National Practice Research Articles

Discussions on the Status of the Ethics Committee and Biobanking Practices in the Nordic Countries

The article analyzes the institutional status of the ethics committee as a social regulator. The object of the study is the practice of legal and administrative regulation in the field of application of genetic technologies in the Nordic countries. To this end, a comparative analysis of national legislation and practices regulating the activities of biobanks in these countries is carried out. Particular attention is given to the legal status of the ethics committee, the possibility of the ethics committee performing a regulatory function, as well as its relation to the legal system, is being investigated. Various positions concerning the legitimization of the decisions of the ethics committee in modern literature are considered. The heterogeneity of this institution is determined, which makes it possible to consider it both as legal, administrative and metaethical social regulators.

Techno-economic assessment of energy and environmental impact of waste-to-energy electricity generation

This study explored cumulative 127.5MW waste to energy (WtE) potential in five populous cities of Pakistan based on local waste characterization profiles and global standards. The 50MW WtE plant in Lahore using National electricity regulator codes and practices resulted in an attractive Levelized cost of electricity (LCOE) of US¢ 7.86/kWh over 25 years with a $151.5 million investment cost. The net savings to Lahore Waste Management Company can be $103.4 and $137.7 million respectively with and without tipping fees on account of waste disposal cost, bricks revenue using bottom ash, and waste fee. The project developers can get net savings of $16.9 and $51.5 million respectively with and without tipping fees other than LCOE. Furthermore, the greenhouse gas emissions of 216.6 million tons of CO2eq can be saved throughout plant life against 279 GWh/year energy generation, in terms of grid emission factor and current methane release into the atmosphere from the dumping site.

Exploring attitudes towards health preparedness in the Middle East and North Africa against chemical, biological, radiological, and nuclear threats: A qualitative study

AbstractSince 1970, Middle East and North African (MENA) countries have witnessed evolutionary industrial development and long‐running terrorist and inter‐country conflicts. Additionally, the risk of accidental, deliberate or natural chemical, biological, radiological, and nuclear (CBRN) threats has also increased, requiring a collaborative review of the health sectors’ preparedness for potential CBRN risks within the region. This study aimed to explore the opinion of multidisciplinary experts interested in disaster management research in MENA about perspectives and challenges on readiness for potential CBRN incidents.A modified interview online link was sent to the participants. A qualitative thematic analysis was performed on the responses using Nvivo®12 software, following semi‐structured modified interviews using the Phonic® application.A total of 29 participants were sufficient to reach the data saturation. Through an inductive coding approach, five themes were identified: ‘CBRN‐Related Incidents are a Threat’, ‘Inadequate National Practice and Policy’, ‘Need for International Cooperation’, ‘Importance of Better Mass Gathering Management’, and ‘Ineffective Hospital Preparedness’.With the assistance of the World Health Organization, there is a consensus on the need for cooperation between the MENA countries to ensure adequate healthcare preparedness for CBRN threats. Suggested measures should be considered, such as creating a unified database and liaison officer designation.

Judge’s discretion in ensuring human rights and freedoms: the significance of the legal position

The article is devoted to the analysis of the judge’s discretion in ensuring human rights and freedoms and the study of the significance of the legal position of the Supreme Court. It has been established that the purpose of the Supreme Court as the highest judicial institution in Ukraine is, first of all, the formation of a justified legal position regarding the application by all courts in the further work of a specific norm of substantive law or compliance with a norm of procedural law that was incorrectly used, and thus directing practice into a unified and proper enforcement. The legal positions of the Supreme Court have a more complex nature, as there is a clear awareness of the tasks of this body as a key subject in the formation of the unity of national judicial practice. The legal literature was studied, which currently discusses the problem of deviating from the legal positions expressed earlier, whereas it is at the level of higher courts that the problem of unanimous application of legal norms by courts in similar legal relations should be resolved. The institution of departure from the pre-legal position is quite an interesting phenomenon and become widely in recent years, and this problem is connected, perhaps, with the reform of procedural legislation. It was established that a massive departure from previous legal positions violates the standards of consistency of judicial practice, and the requirement of legal certainty appeals precisely to the standards of consistency of judicial practice, according to which courts must make similar decisions in similar cases under the same factual conditions. Constancy of judicial practice means that a series of previously adopted and agreed court decisions is a convincing proof of the correct interpretation of the legal norm. Since the legislator has not establish the binding nature of previously adopted resolutions of the Supreme Court of Ukraine, however, the possibility of deviating from them is provided only to the court of cassation instance of the Supreme Court. Deviating from the legal position, the court must provide a serious and convincing argument, since there has to be valid and reasonable grounds for a different application of the law’s prescription in the same (or similar) situation with a similar legal structure. It was concluded that the principles that are guided by judges when making each specific decision and forming the corresponding legal position, namely the principles of the rule of law, justice and legality, are of particular importance.

Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire.

Rearrangements in the anaplastic lymphoma kinase (ALK) gene define a molecular subgroup of non-small-cell lung carcinoma (NSCLC) that should be treated with ALK-targeting tyrosine kinase inhibitors (TKIs). This study aimed to portray the Portuguese reality about the diagnosis and treatment of stage IV ALK-positive NSCLC. Institutions that treat lung cancer in Portugal were invited to participate in an anonymous electronic questionnaire. A total of 22/35 geographically dispersed institutions responded. A descriptive statistical analysis of the results was performed. Reflex molecular testing was done in 54.6% of the institutions. Next-generation sequencing (NGS) was the preferred diagnostic method (90.9%). Typically, physicians obtained molecular study results within 14-21days. Alectinib was the most commonly used first-line treatment. For patients with brain metastases, 86.4% of the physicians preferred alectinib and 13.6% preferred first-line brigatinib. In the case of asymptomatic oligoprogression in the central nervous system, 85.7% of physicians performed local treatment and kept the patient on a TKI; if symptomatic, 66.7% gave local treatment and stayed with the TKI, while 28.6% gave local treatment and altered the TKI. For patients with symptomatic systemic progression, 47.6% and 38.1% of physicians prescribed lorlatinib after initial treatment with alectinib or brigatinib, respectively. After progression on lorlatinib, 42.9% of respondents chose chemotherapy and 57.1% requested detection of resistance mutations. NGS is widely used for the molecular characterization of ALK-positive NSCLC in Portugal. The country has access to up-to-date therapy. Overall, national clinical practice follows international recommendations for the diagnosis and treatment of ALK-positive NSCLC.

Imagining a common homeland: A study of Northeast landscape writing during the war of resistance against Japan

China has undergone a transition from a dynastic state to a nation-state from modern times. The “dynastic realm” subsequently became “national territory,” and the subjects of dynastic rule also became members of the Chinese nation. Under the backdrop of both domestic and international hardships, border regions became spaces for the practice of nationalism. In particular, after the September 18 incident, Chinese people paid more attention to the Northeast. Intellectuals and political elites attempted to establish the notion of a unified nation-state to resist the Japanese imperialist invasion. By writing about natural landscapes with Northeast features, war-ravaged landscapes from the invasion, and landscapes on the lives of members of the nation, war of resistance songs and Northeast resistance literature established the boundaries between the Chinese nation and the “other” (invaders), and molded the northeast, a border region with diverse ethnic groups and culture into a part of the territory of the Chinese nation. Most writers of war of resistance songs like “On the Songhua River” (松花江上 Songhua jiang shang) were not from the Northeast, and their landscape writing was based on their imagination and perception of the Northeast. The landscape writing of Northeast exiled authors was based on memories of their “lost home.” The generation and transmission of this landscape writing itself constituted a part of the national imagination and identification.

Comparison of record linkage software for deduplicating patient identities in California's Prescription Drug Monitoring Program.

To help prevent overdose deaths involving prescription drugs, accurate linkage of prescription drug monitoring program (PDMP) records for individual patients is essential. To compare the accuracy of the linkage program used by California's PDMP against various record linkage programs with respect to accuracy in deduplicating patient identities in the PDMP, with implications for identifying high-risk opioid use and outlier behaviors. We evaluated California's program, Link Plus, LinkSolv, and The Link King on 557 861 PDMP identity records with addresses in two 3-digit zip code areas for patients who filled a controlled substance prescription in 2013. Manual review was performed on a stratified sample of 720 paired records identified as matches by at least one program. We estimated sensitivity and positive predictive value, and computed PDMP patient alerts for the patient entities identified by each program. Sensitivity was 95% for LinkSolv and The Link King, 84% for Link Plus, and 73% for California's program; positive predictive value was ≥93% for all programs. The number of patient entities prompting a PDMP alert was similar among the programs for all alerts except multiple provider episodes (obtaining prescriptions from ≥6 prescribers or ≥6 pharmacies in the last 6 months), which were 10.9%, 26.6%, and 16.9% greater using The Link King, Link Plus, and LinkSolv, respectively, compared to California's program. PDMPs should assess the accuracy of record linkage algorithms and the impacts of these algorithms on patient safety alerts and develop national best practices for PDMP record linkage.

OA1‐AM23‐SN‐05 | Canadian Pediatric Massive Hemorrhage Protocols: A Survey of National Practice and State‐of‐the‐Art Review

OA1‐AM23‐SN‐05 | Canadian Pediatric Massive Hemorrhage Protocols: A Survey of National Practice and State‐of‐the‐Art Review

Trends in nursing feedback for emergency medicine residents: A mixed-methods survey analysis of national practices.

Feedback is critical for physician development. Multisource feedback is especially important in a team-based specialty such as emergency medicine (EM) and is required by the Accreditation Council for Graduate Medical Education. Nursing assessments provide a unique perspective, but little is known about the current national patterns of their collection and use in EM. We surveyed EM program directors using a mixed-methods approach to explore the use of nursing assessment of EM residents. Descriptive data were reported as absolute numbers and percentages. An adjunct analysis of free-text responses was done using the framework method. The response rate for our survey was 63% (190 responses), of which 84% currently collect nursing feedback. Respondents from 94% of programs agreed that nursing feedback is useful in assessing professionalism and respondents from 92% of programs agreed that nursing feedback is useful in assessing communication and interpersonal skills, while 44% agreed that it is useful in informing resident medical knowledge. Forty-two percent reported that nursing feedback did not directly influence residents' progression through their training, while 2% indicated that such feedback played a significant role in leading to dismissal or probation. The majority of programs (64%) that do not collect feedback from nurses have done so in the past and hope to do so in the future. Qualitative analysis revealed themes of logistic challenges with data collection, concern regarding quality of feedback, and retributive or gender-disparate feedback. Nursing assessments of EM residents were collected by most responding programs and majority of those who do not collect them presently wish to do so in the future. They were considered particularly useful in the assessment of interpersonal skills, communication, and professionalism. However, lack of uniform methods for collecting assessment that meaningfully informs resident development and progression represents a challenge and direction for future inquiry.

Detention Pending Execution of the European Arrest Warrant – Dutch and Polish Experience. Some Reflection from the Human Rights Perspective

This article focuses on detention pending surrender, i.e. detention of the requested person in the executing Mem­ber State on the basis of the European Arrest Warrant (EAW). It defines the scope of application of Article 5 of the Euro­pean Convention on Human Rights to such detention and anal­yses the case-law of the Court of Justice of the European Union on time limits of keeping the requested person in detention in the executing MS as well as on the notion of “the execut­ing judicial authority” entitled to decide on detention pending surrender. Both issues are explored with reference to national law and practice of the Netherlands and Poland. The article pro­vides the answer to the question whether national provisions which limit the duration of detention pending surrender prop­erly reflect the normative content of the framework decision on the EAW. The answer to this question is given with due regard to the standard of protection of the requested person stemming from Article 5 § 1 ECHR and Article 6 of the Charter of Funda­mental Rights. Furthermore, the analyses focus on Dutch and Polish provisions concerning the authority entitled to decide on detention pending surrender and their compliance with the CJEU’s jurisprudence on the notion of “the executing ju­dicial authority.” Recognising that detention is the basic meas­ure for ensuring the effectiveness of surrender, we try to define the limits of its use in the EAW procedure, stemming from the requirements of protection of human rights.

Auxiliary collections as active collections: the case of Estonia

ABSTRACT This article explores a recent trend in Estonian museums – the increase in the auxiliary collections against the background of the general slowdown in the development of the main collections. The article demonstrates that the rise of auxiliary collections occurred because of the tension between the regime of eternal preservation supported by the national heritage practice and the new museum practice of active collections implemented by the museums. Based on a study of 20 state-administered museums, the article examines the ambivalent status of the auxiliary collection by juxtaposing its legal and practice-based conceptualisations. The article will demonstrate that auxiliary collections confer on museums the necessary buffer zone to navigate the state’s regulations and the lack of resources. In the context of the eternal preservation regime, an auxiliary collection is a liminal collection waiting to be made meaningful by administrative, curatorial, and preservation processes. However, auxiliary collections tend to dominate exhibitions and programs that understand heritage as emerging through active co-creation and sensory engagement. The rise of the significance of auxiliary collections can be anticipated vis-à-vis the national heritage repository plans as they offer solution for museums to maintain their relevance in the local communities.

Picture naming test: Linguistic challenges of the method and ways to solve them

The paper considers benefits and drawbacks of the Picture Naming Test (PNT) as a diagnostic method suggesting the ways to improve its diagnostic and research validity. Although this test is popular in both national and international neuropsychological assessment and research practice, its use is largely due to tradition and practical convenience. However, theoretical underpinnings for its effectiveness are not sufficiently represented in the pertinent literature, which determines the relevance of the study. The major objective of the paper is to consider the PNT as a research technique from the point of view of psycholinguistics, cognitive science, and corpus linguistics and to propose integrated approaches for the further development of these tests. The material comprises picture naming tests developed for the Russian and English languages. The study sets the following aims: 1) to define the main features of PNT and the principles of its application viewed from a historical perspective; 2) to identify the theoretical foundations (linguistic and neuropsychological) for its use as a diagnostic tool; 3) to highlight the problematic aspects of the method; 4) to suggest possible ways to eliminate them. To accomplish these tasks, various methods of corpus linguistics are applied throughout the article. The historical outline of PNT development suggests that the current design might stem from earlier contexts of use. A review of existing models of lexical access provides a theoretical basis for the test in its current form and suggests possible avenues for its development grounded in experimental research, advances in linguistics and big data analysis. A separate section of the article presents critique of the most popular tests. Finally, the analysis of the existing English and Russian tests through the corpus-based methodology clearly demonstrates the need for more detailed norming and stimuli selection. By way of conclusion the authors outline the principles of designing Picture Naming Tests for specific purposes and put forward a step-by-step algorithm that enables careful selection of the necessary indicators and parameters.

Долгосрочное прогнозирование сроков вскрытия реки Юкон синоптико-статистическим методом

A scheme for obtaining a long-range forecast of the dates of ice break-up is proposed for the Yukon River (North America). The scheme is based on a well-proven national practice of ice forecasting, namely, on the meteorological statistical method. The method utilizes a linear dependence of the predicted value on the characteristics of temperature and pressure fields in the North Atlantic and the North Pacific. The most informative predictors are selected. Statistical stability of the forecast formula parameters is verified. The average forecast lead time is 40 days. The verification of the proposed methodology performed for three stretches of the Yukon River on the basis of independent data for the period from 2009 to 2015 showed that it allows obtaining quite satisfactory results with a fairly low root-mean-square error and a fairly high accuracy of forecasts. Keywords: river ice break-up, long-range forecast, synoptic statistical method, temperature and pressure fields, predictors, stability, method verification

Investigating the Image of Architecture Decoration of ShengJing Imperial Palace in LiaoNing Province, China

Today, throughout antiquity, myriad ethnic collectives have inhabited Liaoning Province, China, significantly shaping the historical trajectory of the nation and fostering a multitude of esteemed architectural and cultural legacies. ShengJing Imperial Palace is in Shenyang, Liaoning Province, China. ShengJing Imperial Palace is a royal building built in the early Qing Dynasty 500 years ago. The information value shown by its architectural decoration needs to be further developed. This paper takes architectural decoration images as the research content. It uses the methodology of practical aesthetics, conducts field research on ShengJing Imperial Palace, and analyzes the three elements of visual impact form, political decoration, and national practice to obtain a single evident, idealized local decoration image characteristics. In conclusion, the visual layout of the rational representation of the Shengjing Palace building decoration is clear and distinct, and the visual feeling of the subject is strong and full of impact. These characteristics can be summarized as strong qualitative architectural decoration image characteristics. Under the Qing rulers' politically strict ideology, the image experience category of architectural decoration showed ethical characteristics. This study can be a reference for adapting traditional architectural decoration to modern design.

Population Analysis of SABR/SRS for the Treatment of Metastatic Cancer in a Jurisdiction of 15 Million People

Stereotactic Ablative Radiotherapy (SABR) or Stereotactic Radiosurgery (SRS) for oligometastatic cancer or oligoprogression of metastatic cancer is supported by an expanding body of evidence in the literature. The degree of uptake of these techniques, supplanting traditional and potentially less resource-intensive techniques in this patient population, would be of interest to clinicians and administrators alike. A review of provincial date for Ontario, Canada (population ∼ 15 million) was performed to quantify the use of SABR/SRS to metastases either in the brain or elsewhere in the body. Data was obtained from a new (April 2022) activity-based hospital funding model, responsible for ALL radiation treatment remuneration at all facilities across the province (i.e., single payer system). Funding is triggered when a patient is treated as per 1 or more of the ∼270 provincial radiation protocols, defined as a "protocol instance". Protocols were developed by clinicians across Ontario according to a consensus-based iterative process, considering provincial, national and international guidelines and/or evidence-based practice. Prerequisite information for remuneration included (but was not limited to): patient demographics, identification of whether a primary tumor or metastasis(es) was treated, protocol, radiation technique, dose/fractionation, and encounter dates. Submission of data was performed by the 17 hospitals who provide radiation services and logic checked centrally by the provincial cancer agency following submission. Validation of data is performed by ongoing iterative processes. From April 1 to November 30, 2022, a total of 31,916 radiation protocol instances were funded for 27,298 patients. Of these, 4,156 (13%) were SABR/SRS protocols. When only treatment to metastases were considered, the total number of SABR/SRS protocol instances was 3,024 (9.5% of total) and 29.4% of the total number of protocol instances delivered to metastases (10,271). The 29.4% was split further as 1567 protocol instances (15.3%) to brain metastases and 1457 protocol instances elsewhere in the body, most often to lung (3.9%), spine (3.4%), non-spine bone (2.2%) and liver (1.7%), with a further 2.9% to unspecified extra-cranial metastases. Data for all 17 Ontario treatment facilities revealed a range of SABR/SRS usage for metastases from 1.8 to 59.8% (median 23.2%, IQ range 16.9%). On review of recently submitted data, nearly 1/3 of all radiation treatments to metastases in Ontario are delivered using a SABR/SRS technique. There is wide regional variation in the use of these techniques. Reasons for this variation require further investigation.

Practice Patterns and Disparities of Fractionation Schemes for Post-Mastectomy Comprehensive Nodal Irradiation

Hypofractionated (HF) radiotherapy is the established standard of care for whole breast irradiation and is being investigated for comprehensive nodal irradiation, but appropriate patient selection for the latter is currently undefined. This study aims to report national practice patterns and patient selection for HF comprehensive nodal irradiation compared to conventional fractionation (CF). The hypothesis is that the rate of HF for comprehensive nodal irradiation in breast cancer has been increasing over time and is more likely to be offered to disparate demographic populations. We queried the National Cancer Database and identified 128,693 patients who received comprehensive nodal irradiation between 2008-2016 in the United States. No patient who underwent lumpectomy received HF nodal irradiation; therefore, only post-mastectomy patients were included in this study. After the exclusion, 29,053 post-mastectomy patients with adjuvant comprehensive nodal irradiation remained. A multivariable binomial regression analysis between HF and CF patients was performed. Of the patients identified, 1,910 received HF (6.57%), and 27,143 received CF (93.43%) radiotherapy. All patients had locally advanced breast cancer treated with mastectomy, lymph node dissection, adjuvant radiation, and +/- chemotherapy. The median dose in the HF group was 4,256 cGy in 16 fractions, and in the CF group was 6,040 cGy in 33 fractions. HF rate grew from 3.56% in 2004-2007, 5.29% in 2008-2011, 7.42% in 2012-2013, and 12.05% in 2014-2016. HF was favored in older patients (median age 66 vs. 51, OR = 1.16, 95% Cl 1.11-1.22) and those who lived in suburban or rural regions compared to urban or metropolitan regions (OR = 9.48, 95% CI 1.17-76.9). However, there was no correlation when distance from treatment site was evaluated as a continuous variable. A "boost" dose was used in only 10.58% of HF patients compared to 54.6% of CF patients (OR = 0.17, 95% Cl 0.14-0.21). Chemotherapy was delivered in 36.91% of HF patients compared to 78.14% of CF patients (OR = 0.77, 95% Cl 0.59-0.99). There were no statistically significant correlates of either fractionation scheme for breast laterality, stage, grade, or receptor status. Notably, other than population density and age, demographic factors including race, Hispanic origin, insurance type, median income, and education level demonstrated no correlation with radiation fractionation scheme. HF for comprehensive nodal irradiation in breast cancer is still uncommon but growing in popularity. Currently, HF is more likely to be used in elderly patients and lower population density centers and less likely to be used in those determined to benefit from receipt of a boost or chemotherapy.

Differential Impact of Consolidative Thoracic Radiotherapy in Extensive-Stage Small Cell Lung Cancer Based on Systemic Therapy Type and Sex

Consolidative thoracic radiotherapy (cTRT) has been shown in phase III RCTs to improve overall (OS) and progression-free survival (PFS) after initial chemotherapy (chemo) in extensive-stage small cell lung cancer (ES-SCLC). This benefit was particularly pronounced in women compared to men in the 2015 CREST trial (hazard ratio [HR] 0.68 vs. 1.01, respectively). However, it is unknown whether similar findings would apply after chemoimmunotherapy (chemo-IO) became standard of care first-line treatment in 2018. In this analysis, we report national practice patterns and survival outcomes of cTRT versus no cTRT following chemo or chemo-IO, stratified by sex. Patients from the nationwide Flatiron Health de-identified electronic health record-derived database were included if they completed 4-6 cycles of first-line systemic therapy (platinum-doublet chemo or chemo-IO) for stage IV SCLC diagnosed between 2014 and 2021. Patients who progressed or started cTRT within 14 days or died within 90 days of completing systemic therapy were excluded to account for immortal time bias. We evaluated OS and PFS using multivariable Cox proportional hazards regression with receipt of cTRT as an independent covariate and last date of chemo as index date. As a sensitivity analysis to address potential selection bias, we weighted the models by the inverse probability of receiving cTRT. All OS and PFS analyses were stratified by systemic therapy type and sex. A total of 1,227 patients were included (850 chemo, 377 chemo-IO). The proportion of patients who received cTRT increased from 11.7% in 2014 to 20.7% in 2017, and then decreased to 16.4% in 2021. There were no statistically significant differences in baseline characteristics between patients who did and did not receive cTRT. In adjusted analyses among women receiving chemo, cTRT was associated with superior OS (HR 0.68; 95% confidence interval [CI] 0.51-0.91) and PFS (HR 0.64; 95% CI 0.47-0.86) [Table 1]. There was a non-statistically significant trend towards improved OS (HR 0.57; 95% CI 0.32-1.02) and PFS (HR 0.59; 95% CI 0.34-1.02) among women receiving chemo-IO. No OS or PFS benefit with cTRT was observed in men receiving either chemo or chemo-IO. Findings were similar in weighted analyses. The survival impact of cTRT may be differentially impacted by sex, with female patients appearing more likely to benefit than male patients regardless of systemic therapy type. While the underpinnings of this association need to be elucidated, stratification by sex should be considered for RCTs studying cTRT in ES-SCLC.

Cherenkov and Plan Integration for Real-Time Delivery Verification: The Opportunity for Automated Visualization and Guidance of All Treatments in EBRT

Initiatives in the national radiation oncology incident learning system (RO-ILS) have been exceptionally useful in discovery of factors that lead to incidents and learning of best practices that can help make the national practice of RO safer as a whole. Incident learning systems come from the flight industry, where both visual cues and instrument control are essential parts of implementation, and similarly both human and instrument tools are used in RO. However, numerous RO studies have reported that human factors are a leading cause of incidents discovered and that timelines, such as QA, setup, delivery, and verification are areas where most incidents are found. Tools such as Cherenkov imaging and SGRT can be used to automate many of the riskiest human decisions and/or providing both human vision and instrument-guided oversight in these areas of treatment delivery process. The value of continuous online imaging is reviewed and the two parts have been tested towards complete automation. The conceptual framework of comparing images to the patient treatment plan is outlined with software examples. Development towards a combined SGRT & Cherenkov imaging system that could achieve fully automated incident detection is outlined. Cherenkov imaging has shown direct visualization of many instances of beam delivery to patients that were sub-optimal. These are seen mostly in isolated cases of normal tissue in the beam where it was not expected, such as limbs, chin, contralateral breast or axilla. Incorrect placement of bolus is also readily visualized. Comparisons can be made on a day-to-day basis, but also on a delivery to plan basis if the plan was incorporated into the treatment delivery process. Analysis of the incidents seen indicates that there are automatable metrics of image quality that could have detected them. Overall, if the system detection of variations were fully automated, these could be detected without human intervention. The capabilities for reducing nearly all human error in setup and delivery are available or emerging, and Cherenkov imaging is perhaps one of the most direct ways to capture and computationally analyze the treatment in real time. These tools require further integration with automated analysis and plan integration, but the initial steps are well underway and individual parts are now possible with advances in R&D of the system integration.

Features and challenges of national and international practices in representing operations with government grants in enterprise accounting

Manuscript is dedicated to the examination of key aspects related to the representation of government grant operations in accounting records. It aims to identify critical issues, analyze previously proposed methodologies, and provide recommendations for enhancing the accounting system to consolidate information regarding government grants and earmarked receipts within the accounting framework. The purpose of the paper is to analyze existing methodologies for recording government grant transactions, identify their strengths and weaknesses, and provide recommendations for improving the process of recording government grant transactions in accounting records. The research findings reveal key aspects of the scholarly discourse on the issue of registering government grant transactions in accounting records. The paper proposes an enhanced accounting model for representing government grant operations and earmarked receipts. The manuscript provides a comparative perspective on accounting practices for recording government assistance in Ukraine and several foreign countries. The author summarizes that there are significant issues in the domestic methodology for registering government grant transactions. The paper presents approaches to improving the accounting tools for government grants and earmarked receipts, aiming to enhance the quality of financial information. The author suggests categorizing transactions into two groups: government grant transactions and earmarked receipts transactions. Researching international practices in recording government grant transactions allowed for identifying commonalities and differences with national accounting practices.

Assessment of knowledge, attitude, and practice of primary healthcare physicians in Qatar towards hypertension management: An online cross-sectional study.

Primary health care is integral to diagnosing and managing hypertension. This study aimed to assess the knowledge, attitude, practice, priority, and confidence of primary care physicians in Qatar toward hypertension diagnosis and management, and to measure the determinants of good knowledge, desirable attitudes, and desirable practices. We conducted a cross-sectional web-based survey using a modified version of the World Hypertension League Questionnaire during the period from August 30th to October 23rd, 2020. All primary care physicians working in any of Qatar's 27 publicly run primary healthcare centers were invited to participate in the survey. Out of the 450 primary care physicians working at that time, 197 completed the study questionnaire with a response rate of 43.8%. Most respondents stated that they followed local or international treatment guidelines for hypertension management (96.4%). Primary care physicians were highly confident and prioritized hypertension management. The overall desirable practice score was 73.8%, with the highest score (95.4%) for assessing adherence to antihypertensive medications, whereas the lowest desirable practice score was 33.5% for counseling on home blood pressure monitoring. Fifty-one-point eight percentage and 62.4% correctly identified 140 mm Hg and 90 mm Hg as the systolic and diastolic blood pressure threshold for diagnosing hypertension in most patients. The lowest knowledge scores were for hypertension epidemiology in Qatar and recommended dietary modification for hypertensive patients. Respondents had positive attitudes toward task sharing with nonphysician healthcare workers for most items (58.9%-78.2%), except for drug prescriptions (30.5%). Primary care physicians in Qatar had positive attitudes, with high overall confidence and conviction (priority) scores toward hypertension. However, their knowledge scores and certain practices were suboptimal. Healthcare policymakers in Qatar should raise primary care physicians awareness of the current burden of untreated hypertension in the country by organizing targeted educational programs and emphasizing the importance of following national clinical practice guidelines in the diagnosis and management of hypertension.