Access Restrictions Research Articles

Themes in Abortion Forum Discussions in a Restrictive Access Context: Qualitative and Quantitative Analyses.

Abortion is one of the most common medical procedures worldwide. Despite this, access to abortion on demand remains restricted in many countries, including Poland. As a result, many women resort to undergoing the procedure without medical supervision, putting themselves at risk of serious health consequences such as drug poisoning, excessive bleeding, and hypovolemia. Unfortunately, some abortions also lead to severe infections. This study aims to qualitatively identify key themes in abortion forums to analyze the issues faced by individuals. The forums were then quantitatively analyzed to determine which problems were most prevalent. The most popular abortion forums were identified. A preliminary thematic analysis was conducted for the qualitative phase, followed by a manual quantitative analysis. Two independent researchers reviewed forum posts, categorizing them into specific themes. An analysis of 13,397 responses from 370 threads across 4 forums revealed "Abortion Process Progression" as the most discussed theme, highlighting a strong demand for information, emotional support, and medical guidance. The highest percentage of threads (162/886, 18.3%) focused on the need for mental support and the desire to have someone in contact during the abortion process. Concerns about the effectiveness of the termination also emerged as a significant topic, accounting for 83 of the 886 (9.4%) discussions. "Emotional and Psychological Aspects" and "Medical and Pharmacological Aspects" were also significant, highlighting the need for holistic care. Anxiety and fear related to the process were frequently discussed, accounting for 60 of the 886 (6.8%) responses. The issue of isolation and lack of support was also a common topic, appearing in 30 of the 886 (3.4%) threads. Notably, "Social and Ethical Perception" accounted for only 13 of the 886 (1.5%) responses and appeared in just 13 threads. This study highlights the critical need for information and support for women navigating abortion, particularly in regions where access is restricted. It emphasizes the importance of addressing the multifaceted challenges women face and calls for policy changes and strengthened support networks to improve the health and rights of women, as well as all those seeking gynecological care in abortion contexts. Further research is encouraged to refine and expand support strategies.

The Dynamics of Humanitarian Diplomacy During Wartime: Insights from Tigray Crisis in Ethiopia

This study examines the role of humanitarian diplomacy during the Tigray humanitarian crisis in Ethiopia, a humanitarian disaster marked by severe shortages in food, healthcare, and essential services that deeply affect civilians. A qualitative approach using both primary and secondary data grounds the study by exploring key actors in humanitarian diplomacy, their successes, and barriers to aid delivery. Humanitarian actors, such as UN agencies, international NGOs, donor countries, the EU, the US, and the African Union, have engaged with the Ethiopian government, the TPLF, and the Tigray Transitional Government to alleviate the crisis. Notable achievements in humanitarian diplomacy include negotiations, information gathering, communication, civilian needs assessment, resource mobilization, advocacy for international law, and distressed civilians. Humanitarian diplomacy has facilitated international aid operations, saving lives during critical periods, despite practical difficulties. Diplomatic efforts have faced significant interruptions due to access restrictions imposed by the Ethiopian government, security threats from ongoing fighting leading to attacks on aid convoys and casualties among aid workers, and bureaucratic obstacles imposed by the Ethiopian government. This study highlights the necessity for effective humanitarian diplomacy in accounting for complex political landscapes in conflict-affected regions, developing flexible strategies that enhance access to aid, and improving humanitarian interventions.

Parental mediation strategies for social media use: a thematic analysis of perspectives among Indonesian parents and adolescents

ABSTRACT As social media provides opportunities but also involves risks for adolescents, some parents apply strategies to help their children adaptively use social media. Taxonomies of these strategies were primarily based on research conducted in the Global North. However, while social media use is also highly prevalent in the Global South, research on parental mediation strategies in the Global South is relatively scarce. The aim of this study is to increase our understanding of parental mediation strategies for social media use that occur in Indonesia. We conducted a qualitative study consisting of eight focus group discussions and eight semi-structured interviews (15 Indonesian parents and 30 Indonesian adolescents). The thematic analysis revealed that participating Indonesian parents typically applied a combination of specific restrictive and enabling strategies, including access restriction, interaction restriction, technical mediation, monitoring, interpretative mediation, supervision/co-use, modelling, and norm implementation. Parents reported a range of difficulties when trying to implement mediation strategies but overall, they believed that their strategies help their children to use social media more adaptively.

Factors influencing the use of e-library resources by postgraduate engineering students at Kyambogo University in Uganda

The aim of this study was to investigate the factors influencing the use of e-library resources among postgraduate engineering students at Kyambogo University in Uganda to make suggestions on how to improve access to and use of e-library resources. The study adopted a survey research design to collect data from postgraduate engineering students. Following a census sampling strategy, data was obtained from 58 out of 80 registered postgraduate engineering students using online self-administered questionnaires. The findings revealed that the use of e-library resources by postgraduate engineering students was influenced by ease of use, convenience, level of awareness, and information search skills. However, access restrictions and high internet costs negatively affected e-library resources usage. It is the conclusion of the study that the use of e-library resources was largely influenced by personal factors. This study has implications on e-library resources collection development, policy development, and service delivery in academic libraries. The study bridges the knowledge gap in the use of e-library resources among postgraduate engineering students.

Great Expectations: Semaglutide as Antidiabetic Weight Management in a Psychiatric Hospital.

This report explores the potential role of glucagon-like peptide 1 (GLP-1) receptor agonists in minimizing the metabolic side effects of psychotropic medications in patients with underlying type 2 diabetes (T2D) in inpatient psychiatric settings. The introduction of novel antidiabetic medications such as GLP-1 receptor agonists has broadened the options for managing metabolic disorders, particularly T2D. These medications not only offer effective glycemic control but also provide cardiovascular and renal benefits and help with weight management. Given the tendency of psychotropic medications to cause weight gain and metabolic complications, this report presents 2 cases where weekly doses of semaglutide improved blood glucose levels and prevented weight gain in patients receiving chronic psychotropic medications. Integrating GLP-1 receptor agonists into inpatient psychiatric care can help mitigate the metabolic adverse effects of psychotropic medications. However, considerations such as cost, accessibility, and institutional formulary restrictions are essential to ensure comprehensive patient care.

“Phones off while school's on”: Evaluating problematic phone use and the social, wellbeing, and academic effects of banning phones in schools

AbstractBackground and aimsMobile phone bans in secondary schools are claimed to reduce student distraction and promote learning and face-to-face socializing. Currently, the evidence on phone bans is limited. The aim of this preregistered study was to evaluate the South Australian mobile phone ban's effects on students' problematic phone use, academic engagement, school belonging, and bullying. The study also sought to identify student variables that predict phone ban compliance.MethodsAs the ban was phased in over 2023, a 2 (phone ban: yes/no) × 2 (time: baseline, 1-month follow-up) repeated-measures design was employed. Students (n = 1,282 at baseline; n = 1,256 at follow-up) in Grades 7 to 12 were recruited from five public secondary schools. Surveys included measures drawn from the Longitudinal Study of Australian Children (LSAC) and the Programme for International Student Assessment (PISA).ResultsProblematic phone use was reported by 2.6% of the sample. Being older and a more frequent user of social media predicted lower phone ban compliance. Linear mixed models indicated that ban and no ban school groups did not differ significantly in terms of problematic phone use, academic engagement, and school belonging. There was slightly higher bullying in the ban group but bullying decreased significantly in both groups.DiscussionImposing access restrictions may not affect the underlying psychological mechanisms that drive problematic phone use. Although these results indicate limited to no short-term benefits of the ban, further evaluation with more sensitive methodologies is recommended.ConclusionsStudent-technology interactions in learning institutions should be continually monitored to determine the optimal balance to support student etiquette, learning, and wellbeing.

Digital natives, digital activists in non-digital environments: How the youth in Zambia use mundane technology to circumvent government surveillance and censorship

This study investigates the technological strategies the youth in Sub-Saharan Africa employ to circumvent government surveillance and censorship. Centered on the 2020 Zambian youth protests and informed by interviews with 37 participants, we explore the youth's innovative use of mundane skills to build digital communities, evade government surveillance, and leverage algorithms. The findings indicate that despite limited online access and government restrictions, the Zambian youth creatively employed their local skills to build social networks, disseminate information, and mobilize for social change. However, two contrasting narratives emerge: one celebrating the innovation and resilience of these young people, with the other raising concerns about the broader implications of their actions. Notably, some youth transitioned from influential activists to government insiders, a shift that may have diluted their capacity to champion social justice. The study emphasizes the need to scrutinize the balance between technological cooperation and potential discord, urging a more profound exploration of technology's role in shaping the trajectory of democracy, especially in settings akin to sub-Saharan Africa. We argue for further research into the role of digital influencers in electoral processes and democratic systems.

Toward Universal Health Coverage: What Socioeconomic and Clinical Factors Influence Health Insurance Coverage and Restrictions in Access to Viral Hepatitis Services in Nasarawa State, Nigeria?

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36-40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38-50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67-65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85-87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55-10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO's 2030 elimination goals.

Cyber attacks on radiological systems

The base of today’s radiological devices are computers and networks. The radiology department has a specific way of working and there are standards such as DICOM for medical image records, PACS for archiving and communication, and HL7 for information exchange in the medical system. As radiology becomes an economically interesting branch, it becomes a target for cyber-attacks. At the same time, radiological systems contain a lot of personal data that are valuable. The reasons for the attacks are often financial gain, political, ideological or personal. The start of an attack can be physical access to radiological devices or network access. DICOM files can be the trigger of an attack. We divide attacks into those that directly affect patients, those that have an indirect impact, and those that affect the infrastructure. Well known types are Denial-Of-Service, malware, cryptographic attacks and making changes of device settings. When defending against cyber-attacks, it is important to secure communication by e-mail and to keep software updated. The IT department of the radiology department should observe accounts of all users and check the authorizations. Networks must have access restrictions according to workplaces and purposes to prevent unwanted access. Web proxy protection restricts access to Internet sites that are potentially dangerous. The basics of the department’s network, such as servers, must be physically secured from access. DICOM files should be encrypted with the most secure algorithms available. In response to cyber-attacks, it is necessary to have standard procedures and such a system must always be on standby. Known attacks on radiological systems are Kwampiris, Petja/NotPetya, Ryuk, Wannacry, Conti group and BianLian.

Market access and firm productivity: Evidence from a natural experiment

Based on China's Market Access Prohibition List, this paper explores the impact of market access reforms on firm productivity, employing data from Chinese listed companies from 2010 to 2019. To identify causality, we conduct a staggered DID estimation and find that provinces implementing the Market Access Prohibition List exhibit higher growth in productivity than those that do not. Moreover, this positive effect is more pronounced for non-SOEs and firms in less marketed regions. Reducing rent-seeking costs and promoting corporate innovation serve as mechanisms to facilitate firm productivity. This research sheds light on the economic consequences of liberalizing market access restrictions.

Large Language Publishing

The AI hype cycle has come for scholarly publishing. This essay argues that the industry’s feverishーif mostly aspirationalーembrace of artificial intelligence should be read as the latest installment of an ongoing campaign. Led by Elsevier, commercial publishers have, for about a decade, layered a second business on top of their legacy publishing operations. That business is to mine and process scholars’ works and behavior into prediction products, sold back to universities and research agencies. This article focuses on an offshoot of the big firms’ surveillance-publishing businesses: the post-ChatGPT imperative to profit from troves of proprietary “training data,” to make new AI products andーthe essay predictsーto license academic papers and scholars’ tracked behavior to big technology companies. The article points to the potential knowledge effects of AI models in academia: Products and models are poised to serve as knowledge arbitrators, by picking winners and losers according to what they makevisible. I also cite potential knock-on effects, including incentives for publishers to roll back open access (OA) and new restrictions on researchers’ access to the open web. The article concludes with a call for a coordinated campaign of advocacy and consciousness-raising, paired with high-quality, in-depth studies of publisher data harvestingーbuilt on the premise that another scholarly-publishing world is possible. There are many good reasons to restore custody to the academy, the essay argues. The latest is to stop our work from fueling the publishers’ AI profits.

Transmediatic depth of «The New York Times» and «El País» in their coverage of Boris Johnson’s resignation

A decade after the implementation of multimedia frameworks in the news media, it is necessary to determine which mechanisms have been incorporated into the daily routines of the news media. To accomplish this, we analysed the channels, forms and intertextual modalities employed by two leading international newspapers in their coverage of an unpredictable news event with global repercussions and a specific period: the UK government crisis of July 2022, which led to the resignation of the British Prime Minister Boris Johnson. We used a qualitative methodology of transmedia information analysis (Calvo &amp; Serrano Tellería, 2021), adapted to assess the daily operations of online media in updating their content. Additionally, interviews were conducted with the teams responsible for this coverage. The coverage analysis revealed a transmedia depth of ten to eleven informative modalities. We found several residual differences in their audience participation policies. Certain generalist modalities, such as live streaming, video news, podcasts or social networks, were well established and used to attract readership. Furthermore, various models of newsletters and discussion forums with varying levels of access restriction were employed. However, neither of the studied media outlets offered an auditory transcription of their content. While a specific transmedia information model is emerging in digital media, further research should be undertaken to complement these findings.

6957 5-Year Follow-Up of Acute, micro, and Macrovascular Complications of Patients With Type 2 Diabetes Managed by a Multi-Disciplinary Team In A Hospital in Northeastern Mexico

Abstract Disclosure: M. Romero Ibarguengoitia: None. D.P. Morales Rodríguez: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernández-Chau: None. A. Cepeda-Medina: None. A. González-Cantú: None. Type 2 Diabetes Mellitus (T2DM) is a condition associated with various acute and chronic complications, which constitute the leading cause of disability, morbidity and mortality globally. During the SARS-CoV-2 pandemic, vulnerable individuals such as those with T2DM faced a restriction in access to primary healthcare services. Therefore, we decided to compare the presence of micro and macrovascular complications before and during the SARS-CoV-2 pandemic, as well as the incidence of acute complications. A retrospective observational cohort study from 2018 to 2022 was conducted in a hospital in northeastern Mexico on patients with T2DM who were treated by a multidisciplinary team composed of an internist or geriatrician based on the patient's age, endocrinologist, nutritionist, and other diabetes-related specialties. Levels of HbA1C, fasting serum glucose (FSG), low-density lipoprotein cholesterol (LDLc), blood pressure (BP), and microalbuminuria were analyzed. Consequently, presence of micro and macrovascular complications and incidence of acute complications was described. A total of 999 subjects were analyzed, 516 (51.7%) males, with an average age (SD) of 60.1 (12.7) years. There was an increase in the proportion of patients with adequate glycemic control based on HbA1C of 15.2% between 2018 and 2022 (p&amp;lt;0.001) and a 42.3% increase in FSG control during the same period (p&amp;lt;0.001). LDLc showed a decrease in the control proportion of 5.1% between 2018 and 2022 (p&amp;lt;0.001). Systolic BP control in 2018 was 82.7% and 80.1% in 2022 (p&amp;lt;0.001). Diastolic BP control in 2018 was 89.6%, with an increase to 91.4% in 2022 (p=0.01). Microalbuminuria control increased from 80.5% in 2018 to 89% in 2022 (p=0.002). There were 78 (7.8%) cases of microvascular complications, with diabetic neuropathy being the most prevalent (n=35, 3.6%), and a higher incidence in 2021 with 15 (1.6%) cases. A total of 15 (1.5%) patients presented a macrovascular complication, with ischemic heart disease being the most frequent with 11 (1.1%) subjects, and a higher incidence of cases in 2021 (n=4, 0.4%). Hypoglycemia was found to be the most frequent acute complication with 14 (1.4%) cases, with a higher incidence in 2020 (n=5, 0.5%). The low incidence of complications in our population, emphasizes the importance of coordinating patient’s care between a multidisciplinary team to maintain an overall disease control, optimize T2DM treatment and enhance patient’s quality of life. Presentation: 6/1/2024

Application of noise remote sensing to conquer loud vehicles in Amsterdam

Techniques for remote sensing of noise are rapidly evolving, allowing for automatic and unsupervised monitoring of individual noise events. In the H2020 project NEMO, noise remote sensing was developed and applied to detect individual loud vehicles in normal road or rail traffic. Potential applications include urban vehicle access restrictions (UVAR) such as in low emission zones, based on real world emissions rather than type approval data. The city of Amsterdam is also experimenting with influencing driving behaviour and raising road user awareness to reduce the number of high noise emitters. Amsterdam uses dynamic roadside signalling for this, which shows a message "too loud" to noise vehicles passing by. New tests are now performed with a more advanced acoustic camera to localize and track the individual vehicle, connected to license plate and speed detectors. This paper describes how NEMO results are used to achieve an actual reduction of high emitters in Amsterdam. First results of experiments are presented along with technical challenges that need to be overcome. These challenges include reduction of measurement uncertainty as well as uncertainty as to what vehicle a high noise event belongs to.

CRYPTOCURRENCY ADOPTION IN INTERNATIONAL MARKETS: CHALLENGES AND OPPORTUNITIES

Cryptocurrency is next in the list of gigantic financial innovations in modern times, changing the way any person, institution, and the government interacts through the global economy. Starting with Bitcoin back in 2009, it refers to decentralized digital currency based on the blockchain technology that can help someone carry out transparent, peer-to-peer, and safe transactions without using banks. There are numerous reasons that have fueled interest in cryptocurrencies, including financial independence, high returns on investment, and increased privacy in transactions. As cryptocurrencies take the world by storm in most international markets, they present major challenges and unique opportunities in equal measure. The acceptance of cryptocurrencies varies widely from country to country, depending on the regulatory environment, technology infrastructure, and cultural orientation toward digital finance. Areas with supportive regulations and the most advanced technological ecosystems promote rapid adoption, while restrictions in policies and limited technology access have hindered adoption in other areas. Apart from that, the inherent volatility of cryptocurrencies gives rise to several concerns with regard to using them as reliable mediums of exchange or stores of value, which may discourage potential users and investors. Security, fraud, and how a cryptocurrency works raise issues with trust, thereby making acceptance complicated. Despite these challenges, cryptocurrencies hold the potential for revolutionizing financial systems through financial inclusion in underbanked regions and facilitating faster, cheaper cross-border transactions. This paper aims to explore what factors drive the adoption or do not of the cryptocurrency by international markets and their related business and consumer implications. Through multiple case studies and insights obtained from various regions, the work attempts to deliver a profound understanding of the challenges posed by cryptocurrency adoption and at the same time the possible opportunities, in order ultimately to show the transformative value that cryptocurrency has in shaping the rapidly changing global economy.

An Analysis of Managing the Cloud: Obstacles and Solutions for Efficient Administration and Protection

Cloud management offers possibilities and difficulties to enterprises looking for effective management and strong data security. This essay examines the challenges associated with cloud administration and suggests workarounds for these issues. Assuring data security, upholding legal compliance, cutting expenses, and overseeing intricate multi-cloud setups are important obstacles. The use of cloud-native monitoring and governance tools, the implementation of extensive data backup and recovery plans, the use of automation for resource provisioning and administration, and the implementation of strong security measures like encryption and access restrictions are all necessary for finding solutions. Organizations may improve the security of their important data assets and expedite their cloud administration procedures by tackling these challenges with suitable solutions. Ensuring data security is a major concern in cloud administration. Organizations are concerned about data breaches, illegal access, and industry regulatory compliance when they move critical data to the cloud. Organizations need to have strong security mechanisms like identity management, access restrictions, and encryption in place to lessen these risks. Furthermore, implementing a defense-in-depth strategy that incorporates several security tiers might improve cloud environments' overall resilience. Upholding legal requirements and industry norms is another challenge for cloud managers. To secure sensitive data and uphold client confidence, businesses in regulated sectors like healthcare and finance are subject to strict compliance regulations. Adherence to frameworks like HIPAA, GDPR, and PCI DSS, as well as thorough policies and frequent audits are necessary to achieve compliance in the cloud. Organizations may minimize the risk of non-compliance penalties and expedite compliance processes by putting governance tools and compliance automation systems into place. For enterprises using cloud resources, cost optimization is another major concern. Pay-as-you-go cloud services might result in overspending and financial restrictions due to improper resource utilization.

Relevant information from the perspective of sustainable forest management – auditing socio-environmental information and data

Purpose: The study aims to: (1) deepen the theory of defining new concepts such as relevant information and information needs, and (2) examine the essence of financial and non-financial information and its usefulness to forest stakeholders. The research problem was formulated as follows: “Since forest management entities generate and disclose financial and non-financial information, which of these sources of information will be considered most useful (relevant) by information users?” In the context of environmental and social challenges, accounting 5.0 must generate, report, and disclose information according to stakeholders’ expectations. Methodology/approach: The following methods were used: literature analysis and critique, document examination, logical analysis and construction, the Delphi method, and snowballing. The Pearson chi-square independence test and the Kruskal-Wallis test were used. Findings: The most important characteristics of information are reliability and timeliness. The most useful information for stakeholders includes forest maps and conservation information, a “forest dictionary”, and rules for timber sales. Information about campaigns, charitable actions, forest hazards, and forest access restrictions is useful. Research limitations: A limitation of the research is the national sample size of the survey, with a higher percentage of internal forest stakeholders than external stake-holders. Practical implications: The practical implications of the article are based on the collected research material, which can contribute to the development of a standard questionnaire for investigating the information needs of stakeholders in the future. Originality/value: The study is the first empirical research of its kind in Poland and involves the participation of foreign experts. Contributions to social science theory include: (1) an original definition of “relevant information”; (2) a definition of “information needs”; (3) comparative frameworks for the impact areas of the sustainable development concept in correlation with information, relevant information, and stake-holders; (4) a conceptual table of differences between types of information from a sustainability perspective.

369. IMPACT OF THE COVID-19 PANDEMIC ON ESOPHAGEAL CANCER PATIENTS UNDERGOING ESOPHAGECTOMY: AN ACS-NSQIP DATABASE ANALYSIS

Abstract Background To cope with the increasing number of infected patients, medical access was restricted, and public facilities were closed throughout the COVID-19 pandemic. Early detection and treatment of esophageal cancer is critical for improved prognosis. However, the impact of pandemic-related medical access restrictions has not be evaluated to date for esophageal cancer. Therefore, the purpose of this research is to determine how the lockdown policy affected the surgical outcome of patients with esophageal cancer. Methods We analyzed patients who underwent esophagectomy for esophageal cancer between 2016-2022 using data obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), including the procedure targeted esophagectomy database. The patients were stratified into two groups based on their operation date relative to pandemic (BEFORE COVID group: 2016-2019 vs AFTER COVID group: 2020-2022). Demographic data and perioperative outcomes were compared between the two groups. Statistical analysis included Chi-square tests for categorical variables and independent student T-tests for continuous data, with a significance threshold set at p &amp;lt; 0.05. Results Between 2016-2022, 7,198 esophageal cancer patients underwent esophagectomy. Clinical T4 increased significantly, but clinical N and pathologic T and N stages showed no impact. PET scan imaging, neoadjuvant chemotherapy and radiotherapy remained unchanged. The utilization of a minimally invasive approach rose substantially from 32.6% to 47.2% (p &amp;lt; 0.001). Positive margin rates increased from 7.5% to 9% (p = 0.03), and anastomotic leak rates increased from 14.1% to 17.2% (p &amp;lt; 0.001). Operative time, blood loss, and conversion rate showed no significant differences. Perioperative complications, including organ space surgical site infections and myocardial infarctions, significantly increased after COVID-19. Conclusion The COVID-19 pandemic altered the clinical staging of esophageal cancer patients undergoing esophagectomy, but it did not disrupt access to essential investigations and treatment. A notable increase in the implementation of minimally invasive techniques was observed after the pandemic. However, significant impacts were noticed on operative outcomes, including positive margin and leak rates.

Defense in Depth Strategies for Zero Trust Security Models

The groundbreaking Zero Trust Security Model challenges perimeter-based protections in cybersecurity. As cyber threats become more sophisticated, corporations are embracing the Zero Trust philosophy of "never trust, always verify." Whether from within or outside the network, this paradigm imposes rigorous access rules and continual authentication. Zero Trust is a strong security foundation, yet it has drawbacks. The Zero Trust paradigm is enhanced by Defense in Depth, which layers several security methods to safeguard assets. This article examines how the Zero Trust Security Model might include Defense in Depth methods for a complete, robust, and adaptable security architecture. Zero Trust requires all users and devices to be verified, approved, and continually vetted before accessing resources, eliminating implicit trust. A typical method employed by attackers after breaching the perimeter is lateral movement inside the network, which this approach mitigates well. However, Defense in Depth—deploying numerous, redundant security measures throughout the IT environment—is a proven method. Defence in Depth and Zero Trust may be combined to strengthen access restrictions, detection, response, and recovery.

Simulation-based education in the Pacific Islands: educational experience, access, and perspectives of healthcare workers.

The World Health Organization (WHO) recommends simulation-based education (SBE) to acquire skills and accelerate learning. Literature focusing on SBE in the Pacific Islands is limited. The aim of this study was to determine Pacific Island healthcare workers' experiences, perspectives, and access to SBE. This was a cross-sectional survey of Pacific Island healthcare workers. We designed an online questionnaire based on existing literature and expert consultation. The questionnaire included Likert scales, multiple-choice, multi-select and open-ended questions. Participants were healthcare workers recruited from professional networks across the region. Descriptive statistics and relative frequencies summarized data, and comparative testing included unpaired t-tests, Mann-Whitney U, Chi-squared and Fisher's exact tests. Free-text responses were presented to illustrate findings. Responses from 56 clinicians working in 11 Pacific Island countries were included. Fifty were medical doctors (89%), including 31 (55%) surgeons. Participants reported experience with scenario-based simulation (73%), mannequins (71%), and simulated patients (61%). Discrepancies were identified between previous simulation experience and current access for simulated patients (P = 0.002) and animal-based part-task trainers (P = 0.002). SBE was seen as beneficial for procedural skills, communication, decision-making and teamwork. Interest in further SBE was reported by most participants (96%). Barriers included equipment access (59%), clinical workload (45%) and COVID-19 restrictions (45%). Some Pacific Island healthcare workers have experience with SBE, but their ongoing access is predominantly limited to low-technology modalities. Despite challenges, there is interest in SBE initiatives. These findings may inform planning for SBE in the Pacific Islands and may be considered prior to programme implementation.