing or lack of efficacy. Eventually treatment with liposomal amphotericin B was given for 18 months. Two years after treatment ceased the patient remains stable and appears cured of infection. This case highlights Prototheca spp. as a rare cause of central nervous system infection and reports the first case of intracerebral lesions caused by Prototheca wickerhamii . Lack of evidence for treatment, antifungal drug toxicity, difficulties with antimicrobial susceptibility and drug tissue penetration were a challenge. Also demonstrated is the importance of a specialist opinion, in this case histopathology, which ultimately determined the diagnosis.

Addressing Post-COVID Symptoms: A Guide for Primary Care Physicians.

Post-COVID symptoms, defined as symptoms lasting >4 weeks postinfection, have been identified not only among those patients who were hospitalized with severe symptoms but also among those who were asymptomatic or with only mild symptoms. Primary care providers (PCPs) will often be the first point of contact for patients experiencing potential complications of post-COVID symptoms. The aim of this article is to present a post-COVID management tool for PCPs to use as a quick reference and guide to the initial workup and management of the most common post-COVID symptoms. Published guidance, recent literature, and expert specialist opinion were used to create the structure outlining the outpatient evaluation and treatment for post-COVID symptoms. A quick-reference guide for management of post-COVID symptoms was created for PCPs. Educational materials were created for clinicians to share with patients. Our article reviews several common complaints including respiratory, cognitive, and neurological symptoms, chronic fatigue, dysautonomia, and anosmia and presents recommendations for management. Data on long-term effects of COVID-19 are still emerging, and rapid dissemination of this data to front-line PCPs is crucial. This table was our effort to make the currently available evidence accessible for our PCPs in a simple, easy-to-use format.

Review Essay: Surgeons at the Bar: From the Crime Scene to the Courtroom

How did English and Welsh medical practitioners enter the common-law courtroom as expert witnesses, and how can one assess their influence on crime-scene investigations and courtroom testimony? Witnesses offering specialist opinions were hardly novel in the eighteenth-century London courtroom, but their participation grew at such a pace that, by the early 1900s, they had become regular participants in police investigation and criminal trials. Even as their presence grew, their evolution was not a singular event: defense lawyers, judges, and juries were experiencing qualitative changes in their roles in the adjudication of crime just as prison surgeons, asylum superintendents, and hospital medical officers entered the witness box. It is the singular achievement of this important study that Katherine D. Watson has isolated critical moments in the growth of medicine's role while embedding the practitioners’ rise within the shifting dynamics of criminal prosecution in early modern England.

An Experimental Reproduction Study on Characteristics of Woodblock Printing on Traditional Korean Paper (Hanji)

The history of printing technology in Korea is studied by investigating existing ancient documents and records and comparing accumulated data and knowledge. Cultural property research requires non-destructive testing and observation with the naked eye or aided by a microscope. Researchers’ experience and knowledge are required even though they cannot guarantee the outcome. For ancient documents and records that are presumed to consist of woodblock printing, wood type printing, metal type printing, or their combinations, each researcher draws various opinions and conclusions. This often causes confusion and divides the opinions of ordinary citizens and field specialists. Among them, the criteria for judging ancient documents or books printed using woodblock and metal movable material are ambiguous. Academic research on the development history of printing technology in ancient Korea has been stagnant, and conflicts among researchers have also erupted. Involvement of national investigative agencies not specialized in cultural properties has exacerbated the situation. In this study, we investigated printing characteristics that are likely to serve as more objective judgment criteria by quantitatively analyzing the experiments of retrieving several sheets of Korean paper (Hanji) using a replicated Hunminjeongeum (訓民正音) woodblock and quantitatively analyzing the images of the printed papers. In addition, the validity and questions for the typical phenomena presented as a method for distinguishing between woodblock and metal print are reviewed. We investigated the possibility of developing new objective judgement criteria through quantitative analysis using image analysis and investigating the printing characteristics of Korean paper through a reproduction experiment of woodblock printing.

Factors associated with the efficacy of atrial fibrillation radiofrequency catheter ablation: opinion of the specialists who use the “Ablation Index” module

This document provides an overview of current problems and trends in the catheter ablation of atrial fibrillation, summarizes the opinions of specialists, obtained during a web-based electronic survey, on aspects and parameters of radiofrequency ablation. The approaches on improving the efficacy and safety of radiofrequency catheter ablation of atrial fibrillation are provided.

Evaluation of a tele-expertise experiment for skin cancer detection: the perspective of GPs

Abstract Background The incidence of skin cancer has shown an increasing trend in the world and in France over the last four decades. In this context, the delay to access a specialist opinion strongly impacts the patient outcomes. However, the medical demographics of dermatologists in France have been decreasing over the past years. Hence, a tele-expertise (TLE) experiment for skin tumors detection, which allows general practitioners to obtain feedback from a dermatologist within 7 days using a smartphone application, has been set up in the Hauts-de-France region since 2015. Thus, this study aims at understanding the advantages and drawbacks of TLE in the detection of skin tumors perceived by general practitioners. Methods Exploratory study carried out with 15 general practitioners participating in the experiment in the Hauts-de-France region. Semi-structured interviews were conducted between february and april 2021 and analyzed after transcription. Results The main advantages perceived by general practitioners are: (i) fast access to a specialized feedback; (ii) formalization of the request and commitment of the dermatologist; (iii) ease of regulating patients to a specialist; (iv) lower travel frequency and stress for patients; (v) ability to send medical information securely. The drawbacks are most related to the lack of functionalities and the graphical user interface of the application. Conclusions Tele-expertise is a well accepted technological innovation in dermatology among general practitioners, which enables the best use of the scarce medical resources available in the region and to address the needs of patients. The sustainability of TLE in dermatology and its extension to other territories is possible and desirable. Key messages Tele-expertise in dermatology has its place in enabling the early management of malignant skin tumors. The qualitative approach makes it possible to understand general practitioners visions after the introduction of a technological innovation into their practices.

P09 Uncommon cause of back pain

P09 Uncommon cause of back pain

Modeling and analysis of barriers in controlling TB: developing countries' perspective

PurposeTuberculosis (TB) continues to c-exist with humans despite many TB control programs and elimination strategies. This depicts that some barriers are not allowing achieving the desired results. The current study aims to focus on identification and ranking of such barriers to facilitate TB control programs in developing countries.Design/methodology/approachIn the present study, 13 barriers that can influence success rate of TB elimination strategies have been recognized with an in-depth assessment of related literature and opinions of specialists from medical industry and academic world. The interpretive structural modeling (ISM) and decision-making trial and evaluation laboratory (DEMATEL) techniques have been employed for the ranking of barriers.FindingsBased on driving power of barriers, the study coined that underinvestment is a major barrier followed by poor implementation of government policies and programs, poverty and poor primary health care infrastructure.Research limitations/implicationsThe findings may guide healthcare service providers and researchers in analyzing the barriers and understanding the necessity of further advancements to decrease the count of already existing and incident cases.Practical implicationsPolicy- and decision-makers may utilize the information on dependence and driving power of barriers for better planning and effective execution of TB control strategies.Originality/valueAlthough a lot of literature is available on different barriers that are affecting success of TB strategies, the current study analyzes all the key barriers collectively for the prioritization of barriers.

USING ART OF GRAPHICS FOR PRODUCING GUIDING MEANS FOR DEVELOPING ENVIRONMENTAL LITERACY AMONG PREPARATORY SCHOOL STUDENTS

This researchs' purpose is to develop environmental literacy through the use of graphic art for preparatory stage students through the design of guiding means. Therefore, the researchers have prepared a list of some environmental problems by reviewing some previous research and studies and the opinions of specialists which have included (5) major issues branching from them (9) environmental problems, which in turn have included (43) concepts. The researchs tools are prepared to include (6) posters with different designs, a brochure with two covers, the design of (2) (folded) magazines, a design of the cover of the face and the back of the notebook. Inside it, contains a number of recycled paper, the design of one desk-calendar which contains 12 designs; inside it, there is a folder design for keeping papers, a CD sticker design, a card design, a design of 4 prints on Cochet paper, environmental games, printing on a mug, printing on a paper folder. A scale of Environmental Literacy has been also designed, including (a Test of Environmental Information, a Scale of Environmental Attitudes and a Scale of Environmental Skills). A program of the proposed activities has been applied to a group of (30) students of the second year of preparatory school. The experimental method has been used for its suitability to the nature of this research. After the application of the guiding means program, a post-application of the scale of environmental literacy has been subsequently conducted to the research group. Results indicate that the average scores of the experimental group has increased after the statistical treatment of these scores and that: There is a statistically significant difference between the mean scores of students on the scale of environmental literacy pre/post application of the guiding means, in favor of the post-application. There are also statistically significant differences regarding the scores of each dimension of the environmental literacy dimensions pre/post application of the program, in favor of the post-application. This indicates the effectiveness of the program of the guiding means produced using graphic art for the development of environmental literacy. The researcher recommends the necessity of including the guiding means designed using graphic art in the schools of the preparatory stages and using the means that have been designed as well.

Treating chronic hepatitis C in general practice.

Hepatitis C virus (HCV) infection continues to result in significant morbidity and mortality in Australia. Eradication of HCV remains a challenge, with many patients unaware of their infection. With the new era of direct-acting antivirals (DAAs), higher viral eradication rates are attainable, and access to treatment can be expanded bytreating most patients with HCV in general practice, moving away from the traditional model of treatment by a gastroenterologist, hepatologist or infectious diseases physician. Currently available DAAs are pan-genotypic, well tolerated and safe; hence, HCV treatment can be easily undertaken in general practice. The aim of this article is to highlight how to use pan-genotypic DAAs and when to consider referral for a specialist opinion. Most patients with HCV can be treated ingeneral practice, increasing the number of patients who have access totreatment and hence reducing the likelihood of progression to advanced liver disease in these patients, as well asadvancing progress towards HCV eradication in Australia.

Building and testing an information portal to collect and analyze terrorism-related content on the dark web

This study aimed to build and test an information portal related to the collection and analysis of content related to terrorism on the dark web, to benefit from it in the field of combating terrorism, which could be developed in the future more broadly to support the security and practical decision, towards reducing terrorism in all its forms on the one hand. The importance of this study lies - to our knowledge - in the absence of studies at the Arab level that dealt with such a subject. The research used the case study method to study the topic from its various aspects, and in surveying the opinions of specialists this was done using the interview tool, as the research designed a questionnaire for this purpose, which included a group of (19) questions in the closed end method, and it came in two parts: and the main questions on the subject of the study, in addition to two open-ended questions about the suggestions and observations on the information portal. The results of the study concluded that an information portal was built to collect and analyze the content of terrorist groups and organizations on the dark web, and to test their functions through the study sample, which the results showed that it is very suitable for the idea of ​​the portal project and its development. The study also concluded with a number of recommendations, the most prominent of which is the recommendation to adopt the idea of ​​the study, by developing a broader and comprehensive (informational - knowledge) portal system, so that it becomes an institutional project, adopted by scientific and security institutions, such as the Artificial Intelligence Research Laboratory at the University of Arizona.

A study on the intellectual capital management over cloud computing using analytic hierarchy process and partial least squares

PurposeIn the age of a knowledge-based economy and following extensive socio-economic changes, the success of organizations is not limited to gaining financial and material resources. Instead, it depends on the acquisition of intangible assets that can be used to achieve a sustainable competitive advantage. In the new strategic environment, organizations will thrive when they see themselves as a learning organization whose goal is to improve intellectual capital continually; an organization that cannot increase its intellectual capital cannot survive. The term intellectual capital is used in the overlap of all assets, intangible resources and non-physical resources of an organization, including processes, innovation capacity and implicit and explicit knowledge of its members and partner network. However, despite the growing importance of intellectual capital and cloud computing as vital resources for organizations' competitive advantage, there is a limited understanding of them. Simultaneously, the management of intellectual capital enables organizational managers to create, nurture, control and preserves a strong competitive advantage source, the advantage that competitors will not easily capture. So, the main objective of the present investigation is to check out the factors affecting the adoption of intellectual capital management systems based on cloud computing in hospitals.Design/methodology/approachIn the last two decades, we have moved toward economics, where investment in Information Technology (IT), human resources, development, research and advertising is essential to maintain competitive advantage and certify the sustainability of organizations. Therefore, it can be stated that the economic value is the creation and management of intangible assets, which are referred to as intellectual capital. On the other hand, cloud computing is presented as a new paradigm for hosting and providing services through the Internet. Cloud computing can lead to too many benefits to organizations, including cost reduction, flexibility and improved performance. The present article examines how optimal intellectual capital management can be achieved using cloud computing. So, seven hypotheses were developed through the dimensions of technology, environment, organization and innovation. In this study, the path analysis was performed using Analytic Hierarchy Process (AHP) and Partial Least Squares (PLS). By reviewing the literature related to the model of technology, organization, environment and innovation dissemination theory, four main criteria, and 15 sub-criteria were identified based on the opinions of specialists, professors and IT experts based on AHP and PLS methods.FindingsThe results of this investigation confirmed all the hypotheses. The results illustrated that environmental and technological factors should be regarded more when adopting intellectual capital management systems based on cloud computing. The results also indicated that intellectual capital highly influences improving performance. Furthermore, cloud apps, like other disruptive technology, deliver superior benefits while still presenting a slew of realistic challenges that must be tackled. In order to draw a growing customer base to this business model, software vendors should resolve these concerns. The literature revealed that the computing industry is making tremendous strides around the world. Nevertheless, in order to achieve a faster and softer adoption, newer and more advanced techniques are still required.Research limitations/implicationsThe research outcomes can significantly impact a wide range of organizations, such as health-related organizations. However, there are some limitations; for example, the sample is limited to one country. Therefore, future studies can measure the data of this study in different samples in different countries. Future researchers can also boost the model's predictive capability to adopt cloud computing in other organizations by adding environmental, organizational, innovation and other technical factors.Practical implicationsManagers will use these emerging innovations to minimize costs and maximize profits in the intellectual capital management competition. An effective cloud computing based on an electronic human resource management system can significantly increase system performance in industries. The investigators expect that the results will direct clinicians and scholars into a more advanced and developed age of cloud-based apps.Originality/valueInvestigations on the impact of cloud computing on intellectual capital management are rare. Accordingly, this investigation provided a new experience in terms of intellectual capital in the field of cloud computing. This study filled the scientific research gap to understand the factors affecting intellectual capital management systems based on cloud computing. This study provides a better insight into the power of organizational and environmental structure to adopt this technology in hospitals.

Interaction of constitutional guarantees of human rights with power, economy and capital

The article contains a study in the field of interaction and dependence of constitutional guarantees of human rights in the Republic of Moldova on power, economy and capital. An example is given of the set of meanings and forms of this democracy, the measure, level and values of the citizens who make up a collective or make up the crowd, from the point of view of organizing the means by leading the people over the state. The causal relationship is analyzed between the interaction and the direct dependence of the implementation of the constitutional norms on the political will, the level of the economy, including the interest and purpose of the capital dictatorship. This prism studies the real issue of democracy in the Western sample regarding the completeness of citizens' expectations. The article provides an assessment of democratic values in their presence, ie form. The most frequent and richest opinions, ideas and doctrines are evaluated, for the general ideological purpose, in order to effectively achieve objectives, including the subsequent onset of certain consequences. A comparative analysis is made regarding the opinions of other authoritarian specialists in this field.

TRAINING OF ENTREPRENEURIAL SKILLS FOR PERFORMANCE SPORTSMEN FOR THE DEVELOPMENT OF THE BUSINESS ENVIRONMENT IN THE REPUBLIC OF MOLDOVA (ASCERTAINING FRAMEWORK)

In order for the sports field to be in permanent development, it is considered particularly necessary to weaken a sports-professional continuity, which should reflect the manifestation of the volume of skills of performance athletes in the subsequent activity, after completing their career. They certainly know in detail the specifics of multi-annual training, strategies, technologies, training methodologies and, obviously, are considered the right people to become entrepreneurs in sports activities, thus promoting the field. This article describes some innovative ways that can be the basis for training entrepreneurial skills in performance athletes for business development in the Republic of Moldova. The study is focused on reporting the opinions of many specialists in the field, performance athletes, and obviously on the author's research, all aimed at establishing a special course of lessons in the reference discipline, which will provide the most eloquent information in the sense of high professional training to entrepreneurship.

Legal regime for waste management in the Republic of Moldova

This article contains a study in the field of interaction and dependence of constitutional guarantees of Human Rights in the Republic of Moldova on power, economy and capital. The author analyzes the set of meanings and forms of this democracy, the measure, level and values of citizens who make up a collective or a lot of people, from the point of view of the means and methods of applying democratic principles through the prism of citizens ' involvement in the leadership of the state. The interaction and direct dependence of the implementation of constitutional norms by the political will, the level of the economy, including the interest and purpose of the dictatorship of capital, is subject to analysis. The real problem of Western-type democracy with regard to the expectations of citizens is also analyzed. The article also provides an assessment of democratic values in their current form and content. The most common and independent opinions, ideas and doctrines are analyzed. Similarly, an analysis is carried out from the general ideological point of view and the achievement of objective effects, including the subsequent occurrence of certain consequences. A comparative analysis is made on the opinions of other famous specialists in this field.

Modeling global transfusion medicine education.

Modeling global transfusion medicine education.

APPE continues the battle against counterfeit respirators

The Association of Personal Protective Equipment (APPE) in connection with the next outbreak of coronavirus infection in Russia has doubled its efforts to restore order when purchasing personal respiratory protective equipment (RPE) at state medical institutions. Expert opinions of specialists show that the reason for the real threat to physicians working with covid patients, as well as to relatives and people around them, is unregulated legislation.

A Machine Learning Methodology for Identification and Triage of Heart Failure Exacerbations

Inadequate at-home management and self-awareness of heart failure (HF) exacerbations are known to be leading causes of the greater than 1 million estimated HF-related hospitalizations in the USA alone. Most current at-home HF management protocols include paper guidelines or exploratory health applications that lack rigor and validation at the level of the individual patient. We report on a novel triage methodology that uses machine learning predictions for real-time detection and assessment of exacerbations. Medical specialist opinions on statistically and clinically comprehensive, simulated patient cases were used to train and validate prediction algorithms. Model performance was assessed by comparison to physician panel consensus in a representative, out-of-sample validation set of 100 vignettes. Algorithm prediction accuracy and safety indicators surpassed all individual specialists in identifying consensus opinion on existence/severity of exacerbations and appropriate treatment response. The algorithms also scored the highest sensitivity, specificity, and PPV when assessing the need for emergency care.Lay summaryHere we develop a machine-learning approach for providing real-time decision support to adults diagnosed with congestive heart failure. The algorithm achieves higher exacerbation and triage classification performance than any individual physician when compared to physician consensus opinion.Graphical abstract

Organizing internal audit at enterprises: a risk-based approach

The paper investigates organization of internal audit at risk-oriented enterprises. The differences between traditional and risk-oriented approaches of internal audit at enterprises are considered. The risk-oriented internal audit allows us to investigate not only financial risks that arise in internal control and accounting, and the risks of differentiated audit are to evaluate various risks groups: financial, operational, technical, informational, etc. Each group has a corresponding hierarchy. Thus, financial risks include accounting risks (second level), which in accordance with IFRS and GAAP requirements include three groups of economic risks: market risk, credit risk and risk of main activity - third level. The risk-oriented internal audit allows you to evaluate the risks at the level of the enterprise divisions. The introduction of the principles and postulates of the concept of "liability centers" in the enterprise allows, for example, in the implementation of expert risk assessment, use personal opinion of managers and specialists of various units in the formation of the chain of values of the enterprise. The risk-oriented internal audit focuses on assessing risks that are not enough or excessively controlled. At the same time, risks are taken into account by the level of significance on the Luckyert scale: minor, moderate and large. But for each subdivision, the level of materiality can be different - it is necessary to calculate the integral risk for the enterprise in general. The risk map of the financial department of the enterprise is built on the basis of the concept of stakeholders. It has been proved that the risk map allows monitoring of the risks of significant distortion of accounting (financial) and non-financial reporting in terms of responsibility centers. The prospects for further research are determined: the development of internal audit documents using the principles of risk-oriented approach - an audit plan, audit program, audit report, schedule document circulation of internal audit service, etc.