Provision Of Access Research Articles

The Utilization of the Accelerated Approval Pathway in Oncology: A Case Study of Pembrolizumab.

The accelerated approval (AA) pathway was established by the United States Food and Drug Administration (FDA) to provide earlier access to therapies for patients with serious medical conditions and unmet medical needs. Since its inception, the AA pathway has been used for novel treatments across different therapeutic areas, but most prominently in oncology, including the immune checkpoint inhibitor class. This review article describes the history of regulatory approvals for pembrolizumab, an immunotherapy agent targeting programmed death receptor-1 (PD-1), and use of the AA pathway and the corresponding regulatory decisions made by the FDA. From its first AA in September 2014 to February 2024, pembrolizumab has used the accelerated pathway for roughly 40% of the approved indications listed in the US Prescribing Information and was the first oncology therapy to receive an AA for an alternate dosing regimen and a tissue-agnostic indication. As of February 2024, 14 of the 18 indication-specific AAs and 1 post-marketing requirement (PMR) for the alternate dosing regimen AA were converted to traditional approvals. Accelerated approvals for two indications were withdrawn, and the remaining ongoing PMRs are not due until later in 2024 or 2025. The median conversion time from AA to traditional approval was 2.6 years, which is roughly 6 months earlier than the median time reported for oncology AAs. While FDA was the first agency to establish an expedited approval pathway, regulators from other countries have established similar pathways. For pembrolizumab, approximately half of the datasets that supported US AAs also supported expedited approval, or sometimes full approval, in Canada, EU, Australia or Japan. Ultimately, the AA pathway balances the provision of earlier access to therapies with overcoming uncertainty about potential effectiveness, and therefore it is important to confirm treatment benefit and withdraw indications that do not confirm benefit in a timely manner. The regulatory strategy and use of this expedited program for pembrolizumab highlights the importance of the AA pathway in providing oncology patients with earlier access to life-saving medications.

Audio description for all? The benefits and concerns of extending access provision to sighted people

AbstractAudio description (AD) is an established part of museums' access programs for blind and partially blind (BPB) people. This paper explores the merits and caveats regarding “AD for all”, rolling out the provision for sighted people as well. It draws from four separate Access All Senses (AAS) events in three different London museums, each conducted under slightly different conditions. In addition to collecting nearly 100 audience feedback forms, this study has involved museum access staff, audio describers, and BPB art lovers. These events demonstrate that there is a demand among sighted people to include AD in museum tours as “guided looking”. The main concern regards the unintended consequences that could threaten the specific provision that BPB people need. A brief survey at the end offers examples of museum initiatives where AD is being rolled out while protecting these interests.

Mental Health Management Strategies in Pregnant Women and The Impact on Infant Health

The first stage of labor often takes a long time and causes discomfort for the mother, so methods are needed to accelerate it. This study aims to evaluate the effectiveness of microcontroller-based nipple stimulation in accelerating the labor process by stimulating the release of the hormone oxytocin which increases uterine contractions and accelerates cervical opening. Microcontroller technology is used to ensure the stimulation is done automatically and measured according to the mother's physiological needs. This study involved two groups, namely the group that received stimulation and the control group that did not receive stimulation. There are shortcomings in studies examining the effectiveness of interventions implemented at the organisational level in reducing stigma and improving mental health support. A variety of strategies can be used to address stigma, including proper education, awareness campaigns, and training for managers and employees on the importance of mental health. The development of inclusive policies and the provision of easy and non-discriminatory access to mental health services are essential. Consistent managerial support also plays a key role in creating a supportive work environment. Creating a positive and inclusive organizational culture will help companies improve employee mental health and well-being, while also increasing workforce productivity and retention. Reducing stigma and increasing support can create a healthier work environment, which ultimately supports individual development and the long-term success of the company.

From legislation to actual health service: evaluation of health provisions in the disability law of Ghana by adolescents with mobility and visual impairments and their families

BackgroundDespite Ghana’s Persons with Disability Act, 2006 (Act 715) making provisions for access to healthcare services for adolescents with disabilities and their families, a corpus of literature has reported that persons with disabilities continue to face challenges in accessing healthcare services. However, the voices of adolescents with disabilities and their families are very scarce in such discourse. This study explored the experiences of adolescents with disabilities and their families in accessing healthcare services as per the provisions described in Ghana’s Act 715.MethodsThis study involved 45 participants, including 25 adolescents with disabilities and 20 family members from a municipality in Ghana. Employing a qualitative descriptive design, semi-structured interviews were conducted which was then analyzed thematically and interpreted using Critical Disability Theory.ResultsThe study identified two major categories of barriers to healthcare access: environmental (socio-economic difficulties, poor built environment, unavailability of rehabilitation services) and systemic (cultural beliefs, poor support at healthcare facilities and inadequate healthcare legislative provisions for families of children with disabilities). Despite legal provisions for free healthcare, participants faced significant financial barriers, with specialist services often not covered by the National Health Insurance Scheme.ConclusionsThe study calls for policy adjustments to fully cover specialist care under Ghana’s National Health Insurance Scheme, establishment of local-level health assessment and resource centers, educational campaigns to change cultural perceptions, and training of healthcare workers to promote quality access to healthcare.

Community Preferences for Agrarian Reform in Kampung Reforma Agraria: A Case Study of Mekarsari Village, Banten

Abstract: An agrarian reform program encompassing asset and access arrangement was implemented to address the inequality in land ownership. Furthermore, asset management and access management models are integrated in the same location to increase the effectiveness of the agrarian reform program. As a pilot project, the first Kampung Reforma Agraria (KRA) was implemented in Mekarsari Village, Panimbang District, Pandeglang Regency, by distributing land to 225 subjects. However, after five years of implementing agrarian reform, some subjects still have not occupied KRA locations. This condition indicates that some subjects are reluctant to live in the designated location. Therefore, this research aims to analyze the profile and characteristics of TORA subjects’ residences who have yet to occupy the land granted in the KRA and the influence of these two factors on their spatial preferences regarding agrarian reform policies. By interviewing 23 TORA subjects who had yet to occupy the Tanah Objek Reforma Agraria (TORA) location and transfer their land rights, the results show that 52.5% wanted to move to KRA. In contrast, 47.5% did not want to occupy their land in KRA. Based on the analysis of the physical characteristics of the TORA subjects’ residences, the relationship between the physical distance from the subject’s current residence to KRA and the subject’s preference to move to KRA was not very significant. The factors most influencing the subject’s preferences are the residence’s non-physical characteristics, the land’s current legal status, and the socio-economic profile. Based on these findings, policymakers responsible for setting the criteria for land recipients should enhance the supervision system for subject selection from the outset. Furthermore, when designing access provision programs, it is essential to account for the diverse preferences and needs of each subject group. Keywords: Agrarian Reform; Access Arrangement; Asset Arrangement; Kampung Reforma Agraria; Spatial Preferences.

Exploring considerations of equality, diversity and inclusion in selection for a doctorate in clinical psychology programme: A qualitative study

Diverse and inclusive healthcare workforces are important to optimise patient access and outcomes. Various attempts have been made to promote equality, diversity and inclusion (EDI) in clinical psychology; however, clinical psychology doctoral training programmes (DClinPsy) frequently fail to reflect the population demographics of the communities that they serve within the make-up of their trainees. Some research indicates that the lack of diversity might be linked to potential biases within the selection process.This study seeks to qualitatively explore how application screeners and interview panellists for a DClinPsy programme consider EDI in the selection process. Content analysis of seven semi-structured interviews suggests that participants think broadly about EDI, considering differences between marginalised groups and the provision of equal access for members of these groups. Content analysis of discussions of protected characteristics suggests that, when considering EDI, race, sex, disability, sexual orientation, and socio-economic status prove more salient than other factors such as age, and religion or belief.Barriers and facilitators to accessing the DClinPsy are discussed. Participants discuss the perceived inadequacy of EDI training for their roles in selection, and conflicts related to different EDI measures such as positive action and standardisation. The findings are discussed with reference to existing literature. Future research should seek to examine the EDI training needs of those involved in the selection process and examine the efficacy of EDI initiatives to improve equity and inclusion for underrepresented groups.

Internal bordering and debordering in urban humanitarian health care

ABSTRACT Current literature on internal bordering has suggested understanding health care as a key migration control field. This article takes a closer look at the humanitarian medical offices in Frankfurt am Main, Germany, and patients from Romania and Bulgaria in precarious life circumstances. It addresses the strategies identified in the accounts of frontline workers beyond the mere provision of access to free and anonymous medical attention. Based on 16 interviews with medical staff, social workers and administrative officers, two approaches emerged. One clearly strives for the formalisation of the human right to health care in close collaboration with, or by challenging the local bordering actors; the other insists on bypassing any point of contact with them, focusing exclusively on informal and direct solutions. The interviews showcase how the resulting strategies can contribute to internal bordering and debordering on an urban scale, and affect the individuals’ trajectories as patients and as migrants.

Technology of preparation and determination of the properties of kvas from table beet for use in bakery

In connection with the deterioration of the health of the population of Ukraine, the primary task should be to enrich the usual diet with products of functional purpose and to add natural biologically active additives that contribute to the removal of radionuclides, toxins, normalization of the body's systems and increased immunity. This work is devoted to the study of the process of beet processing and its further use in the bakery and confectionery industries. The refractometric method was used to determine the content of soluble solids. The content of trace elements was determined using the atomic adsorption method. When preparing kvass from table beets, additional raw materials were added: sprouted flax seeds, whey, yeast, viburnum powder, rye bread crackers. It was established that the variety of the Dutch selection Roket differs from the varieties Bordeaux 237 and Cylindra in terms of dry matter, organic acids, dyes and sugars. It is important to note that when improving kvass preparation technology, optimal fermentation conditions and dosing of additives are taken into account in order to maximize the shelf life of the product without losing its quality. In view of the increase in the number of genetic and complicated diseases, it is worth noting the introduction of specialized dietary programs, which are gaining more and more relevance. Such programs have been found to ensure food security and meet all essential nutrient needs. Considered the problem of the need for constant improvement of recipes of food products, study of new gluten-free alternatives and provision of access to high-quality gluten-free products. Studies have proven that the use of natural raw materials in the production of beet kvass is an effective means of improving its quality characteristics. Therefore, a promising direction in the production of flour products is the improvement of the recipe of the existing assortment due to the use of natural plant components of increased biological value. Kvass from table beet can be a source of natural biologically active substances (BAR). Table beets have a rich chemical composition. The nutritional value of beets is additionally balanced by the content of sugars and acids (citric and oxalic), the content of organic substances, minerals and vitamins. The production of bakery products using kvass from table beet as a natural food additive is relevant today.

Energy Consumption, Bank Credit and Manufacturing Industry Performance: A Panel ARDL Analysis in Western Indonesia

The energy growth nexus is still being debated due to mixed empirical findings. This study seeks to establish a relationship between energy consumption, bank credit, and the performance of the manufacturing industry. This study also aims to determine the pattern of the dynamic causal relationship between energy use, bank credit, and the performance of the manufacturing industry in 17 provinces in western Indonesia. This study used secondary data from the Central Bureau of Statistics and the Financial Services Authority. Panel data are from 17 provinces in western Indonesia, spanning from Q1 2010 to Q4 2022 (2010Q1–2022Q4). We employed the panel ARDL and causality test to explore the connection between the variables of interest. The panel ARDL confirms that energy consumption and bank credit play a crucial role in boosting the performance of the manufacturing industry in the long term. This study found strong evidence to support the long-term feedback hypothesis of the energy-output growth nexus. However, in the short term, bank credit was statistically insignificant at all confidence levels. We recommended several policies to local governments and stakeholders, prioritizing the provision of more adequate energy infrastructure and greater access for industrial businesses to utilize banking services. Advancing infrastructure and developing the utilization of new renewable energy are proposed to support sustainable economic development.

Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review.

Perinatal mental health is a growing public health concern. Refugee and asylum-seeking women are particularly susceptible to experiencing perinatal mental illness and may encounter a range of challenges in accessing healthcare. This scoping review sought to identify the enablers of and barriers to healthcare access and healthcare provision for refugee and asylum-seeking women experiencing perinatal mental illness in the WHO European Region. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. Nine databases and six grey literature sources were initially searched in April 2022, and an updated search was completed in July 2023. The search identified 16,130 records, and after the removal of duplicates and the screening process, 18 sources of evidence were included in this review. A data extraction table was used to extract significant information from each individual source of evidence, which was then mapped to the seven dimensions of the candidacy framework. Empirical (n = 14; 77.8%) and non-empirical (n = 4; 22.2%) sources of evidence were included. The literature originated from seven countries within the WHO European Region, including the United Kingdom (n = 9; 50%), Germany (n = 3; 16.7%), Denmark (n = 2; 11.2%), Norway (n = 1; 5.6%), Greece (n = 1; 5.6%), Sweden (n = 1; 5.6%), and Switzerland (n = 1; 5.6%). The results indicate that, although enablers and barriers were apparent throughout the seven dimensions of candidacy, barriers and impeding factors were more frequently reported. There was also a notable overall lack of reported enablers at the system level. Unaddressed language barriers and lack of attention to the diversity in culturally informed perceptions of perinatal mental illness were the main barriers at the individual level (micro-level) to identifying candidacy, navigating healthcare systems, and asserting the need for care. The lack of culturally appropriate alignment of healthcare services was the key organizational (meso-level) barrier identified. The wider structural and political contexts (macro-level factors), such as lack of funding for consultation time, focus on Western diagnostic and management criteria, and lack of services that adequately respond to the needs of refugee and asylum-seeking women, negatively influenced the operating conditions and wider production of candidacy. It can be concluded that there are multilevel and interconnected complexities influencing access to and provision of perinatal mental healthcare for refugee and asylum-seeking women.

The Resilience Hub approach for addressing mental health of health and social care workers during the COVID-19 pandemic: a mixed-methods evaluation.

Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic. To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic. Mixed-methods evaluation. Four Resilience Hubs. Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (N = 1973); follow-up questionnaire data (N = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs. Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes. Feedback was otherwise very positive. Main limitations included lack of comparative and pre-pandemic/baseline data, small numbers from under-represented groups limiting fine-grained analysis, and participant self-selection. Findings highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support during the coronavirus disease 2019 pandemic, and as a potential model to respond to future crises. The research provided recommendations to improve Hub promotion, equality/diversity/inclusion access issues, management of specialist resources and collection of relevant data on Hub outcomes and activities. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges. Research recommendations are made to conduct more robust evaluations of the clinical and cost-effectiveness of the Hubs, using larger data sets and comparative data. This study is registered as researchregistry6303. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information.

The Relation of Infectious Diseases, Water Access, Hygiene Practice, and Sanitation with the Stunting: A Case-Control Study in Sambas Regency

Background: The main nutritional problem concerned by the Indonesian government is the stunting. This condition is affected by various aspects, mainly caused by infectious diseases, clean and unharmonious living behavior, the availability of drinking water, and environmental sanitation. Objectives: The purpose of this study is to determine the relation of infectious diseases, water access, hygiene practices, and sanitation towards the stunting incidence factors in Sambas Regency. Methods: This research used Ex Post Facto with a case-control design. The study population was residents of Sambas Regency with a total of 535,725 people, a total sample of 241 children aged 0-59 months comprising of 89 respondents as cases and the rest 159 respondents as controls, using inclusion and exclusion criteria both from the control group and from the case group. Data analysis used the chi-square test. Results: The results showed a relation of infectious diseases (p-value=0.000), drinking water sources (p-value=0.000), clean and healthy living behavior (p-value=0.000), and environmental conditions (p-value=0.000) with the stunting incidences. Conclusions: The study concludes that there is a significant relation of infectious disease variables, the drinking water sources, hygiene practices, and environmental conditions with the stunting. It requires control and completion of the stunting cases through environmental sanitation improvement, namely the provision of access to clean water, healthy and clean living behaviors, and good cooperation between the government and the community, in educating people through counseling and socialization of the stunting prevention and management.

INTENSIVE TREATMENT OF SEPTIC SHOCK IN PEDIATRIC PRACTICE

In pediatric practice, septic shock (SS) is a serious, urgent condition with a high incidence and increased risk of death. Intensive therapy in this condition is based on provision of volume-expansion fluid management, prescription of antibiotic medications, and vasopressor support. Urgent care for children is provided in an intensive care unit and includes mandatory determination of the aetiology of SS (by inoculation of blood samples for sterility), provision of venous access and continuous monitoring of vital signs with measurement of lactate levels. The intensity of respiratory support changes according to the following stepwise logic: oxygen therapy – non-invasive ventilation – mechanical ventilation. When providing fluid management to a patient with SS, preference is given to crystalloid solutions. Antibacterial therapy is devised empirically and must be administered within the first hour of ICU admission. If fluid management proves insufficient to ensure stable hemodynamic parameters, vasopressor support is provided by administering inotropic agents, vasodilators and inodilators (norepinephrine, epinephrine, dopamine and dobutamine). Evidence on the effectiveness of corticosteroids in children and adolescents with SS is lacking. Knowledge of the latest algorithms of intensive treatment of SS in pediatric practice will enhance the quality of care and improve the therapeutic prognosis in this category of patients.

Facilitating remote and virtual access provision by European research infrastructures - requirements, issues, and recommendations.

Research Infrastructures (RIs) are strategic assets facilitating innovation and knowledge advancement across all scientific disciplines. They provide researchers with advanced tools and resources that go beyond individual or institutional capacities and promote collaboration, community-building and the application of scientific standards. Remote and virtual access to RIs enables scientists to use these essential resources without the necessity of being physically present. The COVID-19 pandemic restrictions where a catalyst for the expansion and further development of remote and virtual access models, particularly in fields where physical access had been the predominant model. The eRImote project explores pathways for digital and remote RI access through targeted surveys, stakeholder workshops, expert groups discussions, and the analysis of specific use cases. This paper provides a definition of remote and virtual access and remote training and explores their implementation across various RIs, highlighting the implications for their operational processes and the dynamics of interaction between RIs and their user communities. It presents the identified advantages, obstacles, and best-practices, alongside strategies and recommendations to navigate and mitigate challenges effectively. Key issues and recommendations are summed up separately for remote access, virtual access, and remote training, complemented by general recommendations for facilitating remote and virtual access to RIs. These relate to budgeting and funding, the balancing of RI access models, the need for regulatory frameworks for sample shipments, collaboration among RIs, impact assessment of remote and virtual access on user interactions, operational efficiency and the environment footprint of RIs, and the adaption of data sharing policies. Stakeholders are broadly invited to give their feedback on the paper's findings and conclusions, which will be integrated into improved versions of this paper.

The Urgency of Disability Service Units in Higher Education as an Effort to Realize Inclusive Access to Higher Education

This research is based on the gap between theory, regulation and implementation of the fulfillment of rights for students with disabilities in higher education based on Law No. 8 of 2016. One of the important issues of rights fulfillment in the Law is the right to education in higher education. Explicitly, the law mentions several obligations of universities, public and private, to play an active role in fulfilling and promoting the rights of persons with disabilities. In this literature study, we aim to study in depth the implementation of each policy and advocacy for the rights of students with disabilities carried out by several universities in Indonesia with the formation of disability service units that have a role in pursuing good practices to realize inclusive universities. Based on the results of the research, the disability service unit is one of the efforts to realize inclusive universities and become a forum for fulfilling the rights of students with disabilities to obtain the right to education, which includes the rights of persons with disabilities, fulfillment of equal opportunities for persons with disabilities, respect, protection and fulfillment of the rights of persons with disabilities, including the provision of accessibility and proper accommodation.

Немедицинские аспекты доступности медицинской помощи при территориальном планировании в здравоохранении.

Improving the accessibility of medical care is one of the tasks to achieve the goals of state policy in saving the population and human development of a number of strategic documents of the Russian Federation. Purpose of the study is to analyze the non-medical aspects of ensuring accessibility of medical care, their normative legal regulation in territorial planning in healthcare at the regional level. Materials and methods. The source of information was legal acts from the reference legal system ConsultantPlus. Descriptive and analytical methods were used in the study. Results. It is shown that the issues of ensuring accessibility of medical care and creating conditions for its provision and development are attributed by various legislative and regulatory acts both to the powers of public authorities of the subject of the Russian Federation and to the powers of local governments within the competence defined by the legislation of the Russian Federation, but these provisions of powers are fixed differently and require amendments and clarifications. The expediency of making amendments to normative acts of different levels and departments within the framework of clarifying the norm on creating conditions for the provision of medical care to the population on the territory of a municipal district or municipal, urban district in terms of providing transport services to the population and organization of transport services, parking space with the possibility of getting to a medical organization for all groups of the population has been determined. Within the framework of regulation, other social guarantees for children of medical workers and norms on providing medical workers with housing (office housing, under a social rent agreement, provision of relevant subsidies and payments for the purchase of housing) need to be specified. The presence of sufficient regulation in terms of the rules of construction and maintenance of roads in the legal field was determined, however, the federal laws and subordinate regulations cited in the study lack specificity and correlation of these legal norms in relation to medical organizations. Conclusions. The necessity to improve the normative basis of non-medical aspects of state and municipal provision of accessibility of medical care to the population in terms of correlation between constitutional norms and legal acts of different departments has been determined in order to specify measures aimed at improving accessibility in the provision of medical care regarding transport accessibility, social guarantees for medical personnel and other measures to develop infrastructure.

Empirical Investigation into Collaborative Model Development for Resolving Tenure Conflicts in Forested Regions

Tenure conflict is a challenge and dilemma experienced by many countries. The dilemma is because on the one hand, there is an interest in preserving forests, on the other hand, there are claims to land ownership in forest areas long before they are designated as forest areas. The next dilemma is that the party claiming property rights is generally used for agricultural activities which have been the main livelihood for generations. This study tries to examine the incidence of tenure conflicts in various countries to map how these conflicts occur, the factors that encourage land tenure approaches in resolving them, and government (state) policies. Using secondary data resulting from a review of previous research published in reputable international journals and other reliable and credible reports. The review study model used is systematic with meta-synthesis. Apart from journals, secondary data comes from other reliable and credible reports. Data and materials consist of 67 reputable international journals and 14 books/reports published in the last ten years. The results of the analysis found that tenure conflicts were caused by many things, motivated by the ownership and interests of natural resources specifically for agriculture for the lives of the surrounding community. An interesting fact is that the handling of tenure conflicts in several countries is considered successful, marked by the provision of access to forest management ownership. Other studies such as those conducted in Latin America, Africa, and Asia offer partnership models to resolve tenure conflicts. Similar things have also been done in Indonesia but have not been completely successful. Learning from this, this research offers a model for developing forest management partnerships to resolve tenure conflicts in forest areas, while also accommodating special agricultural activities for local communities. The model offered theoretically complements and/or perfects the models used so far which have proven unsuccessful in resolving conflicts. The practical implications are a reference for the government and interested parties to resolve tenure conflicts so that forests are maintained and can provide benefits for community welfare.

On the form of granting a license to use copyright and related rights objects in certain ways on the Internet

Introduction. The high pace of development of the Internet and globalization of processes necessitate the introduction of new approaches to the regulation of relations in the field of intellectual property. The transition of business to online, the use of the Internet as a tool for advertising and promotion of goods and services, including the use of content of other parties, creates new challenges related to the efficient and, at the same time, legal transfer of intellectual property rights between the parties. The purpose of the paper is to highlight the aspects of national legislation that complicate the transfer of rights to copyright and related rights on the Internet and to find solutions to overcome them by enshrining special rules. Results. The paper reveals the need to introduce an individual approach by adopting special rules to determine the forms of transactions for the disposal of intellectual property rights in respect of certain objects in certain ways. In particular, this applies to granting permission (license) to use copyright and related rights objects in certain ways on the Internet. The paper provides examples of the already implemented individual approach to the regulation of intellectual property rights in the national legislation of Ukraine with regard to certain categories of objects. The author analyzes the forms of transactions enshrined in the legislation, the methods of their execution and the consequences of non-compliance with such forms, namely, the written form, in particular, with regard to transactions on disposal of intellectual property rights. The author recognizes the need to introduce alternative methods of granting permission (license) for the use of copyright and related rights objects on the Internet in order to eliminate formal obstacles, which will simplify the process of making such transactions and meet the needs of users of Internet resources who are interested in distributing user-generated content of others. Conclusion. It is proposed to amend the Law of Ukraine "On Copyright and Related Rights" to establish a new type of transaction on the basis of which intellectual property rights are disposed of, namely, a license for reproduction and interactive provision of access to a copyrighted work or a related work on the Internet, and to define the terms and conditions of such a license and the form (method) of its transfer.

Utilization of 12 health packages extended under Ayushman Arogya Mandir in block Marh, Jammu, Jammu and Kashmir

BackgroundThe establishment of the Ayushman Arogya Mandir marks a fundamental change in India's approach to healthcare. The present study aimed to examine the effectiveness and shortcomings of health packages extended through the Ayushman Arogya Mandir in Block Marh, Jammu, Jammu and Kashmir identifying areas for improvement, and addressing barriers to optimal utilization. MethodsThis cross-sectional study was done among 10 centres in the Marh block of Jammu, Jammu and Kashmir to achieve the desired objectives using structured and self-administered questionnaires. A convenience sampling of 105 participants, including 55 healthcare professionals and 50 community members, was adopted using time-bound enumeration. Checklists were also included to assess healthcare services, ensuring a thorough understanding of how healthcare packages are administered and implemented. Confidentiality was prioritized and ethical considerations guided the data collection process, allowing for a comprehensive examination of healthcare utilization patterns in the target region. ResultsThe results revealed that reproductive and family planning services, as well as neonatal/infant healthcare, have high utilization rates (95 % and 78 %, respectively), highlighting their significance, whereas lower rates in elderly/palliative care, psychiatric/neurological/substance use disorder care, and eye/ENT treatments indicate potential areas for improvement in healthcare awareness, access, and service provision barriers. ConclusionThe Ayushman Arogya Mandir in Block Marh, Jammu, Jammu and Kashmir are heavily leaning towards maternal and child health initiatives while other services are underutilised, highlighting the need for targeted awareness of the availability and accessibility to these services.

Comparative outcomes of arterial bypass using the human acellular vessel and great saphenous vein in patients with chronic limb ischemia

ObjectiveThe Human Acellular Vessel (HAV) is a novel, off-the-shelf biologic conduit being evaluated for arterial reconstructions. Regulatory studies in peripheral arterial disease (PAD) to date have consisted of single-arm cohorts with no comparator groups to contrast performance against established standards. This study aimed to compare outcomes of the HAV with autologous great saphenous vein (GSV) in patients with advanced PAD undergoing infrageniculate bypass. MethodsPatients with advanced PAD and no autologous conduit who underwent bypass with the 6-mm diameter HAV (Group 1; n = 34) (March 2021-February 2024) were compared with a multicenter historical cohort who had bypass with single-segment GSV (group 2; n = 88) (January 2017-December 2022). The HAV was used under an Investigational New Drug protocol issued by the Food and Drug Administration (FDA) under the agency's Expanded Access Program. ResultsDemographics were comparable between groups (mean age 69 ± 10 years; 71% male). Group 1 had higher rates of tobacco use (37 pack-years vs 28 pack-years; P = .059), coronary artery disease (71% vs 43%; P = .007), and prior coronary artery bypass grafting (38% vs 14%; P = .003). Group 1 had more patients classified as wound, ischemia, and foot infection clinical stage 4 (56% vs 33%; P = .018) and with previous index leg revascularizations (97% vs 53%; P < .001). Both groups had a similar number of patients with chronic limb-threatening ischemia (Rutherford class 4-6) (88% vs 86%; P = .693) and Global Anatomic Staging System stage III (91% vs 96%; P = .346). Group 1 required a composite conduit (two HAV sewn together) in 85% of bypasses. The tibial vessels were the target in 79% of group 1 and 100% of group 2 (P < .001). Group 1 had a lower mean operative time (364 minutes vs 464 minutes; P < .001). At a median of 12 months, major amputation-free survival (73% vs 81%; P = .55) and overall survival (84% vs 88%; P = .20) were comparable. Group 1 had lower rates of primary patency (36% vs 50%; P = .044), primary-assisted patency (45% vs 72%; P = .002), and secondary patency (64% vs 72%; P = .003) compared with group 2. ConclusionsImplanted under Food and Drug Administration Expanded Access provisions, the HAV was more likely to be used in redo operations and cases with more advanced limb ischemia than GSV. Despite modest primary patency, the HAV demonstrated resilience in a complex cohort with no autologous conduit options, achieving good secondary patency and providing major amputation-free survival comparable with GSV at 12 months.