Present Trends Research Articles

Past, present, and future of the Hurst-Kolmogorov dynamics in Stochastics: A bibliometric analysis of the last 50 years in water resources

Hurst’s paper on the Nile’s flow variability marked a pivotal moment in hydrology and beyond by introducing what was called the Hurst phenomenon. Independently, Kolmogorov developed a mathematical model describing this behaviour a decade earlier. The Hurst-Kolmogorov dynamics (HKd) is used to express this phenomenon physically and mathematically, which is characterised by high uncertainty and persistence (across spatial and temporal scales) and challenges traditional analytical frameworks, particularly in water resources-related topics and implications in engineering designs. Given the importance of HKd, a bibliometric analysis of it in water resources is helpful to trace its historical development, current state, and (possible) future trajectories. The latter intends to offer a comprehensive perspective on HKd, serving as a guide for new readers seeking an entry point into this field. Using the Web of Science database, 617 publications from 1974 to 2023 are analysed, revealing a consistent growth trend in research outputs up to 2018. Collaborative efforts among researchers worldwide have been prominent, with the USA and China leading in international collaborations. High-impact journals on topics related to water resources and geosciences are primary outlets for research related to the HKd. Interestingly, only two journals published the 20 most cited papers on this topic. A clear pattern from “groundwater” to “streamflow” to “soil moisture” to “precipitation” was observed from the past to the present. Overall, this analysis provides a comprehensive overview of the past, present, and future trends in HKd research, and highlights its contribution to the scientific literature of water resources.

Regional Differences in Carbon Budgets and Inter-Regional Compensation Zoning: A Case Study of Chongqing, China

Carbon compensation can guide human activities in reducing carbon emissions or increasing carbon sequestration and also represents an important approach for coordinating regional development. In this paper, Chongqing Municipality, whose internal development is varied, was selected as a case study. The annual carbon emissions, carbon sequestration, carbon deficits, and inter-regional carbon compensation costs from 2000 to 2021 were continuously estimated via local optimization methods, and a carbon compensation zoning scheme was proposed that integrates the present situation and trend analysis. The results show that (1) Chongqing’s total carbon emissions were greater than the total carbon sequestration, and the carbon deficit was approximately 556.24 × 104 t~3621.58 × 104 t. (2) County-level carbon budgets have large regional differences; the counties that should always receive carbon compensation are from the southeast and northeast regions, and the counties that should always pay carbon compensation are from central urban areas and the surrounding new urban areas. (3) All the counties were zoned into key payment areas, basic payment areas, key recipient areas, and basic recipient areas. The key payment areas, which account for 39.47%, maintain and grow payment status and are the main sources of carbon compensation costs, while the key recipient areas, which account for 44.74%, maintained a negative compensation status and a continuous downward trend, meaning that they may receive increasing carbon compensation costs. This paper revealed inequities in carbon compensation and proposed a novel zoning solution, which can provide scientific reference and data support for further establishing inter-regional carbon compensation mechanisms.

328 Assessment of chronically ill or injured feedlot cattle populations at eight United States and nine Canadian feedlots and implications for cattle welfare

Abstract Cattle health management in the feedlot sector continues to evolve and improve cattle welfare by promoting an understanding of illness and injury to minimize their effects. Many papers have focused on treating individual ill or injured cattle in cattle feeding facilities. However, care, treatment, and outcomes for chronically ill or injured cattle (“chronic cattle”) have received little attention in the literature. The purpose of this descriptive study was to present demographics, diagnoses, and outcomes of chronic cattle in 17 feedlots in the U.S. and Canada and discuss potential risk factors and welfare implications. Individual chronic cattle information and treatment records from 17 feedlots (U.S.: 8; Canada: 9) over 7 yr (2014 – 2020) were retrospectively retrieved from a large feedlot consulting and data-management service (Feedlot Health Management Services, a division of TELUS Agriculture Solutions Inc.). Chronic cattle were defined as those that had spent time in a feedlot’s designated chronic pen. Descriptive results are presented as means ± standard deviations. U.S. feedlots averaged 31,280 ± 23,231 cattle/yr, had an average chronicity rate of 2.24 ± 2.42 % (median 1.53%), and contributed 52,709 chronic cattle to the dataset. Canadian feedlots averaged 21,913 ± 10,497 cattle/yr, had an average chronicity rate of 1.41 ± 0.82% (median 1.10%), and contributed 15,940 chronic cattle to the dataset. U.S. chronic cattle were sourced across all seasons primarily from auctions and ranches, had an average arrival weight of 163 ± 59 kg, and an average days on feed (DOF) of 362 ± 172 d. Canadian chronic cattle were primarily auction-sourced in the fall, weighed 272 ± 95 kg at arrival, and averaged 246 ± 141 DOF. Chronic cattle were treated at least once for respiratory issues (U.S.: 46.3%; Canada: 26.9%), bullers (U.S.: 34.5%; Canada: 5.8%), musculoskeletal issues (U.S.: 2.2%; Canada: 1.4%), lameness (U.S.: 1.7%; Canada: 28.1%), metabolic issues (U.S.: 0.5%; Canada: 4.5%), or other diagnoses (U.S.: 2.2%; Canada: 6.3%), with many cattle treated for multiple issues (U.S.: 12.5%; Canada: 27.0%). Outcomes for chronic cattle were shipped (U.S.: 73.1%; Canada: 52.5%), railed (U.S.: 8.1%; Canada: 20.7%), euthanized (U.S.: 0.7%; Canada: 9.9%) died unassisted (U.S.: 18.1%; Canada: 16.2%), or transferred (U.S.: < 0.1%; Canada: 0.8%). These results are some of the first to describe chronic cattle populations and present interesting trends for further analysis. For example, differences in buller and lameness rates could reflect actual differences but may be artifices of the dataset and feedlot definitions. Additionally, high marketed cattle rates (shipped and railed) indicate positive outcomes for most cattle, but variable mortality rates merit further scrutiny.

Novel trends of frequency, demographics and clinical presentation of skin disorders in only public hospital in south of Lahore: A Descriptive observational study over 1 year.

Objective: To study the pattern of skin diseases in our population with respect to different age groups, gender and seasonal variations. Study Design: Observational Retrospective study. Setting: Department of Dermatology, Lahore General Hospital, a tertiary care referral hospital situated in second big city of Pakistan i.e Lahore. Period: July 2021 to June 2022. Methods: A total of 65284 patients presenting to skin OPD were studied. Demographic details were noted and diagnosis was made after detailed history, examination and appropriate investigations like scraping or smears. Data was analyzed for various age groups, gender distribution and effect of variables on diagnosis. Results: Out of 65284 patients, 38 %were male & 62% were female. Most of the patients (43%) were in age group of 21-40 years. Scabies was the most prevalent dermatosis and affected 27% of study population. Three most common dermatosis were tinea, scabies and acne. The maximum number of dermatosis was seen in the months of summer. Conclusion: Infectious diseases pose a major burden to skin health of most of the population suffering from dermatological problem. Fungal infections and scabies are treatable but very common diseases contributing in burden of dermatological disorder in population presenting to hospitals.

Temporal Trends in Takotsubo Syndrome: Results From the International Takotsubo Registry

BackgroundThe perception of takotsubo syndrome (TTS) has evolved significantly over the years, primarily driven by increased recognition of acute complications and mortality. ObjectivesThis study aimed to explore temporal trends in demographic patterns, risk factors, clinical presentations, and outcomes in patients with TTS. MethodsPatients diagnosed with TTS between 2004 and 2021 were enrolled from the InterTAK (International Takotsubo) registry. To assess temporal trends, patients were divided into 6 groups, each corresponding to a 3-year interval within the study period. ResultsOverall, 3,957 patients were included in the study. There was a significant demographic transition, with the proportion of male patients rising from 10% to 15% (P = 0.003). Although apical TTS remained the most common form, the diagnosis of midventricular TTS increased from 18% to 28% (P = 0.018). The prevalence of physical triggers increased from 39% to 58% over the years (P < 0.001). There was a significant increase in 60-day mortality over the years (P < 0.001). However, a landmark analysis excluding patients who died within the first 60 days showed no differences in 1-year mortality (P = 0.150). ConclusionsThis study of temporal trends in TTS highlights a transition in patients demographic with a growing prevalence among men, increasing recognition of midventricular TTS type, and increased short-term mortality and rates of cardiogenic shock in recent years. This transition aligns with the rising prevalence of physical triggers, as expression of increased recognition of TTS in association with acute comorbidities.

Emerging Trends in Lung Cancer Presentation at a Leading Tertiary Oncology Center and the Need for Lung Cancer Screening in Pakistan.

Background Lung cancer is a significant global health concern, with Pakistan lacking a national cancer registry. Methods A retrospective study analyzed 345 lung cancer patients at Shifa International Hospital from 2018 to 2020. Demographics, symptoms, cancer stage, site, and histological types were assessed using descriptive statistics and Pearson'schi-square test. Results Most patients were male (267, 77.4%) with a mean age of 45-75 years. Common symptoms included patients with cough (168, 49%), blood in sputum (114, 33%), and chest pain (120, 35%). Most cases presented at advanced stages (81% at stage 4). Adenocarcinoma (131, 38%) was the most common histological type, with significant differences noted between smokers and non-smokers. Conclusion Gender disparities exist in lung cancer incidence, with a higher proportion of male patients. Both smokers and non-smokers are affected, emphasizing the need for comprehensive screening. Early detection and intervention strategies are crucial, especially considering the advanced stage of presentation. Tailored approaches considering histological types are essential for effective management. This study underscores the urgency of implementing screening programs and raising awareness to mitigate the burden of lung cancer in Pakistan.

Trends in Emotional Labor Research: Bibliometric and Science Mapping Analysis

Emotional labor is about employees in the service sector involving their emotions while performing the service job as required. Emotions are also used for commercial purposes. The study analyzes data on emotional labor through bibliometric and science mapping methods. For the analyses, data between 1982 and 2024 are scanned in the Web of Science (WoS) database, and data for 2,925 documents are accessed. After loading the data, the VOSviewer program is utilized to analyze it for bibliometric and science mapping purposes. Subsequently, the investigation unveiles the foremost authors, countries, journals, institutions, and keywords in emotional labor research. This is followed by analyzing their co-authorship, co-citation, bibliographic coupling, and keyword co-occurrence models. As a result, in emotional labor research, it is found that Alicia A. Grandey is the most productive and most cited author, the USA is the most productive country, Frontiers in Psychology is the most productive journal, and the most frequently encountered keywords are burnout, surface acting, job satisfaction, deep acting, and emotional exhaustion, respectively. The analysis findings reveal a collaborative nexus among authors, countries, and institutions, offering visual network maps and comprehensive insights into emotional labor's present status and trends within the scientific literature.

Socio-Economic Factors Influencing Growth of Small and Medium Enterprises in Mombasa County, Kenya

Small and Medium Enterprises (SMEs) contribute over 70% of jobs, contribute to GDP, aid industrial development, satisfy local demand for services, innovate and support large firms with inputs and services. However, the SMEs in Mombasa County are constantly faced with the threat of failure where three out five fails at infancy. The study investigated the influence of economic factors (taxation, finance access and wages and unemployment) on growth of SMEs in Kenya, in Mombasa County. The specific objectives of the study were; to explore the effect of taxation on growth of SMEs, to find out the effect of Financial Access on growth of SMEs, to determine the effect of wages on growth of SMEs operating, and to evaluate the effect of general unemployment on growth of SMEs operating in Mombasa County. This study employed the institutional theory of growth, the Schumpeter theory of growth and the Endogenous growth theory anchored the study. An explanatory research design was used so as to meet the research objectives. The target population was 54,245 registered SMEs and a sample size of 246 was derived using the Cochran, statistical formula. The list of registered SMEs in Mombasa formed the study population. A Systematic Random Sampling was used from a sample of 246 SMEs was drawn. Data was collected using a structured questionnaire. Multiple regression Analysis technique was the main technique to find the effect of social economic factors on SME growth. to analyze the data using the Statistical Package for Social Sciences with a significance level set at 0.05. Findings showed that SE conditions are just modest level. Correlation results showed that Taxation conditions (r=.344, p=.000), Financial Access (r=.430, p=.000), Wages affordability (r=.241, p=.000) are positively and significantly correlated with SME growth. Regression results showed that SE factors; Taxation conditions (=.268, p=.000), Financial Access ( =.383, p=.000), Wages ( =.182, p=.015) and Unemployment ( = -.170, p=.045) has significance effect on SMEs growth. Conclusions; Socioeconomic can reverse the current trend of high SMEs failure rate. Socioeconomic factors can buck the present trend of a high failure rate among SMEs. The study recommended that the county and national governments should implement measures enhancing tax benefits for SMEs such as utilizing the taxes prudently. Additionally, the SMEs should adopt strategies that enhance internal financial capabilities so as to incase their revenue streams. Moreover, it is recommended the SMEs to have a working and sustainable wage policy that is able to attracts and keeps talented workforce and therefore ensure continued business growth. By using a multi-sectoral approach, both local and national governments should prioritize and focus on short- and long-term policies that lower the rising rates of unemployment.

Study on Soil Pollution Control and Land Ecological Restoration Technology

This paper discusses the present situation and development trend of soil pollution control and land ecological restoration technology. Soil pollution mainly comes from industrial emissions, excessive use of pesticides and fertilizers and improper treatment of municipal garbage, which poses a threat to agriculture, human health and ecological balance. Treatment technologies include engineering remediation (such as soil replacement and water washing), physical-chemical remediation (such as solidification-stabilization, leaching, etc.), and biological remediation (using microorganisms, plants and animals). Land ecological restoration emphasizes integrity and sustainability, and adopts various methods such as plant and microbial restoration. In addition, prevention and control strategies and policy suggestions are put forward, including strengthening waste treatment standards, rational use of pesticides and fertilizers, and promoting waste classification. It is also suggested to establish a sound legal system for soil pollution prevention and control and raise public awareness of environmental protection.

Measuring the social effects of urban logistics facilities development, the case of New York city

ABSTRACT With customers expecting near-immediate deliveries, there has been a growth of heterogeneous networks of proximity logistics facilities within urban centers. Although resulting in higher operational efficiency, this trend challenges traditional planning paradigms and generates externalities for communities. This research provides an approach to analyze the effects of facility development in communities, using the case of New York City. Published information and public data sources are used to identify the location and type of facilities. Census data allows the calculation of existing vulnerability near the identified areas, and labor indicators present local trends in proximity-logistics-related sectors. Results show that logistics facilities are in areas where the population is vulnerable. However, new warehouse trends do not follow this tendency and can escape zoning codes. As a result, the quest for faster deliveries challenges existing planning processes. Job changes vary by location and over time, demonstrating inconsistency and sometimes volatility in worker effects.

Root Cause Analysis of Increased Referral Rates in a Sub-district Hospital, Tamil Nadu: A Quality Improvement Initiative.

Background Sub-district hospitals in Tamil Nadu are critical in providing essential healthcare services, but they face significant challenges that can lead to increased patient referrals to higher-level facilities. High referral rates can overburden tertiary care centers, delay specialized treatment, and affect patient outcomes. This study aims to identify the root causes of increased referral rates in a sub-district hospital and implement targeted interventions to reduce unnecessary referrals. Methods A descriptive study was conducted at Sriperumbudur sub-district hospital in Tamil Nadu from May to August 2023. The study utilized a root cause analysis (RCA) approach, incorporating qualitative data from brainstorming sessions with healthcare providers and administrative staff, and quantitative data from hospital records on referral rates. A fishbone (Ishikawa) diagram was employed to map causal factors, and Pareto and bar charts were used to analyze and present referral trends. Interventions were implemented using the Plan-Do-Study-Act (PDSA) cycle. Results The analysis identified several key factors contributing to high referral rates, including inadequate diagnostic services, insufficient staffing, and lack of essential resources such as CT scans and blood components. Following targeted interventions, referral rates decreased significantly from 101 cases in May-June 2023 to 52 cases in July-August 2023 highlighting a reduction of over 48%. The most notable reductions were seen in referrals for road traffic accidents with head injury (38.7%) reduction, chronic kidney disease (CKD)/hypertension (HT)/diabetes mellitus (DM) (46.2%) reduction, and crush injuries (45.5%) reduction. Conclusions The RCA revealed systemic issues that were contributing to increased referral rates at the sub-district hospital. Implementing targeted interventions based on the RCA findings led to a significant reduction in referrals, improving patient care at the local level and alleviating the burden on tertiary care centers. This study underscores the importance of continuous quality improvement initiatives in strengthening healthcare delivery at the sub-district level.

Development, Calibration and Validation of Time Series Analysis and Artificial Neural Network Joint Model for Urban Noise Prediction

Noise in large urban areas, which is mainly generated by road traffic and by the human activities carried out nearby and inside the area under study, is a relevant problem. The continuous exposure to high noise levels, in fact, can lead to several problems, largely documented in the scientific literature. The analysis and forecasting of the noise level in a given area are, then, fundamental for control and prevention, especially when field measurements present peculiar trends and slopes, which can be modeled with a Time Series Analysis approach. In this paper, a hybrid model is presented for the analysis and the forecasting of noise time series in urban areas: this technique is based on the application of a deterministic decomposition model followed in cascade by a predictor of the forecasting errors based on an artificial neural network. Two variants of the hybrid model have been implemented and presented. The time series used to calibrate and validate the model is composed of sound pressure level measurements detected on a busy road near the commercial port of an Italian city. The proposed hybrid model has been calibrated on a part of the entire time series and validated on the remaining part. Residuals and error analysis, together with a detailed statistical description of the simulated noise levels and error metrics describe in detail the method’s performances and its limitations.

A comprehensive taxonomy for forest fire risk assessment: bridging methodological gaps and proposing future directions.

Forest fire risk assessment plays a crucial role in the environmental management of natural hazards, serving as a key tool in the prevention of forest fires and the protection of various species. As these risks continue to evolve with environmental changes, the pertinence of contemporary research in this field remains undiminished. This review constructs a comprehensive taxonomic framework for classifying the existing body of literature on forest fire risk assessment within forestry studies. The developed taxonomy categorizes existing studies into 8 primary categories and 23 subcategories, offering a structured perspective on the methodologies and focus areas prevalent in the domain. We categorize a sample of 170 articles to present recent trends and identify research gaps in forest fire risk assessment literature. The classification facilitates a critical evaluation of the current research landscape, identifying areas in need of further exploration. Particularly, our review identifies underrepresented methodologies such as optimization modeling and some advanced machine learning techniques, which present routes for future inquiry. Moreover, the review underscores the necessity for model development that is tailored to specific regional data sets but also adaptable to global data resources, striking a balance between local specificity and broad applicability. Emphasizing the dynamic nature of forest fire behavior, we advocate for models that integrate the burgeoning field of machine learning and multi-criteria decision analysis to refine predictive accuracy and operational effectiveness in fire risk assessment. This study highlights the great potential for new ideas in modeling techniques and emphasizes the need for increased collaboration among research communities to improve the effectiveness of assessing forest fire risks.

Special Issue on Robotics and Mechatronics Technology for Sports, Exercise, and Health Care (Part 1)

Robotics, mechatronics, and digital technologies are rapidly advancing in the fields of sports, exercise, and healthcare, and their applications are expanding daily. In part 1 of our special issue, we focus on the innovative contributions of cutting-edge technologies in various domains. Robotics technology is crucial in sports and exercise training as it monitors individual movements and forms, provides user feedback, and enables effective training. The development of robots to enhance the accuracy and reproducibility of sports techniques is a key element directly linked to performance improvements. Robotics and mechatronics provide new possibilities for treatment and rehabilitation in healthcare. Developing beneficial systems for medical professionals and patients contributes to increased precision in surgery and productive support in rehabilitation. Power assistance and motion augmentation are witnessing advancements that prolong individual capabilities and achieve better performance. These studies may reduce the physical burden of daily activities and specific tasks, thereby enhancing efficiency. Therefore, studies on haptics and sensory feedback are important. Efforts to improve user interfaces through virtual haptic experiences represent a promising new application of digital technology. The studies included in part 1 of this special issue present recent technological trends and practical examples of sports, exercise, and healthcare and aim to provide valuable information and inspire the readers. We hope that these studies will serve as significant steps toward future technological advancement and social implementation.

Peri-urban dynamics: assessing expansion patterns and influencing factors

BackgroundPeri-urbanization, the expansion of large metropolitan centers into adjacent peri-urban regions, is a growing concern due to land scarcity and escalating housing costs. These zones, a blend of rural and urban features, blur the line between urban and rural areas, creating new landscapes. This study examines historical, present, and potential growth trends in the peri-urban area surrounding Durgapur Municipal Corporation (DMC). Analytical techniques and spatial metrics are used to track development intensity changes over time, including built-up density, Shannon’s entropy, Landscape expansion index, Average Weighted Mean Expansion Index, Annual Built-Up Expansion Rate, Built-Up Expansion Intensity Index, and Built-Up Expansion Difference Index. Landscape indices like Patch Density, Edge Density, Landscape Shape Index, Largest Patch Index, Ratio of Open Space, and Area Weighted Mean Patch Fractal are used to understand fragmentation, connectivity, and spatial relationships. The Logistic Regression Model (LRM) is used to identify influencing factors and CA-Markov modeling for future built-up areas.ResultsBetween 1991 and 2001, built-up area in the region increased significantly, primarily due to urban development near industrial zones, roadways, and mining areas. The growth was primarily concentrated in the western sector and near National Highway-2 (NH-2). Urban sprawl was a continuous trend, with the highest built-up density in the South-South-East (SSE) direction from 1991 to 2011. Additionally, a key determinant of built-up development was the distance to the city core. By 2031, the built-up area is expected to concentrate in the western and southeast regions, reaching 177.90 km2.ConclusionsThis expansion is attributed to urban development near industrial zones, roadways, mining areas, and other infrastructure. The study identifies distance to the city center as a significant influencing factor for built-up development. The results emphasize the need for inclusive urban planning methods prioritizing sustainable development principles and prudent resource management for future growth and efficient management in the DMC’s peri-urban area.

Revisiting the Spatial Cycle: Intra-Regional Development Patterns and Future Population Dynamics in Metropolitan Athens, Greece

Being intertwined with economic development, urbanization determines the present and future development path of regions and countries. The intimate relationship between urban expansion and economic development is of particular interest in the case of large regions with complex (and mostly non-linear) socio-demographic dynamics and a relevant primacy in the metropolitan system of a given country. Typical examples of advanced economies with settlement systems characterized by a high degree of city primacy are peripheral and disadvantaged European countries such as Portugal and Greece. For instance, the administrative region of Attica—centered on Athens, the Greek capital city—represents the largest metropolitan area of the country, hosting almost 3.8 million inhabitants in 2021 (36.2% of the Greek population). In this context, this study investigates the internal redistribution of the resident population in metropolitan Athens and the progressive development of satellite cities over a relatively longtime interval, testing the assumptions of the Spatial Cycle Theory (SCT) between 1951 and 2021 and predicting future development paths up to 2051. To investigate past, present, and future intra-regional population trends, we used data released from decadal (1951–2021) censuses and demographic forecasts for the years 2031, 2041, and 2051. Being in line with the SCT, the empirical results of our study document how demographic dynamics of individual centers influence largely—and independently—the long-term development of metropolitan regions, both with policy/planning regulation and in conditions of non-intervention (spontaneous urban growth).

Spiritual Care in Palliative Medicine and End of Life: A Bibliometric Network Analysis.

Background and Objectives: Spiritual care is an essential component of care for the terminally ill, because of its potential to positively impact patient perception of quality of life and dignity. However, it continues to be the least cultivated or even most overlooked aspect of palliative care and end of life. We performed a methodological review using bibliometric analysis to provide a holistic view of the scientific output published on this topic in the literature at the same time outlining present perspectives and research trends. Methods: In accordance with the BIBLIO checklist for reporting the bibliometric reviews of the biomedical literature, pertinent articles were retrieved from the Web of Science (WOS) database. The search string included "spiritual care," "end of life," and their synonyms. The VOSviewer (version 1.6.17) software was used to conduct comprehensive analyses. Semantic and research networks, bibliographic coupling, and journal analysis were examined. Results: A total of 924 articles were identified in WOS, and 842 were retrieved. An increasing trend in the number of publications is observed from 1981 to date, with a peak in the 2019-2021 timeframe. Most articles focused on palliative care, spirituality, spiritual care, religion, end of life, and cancer. The Journal of Pain and Symptom Management contributed the highest number of published documents, while the Journal of Palliative Medicine was the top-cited journal. The highest number of publications originated from collaborations of authors from the United Kingdom, the United States, and Australia. Conclusion: The remarkable increase in the number of publications on spiritual care observed in the years of the COVID-19 pandemic likely reflected global concerns, reasserting the importance of prioritizing spiritual care for whole-person palliation. Spiritual care is integrated with palliative care, in line with the latter's holistic nature and the recognition of spirituality as a fundamental aspect of end-of-life care. Nurses and chaplains exhibited more involvement in palliative-spiritual care than physicians reflecting the belief that chaplains are perceived as specialized providers, and nurses, owing to their direct exposure to spiritual suffering and ethos, are deemed suitable for providing spiritual care.

Trends in Presentation, Management, and Survival of Women With Breast Cancer in a Multiethnic, Middle-Income Asian Setting.

Granular data on breast cancer (BC) are pertinent for surveillance, planning, and monitoring of cancer care delivery. We determined the trends in clinical presentation, management, and survival of women with BC in a multiethnic middle-income Asian setting over 15 years. Data of 7,478 Malaysian women newly diagnosed with invasive BC between 2005 and 2019 from three hospital-based cancer registries were included. Trends in demographic, tumor, and treatment characteristics were compared across period 1 (P1): 2005-2009, period 2 (P2): 2010-2014, and period 3 (P3): 2015-2019. Overall survival and net survival were determined. More women in P3 than P1 were older than 60 years at diagnosis. Only a marginal increase in proportion of women with stage I disease was observed (23.7% v 27.2% in P1 and P3, respectively, P = .004). Nonetheless, patients were increasingly presenting with smaller tumors, fewer axillary node involvement, well-differentiated tumors, and hormone receptor expression in recent times. Proportion of women with human epidermal growth factor receptor 2 (HER2)-overexpressed tumors significantly decreased. Among indicated patients, receipt of anticancer therapies was somewhat similar over the calendar periods, except for neoadjuvant chemotherapy and anti-HER2 therapy, where increases in administration were noted. Significant improvements in survival were observed over the 15 years, particularly for HER2-overexpressed BCs. Although the improvements in BC survival that we have observed validate ongoing cancer control efforts and treatment advances, study findings suggest that more could be done for earlier detection and improved access to effective therapies in our settings.

Assessing the HIV care continuum among transgender women during 11 years of follow-up: results from the Netherlands' ATHENA observational cohort.

Transgender women are at increased risk of acquiring HIV. Earlier studies reported lower retention in HIV care, antiretroviral therapy uptake, adherence and viral suppression. We assessed the stages of the HIV care continuum of transgender women in the Netherlands over an 11-year period. In addition, we assessed new HIV diagnoses and late presentation, as well as disengagement from care, between 2011 and 2021. Using data from the Dutch national ATHENA cohort, we separately assessed viral suppression, as well as time to achieving viral suppression, among transgender women for each year between 2011 and 2021. We also assessed trends in new HIV diagnoses and late presentation (CD4 count of <350 cells/µl and/or AIDS at diagnosis), and disengagement from care. Between 2011 and 2021, a total of 260 transgender women attended at least one HIV clinical visit. Across all years, <90% of transgender women were virally suppressed (207/239 [87%] in 2021). The number of new HIV diagnoses fluctuated for transgender women (ptrend = 0.053) and late presentation was common (ranging between 10% and 67% of new HIV diagnoses). Of the 260 transgender women, 26 (10%) disengaged from care between 2011 and 2021 (incidence rate = 1.10 per 100 person-years, 95% confidence interval = 0.75-1.61). Between 2011 and 2021, less than 90% of transgender women linked to HIV care were virally suppressed. Late presentation at the time of diagnosis and disengagement from care were common. Efforts are needed to identify barriers to early HIV diagnosis and to optimize the different steps across the care continuum for transgender women.

Contemporary Management of the Upper Limb in Apert Syndrome: A Review.

Apert syndrome is a relatively rare genetic disorder with a constellation of distinct craniofacial deformities and bilateral syndactyly of the hands and feet. Although the literature contains ample evidence for the need to treat cranial, midfacial, and hand abnormalities, there are severe shortcomings in the literature when attempting to describe the pathology and management of the entire upper limb in patients with Apert syndrome. A thorough literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar, on the management of the upper extremity in Apert syndrome, including the shoulder, elbow, and hand. Our findings of the literature discuss the clinical presentation and management trends of the upper extremity in patients with Apert syndrome. Through multicenter collaboration, discussion among experts in the field, and evidence gathered from the literature, we propose treatment algorithms to treat deformities of the hand, shoulder, and elbow in patients with Apert syndrome. This review identifies that even if hand pathologies have been correctly treated, shoulder and elbow abnormalities in patients with Apert syndrome are largely ignored. To optimize outcomes, added cognizance of additional upper limb congenital differences and their management should be highly advocated in this patient population.