Regular Exchange Research Articles

The Research on the International Police Cooperation Mechanism in Cross-border Cybercrime

With the arrogance of criminals abroad increasing, new cases including overseas fraud, drug smuggling, smuggling, and trafficking of women from various countries are emerging one after another. International police cooperation is inevitably the trend. This article mainly studies the problems in the international police cooperation mechanism, which are manifested in the inadequate establishment and coordination of police agencies. The root problem lies in the differences in legal systems, cultural concepts, and social backgrounds among countries. This paper uses the research method of case analysis to study these problems and contradictions. The main measures are to establish a new seminar mechanism, strengthen the construction of the data information sharing mechanism, and carry out regular exchanges. Therefore, countries can learn from each other, take its essence, and discard its dregs. These measures can achieve consensus on cooperation, achieve multilateral win-win, and make international police cooperation becomes more successfully.

Lightweight semantic segmentation network with configurable context and small object attention.

The current semantic segmentation algorithms suffer from encoding feature distortion and small object feature loss. Context information exchange can effectively address the feature distortion problem, but it has the issue of fixed spatial range. Maintaining the input feature resolution can reduce the loss of small object information but would slow down the network's operation speed. To tackle these problems, we propose a lightweight semantic segmentation network with configurable context and small object attention (CCSONet). CCSONet includes a long-short distance configurable context feature enhancement module (LSCFEM) and a small object attention decoding module (SOADM). The LSCFEM differs from the regular context exchange module by configuring long and short-range relevant features for the current feature, providing a broader and more flexible spatial range. The SOADM enhances the features of small objects by establishing correlations among objects of the same category, avoiding the introduction of redundancy issues caused by high-resolution features. On the Cityscapes and Camvid datasets, our network achieves the accuracy of 76.9 mIoU and 73.1 mIoU, respectively, while maintaining speeds of 87 FPS and 138 FPS. It outperforms other lightweight semantic segmentation algorithms in terms of accuracy.

Challenges in Implementing STEM Education: Insights from Novice STEM Teachers in Developing Countries

Economic growth has been attributed to STEM education in many countries. It is widely recognized as crucial to improve science, technology, engineering, and mathematics (STEM) education, especially for traditionally disadvantaged groups. In this age of the fourth Industrial Revolution, we are going through a rapid change. Several difficulties have been associated with STEM’s implementation, particularly troubling developing countries. In this article, we investigated STEM teachers’ unique challenges in their classroom experiences and how these factors influence their instructional practices and students’ learning outcomes. STEM teachers’ teaching reflections at the secondary level were examined in this qualitative study. A purposive sampling method was used to recruit ten novice STEM teachers. The data were analyzed using NVivo11. Despite their disciplinary expertise and the variety of teaching methods they employed, the teachers faced numerous challenges. Teachers faced difficulties managing classrooms, developing curriculums, and recognizing practical constraints in STEM education. Teacher beliefs about effective STEM education, the tension between these beliefs and the teaching goals of the teachers were closely linked to the teachers’ beliefs about effective STEM education and the educational system’s expectations. For STEM teachers, the mastery of content knowledge is critical. A regular exchange of experience is of significant help to teaching. Teachers’ pedagogy and professional development in STEM education are discussed concerning underdeveloped countries’ contexts. Researchers and educators in developing countries might not understand STEM education’s significance. The reason may also be that STEM education in developing countries faces several challenges.

Complement inhibition in Myasthenia – from basics to RCT data

Myasthenia gravis (MG) is the prototypic autoimmune neurological disorder causing fatiguable muscle weakness either limited to the ocular muscles or becoming generalised involving the limb and bulbar muscles. Nine out of 10 generalised MG patients have IgG1 or IgG3 antibodies against the acetylcholine receptor (AChR). AChR antibodies cause neuromuscular weakness by internalisation of AChR, receptor blockade and by activating the complement pathway. Complement activation causes formation of the membrane attack complex (MAC) leading to degradation of the neuromuscular junction (NMJ). Several animal models have confirmed the role of complement in the pathogenesis of MG, with the experimental models (EAMG) often needing complement inhibitory therapies to prevent or reverse the disease. Various molecules that target the complement system have now been developed to treat myasthenia gravis. The vast majority of the currently studied molecules target the C5 protein, thereby preventing the formation of MAC and subsequent NMJ destruction. The currently studied anti-complement therapies for MG include Eculizumab, Zilucoplan, Ravulizumab, Pozelimab, Cemdisiran, Gefurilimab, Danicopan and few others in the pipeline. Eculizumab has been shown in clinical trials to be effective in the treatment of refractory MG, but further sub-group analysis and real-life experience have shown that this can be beneficial in various patients including those receiving regular IVIG, plasma exchange or Rituximab. It was approved for use by FDA in Oct 2017. Ravulizumab is a long-acting monoclonal antibody which has similar mechanism of action to Eculizumab and was approved for use in MG by FDA in April 2022. Zilucoplan is a macrocyclic peptide which binds to C5 and C5b thus preventing terminal complement activation, which can be given subcutaneously (FDA new drug application accepted in Nov 2022). Many of these have also been shown to have long term benefit in different sub-groups of patients with MG. Patients would need to be vaccinated against Neisseria meningitidis because of the risk of Gram-negative septicaemia, although no major safety signatures have been noted in the studies so far. Future studies may be able to identify specific biomarkers which might aid in selecting the most appropriate patients who might respond to these therapies.

Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem.

The aim of this study was to evaluate the causes of the dysfunctional tunneled cuffed catheters (TCCs) using multi-spiral computed tomography venography (MSCTV), and to analyze the outcomes of endovascular salvage techniques. This retrospective review data from 27 patients who experienced TCC dysfunction between July 1, 2016 and January 31, 2021 was conducted. Patients' demographic data, clinical signs and symptoms, and imaging data were collected from interventional radiology database. MSCTV showed a range of abnormalities in the hemodialysis (HD) patients, including central venous occlusion (n = 4), fibrin sheath formation (n = 3), malposition of the catheter tips (n = 4), central venous perforation (n = 1), thrombus formation (n = 12), regular catheter exchange without determined lesions (n = 3). Interventional catheter salvage procedures were performed, such as catheter exchange, balloon disruption of a fibrin sheath, angioplasty for central vein stenosis, and stent deployment. The technical success rate for catheter insertions was 100%, and no procedure-related severe complications were observed. The 30-day catheter patency for all assessable catheters was 85.2%. The use of MSCTV showed abnormal findings in almost 88.9% of cases concerning dysfunctional TCC. In this study, the examined appropriate endovascular techniques were found to be safe and technically successful, with a low incidence of procedure-related complications.

When the law is unclear: challenges and opportunities for data and information exchange in the Tigris-Euphrates and Indus river basins

Abstract Data and information exchange are vital for long-term transboundary water cooperation. However, many transboundary river basins lack regular data exchange between riparian States. In many cases, this is simply a feature of the generally fragmented nature of transboundary water cooperation; in others, transboundary river basin data sharing may be withheld for geopolitical reasons. The Tigris-Euphrates and Indus river basins are among the most highly politicized river basins globally. Cooperation between riparians is complicated by a lack of certainty regarding data, information exchange and legal obligations, as upper riparians in both basins have persistently objected to the customary law of international watercourses. With reference to international water law, this article ascertains the level of data and information exchange in these two basins, both through formal and informal structures, as well as prevalent obstacles and the institutional and technological responses to them. Despite significant challenges, the authors argue that technological advances can stimulate enhanced riparian cooperation.

Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study

Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study Abstract. Background: There is a need to strengthen interprofessional collaboration of general practitioners and home care nurses in the primary care of people with chronic diseases and long-term care needs. Aim: This study investigated a) how general practitioners and nurses in Germany perceive their collaboration in primary care and b) which development perspectives of collaboration exist from their point of view. Methods: Expert interviews were conducted with seven general practitioners and eight home care nurses. The data were analysed using thematic-structured qualitative content analysis. Results: The interviewees from both professional groups report that their collaboration is hindered by poor mutual accessibility. At the same time, they emphasise their appreciation of the professional exchange with the other professional group. Nevertheless, the perceptions of the professional competence of home care nurses differ. To improve their cooperation, the interviewees recommend the establishment of interprofessional meetings and cooperation in spatial proximity for regular professional exchange. They expect this to lead to a joint development of trust and competence and to an expansion of the area of responsibility of home care nurses in primary care. Conclusions: Binding communication structures, cooperation in spatial proximity and an expansion of the area of responsibility of home care nurses offer high potential for strengthening primary care in Germany.

The Effectiveness of Coffee Morning, Press Meeting and Public Meetings in Distribution of Information in the Communication and Informatics Department of North Sumatra Province

Background: Communication is a need in human lifestyles, in regular lifestyles verbal exchange is used to engage among one person and another. Communication may be executed anywhere, together with at home, office, campus, corporations and organizations. Aims: This study aimis to know the effectiveness of coffee morning, press meeting and public meetings in distribution of information in the communication and informatics Department of North Sumatera. Methods: The verbal exchange method is largely a method of turning in messages. In the verbal exchange method, the content material of the message may be withinside the shape of facts, the want for facts is a completely crucial requirement in numerous human sports. Results: The Communication and Information Office of North Sumatra Province, in sporting out espresso morning sports as one of the habitual sports completed to carry evaluations, ideas and actual information about the company is believed to be able to reduce this. Conclusion: Coffee morning is as a means to share information between management and employees for the sake of the company's progress and supporting factors for achieving company goals. From the media employee relations communication that exists between leaders and employees through coffee mornings.

Clinical analysis of fifteen transplant ureteral stricture cases

This research aims to explore the clinical characteristics and treatment of transplant ureteral strictures. We retrospectively analyzed the clinical data from fifteen patients diagnosed with transplant ureteral stricture. Of the fifteen patients, five underwent regular ureteral stent or nephrostomy tube exchanges, while ten underwent open surgery. There were no significant differences in basic clinical characteristics between the two groups. The median follow-up time for regular ureteral stent or nephrostomy tube exchanges and open surgery group was 36.8 (11.8-56.0) months and 25.0 (4.5-31.2) months, respectively. Among patients who underwent regular exchanges, one required regular dialysis. Nine patients in the open surgery group had successful removal of the ureteral stent. Our findings suggest that regular ureteral stent or nephrostomy tube exchanges, as well as open surgery, are effective treatment options for transplant ureteral strictures.

The centrality of education

Abstract This article is intended as a precis of The Main Enterprise of the World and hopes to orient those who have not read it to the symposium discussion that follows. It outlines my own version of a radical rethinking of education. Instead of holding that educational systems should be shaped so as to satisfy socio-economic constraints, interpreted narrowly in recent decades to emphasize the preparation of the young to compete in the global economy, it proposes to view education as ‘the main enterprise of the world’ (in Emerson's resonant phrase). I attempt to harmonize three important educational goals: equipping people to maintain themselves; providing the opportunity for fulfilling lives; and creating citizens who can live and work together to sustain democratic societies. The notion of fulfillment is elaborated by following J. S. Mill in emphasizing individual freedom to ‘pursue one's own good in one's own way’, and requiring the chosen project to contribute to a transhistorical pan-human enterprise. This requires a serious probing of the concept of autonomy. I argue that the reworked notion is closely linked to capacities for democratic deliberation, and, like Dewey, I view regular exchanges among citizens as crucial for genuine democracy. In light of these perspectives, shifts in the labor market, brought about by increasing automation, provide the opportunity for people to undertake rewarding (and properly respected) service work, participating throughout their lives in the education of others. The resulting position has curricular consequences, and these in turn require social and economic changes. I conclude by defending the approach I have sketched against charges of utopianism.

АДАПТАЦІЯ МОДЕЛІ ДИНАМІЧНИХ ВЗАЄМОВІДНОСИН «ПОСТАЧАЛЬНИК-СПОЖИВАЧ» ДО УМОВ ФУНКЦІОНУВАННЯ В ЛАНЦЮГУ ПОСТАЧАННЯ

An adaptation of the model of dynamic «supplier-customer» relationships to the conditions of supply chain functioning is presented, which is based on the IRM model and involves considering procurement and sales in the industrial market as not independent agreements but long-term relationships between the supplier and the customer. This model consists of several components. The first aspect is the interaction process, which includes the analysis of two key factors: episodes (short-term in nature) and partnerships (long-term cooperation based on mutual trust). The second element involves the interacting parties with the identification of the distinctive features of the supplier and the customer, including their organizational and individual factors. The third element is the atmosphere, which relates to the degree of dependence between the supplier and the customer. The fourth element is the interaction environment, encompassing market structure, market dynamics, international relations, and the social system. On the other hand, the rationale for transforming the «supplier-customer» relationship pyramid into a model of «supplier-customer» relationships with a comprehensive combination of logistics and partnership marketing concepts is justified. This model consists of the following components. The first stage involves relationships at the contract level, meaning direct interactions between the supplier and the customer, characterized by one-time or multiple agreements. The second stage comprises relationships of advantage, where one party has the right to enter into agreements on more favorable terms than the other. The third stage involves strategic relationships, which can be non-partner (relationships arising from long-term decisions based more on rationality) or partnership (relationships where two or more organizations are linked to each other through regular open exchange of knowledge and experience). Partnership in the supply chain is considered in three forms: 1) cooperating organizations are perceived as partners and, to a limited extent, coordinate their plans and actions; 2) cooperating organizations transition from coordination to integration; 3) each organization perceives the partner as a natural extension of its firm’s processes.

Content of heavy metals in cow milk-raw materials of Poltava district (Ukraine)

The concentration of heavy metals (Pb, Cd, Cu, As, Zn, Hg) in cow milk-raw materials was detected on the territory of the Poltava district (central part of Ukraine). Milk is one of a person's most valuable foods. It enriches the human body with necessary substances: proteins, fats, and carbohydrates, which are in balanced proportions and easily assimilated. At the same time, it contains different enzymes, vitamins, and low-molecular microelements, which are necessary to ensure the regular exchange of substances. On the other hand, the choice of cow's milk is considered to be one of the largest sources of food, which is contaminated by toxic elements. The work aimed to determine the level of heavy metals in milk-raw materials received from cows from personal peasant farms in the Poltava district (Ukraine). We divided working samples into three groups; they had a territorial affiliation with the Dykanka, Reshetylivka, and Poltava communities (8 each). The samples were immediately cooled, transported to the laboratory, and stored at -20 °C for further analysis. The research was carried out using atomic and absorption spectrometry based on the Regional State Laboratory of Veterinary Medicine in the Poltava region. The Mann-Whitney test was used to compare the results. The P value below 0.05 was considered significant. So, in the milk of the group of the Dykanka territorial community, the contents of Cu were at 0.05 ± 0.01. In contrast, in the cows of the Poltava territorial community, this indicator was probably higher and made 0.08 ± 0.01 mg/kg (Р < 0.05). The concentration of copper in the milk of animals of the Reshetylivka territorial community did not exceed 0.06 ± 0.01 mg/kg, and it did not have a reliable difference from other groups. Content of Zn is probably lower in the group of the Dykanka territorial community, compared to other groups (2.6 ± 0.13), while in the group of Poltava territorial community, its concentration was 3.3 ± 0.25 (Р < 0.05), and in the group of the Reshetylivka territorial community – 3.45 ± 0.24 mg/kg (P < 0,01). In our studies, the range of heavy metals is presented as follows: Zn>Pb>Cu>As>Cd>Hg.

Managing Kidney Disease in Patients with Sickle Cell Disease: A Quality Initiative at the Cleveland Clinic

Background Sickle cell disease (SCD) when complicated by sickle cell nephropathy and chronic kidney disease (CKD) is associated with high morbidity and mortality. Early intervention with appropriate specialist care and timely evaluation for transplant are essential to improve outcomes. There is considerable variability in the screening, diagnosis and management of renal complications in SCD. Current guidelines from the NHLBI (2014), ASH (2019) and expert opinion endorse (1) annual screening for proteinuria, (2) the initiation of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) in patients with significant proteinuria, (3) early involvement of nephrology for declining renal function, (4) testing for alternative etiologies of kidney disease, (5) referral for renal transplant in advanced CKD with regular red cell exchange in those being considered for transplant, and (6) combination therapy with hydroxyurea and erythropoiesis-stimulating agents (ESA) for patients with worsening anemia from CKD. We sought to audit our care of SCD patients along these metrics to devise effective interventions to improve outcomes in SCD patients with comorbid kidney disease. Methods We conducted a retrospective quality review of renal disease screening, referral, and management in adults with SCD who were seen in the outpatient setting at the Cleveland Clinic in the past 3 years. Results We reviewed 258 adults with SCD who were seen between July 2019 and July 2022. Of these, 16 patients had insufficient laboratory data and were excluded from further analysis. Our final cohort of 242 patients was comprised of 169 (70%) female patients and the median age was 42 (18-90) years. The majority [213 (88%)] had appropriate screening for proteinuria. Of 46 patients with significant proteinuria, 18 (39%) were on ACEi/ARB in part reflecting challenges with tolerance (hyperkalemia, cough, hypotension). CKD was present in 43 (18%) patients; 25 (58%) had CKD stage 3a, 5 (12%) stage 3b, 6 (14%) stage 4, and 7 (16%) were on dialysis. Nephrology was involved in 27 (63%) of those with CKD. Most [31 (72%)] were evaluated for other causes of CKD, however the extent of testing was inconsistent. Referral for renal transplant evaluation was made in 7 (16%) patients with CKD and approximately half [3 (43%)] of these patients were receiving regular red cell exchange transfusions. Only 2 (5%) patients received a kidney transplant. Of the subset of 13 patients with advanced CKD stages 4 or 5, 9 (69%) were receiving ESA and 3 (23%) were on combination hydroxyurea and ESA. In our larger cohort of 242, an additional 30 (12%) patients had isolated persistent microscopic hematuria and 44 (18%) patients demonstrated a trend of chronically rising creatinine within the laboratory normal range. Additional analysis is planned to evaluate screening and management in this at-risk cohort with more subtle presentation. Discussion The management of renal disease in SCD is complex and a paucity of data to support evidence-based guidelines presents a major challenge. We found that rates of screening for proteinuria and declining renal function in SCD patients were high, however the subsequent management was inconsistent. CKD in SCD is highly morbid, and patients with SCD continue to experience low rates of transplant evaluation and eligibility with devastating consequences. A root cause analysis, patient and provider education campaigns, and additional activities are planned to improve the management of kidney disease in patients with SCD.

Leveraging the Potential of SME Capital Markets: Evidence from Small and Medium-Sized Enterprises in Jammu Region, India

The paper intends to explore the potential for developing Small and Medium-sized Enterprise (SME) capital markets in India by analyzing the business conditions of SMEs, the priority, reasons, necessary actions and critical factors needed for developing capital markets for SMEs, and to offer strategies for development of new SME capital market. Besides, the status of the SME capital market in India has also been analyzed. The study has been restricted to 114 non-financial firms consisting of 43 SMEs engaged in manufacturing activities and limited to five selected major industrial areas surrounding suburbs of Jammu city. The study covered 71 SMEs engaged in service activities and confined to hotel and restaurant, computer and electronics, offset printing, pharmaceutical distribution, wine trade, motor parts, gold jewelry, and wholesale general merchant in the commercial areas of Jammu city in Jammu and Kashmir. The study has used a life cycle approach to analyze the sources of finance in different stages of the SME. A simple descriptive technique has been used to analyze the data. The study reveals that there are various challenges to establish direct growth capital financing for SMEs. Looking at numerous viewpoints on the development of SME capital market, a specialized market infrastructure of non -exchange foundation equity market for SMEs can be developed. The establishment of a separate foundation equity market for SMEs from exchange market can be advantageous. There is a need to develop a preliminary market for growing SMEs. This should ultimately integrate into the regular SME stock exchange market. A preliminary market is expected to endow SMEs with a chance to understand clearly SME capital market rules and responsibilities linked to disclosures before integrating into the organized capital market. It will imbibe the corporate culture through knowledge regarding the significance of enhanced corporate value for the growth and development of firms. The foundation market should evolve into a robust system for carrying SMEs in equity finance from various dimensions. These dimensions can be the promotion of the venture capital market to provide initial risk capital for SMEs, the development of a strong base of capital market professionals to train and goad the SME disclosure process through a network of certified public accountants, and the development of a blueprint for government policy support measures including tax incentives for SME issuers and investors.

Rationale and design of the peripheral nerve tumor registry: an observational cohort study

ABSTRACT Aim Peripheral nerve tumors (PNT) are rare lesions. To date, no systematic multicenter studies on epidemiology, clinical symptoms, treatment strategies and outcomes, genetic and histopathologic features, as well as imaging characteristics of PNT were published. The main goal of our PNT Registry is the systematic multicenter investigation to improve our understanding of PNT and to assist future interventional studies in establishing hypotheses, determining potential endpoints, and assessing treatment efficacy. Methods Aims of the PNT registry were set at the 2015 Meeting of the Section of Peripheral Nerve Surgery of the German Society of Neurosurgery. A study protocol was developed by specialists in PNT care. A minimal data set on clinical status, treatment types and outcomes is reported by each participating center at initial contact with the patient and after 1 year, 2 years, and 5 years. Since the study is coordinated by the Charité Berlin, the PNR Registry was approved by the Charité ethics committee (EA4/058/17) and registered with the German Trials Registry (www.drks.de). On a national level, patient inclusion began in June 2016. The registry was rolled out across Europe at the 2019 meeting of the European Association of Neurosurgery in Dublin. Results Patient recruitment has been initiated at 10 centers throughout Europe and 14 additional centers are currently applying for local ethics approval. Conclusion To date, the PNT registry has grown into an international study group with regular scientific and clinical exchange awaiting the first results of the retrospective study arm.

The CIVISANO protocol: a mixed-method study about the role of objective and perceived environmental factors on physical activity and eating behavior among socioeconomically disadvantaged adults

BackgroundOverweight and obesity have a strong socioeconomic profile. Unhealthy behaviors like insufficient physical activity and an unbalanced diet, which are causal factors of overweight and obesity, tend to be more pronounced in socioeconomically disadvantaged groups in high income countries. The CIVISANO project aims to identify objective and perceived environmental factors among different socioeconomic population groups that impede or facilitate physical activity and healthy eating behavior in the local context of two peri-urban Flemish municipalities in Belgium. We also aim to identify and discuss possible local interventions and evaluate the participatory processes of the project.MethodsThis study (2020–2023) will use community-based participatory tools, involving collaborative partnerships with civic and stakeholder members of the community and regular exchanges among all partners to bridge knowledge development and health promotion for socioeconomically disadvantaged citizens. Furthermore, a mixed-methods approach will be used. A population survey and geographic analysis will explore potential associations between the physical activity and eating behaviors of socioeconomically disadvantaged adults (25–65 years old) and both their perceived and objective physical, food and social environments. Profound perceptive context information will be gathered from socioeconomically disadvantaged adults by using participatory methods like photovoice, walk-along, individual map creation and group model building. An evaluation of the participatory process will be conducted simultaneously.DiscussionThe CIVISANO project will identify factors in the local environment that might provoke inequities in adopting a healthy lifestyle. The combination of perceived and objective measures using validated strategies will provide a robust assessment of the municipality environment. Through this analysis, the project will investigate to what extent community engagement can be a useful strategy to reduce health inequities. The strong knowledge exchange and capacity-building in a local setting is expected to contribute to our understanding of how to maximize research impact in this field and generate evidence about potential linkages between a health enhancing lifestyle among socioeconomically disadvantaged groups and their physical, food and social environments.

Management of Kidney Stone Disease in Pregnancy: A Practical and Evidence-Based Approach.

Suspected kidney stone disease during pregnancy is a difficult condition for health professionals to manage. This is partly due to the more limited range of diagnostic and therapeutic strategies, which can be safely applied. A comprehensive review of literature was performed to identify evidence to develop a practical guide to aid clinicians. Ultrasound remains the recommended first line option for imaging. Complicated cases, such as suspected infected obstructed system, require urgent decompression such as in the form of percutaneous nephrostomy. This article highlights the pharmacotherapeutic agents, which are considered safe for use in pregnancy. Where surgical intervention is indicated, evidence supports ureteroscopy to be a safe option as long as infection has been treated. Ureteroscopy can offer definitive clearance of the stone(s) and can be less burdensome regarding bothersome symptoms compared to indwelling ureteral stent or nephrostomy, which also require regular exchange due to the high propensity for encrustation in pregnancy. A multidisciplinary approach is fundamental to safely manage suspected kidney stone disease in pregnancy. Adoption of a locally agreed pathway as suggested in this article supports improved patient care.

Management of encrusted ureteral stents: Two center experience.

We present our experience of the endourological management of encrusted ureteral stents (EUS) and a literature review on forgotten encrusted ureteral stents. A total of 13 encrusted ureteral stents from 12 patients were removed in two hospitals. The medical records were retrospectively analyzed for stent indication, indwelling time, clinical presentation, investigations, type and the number of surgical procedures, operative time, complications, duration of hospital stay, and the follow-up. Five ureteral stents (US) inserted before ESWL (extracorporeal shockwave lithotripsy) for renal stones, seven US for ureteric stones with ureteric colic, and one ureteral stent for post ureteroscopy procedure. The mean indwelling time was 15.07 ± 7.34 months with a range from 6 to 24 months. The mean Kidney,Ureter and Bladder (KUB) score of encrusta-tion grading was 11.84 ± 2.07 with a range from 9 to 15. The encrusted stents were removed by a combination of cystolithotripsy, semi-rigid ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and ESWL. The average total number of procedures to remove one EUS was 3 ± 1.08 with a range of 2 to 5 proce-dures. Six encrusted stents were removed in one, five stents required two, one stent required three and one stent required four hospital admissions. The median operative time was 210 minutes with a range of 60 to 660 minutes per EUS removal and the mean hospital stay was 2.69 ± 1.43 days with a range of 1 to 6 days. All patients had successful removal of encrusted stent and complete stone clearance with no major complica-tions. In the follow-up, one patient had recurrent ureteric stone, one patient on regular stent exchange due to poor renal function and one patient developed significant ureteric stricture referred for reconstruction. Removal of forgotten encrusted impacted ureteral stents is challenging and requires a multimodal surgical approach. It adds significant costs to the health care system and in addition it affects patient safety and quality of life. Patient education, avoiding unnecessary ureteral stent place-ment and a computerized stent monitoring system reduces the incidence of forgotten ureteral stents and their complications.

A Call for Behavioral Science in Embedded Bioethics.

Bioethicists today are taking a greater role in the design and implementation of emerging technologies by "embedding" within the development teams and providing their direct guidance and recommendations. Ideally, these collaborations allow ethical considerations to be addressed in an active, iterative, and ongoing process through regular exchanges between ethicists and members of the technological development team. This article discusses a challenge to this embedded ethics approach-namely, that bioethical guidance, even if embraced by the development team in theory, is not easily actionable in situ. Many of the ethical problems at issue in emerging technologies are associated with preexisting structural, socioeconomic, and political factors, making compliance with ethical recommendations sometimes less a matter of choice and more a matter of feasibility. Moreover, incentive structures within these systemic factors maintain them against reform efforts. The authors recommend that embedded bioethicists utilize principles from behavioral science (such as behavioral economics) to better understand and account for these incentive structures so as to encourage the ethically responsible uptake of technological innovations.

Exploring changes in collaboration through the professionalisation of learning and support assistants: a mixed methods study

ABSTRACT The inclusion of all children in regular classrooms is an important aim in many European countries. For the implementation of inclusion some children rely on support via learning and support assistants. Despite the benefits assistants provide by enhancing student access and progress, assistants’ support has also been criticised for contributing to more exclusive than to inclusive processes in class. A necessary precondition for enhancing inclusive processes is the assistants’ extension of professional knowledge and competence. This study aims to evaluate the effects of a developed online tool for assistants’ professionalisation on the collaboration with teachers and parents. Moreover success factors in assistants’ work are identified. The quantitative study sample consisted of 70 assistants, teachers and parents. Focus group interviews with nine assistants and teachers were also conducted. The results of this mixed methods study showed that assistants, teachers and parents have a tendency to evaluate their collaboration more positively after assistants have made use of an online tool for professionalisation. All of them perceived the regular exchange of information to be particularly important. The results of this study also showed that clear definition of the roles and responsibilities of assistants is necessary if they are to work successfully in schools.