Review Board Research Articles

Unintended Consequences of Data Sharing Under the Meaningful Use Program.

Interoperability has been designed to improve the quality and efficiency of health care. It allows the Centers for Medicare and Medicaid Services to collect data on quality measures as a part of the Meaningful Use program. Covered providers who fail to provide data have lower rates of reimbursement. Unintended consequences also arise at each step of the data collection process: (1) providers are not reimbursed for the extra time required to generate data; (2) patients do not have control over when and how their data are provided to or used by the government; and (3) large datasets increase the chances of an accidental data breach or intentional hacker attack. After detailing the issues, we describe several solutions, including an appropriate data use review board, which is designed to oversee certain aspects of the process and ensure accountability and transparency.

Abstract 4115015: Hyperpolarized Carbon-13 Metabolic Imaging Detects Changes in Cardiac Mitochondrial Metabolism in Patients Before and After Coronary Artery Bypass Graft Surgery

Background: Coronary Artery Disease (CAD) is a significant global health issue, necessitating improved diagnostic tools for visualizing cardiac energetics. Traditional imaging methods such as PET and dobutamine stress echocardiography do not directly assess mitochondrial metabolism. Hyperpolarized Carbon-13 metabolic magnetic resonance imaging (HP- 13 C MRI) offers a promising non-invasive method for investigating mitochondrial function in CAD. This study utilizes HP- 13 C MRI to detect changes in mitochondrial metabolism in patients undergoing Coronary Artery Bypass Graft (CABG) surgery (Fig.1). Methods: We conducted HP- 13 C MRI examinations on two patients with advanced CAD before and (~4-6 months after CABG surgery and one healthy subject (Fig. 2 A,B). Participating subjects provided informed consent according to a protocol approved by the Institutional Review Board and Protocol Review Committee. Baseline blood samples were analyzed for pyruvate, triglycerides, free fatty acids, and insulin levels. Post-glucose load, patients received an intravenous injection of an IND-approved metabolic probe, [1- 13 C] pyruvic acid, prepared under Good Manufacturing Practice regulations. The HP solution was administered after polarization in a clinical polarizer (SPINlab™, GE Healthcare). Imaging was performed using a GE MR750 MR system with a Helmholtz loop-pair 13 C coil (PulseTeq Limited, UK). Data were reconstructed and analyzed with MATLAB scripts. Results and Discussion: Baseline blood measurements were normal for the healthy subject, but those with advanced CAD showed variable and abnormal values (Fig. 2C). HP- 13 C MRI safely assessed cardiac metabolism in patients with advanced CAD. Patients with advanced CAD exhibited reduced pyruvate metabolism compared to healthy controls, shown by lower myocardial bicarbonate/(bicarbonate+lactate) ratios (Bic/(Bic+Lac)). Following CABG, only Patient 2 showed improved Bic/(Bic+Lac), while Patient 1 did not (Fig. 3A-B). This variability may be influenced by differences in nutrition, hormonal status, medication regimens, or other factors. Changes in % Bic/(Bic+Lac) across different coronary artery segments were observed post-CABG in CAD patients (Fig. 3C). Conclusion: HP- 13 C MRI non-invasively assesses cardiac metabolism in CAD patients, demonstrating the potential to evaluate post-CABG metabolic changes. Our efforts continue to recruit large cohort to understand individual variability.

Precision of artificial intelligence in paediatric cardiology multimodal image interpretation.

Multimodal imaging is crucial for diagnosis and treatment in paediatric cardiology. However, the proficiency of artificial intelligence chatbots, like ChatGPT-4, in interpreting these images has not been assessed. This cross-sectional study evaluates the precision of ChatGPT-4 in interpreting multimodal images for paediatric cardiology knowledge assessment, including echocardiograms, angiograms, X-rays, and electrocardiograms. One hundred multiple-choice questions with accompanying images from the textbook Pediatric Cardiology Board Review were randomly selected. The chatbot was prompted to answer these questions with and without the accompanying images. Statistical analysis was done using X2, Fisher's exact, and McNemar tests. Results showed that ChatGPT-4 answered 41% of questions with images correctly, performing best on those with electrocardiograms (54%) and worst on those with angiograms (29%). Without the images, ChatGPT-4's performance was similar at 37% (difference = 4%, 95% confidence interval (CI) -9.4% to 17.2%, p = 0.56). The chatbot performed significantly better when provided the image of an electrocardiogram than without (difference = 18, 95% CI 4.0% to 31.9%, p < 0.04). In cases of incorrect answers, ChatGPT-4 was more inconsistent with an image than without (difference = 21%, 95% CI 3.5% to 36.9%, p < 0.02). In conclusion, ChatGPT-4 performed poorly in answering image-based multiple-choice questions in paediatric cardiology. Its accuracy in answering questions with images was similar to without, indicating limited multimodal image interpretation capabilities. Substantial training is required before clinical integration can be considered. Further research is needed to assess the clinical reasoning skills and progression of ChatGPT in paediatric cardiology for clinical and academic utility.

Awareness and acceptability of assisted reproductive technology among non-medical tertiary students in a low-resource setting

BackgroundAssisted Reproductive Techniques (ART) have significantly advanced infertility treatment worldwide. However their availability and use in sub-Saharan Africa, remains limited although infertility is highly prevalent, with significant psycho-social challenges including stigma. This study assessed the awareness, attitudes, and perceptions of ART among non-medical tertiary students in Ghana.MethodA cross-sectional study was conducted among non-medical students in tertiary institutions in Ghana. Pre-tested questionnaires were administered to both post-graduate and undergraduate students after obtaining informed consent. Ethical approval was obtained from the Review Board at Community Health Department of the University of Ghana Medical School. The data collected was analyzed using SPSS (version-27) and the results presented using frequency tables, graphs, and charts. significance was P-value below 0.05 was considered statistically significant.ResultsOverall, 196 participants from the two largest universities and other tertiary institutions in Ghana took part in this study. Majority (63.5%) of respondents demonstrated awareness on ART services, but 60.3% showed poor knowledge of the types of ART. Males generally exhibited lower knowledge of ART services compared to females, and knowledge of ART services showed an inverse relationship with age. In-vitro fertilization (IVF) was the most widely recognized and recommended ART technique, known by 65.1% of respondents who were aware of the types of ART. Most participants expressed reluctance to accept or recommend gamete donation due to religious reasons, fear of complications, and a preference for conventional means of procreation.ConclusionThe majority of tertiary students in Ghana are aware of ART for infertility treatment however, many are hesitant toward donor-gamete treatment protocols. Fear of complications and related costs pose major barriers to considering ART among the respondents. Participants unanimously suggested government subsidies and the inclusion of ART under the national health insurance coverage package.

SoundMind Trial: a study protocol for a randomised controlled trial for online acceptance and commitment therapy and sound therapy for tinnitus

IntroductionTinnitus is a common ailment that affects 10%–15% of adults worldwide. Comorbidities associated with tinnitus often include hearing loss, emotional distress and sleep disorders, with insomnia being a common issue...

P10.06.A AGENT-BASED MODELING FOR PATIENT-CENTERED CLINICAL DECISION SUPPORT IN NEURO-ONCOLOGY

Abstract BACKGROUND Complex clinical decision-making in neuro-oncology is a multifaceted process involving numerous specialties influenced by various objective factors and patient preferences. Modeling these multidisciplinary neuro-oncology discussions presents significant challenges, particularly given the multimodal nature of the data. Recent advancements in large language models (LLMs) have enabled the development of LLM “agents”. These agents pave the way for multi-agent systems capable of simulating interacting components, thus capturing the nuances of interdisciplinary clinical discussions. MATERIAL AND METHODS Utilizing GPT-4, we developed conversational agents with an agent-based modeling (ABM) approach; each agent was assigned a specific specialty. We simulated their interactions in various clinical decision-making scenarios. Lastly, we simulated 30 patient-agents and included them in the ABM system. We applied this ABM approach to a dataset of 16 clinical vignettes extracted from the UCSF Clinical Data Warehouse of primary adult glioma patients who underwent tumor board (TB) reviews. The TB decision was used as ground truth for quantitative evaluation. Seven independent clinicians evaluated the final decisions. RESULTS Our quantitative assessment showed that, when blinded to whether ABM or TB generated responses, evaluators preferred ABM recommendations 47.8% of the time, followed by TB recommendations (38%). The highest recommendation concordance was between TB and ABM (50.6%). The ABM was deemed clinically accurate in 76.8% of cases and provided clinically appropriate reasoning in 73.2%. Our qualitative assessment showed that including the patient agent significantly influenced the course of discussions, notably when the patient agents participated in the system by stating their healthcare goals. The most recommended individual treatment was standard-of-care chemotherapy, followed by targeted therapies, clinical trials, immunotherapy, and palliative care. The least frequently recommended management options were radiation, surgery, consultation with other specialties, and devices. CONCLUSION This study underscores the potential of ABM in neuro-oncology, particularly in simulating complex, real-world scenarios. ABM not only empowers patients but also offers clinicians a novel tool for understanding and navigating the multifaceted landscape of patient preferences and treatment options. It provides a platform for clinicians to visualize the potential impacts of various decisions, enhancing their ability to provide personalized, effective care. We envision future work where ABM systems are patient-centric, enabling patients to explore the potential impacts of their individual characteristics on clinical management options.

Book Review for Neuromuscular and Electrodiagnostic Medicine Board Review.

Book Review for Neuromuscular and Electrodiagnostic Medicine Board Review.

The Quality Improvement Review Board: An Innovative Approach to Oversight of Projects That Do Not Meet Criteria of Human Subject Research.

This article describes the development of an institutional quality improvement review board (QIRB) as an effective and efficient method for reviewing and overseeing institutional quality improvement (QI) initiatives. QI projects involve the systematic collection and analysis of data and the implementation of interventions designed to improve the quality of clinical care and/or educational programs for a distinct population in a specific setting. QI projects are fundamentally distinct from human subjects research (HuSR); however, the differences between them are subtle and highly nuanced. Determining whether a project meets the definition of QI or qualifies as HuSR, thus requiring institutional review board (IRB) review, can be confusing and frustrating. Nevertheless, this distinction is highly consequential due to the heavy regulatory requirements involved in HuSR and IRB oversight. Making the correct determination of a project's regulatory status is essential before the project begins. Project leaders may not realize that their work meets the definition of HuSR and, therefore, might conduct the project without appropriate IRB review. Therefore, best practices dictate that project leaders should not decide which type of institutional review is appropriate for their projects. In addition, when QI project teams attempt to disseminate the results of their work, documentation of formal review and approval is generally required by peer-reviewed journals and professional organizations. However, institutional review mechanisms are rarely available. Projects that do not meet the definition of HuSR fall outside the purview of IRBs and most institutions do not have an alternative review body. This creates frustration for both project leaders and IRB administrators. Apart from IRB review, a separate process for reviewing QI projects offers several benefits. These include (1) relieving the burden on busy IRB staff; (2) promoting scholarly activity; (3) protecting the institution, project leaders, and participants from HuSR conducted outside of appropriate IRB review; and (4) promoting rigorous QI methods.

Evaluating Performance of ChatGPT on MKSAP Cardiology Board Review Questions

Chat Generative Pretrained Transformer (ChatGPT) is a natural language processing tool created by OpenAI. Much of the discussion regarding artificial intelligence (AI) in medicine is the ability of the language to enhance medical practice, improve efficiency and decrease errors. The objective of this study was to analyze the ability of ChatGPT to answer board-style cardiovascular medicine questions by using the Medical Knowledge Self-Assessment Program (MKSAP).The study evaluated the performance of ChatGPT (versions 3.5 and 4), alongside internal medicine residents and internal medicine and cardiology attendings, in answering 98 multiple-choice questions (MCQs) from the Cardiovascular Medicine Chapter of MKSAP. ChatGPT-4 demonstrated an accuracy of 74.5 %, comparable to internal medicine (IM) intern (63.3 %), senior resident (63.3 %), internal medicine attending physician (62.2 %), and ChatGPT-3.5 (64.3 %) but significantly lower than cardiology attending physician (85.7 %). Subcategory analysis revealed no statistical difference between ChatGPT and physicians, except in valvular heart disease where cardiology attending outperformed ChatGPT (p = 0.031) for version 3.5, and for heart failure (p = 0.046) where ChatGPT-4 outperformed senior resident. While ChatGPT shows promise in certain subcategories, in order to establish AI as a reliable educational tool for medical professionals, performance of ChatGPT will likely need to surpass the accuracy of instructors, ideally achieving the near-perfect score on posed questions.

Developing and reporting a healthcare-associated infection composite score for health system board review

Background One strategy for supporting a hospital or health system's board of directors (Board), with their quality oversight responsibility is to review the organization's performance on quality measures. But for large systems, the number of measures needing review is quite burdensome and makes priority setting difficult. Our goal was to develop a scoring method that summarizes multiple quality measures together, while still maintaining the Board's opportunity to examine individual measures where there are specific concerns. Methods We calculated an overall health system-level composite performance score using six publicly reported healthcare-associated infections reported by the Centers for Medicare and Medicaid Services on their Care Compare website [central-line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSIs) for colon surgery and abdominal hysterectomy, hospital-onset Methicillin-resistant Staphylococcus aureus bacteremia (MRSA), and hospital-onset Clostridioides difficile ( C. diff)], where relative weights assigned to each infection type reflect the severity of patient harm. We also calculated a health-system composite performance target. For individual infection types, we calculated system-wide scores and targets and categorized individual hospital performance into three performance categories. Results The health system's composite score between 2015 and 2019 ranged from a high of 1.10 to a low of 0.71. The health system's composite score in 2017–2019 was better than the composite target. Of the 34 measures used to calculate the 2019 composite score, 20 were better than internal standardized infection ratio (SIR) targets, seven were between internal targets and SIR of 1.0, and seven were worse than SIR of 1.0. Discussion The Board communicated they find this composite score reporting approach helpful for streamlining their understanding of HAI performance, as compared to traditional approaches of reporting out individual performance measures. Approaches that streamline Board review of quality and safety performance are important as we hold Board members accountable for overseeing quality, seek greater engagement from the Board, and work to minimize measure review overload.

Preface

Proceeding of The 7th International Symposium on Green Technology for Value Chains (GreenVC) 2023 November 14-15, 2023 Bandung, West Java Indonesia Organized by: Research Center for Environmental and Clean Technology National Research and Innovation Agency (BRIN) The seventh International Symposium on Green Technology for Value Chains (GreenVC) 2023 was held on November 14-15, 2023, as a hybrid event in Bandung, West Java, Indonesia. The fundamental goals of this symposium were to exchange ideas and information, encourage technology development, and strengthen networking and collaboration among all attendees. The symposium was organized by the Research Center for Environmental and Clean Technology, National Research and Innovation Agency (BRIN). The GreenVC 2023 is an annual international symposium that was first held in 2016. This year’s theme is Unlocking a Sustainable Future through Green Technology Innovations. Due to the transition from the pandemic situation, the symposium should be held as a hybrid event, combining virtual and physical, with some attendees joining in person and others joining remotely online. On the positive side, we could gather 9 keynote speakers (5 attend in person and 4 attend virtually), 5 invited speakers (2 attend in person and 3 attend virtually), 102 presenters (46 attend in person and 56 attend virtually), and participants from various places including Japan, Sri Lanka, Australia, Taiwan, Netherlands, Malaysia, Italy, and of course Indonesia. We were gathered to share knowledge and exchange experiences through meaningful discussions on the latest innovations and technologies in environmental issues. The proceeding of GreenVC 2023 presents the original and unpublished results in all areas of interest. In total, 69 papers have been selected to be published based on the originality of the research and the relevance with the symposium topics: environmental remediation and reclamation; green material and sustainable nanotechnology; waste valorization and biorefineries; smart solutions for climate change and environmental monitoring; and water, sanitation, and hygiene. We would like to express our sincere gratitude to our Advisory Board, Scientific Board, Editorial Board, and Scientific Reviewers for their positive contribution to the quality of the articles presented in this proceeding. We also would like to appreciate all participants attending this symposium as well as the Organizing Committee, who made the symposium a success. Dr. Veny Luvita M.T. Chief Editor List of Committee, Main Rundown and Sponsorship are available in this Pdf.

The Fletcher-Cox Pathway: A Unique View on Clinical Trial Education

PurposeThere currently are no established formal mentorship and training program for radiation oncology (RO) trainees to learn trial design, creation, writing, or implementation. There only exists informal training on analyzing clinical trials in RO residency programs. The integration of a longitudinal formal training and mentorship program for clinical trialists - consisting of clinical trial education, design, mentorship, and implementation during the RO residency education will give residents not only formal teaching in the subject, but strong tools and requisite mentorship in hopes to help them succeed as future academic physicians and leaders in the field of radiation oncology. Methods and MaterialsWe developed a clinical trial training pathway in 2018 at XXX, proposing it as a pilot program. The “Fletcher-Cox Pathway” was accepted with a highly positive response by trainees. and is is now offered as a standard option to RO trainees at our institution. ResultsWith the guidance of their principal investigator (PI), residents participating in this pathway design and submit a clinical trial for institutional review board (IRB) review. In 2019, after implementation of the pilot program, 4 of the incoming 7 residents joined the pathway. The program continues, and the current cohort of trainees have received training in clinical trials design andworked with dedicated mentor(s) regarding clinical trial ideas; their studies are currently accruing patients. ConclusionsThis pilot program has been viewed by trainees and mentors as successful; it highlights how a structured approach meets a clear need within RO training. We envision the creation of a national platform to increase access, whereby programs adopt this clinical trialist educational pathway, which ultimately leads to the development of a robust clinical trial community with communal resources. We hope that this not only improves and provides educational initiatives to all trainees but also initiates further collaboration.

51069 Temporal coordination of the CORE Exams promotes organization of a boards review curriculum enhancing residents’ preparation, confidence, and awareness of content

51069 Temporal coordination of the CORE Exams promotes organization of a boards review curriculum enhancing residents’ preparation, confidence, and awareness of content

Clinical Utility of Molecular Tumor Board Review for Identification of Possible Germline Pathogenic Variants on Tumor Next-Generation Sequencing Reports.

Tumor next-generation sequencing (NGS) testing identifies possible germline pathogenic variants (PGPVs), creating a dilemma for appropriate recognition, triage, and management. The objective of this study was to determine the clinical utility of an institutional molecular tumor board (MTB) in assessing tumor NGS reports for PGPVs. Our institutional MTB reviews all NGS reports to provide treatment and further testing recommendations, including genetic counseling referral and consideration of genetic testing (GC/GT). We studied the patients reviewed by the MTB who were recommended for GC/GT to determine the frequency of referral to a GC, germline test completion, rate of pathogenic germline variants (PGVs), factors related to PGVs, and germline conversion rate (GCR). Of the 2,355 patients reviewed by the MTB during the study period, 609 (25.9%) had a recommendation for GC/GT. Of the 609 with a GC/GT recommendation, only 181 (29.7%) were referred for GC/GT by their treating physicians, and only 107 (17.6%) completed GT. Of the 107 patients completing GT, 29 (26%) had a confirmed PGV. The only factors significantly associated with PGVs were testing due to a PGPV and higher mean variant allele fraction on the tumor NGS. Only 40 patients with a GC/GT recommendation (14.3%) due to a PGPV completed GT; however, the GCR was 42.5% (n = 17/40). The MTB review of PGPV is clinically valuable, identifying PGPV in 12% of patients undergoing tumor NGS and a GCR of 42.5%. Rates of GC/GT completion were relatively low due to under-referral by treating physicians. Given the high GCR, the authors encourage institutional algorithms to help increase GC/GT rates for patients found to have PGPV following tumor NGS testing.

Neurological Surgery Resident ABNS Written Exam Scores Before and After Introduction of a Weekly Didactic Educational Intervention: A 12-Year Single-Institution Retrospective Study.

United States neurological surgery residency education has undergone substantive changes over the past 2 decades. Neurosurgical professional bodies have developed numerous initiatives providing standardized assessments and training opportunities for residency programs. However, there have been few studies using standardized measures to assess core components of educational programming in individual programs. We conducted a 12-year retrospective review of resident American Board of Neurological Surgery (ABNS) board scores using our institutional data from 2010 to 2021 to determine the effect of introducing a weekly didactic resident education hour (REH) on resident scores in the ABNS written in-training examination. ABNS scaled scores were analyzed before (2010-2016) and after (2017-2021) REH introduction. To account for a practice effect, we used a 2-factor linear regression model with an interaction term. We obtained ABNS scores from 43 residents representing 132 test attempts. The average ABNS scaled score significantly improved after the introduction of REH (319 vs 410, t = -3.44, P = .0008). Accounting for the practice effect revealed a significant interaction effect between the number of attempts taking the ABNS examination and whether formal didactics were taught, accounting for 46.2 points on the examination (t = 2.309, P = .023); however, REH alone did not have a significant effect on the scaled scores (t = -1.649, P = .102). ABNS written board scores represent a standardized metric by which educational initiatives within training programs may be assessed for efficacy. Further research is needed to identify educational approaches that are effective to meet the goal of demonstrated mastery of fundamental knowledge in neurosurgery across a diversity of neurological surgery residency programs.

Global hepatitis B and D community advisory board: expectations, challenges, and lessons learned.

Community Advisory Boards (CABs) play an important role in developing and delivering patient-centered care. However, the impact of participation on CAB members has not been well studied, particularly on the global scale. In 2022, the Hepatitis B Foundation (HBF) convened the first global hepatitis B and hepatitis delta CAB with 23 members from 17 countries, representing six out of the seven World Health Organization (WHO) regions, and countries with the largest hepatitis B and hepatitis delta disease burden. To reflect on the process of assembling an effective and motivated CAB and assess the impact on CAB participants, three virtual focus group sessions were held with 16 participants in July and August 2023. Sessions were recorded and transcribed. Questions focused on motivations for joining the CAB, membership experiences, and lessons learned. Grounded theory analysis was used to generate hypotheses about reasons for CAB members' participation, as well as challenges and suggestions. Qualitative analysis using inductive reasoning identified key themes within responses. Transcripts were independently analyzed by a primary and secondary coder. Motivations for joining the CAB included participants' desire to advocate for people living with hepatitis B and hepatitis delta, and other altruistic factors. Participants reflected that through CAB membership, they gained networking and advocacy opportunities and enhanced their hepatitis B- and hepatitis delta-related knowledge. Challenges participants experienced were related to time, physical limitations, and stigma. Finally, participants discussed their limited direct engagement with drug developers and proposed ways the CAB can increase interactions with stakeholders going forward. Based on participants' assessments, establishing a global CAB for stigmatized infectious diseases is worth the effort. Regular internal review of community advisory boards' structure and performance is critical to ensure the CAB is fulfilling its mission.

Assessment of Navy Provider Knowledge of Women's Mental Health Services, Treatment Practices, and Training.

As female active duty populations increase in all military environments, it is critical that women's health be addressed in a comprehensive manner. The study's results will be utilized to assist Navy health care leaders in addressing female force readiness policies, treatment gaps, and training specific to women's mental health. In total, 212 active duty participants were recruited from the Navy's mental health specialties. The survey was hosted on the U.S. Government's MAX.gov survey website and received Institutional Review Board and Survey Review Board approval per Navy and Defense Health Agency requirements. Participants recorded their experiences with various patient presentations using Likert scale assessments, indicated their comfort in prescribing medication to patients with 11 distinct presenting concerns, and responded to six questions regarding their training and clinical experience in the field of women's mental health. Differences were noted for provider gender, treatment setting, patient sex, provider rank, and years of independent practice. Female providers were more likely than males to report that their female patients presented with 15 of the 21 measured issues. Providers located at MTFs were significantly more likely than providers in operational billets to report female patients presenting with certain conditions and reported being more comfortable prescribing medication. Eighty percent of respondents authorized to prescribe medicine rated themselves as very or extremely comfortable prescribing medications to their patients for all specified conditions except two: women who are breastfeeding and women who are pregnant. Senior officers reported the most comfort prescribing medication to women who are planning to become pregnant and women who have experienced perinatal loss. Only a minority of providers (20%, female; 33%, males) reported receiving women's mental health education during their training. Of those who did receive training, it was limited to post-partum and pregnancy. Most participants (93%) agreed that women's mental health should be incorporated into training programs for military providers. This exploratory study highlights that provider variables impact assessment and treatment of and for patients. The study highlights the interplay of gender, treatment setting, experiences, and level of comfort are associated with provider assessment of presenting concerns. The authors hope this study will help in prioritizing women's mental health practices, mental health training, and research, and in informing policy and decision-making.

Nurse Attrition: Content Analysis of Free-Text Responses From Two Military Nursing Practice Environment Surveys.

Staff nurse attrition negatively impacts readiness of the warfighter and the health and wellbeing of all beneficiaries of the Military Health System (MHS). To promote the retention of a robust nursing workforce, a complete understanding of nurses' perceptions regarding their intent to leave is necessary. The purpose of this study was to explore the free-text responses of 1,438 nurses working among military medical treatment facilities for factors influencing their intent to leave, as an indicator of potential turnover, or attrition. This study employed thematic analysis to investigate the qualitative responses from the 2016 and 2018 Military Nursing Practice Environment Surveys. The study was determined to be exempt from Institutional Review Board review through the Womack Army Medical Center's Human Research Protection Program. Findings indicate that leadership and management (n = 647), staffing (n = 353), career opportunities (n = 345), staff outcomes (n = 247), culture (n = 153), quality of care (n = 99), patient care barriers (n = 86), non-patient care activities (n = 79), lack of formal professional development (n = 75), and area or care environment (n = 67) were among the top factors influencing staff nurse intent to leave, respectively. Our findings support the evaluation of retention strategies using implementation science for nurses and nurse resource personnel (e.g., nursing assistants, technicians, medics, and corpsman) to ensure a robust nursing work force throughout the MHS. Staff nurses and resource personnel working among military treatment facilities and embedded in units supporting combat and humanitarian missions ensure access to care and health promotion of the warfighter and all MHS beneficiaries.

Editorial

Dear Readers, It gives me great pleasure to announce the seventh regular issue of 2024. In this issue, 5 papers by 12 authors from 6 countries - Brazil, Ecuador, Germany, Iraq, Spain, Turkey - cover various topical aspects of computer science. In a continuous effort to further strengthen our journal, I would like to expand the editorial board: If you are a tenured associate professor or above with a strong publication record, you are welcome to apply to join our editorial board. We are also interested in high-quality proposals for special issues on new topics and trends. As always, I would like to thank all the authors for their sound research and the editorial board and guest reviewers for their extremely valuable review effort and suggestions for improvement. I also want to thank the readers for their interest in our articles, which is reflected in the consistently high number of user accesses and PDF downloads. These contributions, together with the generous support of the consortium members, maintain the quality of our journal. In the seventh regular issue, I am very pleased to present the following 5 accepted articles: Vinicius Bischoff and Kleinner Farias from Brazil report their study on a controlled experiment with 22 participants (15 students, 7 professionals) in which the correctness and the effort required for the integration of feature models were investigated. Abdulkadir Buldu, Kaplan Kaplan and Melih Kuncan from Turkey present their research on an assistive system based on EEG data and Continuous Wavelet Transform (CWT), which aims to reduce the life-threatening risk for epilepsy patients. In a collaboration between researchers from Ecuador and Spain, Darwin Alulema, Maximiliano Paredes-Velasco and Ricardo de Arriba Lasso report in their manuscript on the LESCA system, which performs adaptive content feedback through scaffolding and supports the development of high-level competencies. In another joint research between colleagues from Iraq and Germany, Anwar Mira and Olaf Hellwich present their approach to improve recognition capabilities by optimizing deep learning features for hand gesture image recognition. Specifically, they propose to enhance features of well-trained DNNs using an improved radial basis function (RBF) neural network, targeting recognition within individual gesture categories. And last but not least, Rasim &amp;Ccedil;ekik and Mahmut Kaya from Turkey propose in their research a new performance metric to evaluate filter feature selection methods in text classification.&amp;nbsp; Enjoy Reading! Best regards,&amp;nbsp; Christian G&amp;uuml;tl, Managing Editor&amp;nbsp;

Global Financial Dynamics: Crisis, Ethics, and Market Impacts: Insights from the June 2023 Issue

With the collaborative support of the editorial board members, authors, reviewers, section editors, technical editors, and production editor, we successfully launched the June 2023 issue of the International Journal of Accounting, Business, and Finance (IJABF). Volume 2, Issue 2 of IJABF features five articles addressing contemporary issues. The authors explore these research questions through empirical results, providing insights and directions for future studies. We extend our gratitude to all contributors to this issue.