Rapidly Evolving Research Articles

The Rapidly Evolving Landscape of DCD Heart Transplantation.

To summarise current international clinical outcomes from donation after circulatory death heart transplantation (DCD-HT); discuss procurement strategies, their impact on outcomes and overall organ procurement; and identify novel approaches and future areas for research in DCD-HT. Globally, DCD-HT survival outcomes (regardless of procurement strategy) are comparable to heart transplantation from brain dead donors (BDD). Experience with normothermic machine perfusion sees improvement in rates of primary graft dysfunction. Techniques have evolved to reduce cold ischaemic exposure to directly procured DCD hearts, though controlled periods of cold ischaemia can likely be tolerated. There is interest in hypothermic machine perfusion (HMP) for directly procured DCD hearts, with promising early results. Survival outcomes are firmly established to be equivalent between BDD and DCD-HT. Procurement strategy (direct procurement vs. regional perfusion) remains a source of debate. Methods to improve allograft warm ischaemic tolerance are of interest and will be key to the uptake of HMP for directly procured DCD hearts.

Complex Thinking Abilities in the Rapidly Evolving Field of Genomics and Personalized Medicine: Analysis of Actionability on Cancer with ChatGPT and Literature

Complex Thinking Abilities in the Rapidly Evolving Field of Genomics and Personalized Medicine: Analysis of Actionability on Cancer with ChatGPT and Literature

Today’s Rapidly Evolving Education Landscape: Challenges and Opportunities [From the Editor

Today’s Rapidly Evolving Education Landscape: Challenges and Opportunities [From the Editor

PAPERLESS MEDICAL HISTORY APPLICATION

THE HEALTHCARE SECTOR IS RAPIDLY EVOLVING TOWARDS IMPROVED EFFICIENCY, ACCURACY, AND PATIENT-CENTRIC TREATMENT, DRIVEN BY THE ADOPTION OF DIGITAL TECHNOLOGIES. CENTRAL TO THIS TRANSFORMATION IS THE IMPLEMENTATION OF THE PAPERLESS MEDICAL HISTORY APPLICATION (PMHA), WHICH IS THE APPLICATION TO STORE DIGITAL VERSIONS OF PATIENTS' HEALTHCARE RECORDS. KEY COMPONENTS OF EHRS INCLUDE ADMINISTRATIVE FUNCTIONS, COMPUTERIZED PHYSICIAN ORDER ENTRY, LAB REPORTS, PHARMACY SYSTEMS, AND CLINICAL DOCUMENTATION. The Paperless Medical History Application (PMHA), a state-of-the-art Electronic Health Records (EHR) system, addresses these needs by providing a user-friendly interface and robust data encryption, contributing to ecological sustainability. However, challenges such as security, patient confidentiality, tampering with health records, system security, and stealing health data persist. Future advancements like the usage of blockchain technology to record the transactions or data entry of every change that the doctor makes are recorded and publicly available. So, there will be no chance of tampering with data without the knowledge of the third person.

The Rapidly Evolving Treatment Landscape of Metastatic Hormone-Sensitive Prostate Cancer.

The management of metastatic hormone-sensitive prostate cancer (mHSPC) or castration-sensitive prostate cancer (mCSPC) has become increasingly complex with the tremendous progress that has been made in this space within the past few decades. In the early days of androgen deprivation therapy (ADT), ADT monotherapy was the mainstay for treatment of advanced prostate cancer. However, novel hormone therapies in the form of androgen receptor pathway inhibitors (ARPI) have emerged; vaccine therapy, chemotherapy with docetaxel and cabazitaxel, and radioactive ligands have shaped the treatment of metastatic prostate cancer in the last decade. Following the initial approval of several drugs for use in metastatic castration-resistant prostate cancer (mCRPC) in combination with primary ADT, these agents were studied and subsequently approved for use in mCSPC. Therefore, ADT monotherapy no longer constitutes an optimal therapeutic option for otherwise fit patients who present with mCSPC. We focus on the treatment of first-line de novo mHSPC or mCSPC and explore frontline doublet and triplet therapy and the pivotal trials that led to their United States Food and Drug Administration approval.

Back to the Future II-A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions.

Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.

The Advanced Practitioner's Role in the Rapidly Evolving Landscape of Precision Medicine.

The advent of precision medicine targeting oncogenic mutations and other alterations has led to a paradigm shift in the treatment of many solid tumors and hematologic malignancies. For many of these agents, predictive biomarker testing is necessary to determine the presence of such alterations in order to select patients who are most likely to respond, and to avoid the use of ineffective and potentially harmful alternative therapy. Recent technological advances such as next-generation sequencing have facilitated the identification of targetable biomarkers in patients with cancer and thus help inform treatment decisions. Moreover, new molecular-guided therapies and associated predictive biomarkers continue to be discovered. For some cancer therapeutics, regulatory approval requires the use of a companion diagnostic to ensure proper patient selection. Advanced practitioners therefore need to be aware of current biomarker testing guidelines regarding who should be tested, how and when to test, and how these results can guide treatment decisions using molecular-based therapies. They should also recognize and address potential barriers and disparities in biomarker testing to ensure equitable care for all patients, and assist in educating patients and colleagues alike on the importance of testing and integration into clinical practice to enhance outcomes.

Pharmacotherapies for Treatment-Resistant Depression: How Antipsychotics Fit in the Rapidly Evolving Therapeutic Landscape.

One in three adults with major depressive disorder (MDD) do not experience clinically significant improvement after multiple sequential courses of antidepressants and have treatment-resistant depression (TRD). The presence of TRD contributes to the morbidity and excess mortality associated with MDD and has been linked to significantly increased health care expenses. In the absence of a consensus definition of TRD, this report takes a broad approach by considering inadequate response to one or more courses of antidepressants and focuses on atypical antipsychotics that are approved by the U.S. Food and Drug Administration for treatment of depression (aripiprazole, brexpiprazole, cariprazine, extended-release quetiapine, and olanzapine-fluoxetine combination). While multiple acute-phase studies have demonstrated the efficacy of these medications in improving depressive symptoms, clinically meaningful improvement (i.e., remission) remains limited, with significant concerns about side effects (including weight gain, metabolic dysfunction, extrapyramidal symptoms, and tardive dyskinesia), especially with long-term use. With the rapidly evolving landscape of antidepressant treatments over the past few years, which has witnessed approval of rapid-acting antidepressants (e.g., esketamine nasal spray and dextromethorphan-bupropion combination) and several more in the late-stage pipeline (e.g., zuranolone and psilocybin), it remains to be seen whether the use of atypical antipsychotics will go the way of the older and rarely prescribed antidepressants (such as tricyclics and monoamine oxidase inhibitors). Pragmatic clinical trials are needed to compare the effectiveness of atypical antipsychotics with TRD-specific pharmacotherapies and neuromodulation treatments and to identify the optimal sequencing of these varied approaches for patients with MDD. When using atypical antipsychotics, clinicians and patients are encouraged to use a shared decision-making approach by personalizing treatment selection based on anticipated side effects, tolerability, cost, and feasibility.

Efficient Resume-Based Re-Education for Career Recommendation in Rapidly Evolving Job Markets

Efficient Resume-Based Re-Education for Career Recommendation in Rapidly Evolving Job Markets

A Multiwavelength View of the Rapidly Evolving SN 2018ivc: An Analog of SN IIb 1993J but Powered Primarily by Circumstellar Interaction

SN 2018ivc is an unusual Type II supernova (SN II). It is a variant of SNe IIL, which might represent a transitional case between SNe IIP with a massive H-rich envelope and SNe IIb with only a small amount of the H-rich envelope. However, SN 2018ivc shows an optical light-curve evolution more complicated than that of canonical SNe IIL. In this paper, we present the results of prompt follow-up observations of SN 2018ivc with the Atacama Large Millimeter/submillimeter Array. Its synchrotron emission is similar to that of SN IIb 1993J, suggesting that it is intrinsically an SN IIb–like explosion of an He star with a modest (∼0.5–1M ⊙) extended H-rich envelope. Its radio, optical, and X-ray light curves are explained primarily by the interaction between the SN ejecta and the circumstellar material (CSM); we thus suggest that it is a rare example (and the first involving the “canonical” SN IIb ejecta) for which the multiwavelength emission is powered mainly by the SN–CSM interaction. The inner CSM density, reflecting the progenitor activity in the final decade, is comparable to that of SN IIb 2013cu, which shows a flash spectral feature. The outer CSM density, and therefore the mass-loss rate in the final ∼200 yr, is higher than that of SN 1993J by a factor of ∼5. We suggest that SN 2018ivc represents a missing link between SNe IIP and SNe IIb/Ib/Ic in the binary evolution scenario.

Role of Finance Professionals in the Rapidly Evolving Fintech Era

The emerging changes in FinTech space have brought in a plethora of new opportunities as well as new challenges to the finance professionals. We will see in this article about some of the unique value additions a finance professional can make in the changing business landscape. We will also explore the impact of AI on the roles of various professionals including Cost Accountants..

The Relationship between Health Literacy and COVID-19 Vaccination Prevalence during a Rapidly Evolving Pandemic and Infodemic.

The gap between how health information is communicated and what people understand and can use to make informed health decisions is called health literacy. This gap was exacerbated by the rapidly changing and excessive volume of information, misinformation, and disinformation during the COVID-19 pandemic. People with lower health literacy may not have understood the importance of COVID-19 vaccination for themselves or for their communities. Our aim was to understand health literacy levels within Fulton County, Georgia, and their relationship to vaccine prevalence. Fulton county residents ages 18 and over (n = 425) completed an on-line Health Literacy Questionnaire. Individual, organizational, functional, interactive, and critical health literacy scales were created. Vaccination prevalence data were collected from the Georgia Vaccine Distribution Dashboard. All data were divided into one of three county areas. There were statistically significant variations in vaccine prevalence χ2(3) = 29.325, p < 0.001 among the three county areas. All levels of health literacy predicted overall county vaccination prevalence F (4,420) = 85.941, p < 0.001, There were significant differences in health literacy levels among two of the three county area pairs; the lowest resourced county area had the lowest vaccination prevalence and health literacy rates. This is the first example of relating direct health literacy measures across a major metropolitan US county with vaccine prevalence data.

The Rapidly Evolving Asymptotic Giant Branch Star, V Hya: ALMA Finds a Multiring Circus with High-velocity Outflows

We have observed the mass-losing carbon star V Hya that is apparently transitioning from an asymptotic giant branch star to a bipolar planetary nebula, at an unprecedented angular resolution of ∼0.″4–0.″6 with the Atacama Large Millimeter/submillimeter Array. Our 13CO and 12CO (J = 3–2 and J = 2–1) images have led to the discovery of a remarkable set of six expanding rings within a flared, warped disk structure undergoing dynamical expansion (DUDE) that lies in the system’s equatorial plane. We also find, for the first time, several bipolar, high-velocity outflows, some of which have parabolic morphologies, implying wide-opening angles, while one (found previously) is clumpy and highly collimated. The latter is likely associated with the high-velocity bullet-like ejections of ionized gas from V Hya; a possible molecular counterpart to the oldest of the four bullets can be seen in the 12CO images. We find a bright, unresolved central source of continuum emission (FWHM size ≲165 au); about 40% of this emission can be produced in a standard radio photosphere, while the remaining 60% is likely due to thermal emission from very large (millimeter-sized) grains, having mass ≳10−5 M ⊙. We have used a radiative transfer model to fit the salient characteristics of the DUDE’s 13CO and 12CO emission out to a radius of 8″ (3200 au) with a flared disk of mass 1.7 × 10−3 M ⊙, whose expansion velocity increases very rapidly with the radius inside a central region of size ∼200 au, and then more slowly outside it, from 9.5 to 11.5 km s−1. The DUDE’s underlying density decreases radially, interspersed with local increases that represent the observationally well-characterized innermost three rings.

The Rapidly Evolving Fudu Estuary Sandbar Lagoon Landform on the East Coast of the Bohai Sea: Recent Changes and Mechanism

The Fudu Estuary Sandbar Lagoon is one of the most representative sandbar-lagoon landforms in China, and has undergone drastic evolution in recent years, accompanied by increased coastal engineering activities. The evolution process and its control factors are studied through remote sensing interpretation and coastal sediment transport calculations. During 2010–2021, the sandbar quickly extended at an average speed of 49.5 m/a, but the annual growth has shown a decreasing trend in both area and width, and the shoreline has retreated by 25–45 m. The recent changes are the result of the combined action of natural conditions and human activities. Coastal sediment transport from west to east under the action of W-oriented waves is the natural cause of extension. An estuary dam and artificial island block the sediment transport path, and the material for the new growth of the sandbar comes from the erosion of its west side, which has directly caused the retreat and narrowing of the sandbar. The reduction in sediments from the river further aggravates the shrinkage. It is predicted that the sandbar will continue its eastward extension to connect with the coast in about 2–3 years. The erosion status is unlikely to change before the sediment supply is restored. Measures such as dismantling the estuary dam are recommended.

The Rapidly Evolving Landscape of First-Line Targeted Therapy in Metastatic Urothelial Cancer: A Systematic Review.

BackgroundMetastatic urothelial carcinoma (mUC) historically is treated with first‐line platinum‐based combination chemotherapy, preferably cisplatin plus gemcitabine whenever possible. In recent years, multiple classes of targeted therapy have demonstrated benefit, with some receiving approval in mUC. This review will summarize phase III efficacy and safety data for targeted agents, principally immune checkpoint inhibitors (ICIs), as either first‐line or first‐line switch‐maintenance therapy for mUC and interpret these findings in the context of the current treatment landscape.Materials and MethodsPublished and presented phase III data on targeted therapy for the first‐line or first‐line switch‐maintenance treatment of mUC were identified using the key search terms “targeted therapy” AND “urothelial carcinoma” AND “advanced” OR respective aliases according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA).ResultsOf the six eligible phase III targeted therapy trials, two assessing ICIs met their primary endpoints in platinum‐eligible patients. First‐line ICI plus chemotherapy combinations have not improved overall survival (OS), although final OS results of the IMVigor 130 trial are pending. Switch‐maintenance using an ICI in patients achieving at least stable disease following platinum‐based chemotherapy statistically significantly improved OS (21.4 vs. 14.3 months, hazard ratio, 0.69; 95% confidence interval, 0.56–0.86; p = .001). Current sequencing options for mUC include first‐line platinum‐based chemotherapy with a switch to ICI either immediately or upon disease progression.ConclusionRecent targeted therapy trials have expanded ICI sequencing options for mUC. The treatment landscape is likely to evolve rapidly, with results from multiple phase III trials expected in the next 5 years.Implications for PracticeMultiple classes of targeted agents are approved for use in metastatic urothelial carcinoma (mUC). Six phase III trials have recently provided insight on the benefit of these agents in the first‐line setting. In platinum‐eligible patients, immune checkpoint inhibitors (ICIs) combined with first‐line platinum‐based chemotherapy failed to demonstrate improved survival, although ICI monotherapy as switch‐maintenance significantly improved overall survival in patients with mUC who had achieved at least stable disease following first‐line platinum‐based chemotherapy. In patients ineligible for any chemotherapy, pembrolizumab, atezolizumab, or pembrolizumab in combination with enfortumab vedotin may be options.

Cycad-Weevil Pollination Symbiosis Is Characterized by Rapidly Evolving and Highly Specific Plant-Insect Chemical Communication.

Coevolution between plants and insects is thought to be responsible for generating biodiversity. Extensive research has focused largely on antagonistic herbivorous relationships, but mutualistic pollination systems also likely contribute to diversification. Here we describe an example of chemically-mediated mutualistic species interactions affecting trait evolution and lineage diversification. We show that volatile compounds produced by closely related species of Zamia cycads are more strikingly different from each other than are other phenotypic characters, and that two distantly related pollinating weevil species have specialized responses only to volatiles from their specific host Zamia species. Plant transcriptomes show that approximately a fifth of genes related to volatile production are evolving under positive selection, but we find no differences in the relative proportion of genes under positive selection in different categories. The importance of phenotypic divergence coupled with chemical communication for the maintenance of this obligate mutualism highlights chemical signaling as a key mechanism of coevolution between cycads and their weevil pollinators.

Perspectives in the Rapidly Evolving Treatment Landscape of Multiple Myeloma: Expert Review of New Data Presentations from ASH 2019

The number and type of therapeutic options available to treat patients with multiple myeloma has risen dramatically over recent years, offering exciting opportunities to significantly improve the future management of this currently incurable disease. Some of the latest advances in the settings of newly diagnosed and relapsed/refractory multiple myeloma were presented at the 61st Annual Meeting of the American Society of Hematology (Orlando, Florida, December 7 to 10, 2019) and are reviewed in this article with accompanying expert commentary. Presentations covered the use of registry-generated real-world data to define the characteristics of ‘functional’ high-risk patients in order to enable early therapeutic intervention for this poor-prognosis subset; studies that reported impressive new and updated data with novel combinations of targeted agents across different settings, including biomarker-specific subgroups; and promising early-phase data with novel immunotherapeutic approaches, such as bispecific antibodies and chimeric antigen receptor T-cell B-cell maturation antigen-directed therapies. This review offers insights into how these latest developments may fit within the rapidly evolving treatment landscape. The adoption and optimal use of novel therapies may be impacted by logistical challenges such as limited funding and access to necessary infrastructure to provide these treatments. In this manuscript, we focus particularly on Asia-Pacific regions and identify areas for development, such as establishment of robust national registries, promotion of investigator-initiated trials, compassionate-use treatment programs, and collaboration between jurisdictions with similar patterns of care. The hope is that such efforts will augment research outputs and ultimately translate into improved patient outcomes in the real world.

First Results from a Panchromatic HST/WFC3 Imaging Study of the Young, Rapidly Evolving Planetary Nebulae NGC 7027 and NGC 6302

We present the first results from comprehensive, near-UV-to-near-IR Hubble Space Telescope Wide Field Camera 3 (WFC3) emission-line imaging studies of two young planetary nebulae (PNe), NGC 7027 and NGC 6302. These two objects represent key sources for purposes of understanding PNe shaping processes. Both nebulae feature axisymmetric and point-symmetric (bipolar) structures and, despite hot central stars and high nebular excitation states, both harbor large masses of molecular gas and dust. The sweeping wavelength coverage of our Cycle 27 Hubble Space Telescope (HST)/WFC3 imaging surveys targeting these two rapidly evolving PNe will provide a battery of essential tests for theories describing the structural and chemical evolution of evolved star ejecta. Here, we present initial color overlays for selected images, and we highlight some of the first results gleaned from the surveys.

Translating the Rapidly Evolving CAR-TCR Research Portfolio to Clinical Practice, a Single Institution Experience at an Academic Medical Center

Topic Significance/Background This is an unparalleled time in cancer research, particularly with the use of cellular therapeutics to target both solid and liquid tumors. This science is challenging the boundaries of clinical care to update guidelines, streamline processes, and integrate clinical and research teams. The University of Kansas Cancer Center was launched into the cell therapy space when we enrolled the first adult patient on Novartis Juliet CAR-T trial for DLBCL. Our team learned that inpatient and outpatient infrastructure and multidisciplinary collaboration are essential to promoting quality clinical care to complement this innovative new field of cellular immunotherapy. As of September 2019, our center has 19 active cell therapy trials, 10 studies in start-up, and 27 in the research pipeline. We have had the opportunity to participate in clinical trials assessing safety and efficacy of TILs, CAR-T and TCR in the cell therapy space, along with expanded umbilical, placental, and mesenchymal stem cell products. In order to optimally contribute in this dynamic and vastly changing landscape, it was essential for our teams, both research and clinical, to come together and develop a forum in which all new cell therapies are discussed and vetted. Intervention In order to facilitate this multi-disciplinary cell therapy forum, we instituted the Immune Effector Cell (IEC) Committee. The IEC committee started as a pre-start-up review panel that focused on feasibility of trial conductivity and ensuring appropriate resources and processes were in place for each trial. The IEC committee has now evolved into a formal Disease Working Group (DWG) responsible for the review of all open trials in the cell therapy space, deviation review and reporting, enrollment and accrual management, and patient safety in addition to feasibility and care algorithm management. The IEC DWG meets monthly. Members include clinicians, dedicated cell therapy research staff, pharmacists, laboratory personnel and cancer center leadership. Discussion/Implications The new era of cellular immunotherapy is challenging current clinical trial oversight and workflow development to ensure novel therapies are transitioned seamlessly into clinical care. Developing a structured, multidisciplinary IEC DWG with supervision over all cell therapy clinical research serves as a foundation for innovative, quality care. This forum's assessment of upfront workload promotes synergy with all teams supporting cell therapy including research, apheresis, cell processing, inpatient and outpatient clinical programs. The IEC DWG infrastructure is a supportive environment for solid tumor cell therapy to integrate into the existing clinical framework. Future work at our institution includes a standard site readiness tool to facilitate communication and integration.

Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) Commonly Presents in the Setting of Prior or Concomitant Hematologic Malignancies (PCHM): Patient Characteristics and Outcomes in the Rapidly Evolving Modern Targeted Therapy Era

Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) Commonly Presents in the Setting of Prior or Concomitant Hematologic Malignancies (PCHM): Patient Characteristics and Outcomes in the Rapidly Evolving Modern Targeted Therapy Era