Position Paper Research Articles

2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP).

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

Public Computing Intellectuals in the Age of AI Crisis

The belief that AI technology is on the cusp of causing a generalized social crisis became a popular one in 2023. While there was no doubt an element of hype and exaggeration to some of these accounts, they do reflect the fact that there are troubling ramifications to this technology stack. This conjunction of shared concerns about social, political, and personal futures presaged by current developments in artificial intelligence presents the academic discipline of computing with a renewed opportunity for self-examination and reconfiguration. This position paper endeavors to do so in four sections. The first explores what is at stake for computing in the narrative of an AI crisis. The second articulates possible educational responses to this crisis and advocates for a broader analytic focus on power relations. The third section presents a novel characterization of academic computing’s field of practice, one which includes not only the discipline’s usual instrumental forms of practice but reflexive practice as well. This reflexive dimension integrates both the critical and public functions of the discipline as equal intellectual partners and a necessary component of any contemporary academic field. The final section will advocate for a conceptual archetype–the Public Computer Intellectual and its less conspicuous but still essential cousin, the Almost-Public Computer Intellectual–as a way of practically imagining the expanded possibilities of academic practice in our discipline, one that provides both self-critique and an outward-facing orientation towards the public good. It will argue that the computer education research community can play a vital role in this regard. Recommendations for pedagogical change within computing to develop more reflexive capabilities are also provided.

Assessment of pediatric patients with suspected nonsteroidal anti-inflammatory drug hypersensitivity.

Background: Beta-lactam antibiotics are the most common cause of hypersensitivity reactions to medications, followed by nonsteroidal anti-inflammatory drugs (NSAID). Objective: The aim of this study was to classify children with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAID-H) according to the latest updates. Methods: ENDA recommendations were used to evaluate all patients with suspected NSAID-H. Children were classified as either selective responders (SR) or cross-intolerant based on the results of the drug provocation test (DPT). Results: Sixty-seven patients with suspected NSAID-H were evaluated in this study. NSAID-H was confirmed in 20 patients (29.9%). Among the 20 patients diagnosed with NSAID-H, 15 were classified according to the 2018 EAACI/ENDA Position Paper. Twelve patients (80%) were classified as cross-intolerant and 3 (20%) as SRs. NSAID-H was confirmed in 4 of 37 patients (10.8%) ages <10 years and 16 of 30 patients (53.3%) ages >10 years (p < 0.001). Twelve patients ages >10 years were classified. Cross-intolerance was detected in nine patients (66.6%). In patients >10 years of age, NSAID-induced urticaria/angioedema (NIUA) (16.7%) was the most common type in the group with classifiable cross-intolerant. In addition, NSAID-exacerbated respiratory disease was detected in one patient. Conculsion: Ibuprofen is the most common NSAID-H drug used in children. NIUA is the most common reaction. In pediatric allergy, hypersensitivity to NSAIDs is a challenging diagnostic issue. Hypersensitivity to NSAIDs poses a challenging diagnostic issue in pediatric allergies. The oral challenge test is the main diagnostic tool; however, in clinical practice, performing multiple challenge tests is difficult.

Preventing Catheter-Associated Urinary Tract Infections: A position paper of the International Society for Infectious Diseases, 2024 update

Preventing Catheter-Associated Urinary Tract Infections: A position paper of the International Society for Infectious Diseases, 2024 update

Human papillomavirus prophylactic vaccines: update on new vaccine development and implications for single-dose policy.

Human papillomavirus (HPV) prophylactic vaccines were first licensed in 2006 with the primary goal of preventing HPV-related cancers, with cervical cancer accounting for the highest morbidity and mortality globally. Six HPV vaccines have been licensed; 4 of these have been prequalified by the World Health Organization, and additional products are in the pipeline. This article provides an overview of HPV vaccine coverage and current and anticipated vaccine supply vs expected demand. Given that the 2022 World Health Organization position paper on HPV vaccines includes a 1-dose regimen as an alternate schedule, we will discuss the evidence for using licensed vaccines in single-dose regimens and the approach to generating similar supportive data for other current and future vaccines. The broad adoption of a single-dose HPV vaccine regimen would expand access to vaccines by improving the supply-demand balance, increasing affordability, and simplifying logistics, which will ultimately impact HPV-related morbidity and mortality.

ITACARE-P/SIGG/SIGOT/SICGE position paper: referral of elderly cardiac patient from geriatrics to cardiac rehabilitation.

Cardiac rehabilitation (CR) is Class IA indication in patients after an acute cardiovascular (CV) event, with efficacy confirmed even in elderly or frail CV patients CV and geriatric outcomes. However, rate of referral and admission to CR of elderly CV patients remains very low. CV patients admitted in geriatric wards are often complex, multimorbid and frail. Therefore, the present position paper addressees their possible referral to CR, since many have various forms of CV diseases amenable to improve with CR. The multidisciplinary and comprehensive model of CR is applicable to these patients where evaluation and interventions should be tailored to the patient functional and clinical status, aiming to appropriate targets. Cardiologist, Geriatrician and other professionals, should synergistically integrate their competences, thus outlining also the new paradigm of "Cardiogeriatric Rehabilitation and Prevention", possibly leading to an increased awareness of the beneficial effect of CR and to an increased referral to CR from Geriatric departments. Operative recommendations are given, based on appropriateness and priority of indications, clinical risk and frailty level, integrating different expertise to reach more effective programs of care.

Mexican position paper for the diagnosis and treatment of cardiac amyloidosis.

La amiloidosis es una enfermedad heterogénea, de origen hereditario o adquirido, que se caracteriza por el depósito anormal de proteínas fibrilares en diversos tejidos. Esta enfermedad puede manifestarse de manera localizada o sistémica, lo que genera una amplia variabilidad en su presentación clínica y, frecuentemente, retrasa el diagnóstico. Por ello, es fundamental la identificación temprana de los signos y síntomas para mejorar el pronóstico. El primer posicionamiento mexicano sobre la amiloidosis cardíaca tiene como objetivo resumir las principales características de la enfermedad y sus subtipos, identificando datos de alarma que incrementen la sospecha de su presencia. Además, busca ofrecer un algoritmo diagnóstico que integre los estudios de imagen y de laboratorio disponibles en nuestro país, con el fin de simplificar la toma de decisiones y llegar a un diagnóstico de manera rápida, práctica y actualizada, basado en recomendaciones sustentadas en evidencia científica. Una vez confirmado el diagnóstico, se abordan los distintos retos terapéuticos, tanto farmacológicos como no farmacológicos, ya que los pacientes no responden al tratamiento convencional de insuficiencia cardíaca. Por ello, el tratamiento debe ser individualizado para cada paciente, teniendo en cuenta la presencia de otras comorbilidades. Finalmente, se presentan los principales factores pronósticos que guiarán un tratamiento adecuado, incluyendo los resultados del asesoramiento genético.

Slow Restoration, Rewilding, and Design

This position paper distinguishes restoration from rewilding and argues for the establishment of a slow restoration movement. Repair takes time. Restoration is an active and ongoing process that unites insights and methods from ecology and landscape architecture and design. Slow restoration acknowledges that repair is a never-ending process, one in which people care for other beings and attempt to undo the harms caused by centuries of colonialism, consumption, and death.

Temporal and geogrpahic trends in female representation within European cardiovascular imaging among 13,436 individuals associated with EACVI

Abstract Introduction Women are under-represented in cardiology trial enrolment, specialty training, faculty, scientific authorship and board membership in cardiology journals and societies. An EACVI Task Force on Women in Cardiovascular Imaging aims to promote women’s representation and leadership, but data is lacking in this area. Purpose To characterise the representation of women in cardiovascular imaging within Europe and examine temporal and geographic trends. Methods We scraped publicly available name data from over 100 online sources including EACVI taskforces, committees, research project members, consensus and position paper authors, board membership and past presidents alongside members of affiliated cardiovascular imaging national societies and working groups. We also included names from EACVI or national accreditation records for cardiac imaging. We recorded data on country location and year of affiliation. We defined gender in a binary manner as either male or female. The previously validated artificial intelligence (AI) system Namsor assigned gender based on name morphology and geolocation data. We pre-set a confidence of gender-name matching of 95%. Results The AI was able to assign gender at 95% confidence to 12,643/13,436 (94.1%) names. The overall number of names assigned female gender was 5903/12643 (46.7%), rejecting the null hypothesis that gender was equally distributed (i.e. 50% female) [p&amp;lt;0.0001]. Among the 9712 individuals with year of affiliation we observed female representation to increase over time: 1989-2000 4/18 (22.2%), 2001-2004 107/287 (37.8%) 2005-2009 77/170 (45.3%), 2010-2014 109/203 (53.7%), 2015-2019 1063/2022 (51.3%) and 2020-2024 3352/3064 (52.2%) (Cochran-Armitage trend test 24.196 [p&amp;lt;0.0001]) (Figure 1). Female representation was lower in countries outside of Europe, compared to within Europe; 740/2654 (27.9%) vs. 5163/9989 (51.7%) [p&amp;lt;0.0001]. The lowest rate of female representation was in Saudia Arabia (15.1%), the highest in Lithuania (83.3%). Figure 2 displays a choropleth of gender representation (%) between European countries with n&amp;gt;20. Conclusion(s) There are significant limitations in this form of analysis, including that we have arbritarily defined gender in a binary format, thereby excluding individuals who do not identify with such a social construct. It is also likely that the excluded names based on the 95% confidence of the AI software disproportionately represents individuals from ethnic minorities. However, our data provides a basic understanding of the representation of women in European cardiovascular imaging over time and between countries. We observed a trend of increasing female participation but with substantial variation between countries both inside and outside of Europe. This data may be useful to refine and direct efforts to improve female representation in areas in which it is needed most.

Towards the Effective Utilisation of Influencer Marketing in Nigeria

Advances in technology and the increased use of social media have made brands' usage of influencer marketing more widespread. Social media users no longer want to hear only from brands; they also want to listen to what others say about the brands and what their favourite influencers say. However, if brands do not understand how to utilise influencer marketing effectively, they cannot harness its benefits and minimise its drawbacks. Therefore, this position paper explored how organisations can gain desired results from well-planned influencer marketing efforts. It used the desk research methodology to gather secondary data on this subject matter. It discovered that organisations stand to benefit significantly from intentional and strategic influencer marketing campaigns if they consider several crucial factors such as the loyalty the influencer garners, how the influencer can persuade their audience, source credibility, content congruence, trustworthiness, values alignment, content informative value, content entertainment value, and the like. It was recommended that before working with influencers, organisations should be clear on their brand values and objectives to derive desired results. They should also develop influencer marketing guides, be more strategic and intentional when selecting influencers, and develop systems to monitor influencer marketing efforts effectively.

Cardiac magnetic resonance in MINOCA patients: a non-tertiary hospital experience

Abstract Background Cardiac magnetic resonance (CMR) is a key tool in the diagnostic process of myocardial infarction with non-obstructive coronary arteries (MINOCA), impacting patient management and prognosis. Its use in non-tertiary hospitals is often constrained mainly by accessibility. Thus, the aim of this study was thoroughly evaluate CMR application in this context to optimize the process. Methods 136 MINOCA patients who were admitted to our hospital between 2016 and January 2024 were analyzed. Each MINOCA patient was reviewed by experts to align with the diagnosis criteria outlined in the 2020 ESC Guidelines and the American Heart Association position paper, which recommended CMR for MINOCA patient’s evaluation. To assess the factors associated with normal-CMR, a logistic regression analysis was performed. In a first step, some factors were detected, showing a trend in the association. In a second step, a backward elimination procedure was used, excluding factors with p&amp;gt;0.1. Results CMR was performed in 65 MINOCA patients (48% of the cohort), with a mean age of 59±15 years old, 35 of them were males (54% of total patients). During the follow-up, there were 4 deaths (6%) and 4 readmissions (6%). Out of the total 65 patients, the CMR diagnosis was myocardial infarction (MI) in 14 (21.5%) and myocarditis in 16 (24.6%), and was normal in 35 (53.9%). Therefore, CMR provided diagnostic information in 46% of the cases. It was noted that a normal CMR was associated with female gender, (OR 2.7, 95% CI 0.96-7.34, p=0.057), hypertension (OR 2.25, 95% CI 0.81-6.22, p=0.11), absence of segmental abnormalities in echocardiography (OR 0.14, 95% CI 0.035-0566, p=0.06) and lower high-sensitivity Troponin T (OR 0.79, 95% CI: 0.66-0.95, p=0.001). In the second step, only segmental abnormalities (OR 0.2, 95%CI 0.04-1.09, p=0.063) and troponin (OR 0.31, 95%CI 0.10-0.99, p=0.048) remained included. Additionally, the Youden Index was determined to obtain the threshold for troponin, resulting a value of 606 nG/mL, area under ROC curve (AUC) = 0.784 (figure). Conclusions - CMR was performed in 48% of the MINOCA patients, reflecting the limitation for its use in routine clinical practice. Furthermore, it was useful in 46% of those patients. - The main factors associated with normal CMR were absence of segmental echocardiography abnormalities and reduced troponin levels. - A troponin cutoff point of 606 ng/mL identified patients with a normal CMR (AUC=0.784).Figure 1.CMR in MINOCA patientsFigure 2.Area under ROC curve = 0.784

Rising From the Rubble: Air Quality Concerns in Post-Earthquake Afghanistan.

This position paper highlights the dire impacts of environmental and household air pollution, which were responsible for 6.7 million deaths globally in 2019. These deaths occurred predominantly in low- and middle-income countries, with Afghanistan reporting the highest age-adjusted mortality rate. The situation worsens during large-scale disasters like earthquakes, which release more pollutants into the air, exacerbating health risks and leading to severe conditions such as pulmonary diseases. Because political factors may hinder foreign NGOs and similar organizations from providing direct support, the frequent occurrence of earthquakes in Afghanistan underscores the critical need for emergency response training for local residents. Consequently, it is essential to provide ERT training, including the proper use of protective equipment, to local populations as well as disseminating risk communication through online technologies and other appropriate means.

Integrated care using the ABC-stroke pathway improves cardiovascular outcomes and survival in patients with recent ischaemic stroke: a population-based cohort study

Abstract Background A recent European Society of Cardiology (ESC) Council on Stroke position paper proposed the ABC-stroke pathway, a holistic and integrated care approach to optimise the post-stroke management for patients with recent stroke, and associated heart disease. The ABC-stroke pathway is based on 3 pillars: "A" Appropriate Antithrombotic therapy; "B" Better functional and psychological status; and "C" Cardiovascular risk factors and Comorbidity optimisation (including lifestyle changes). There are limited data on the impact of adherence to the ABC-stroke pathway on post-stroke patient outcomes. Purpose We aimed to investigate the potential impact of ABC-stroke pathway adherence in the Clinical Data Analysis and Reporting System (CDARS) database in Hong Kong. Methods The analysis included patients with new-onset ischaemic stroke recorded in CDARS between 1st June 2006 and 31st May 2022. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between adherence to the ABC-stroke pathway and the primary outcome. The primary endpoint was a composite outcome of recurrent ischaemic stroke, transient ischaemic attack, haemorrhagic stroke, myocardial infarction, heart failure and all-cause death. Secondary outcomes were the individual components of the composite outcome, and cardiovascular death. Results Of the 9,669 included patients with ischaemic stroke (mean age 69.6 ± 13.4 years; 42.5% female), 58.1% were adherent to all 3 main ABC-stroke pillars. After 1 year of follow-up, adherence to the ABC-stroke pathway was associated with a lower risk of the primary composite endpoint (HR: 0.80; 95% CI: 0.72–0.88). Risk reductions increased progressively with a higher number of ABC-stroke criteria obtained (Figure 1). On multivariate analyses of the secondary outcomes, ABC-stroke pathway-adherent care was associated with a reduced risk of all-cause mortality (HR: 0.72; 95% CI: 0.62–0.85), cardiovascular death (SHR: 0.64; 95% CI: 0.45–0.90), haemorrhagic stroke (SHR: 0.50; 95% CI: 0.38–0.67) and heart failure (SHR: 0.771; 95% CI: 0.596-0.998) (Table 1). Conclusion In a large cohort of patients with ischaemic stroke, adherence to the ABC-stroke pathway was associated with a reduction of the risk of adverse outcomes.

Physical Activity-Related Health Services in Germany: Relevance and Necessary Framework Conditions - a Position Paper of the DNVF Working Group Physical Activity-Related Health Services Research

Based on the relevance of an established and broad foundation of physical activity in healthcare, this position paper of the DNVF working group Physical Activity-Related Health Services research presents current conceptual approaches to physical activity-related health services in Germany and highlights the need for interprofessional and interdisciplinary approaches. Three central positions are outlined and elaborated in order to integrate the evidence on health benefits of physical activity and exercise more strongly into healthcare and to show that, against the background of the challenges in the German healthcare system, physical activity-related health services can make a cost-effective and high-quality contribution to improve healthcare. These three positions include 1) the integration of all professional groups involved in healthcare into physical activity-related health services, 2) the greater integration of physical activity professions and physical activity interventions into all healthcare contexts and 3) the systematic consideration of physical activity- and exercise-related expertise in clinical guidelines.

The State of School Health Services of the School Health Programme in Nigeria: A Position Paper by the Paediatric Association of Nigeria (PAN) Sub-Committee on School Health Programme

The State of School Health Services of the School Health Programme in Nigeria: A Position Paper by the Paediatric Association of Nigeria (PAN) Sub-Committee on School Health Programme

Justice‐centered STEM education with multilingual learners to address societal challenges: A conceptual framework

AbstractWe propose a conceptual framework for STEM education that is centered around justice for minoritized groups. Justice‐centered STEM education engages all students in multiple STEM subjects, including data science and computer science, to explain and design solutions to societal challenges disproportionately impacting minoritized groups. We articulate the affordances of justice‐centered STEM education for one minoritized student group that has been traditionally denied meaningful STEM learning: multilingual learners (MLs). Justice‐centered STEM education with MLs leverages the assets they bring to STEM learning, including their transnational experiences and knowledge as well as their rich repertoire of meaning‐making resources. In this position paper, we propose our conceptual framework to chart a new research agenda on justice‐centered STEM education to address societal challenges with all students, especially MLs. Our conceptual framework incorporates four interrelated components by leveraging the convergence of multiple STEM disciplines to promote justice‐centered STEM education with MLs: (a) societal challenges in science education, (b) justice‐centered data science education, (c) justice‐centered computer science education, and (d) justice‐centered engineering education. The article illustrates our conceptual framework using the case of the COVID‐19 pandemic, which has presented an unprecedented societal challenge but also an unprecedented opportunity to cultivate MLs' assets toward promoting justice in STEM education. Finally, we describe how our conceptual framework establishes the foundation for a new research agenda that addresses increasingly complex, prevalent, and intractable societal challenges disproportionately impacting minoritized groups. We also consider broader issues pertinent to our conceptual framework, including the social and emotional impacts of societal challenges; the growth of science denial and misinformation; and factors associated with politics, ideology, and religion. Justice‐centered STEM education contributes to solving societal challenges that K‐12 students currently face while preparing them to shape a more just society.

Management of human epidermal growth factor receptor inhibitors-related acneiform rash: A position paper based on the first Europe/USA Delphi consensus process.

There is a need for unified guidance in the management of acneiform rash induced by epidermal growth factor receptor inhibitors (EGFRi) among dermatologists. To establish unified international guidelines for the management of acneiform rash caused by EGFR inhibitors, based on an experts' Delphi consensus. The initiative was led by five members of the European Academy of Dermatology and Venereology Task Force 'Dermatology for Cancer Patients' who developed a questionnaire that was circulated to a group of 32 supportive oncodermatology experts in Europe, Canada, Argentina, the US States and Asia. The questionnaire consisted of 84 statements in total, regarding diagnosis and treatment of EGFRi-induced acneiform rash. Experts responded to an anonymous 5-point Likert scale survey. The coordinators collected the first-round responses that were checked for consensus (≥75% agreement in positive [agree or strongly agree] or in negative [disagree or strongly disagree] vote). The statements that did not reach strong consensus in the first round were revised, according to experts' feedback, for a second-round survey. Strong consensus was reached in 75/84 (89.3%) of the statements, whilst moderate consensus was achieved in 6/84 elements. Key points include consideration of low-dose isotretinoin for refractory grade II/III acneiform rash, use of topical steroid-sparing agents like topical pimecrolimus in the maintenance phase and use of doxycycline in either 100 or 200 mg per day as prophylactic treatment. Interestingly, experts did not recommend topical antibiotics, neither for prevention, nor for treatment. Consensus failure in 3/84 objects is mostly related to the lack of robust data on these topics. This consensus offers crucial insights often overlooked by radiotherapists, general practitioners, dermatologists and oncologists, and it is expected to improve the management of oncologic patients treated with EGFRi in different settings and continents.

Position paper: public policy implications in publicly funded infrastructure projects

PurposeThis essay contributes to the ongoing exposition of a project management-focused understanding of “public policy” implementation. Distinct from previous studies that take a predominantly administrative sciences perspective, the delivery and implementation of publicly funded infrastructure projects as an instrument of public policy is explored through the lens of legal frameworks.Design/methodology/approachWe adopt the explanation-building review approach to provide descriptions and explanations of the relevant enablers and context necessary for the successful delivery and implementation of publicly funded infrastructure projects.FindingsThe ambiguity associated with public policy is more likely to hinder than facilitate the use of publicly funded infrastructure projects as preferred instruments of choice for implementing public policy.Originality/valueDespite substantial interest among academics and practitioners in utilising projects as tools for public policy implementation, thorough discussions on the legal complexities inherent in these projects remain scarce.

The United European Gastroenterology green paper-climate change and gastroenterology.

Climate change, described by the World Health Organization (WHO) in 2021 as 'the single biggest health threat facing humanity', causes extreme weather, disrupts food supplies, and increases the prevalence of diseases, thereby affecting human health, medical practice, and healthcare stability. Greener Gastroenterology is an important movement that has the potential to make a real difference in reducing the impact of the delivery of healthcare, on the environment. The WHO defines an environmentally sustainable health system as one which would improve, maintain or restore health while minimizing negative environmental impacts. Gastroenterologists encounter the impacts of climate change in daily patient care. Alterations in the gut microbiome and dietary habits, air pollution, heat waves, and the distribution of infectious diseases result in changed disease patterns affecting gastrointestinal and hepatic health, with particularly severe impacts on vulnerable groups such as children, adolescents, and the elderly. Additionally, women are disproportionally affected, since climate change can exacerbate gender inequalities. Paradoxically, while healthcare aims to improve health, the sector is responsible for 4.4% of global carbon emissions. Endoscopy is a significant waste producer in healthcare, being the third highest generator with 3.09kg of waste per day per bed, contributing to the carbon footprint of the GI sector. Solutions to the climate crisis can offer significant health co-benefits. Steps to reduce our carbon footprint include fostering a Planetary Health Diet and implementing measures for greener healthcare, such as telemedicine, digitalization, education, and research on sustainable healthcare practices. Adhering to the principles of 'reduce, reuse, recycle' is crucial. Reducing unnecessary procedures, which constitute a significant portion of endoscopies, can significantly decrease the carbon footprint and enhance sustainability. This position paper by the United European Gastroenterology aims to raise awareness and outline key principles that the GI workforce can adopt to tackle the climate crisis together.

Artificial intelligence for low income countries

The global adoption rate of artificial intelligence (AI) is rising, indicating its transformative potential. However, this adoption is far from uniform, with low-income countries (LICs) trailing behind significantly. Despite needing AI for development, LICs face multiple challenges in harnessing its benefits, exacerbating existing global disparities in technology adoption. In spite of the potentially important role that AI can play in the development of LICs, AI literature overlooks these countries, with research predominantly focused on more advanced economies. This lack of inclusivity contradicts the principles of distributive justice and global equity, prompting us to explore the importance of AI for LICs, offer a theoretical grounding for AI catch-up, identify effective AI domains, and propose strategies to bridge the AI gap. Drawing insights from the leapfrogging and absorptive capacities literature, our position paper presents the feasibility of AI catch-up in LICs. One crucial finding is that there is no one-size-fits-all approach to achieving AI catch-up. LICs with strong foundations could favor leapfrogging strategies, while those lacking such foundations might find learning and acquisition prescriptions from absorptive capacity literature more relevant. The article also makes policy recommendations that advocate for the swift integration of AI into critical LIC domains such as health, education, energy, and governance. While LICs must address challenges related to digital infrastructure, human capital, institutional robustness, and effective policymaking, among others, we believe that advanced AI economies and relevant international organizations like UNESCO, OECD, USAID, and the World Bank can support LICs in AI catch-up through tech transfer, grants, and assistance. Overall, our work envisions global AI use that effectively bridges development and innovation disparities.