Paradigm Shift Research Articles

A Consensus Statement on the Administration of Systemic Bevacizumab in Patients with Recurrent Respiratory Papillomatosis.

To provide detailed guidance on the administration of systemic bevacizumab in patients with recurrent respiratory papillomatosis (RRP) based on a detailed review of the scientific literature and a consensus of experts with real-world clinical experience. A bevacizumab consensus working group (N = 10) was composed of adult and pediatric otolaryngologists, adult and pediatric oncologists, and a representative from the RRP Foundation (RRPF), all with experience administering systemic bevacizumab in patients with RRP. After extensive review of the medical literature, a modified Delphi method-based survey series was utilized to establish consensus on the following key areas: clinical and patient characteristics ideal for treatment candidacy, patient perspective in treatment decisions, treatment access, initial dosing, monitoring, guidelines for tapering and discontinuation, and reintensifying therapy. Seventy-nine statements were identified across nine critical domains, and 45 reached consensus [clinical benefits of bevacizumab (3), patient and disease characteristics for treatment consideration (7), contraindications for treatment (3), shared decision-making (incorporating the patient perspective) (5), treatment access (3), initial dosing and administration (8), monitoring (7), tapering and discontinuation (6), and reintensification (3)]. This consensus statement provides the necessary guidance for clinicians to initiate systemic administration of bevacizumab and represents a potential paradigm shift toward nonsurgical treatment options for patients with RRP. 5 Laryngoscope, 2024.

Viewpoint: The impending pandemic of resistant organisms - a paradigm shift towards source control is needed.

The United States needs a paradigm shift in its approach to control infectious diseases. Current recommendations are often made in a siloed feedback loop. This may be the driver for such actions as the abandonment of contact precautions in some settings, the allowance of nursing home residents who are carriers of known pathogens to mingle with others in their facility, and the determination of an intervention's feasibility based upon budgetary rather than health considerations for patients and staff. Data from both the U.S. Veterans Health Administration and the U.K.'s National Health Service support the importance of carrier identification and source control. Both organizations observed marked decreases in methicillin-resistant Staphylococcus aureus (MRSA), but not methicillin-susceptible Staphylococcus aureus infections with the implementation of MRSA admission screening measures. Facilities are becoming over-reliant on horizontal prevention strategies, such as hand hygiene and chlorhexidine bathing. Hand hygiene is an essential practice, but the goal should be to minimize the risk of workers' hands becoming contaminated with defined pathogens, and there are conflicting data on the efficacy of chlorhexidine bathing in non-ICU settings. Preemptive identification of dedicated pathogens and effective source control are needed. We propose that the Centers for Disease Control and Prevention should gather and publicly report the community incidence of dedicated pathogens. This will enable proactive rather than reactive strategies. In the future, determination of a patient's microbiome may become standard, but until then we propose that we should have knowledge of the main pathogens that they are carrying.

Facile Coordination Transitions in AgCrX2 (X = S, Se): Unprecedented Electrostrain, Negative Piezoelectricity and Thermal Expansion.

The coefficients of piezoelectricity and thermal expansion are generally positive due to the bond anharmonicity. For converse piezoelectricity, the electrostrain obtained in prevalent ceramics is only around 1%. Here we propose that the coordination transition of metal cations may make a paradigm shift. Through first-principles calculations, we predict a series of low-energy phases with distinct coordinations for Ag ions in superionic conductor AgCrX2 (X = S, Se), including ferroelectric and nonpolar phases with distinct interlayer distances. The mobile feature of Ag ions, which can be attributed to its complex coordination chemistry, can facilitate transformation between various coordination phases. Such facile transitions with ultralow barriers can be driven by applying either pressure, an electric field, or a change in temperature, giving rise to various exotic effects, including electrostrain, negative piezoelectricity, and negative thermal expansion. All with unprecedented giant constants, those mechanisms stem from the coordination transitions, distinct from the weak linear effects in previous reports.

The etiological profile of chronic organic non-bloody diarrhea in India: Emergence of inflammatory bowel disease as a dominant cause.

Chronic non-bloody diarrhea may be attributed either to functional or organic diseases. The latter category may present with malabsorption syndrome if there is extensive involvement of the small bowel, whereas diseases of the large bowel may only present with diarrhea sans malabsorption. Indian data has predominantly focussed on the etiological spectrum of malabsorption syndrome in adults. The primary aim of the current study was to evaluate etiological spectrum of chronic organic non-bloody diarrhea in India. This prospective observational study was done at a tertiary care hospital in North India. Patients ≥ 18years presenting with chronic non-bloody diarrhea of > 4weeks duration were enrolled in the study after exclusion of patients with IBS and anal incontinence. During the study period of 12months, 100 patients with chronic organic non-bloody diarrhea were evaluated. A definite etiological diagnosis was made in 97 patients (97%). The mean age of the patients was 48 ± 16.7years (58% males). The median duration of diarrhea was 5.5months (interquartile range [IQR] 3.5, 11). Inflammatory bowel disease (IBD) accounted for 45% of the cases making it the predominant cause for organic diarrhea. GI infections and adult-onset celiac disease accounted for 18% and 9% of the cases, respectively. Pancreatic disease, benign or neoplastic, accounted for 6% of the total cases. Notably, gastrointestinal (GI) malignancies manifesting as chronic non-bloody diarrhea were diagnosed in 5% of the patients. Our data suggests a paradigm shift in the etiological spectrum of chronic organic non-bloody diarrhea in India with the emergence of IBD as the predominant cause displacing GI infections.

Speech norms shaping adult-child discourse in Ghana: A critical pedagogy perspective

This study investigates the speech norms shaping adult-child discourse in Ghana, focusing on three tribes: Asante, Dagbani, and Akuapem Kyerepon. The study uncovers pervasive cultural conservatism, where challenging established norms is deemed unacceptable, especially in the context of child-elderly interactions. The study reveals a profound acquiescence effect, wherein children are compelled to accept statements from adults, even if they are aware of inaccuracies. Ageism also plays a significant role, as the culture discriminates against children, restricting their ability to contest and/or oppose the knowledge and opinions of the elderly. The implications of these speech norms on critical pedagogy in schools are explored. It was found that the rare practice of critical pedagogy significantly hindered the development of students' critical thinking and problem-solving skills. Students found it quite challenging in question the validity of knowledge, expressing disagreement with teachers views, and initiating discussions due to deeply ingrained speech norms of the Ghanaian society. These findings underscore the need for a paradigm shift in Ghanaian education to foster critical thinking. This calls for the need for sensitization of teachers and educational policy essential for integrating critical pedagogy effectively.

Paradigm Shift to Higher-Quality Education Base on the SDG: A Framework for Reforms in Teachereducation Programs

Paradigm Shift to Higher-Quality Education Base on the SDG: A Framework for Reforms in Teachereducation Programs

Mandatory due diligence legislation: a paradigm shift for the governance of sustainability in global value chains?

Mandatory due diligence legislation: a paradigm shift for the governance of sustainability in global value chains?

The evolution and practice on design concepts of internal fixation devices for intertrochanteric femur fractures

Surgical treatment has been established as the standard method for the treatment of intertrochanteric fractures in the elderly. The design of internal fixation devices has become the key to improving surgical outcomes and reducing postoperative complications. Centered on optimizing biomechanical performance and minimally invasive implantation, coupled with continuous material improvements, the design philosophy of internal fixation devices has also been constantly evolving. There have been several milestone advancements, such as the transition from eccentric fixation to central fixation, the adoption of sliding compression fixation, the replacement of traditional screws with spiral blades, and the shift from single to double (combination) nails. However, the incidence of internal fixation-related complications has remained at a relatively high level of 5% to 10%, without significant breakthroughs. Increasing evidence suggests that in-depth analysis of the anatomy, physiological mechanisms, and mechanical transmission characteristics of the proximal femur can help elucidate the root causes of internal fixation failures. Based on this, the proximal femoral bionic nail (PFBN) has emerged as a new design concept. By fully mimicking the anatomical, mechanical, and biological characteristics of the proximal femur, the PFBN can regulate the local mechanical environment, providing a revolutionary solution and a new approach for the treatment of proximal femoral fractures. This innovative design also has the potential to drive the paradigm shift in the treatment strategies of other fractures.

The replication crisis as mere indicator of two fundamental misalignments: Methodological confirmation bias in hypothesis testing and anthropological oversimplification in theory-building

Psychological research is currently in a phase of transition. The replication crisis has led to the introduction of a number of corrective measures such as preregistration, registered reports, open data and methods in order to make scientific knowledge in psychological science more reliable. In this article, we discuss why these tools remain superficial and provide rather a symptom treatment than a deeper treatment of the causes of the replication crisis. To this end, we address two central misalignments of current psychological research: Confirmation bias, in the sense of overweighting significant, hypothesis-confirming findings over negative ones, and the anthropological oversimplification of the human research subject. We conclude by providing indications of how a paradigm shift in psychological science research and publication practices can help to combat the causes of the replication crisis and poor scientific research practices.

Gate-Based Variational Quantum Algorithm for Truss Structure Size Optimization Problem

Quantum computing has become a pivotal innovation in computational science, offering novel avenues for tackling the increasingly complex and high-dimensional optimization challenges inherent in engineering design. This paradigm shift is particularly pertinent in the domain of structural optimization, where the intricate interplay of design variables and constraints necessitates advanced computational strategies. In this vein, the gate-based variational quantum algorithm utilizes quantum superposition and entanglement to improve search efficiency in large solution spaces. This paper delves into the gate-based variational quantum algorithm for the discrete variable truss structure size optimization problem. By reformulating this optimization challenge into a quadratic, unconstrained binary optimization framework, we bridge the gap between the discrete nature of engineering optimization tasks and the quantum computational paradigm. A detailed algorithm is outlined, encompassing the translation of the truss optimization problem into the quantum problem, the initialization and iterative evolution of a quantum circuit tailored to this problem, and the integration of classical optimization techniques for parameter tuning. The proposed approach demonstrates the feasibility and potential of quantum computing to transform engineering design and optimization, with numerical experiments validating the effectiveness of the method and paving the way for future explorations in quantum-assisted engineering optimizations.

Tumors of the central nervous system. Classification of the World Health Organization 2021. Towards a paradigm shift.

The study of central nervous system (CNS) tumors is a subject of great interest and such knowledge is of great importance in medical practice. The classifications of CNS neoplasms began in the mid-19th century, until the World Health Organization (WHO) published, in 1979, the first edition of a useful systematic review for the purpose of establishing a common language for all medical specialties. To date, 5 updated editions of neoplastic taxonomy have been published. The fifth edition, from 2021, consolidates the paradigm shift brought about by molecular advances, although the transition between morphological and molecular biological characterization is still in progress. In this article, the new modifications introduced in the different most frequent families of tumors in pediatrics are analyzed, emphasizing useful information for pediatricians in their daily practice and multidisciplinary consultations.

Differences in linear and angular measurement of the lower facial third in lateral cephalometry and lateral photometry: A comparative study

BackgroundIn clinical orthodontic practice, to evaluate aesthetics in dentistry, lateral cephalometry and lateral photometry are used to measure and assess craniofacial morphology. In contrast to cephalometry, photometry has no radiation hazard and is less expensive. There has been a paradigm shift in contemporary orthodontics that now emphasizes soft tissue aesthetics, rather than depending entirely on hard tissue evaluation from lateral cephalometry. Therefore, the key question is whether lateral photometry can be a substitute for conventional cephalometry for diagnostics, prognostic analysis, and treatment planning. ObjectiveTo differentiate between lateral cephalometry and lateral photometry measurement in children with stage 2 and 3 vertebrae maturation in the Deutero Malay population. Materials and MethodsA standardized protocol was followed for all lateral cephalograms and photographs from 38 subjects who met the inclusion criteria. Three parameters focusing on the lower third craniofacial measurement were investigated: two linear parameters (mandibular ramus length and mandibular length) and one angular parameter (gonial angle). These parameters were measured using Webceph software. All parameters were digitized on both cephalograms and photographs and were compared using an independent sample t-test. ResultsWhen comparing the angular cephalometric and photometric variables, we found that the mandible length (Go-Me) and gonial angle (∠Go) in the cephalometry measurements had an insignificant difference compared to the photometric measurements, while the ramus length (Co-Go) in the cephalometry measurement had a significant difference compared to the photometric measurements. ConclusionAlthough we cannot rule out cephalometry as the primary record in orthodontics, lateral photometry assessment can be used as an alternative candidate for measuring mandibular body measurements and gonial angle in stage 2 and 3 cervical maturation in the Deutero Malay race.

Patient-Led Research to Develop a Training Programme for Restoring Musical Joy in Cochlear Implant Recipients: A Reflexive Process Evaluation.

The role of patients in healthcare research is slowly evolving, although patient roles in the research process are limited. This paper reports on a patient-led research project aiming to develop a musical hearing training programme for patients with a cochlear implant (CI): the Musi-CI programme. A CI is an inner ear prosthesis that allows people with severe hearing loss to hear. However, while speech can be understood, CI users cannot fully enjoy music or feel aversion to it. The Musi-CI programme aims to reduce this music aversion to ultimately improve music enjoyment and social participation. The development of the Musi-CI programme was supported by a consortium of professionals in CI rehabilitation and research. The aim of this paper is to describe and evaluate the Musi-CI programme development process and its impact on professional CI rehabilitation and research. Programme development was described using a 3-layered process model of action research, distinguishing the CI user process, the healthcare professional process and the research process. To evaluate perceptions on the programme development process, consortium partners provided written commentsand participated in a reflexive evaluation session that was video-recorded. Reflexive evaluation aims for collective learning and strengthening collaboration among participants. Written comments and video data were analysed using template analysis. The involvement of an expert by experience was perceived as challenging but rewarding for all consortium partners, opening up new perspectives on CI-rehabilitation practice and research. Data analysis revealed two themes on the programme development process, professional space and acknowledgement, and two themes on the outcomes on CI rehabilitation and research: critical reflection and paradigm shift. Experts by experience represent a different knowledge domain that may contribute to change in rehabilitation and research. The development of the programme was initiated by a professional musician and CI user who organized the funding, had a leading role throughout the research process, including the write-up of the results, and co-authored this paper.

Additive Manufacturing: A Paradigm Shift in Revolutionizing Catalysis with 3D Printed Photocatalysts and Electrocatalysts Toward Environmental Sustainability.

Semiconductor-based materials utilized in photocatalysts and electrocatalysts present a sophisticated solution for efficient solar energy utilization and bias control, a field extensively explored for its potential in sustainable energy and environmental management. Recently, 3D printing has emerged as a transformative technology, offering rapid, cost-efficient, and highly customizable approaches to designing photocatalysts and electrocatalysts with precise structural control and tailored substrates. The adaptability and precision of printing facilitate seamless integration, loading, and blending of diverse photo(electro)catalytic materials during the printing process, significantly reducing material loss compared to traditional methods. Despite the evident advantages of 3D printing, a comprehensive compendium delineating its application in the realm of photocatalysis and electrocatalysis is conspicuously absent. This paper initiates by delving into the fundamental principles and mechanisms underpinning photocatalysts electrocatalysts and 3D printing. Subsequently, an exhaustive overview of the latest 3D printing techniques, underscoring their pivotal role in shaping the landscape of photocatalysts and electrocatalysts for energy and environmental applications. Furthermore, the paper examines various methodologies for seamlessly incorporating catalysts into 3D printed substrates, elucidating the consequential effects of catalyst deposition on catalytic properties. Finally, the paper thoroughly discusses the challenges that necessitate focused attention and resolution for future advancements in this domain.

Industry 4.0 to Industry 5.0: A Paradigm Shift towards Sustainable and Human Centric Production

Industry 4.0 to Industry 5.0: A Paradigm Shift towards Sustainable and Human Centric Production

A Paradigm Shift: Implications for Social Worker Provision of LGBTQI+ Information and Support in Human Milk Feeding

A Paradigm Shift: Implications for Social Worker Provision of LGBTQI+ Information and Support in Human Milk Feeding

Is It Time for a Paradigm Shift in the Surgical Management of Trigeminal Schwannomas? Evaluating the Role of the Transorbital Approach: An Anatomo-Clinical Study and Systematic Literature Review

BackgroundEndoscopic transorbital approach emerged in recent years as an effective, minimally invasive route to access Meckel’s cave area. Several case series proved its effectiveness in the surgical treatment of trigeminal schwannomas. Nonetheless, this route provides the advantages of a minimally invasive approach associated with low morbidity rates. In this anatomo-clinical study we illustrate the usefulness of the superior eyelid transorbital approach for the surgical treatment of trigeminal schwannoma guiding the clinical applicability of the anatomical findings into the real surgical practice. MethodsSuperior eyelid transorbital endoscopic approach was performed on eight cadaveric specimens, and the surgical results were confirmed in a retrospective review of all the surgical cases of transorbital surgery performed by the senior authors providing an illustrative case. Finally, we performed a literature review of all the case series of trigeminal schwannomas operated through an endoscopic transorbital approach. ResultsStepwise dissection was divided in 3 phases: skin, endo-orbital and endocranial. The illustrative case provided demonstrate gross total resection of a cavernous sinus type trigeminal schwannomas treated through this route. Literature review revealed 68 cases of trigeminal schwannomas that were successfully treated using the transorbital approach. ConclusionsThe endoscopic transorbital approach may offer a valuable alternative for the surgical treatment of trigeminal schwannomas. This technique provides a minimally invasive, direct and natural “interdural” route to the lateral wall of the cavernous sinus and Meckel's cave.

What can we learn from multimorbidity? A deep dive from its risk patterns to the corresponding patient profiles

Multimorbidity, the presence of two or more chronic conditions within an individual, represents one of the most intricate challenges for global health systems. Traditional single-disease management often fails to address the multifaceted nature of multimorbidity. Network model emerges as a growing field for elucidating the interconnections among multimorbidity. However, the field lacks a standardized method to compute and visually represent of these networks. Given the challenges, this study proposes a three-stage methodology to decipher multimorbidity. First, we integrate the Failure Modes and Effects Analysis (FMEA) method with the multimorbidity encapsulation framework to develop the Multimorbidity Risk Network (MRN). Second, we use complex network techniques to identify high-risk patterns within MRN communities. Finally, we apply machine learning techniques to correlate these communities with the biological attributes of patients that have been marginalized in most studies. Our approach advocates a paradigm shift from the conventional focus on single diseases to a holistic, patient-centric approach, providing decision-makers with integrated information technology artifacts for deciphering the multimorbidity.

Water transport and corrosion under insulation: Experimental investigations of drying in mineral wool

Corrosion under insulation (CUI) is a major risk factor for the material integrity of insulated equipment that is encountered i.a. in the chemical process industries. Undetected CUI has been the root cause for major accidents, including loss-of-site, loss-of-life, prolonged plant shutdown, and environmental pollution. Reducing CUI risk via labour-intensive inspection routines is associated with billions of dollars of annual maintenance costs worldwide. CUI is caused by water bypassing a weather shield, migrating through the insulation and contacting the equipment surface. The resulting corrosion rates are very high and the process is hidden from view. Surprisingly, the fundamental mechanisms that drive water migration through insulation have been largely unexplored. In this work we present novel experimental investigations of the evaporation and drying dynamics for a heated vertical pipe with preformed mineral wool insulation and metal cladding. Relative humidity and temperature sensors provide measurements of how the water evaporates and travels through the system during controlled water ingress experiments. The experimental data shows that the drying time of the insulation material is proportional to the amount of water added. We find that the drying process proceeds in two stages, where the length of the first drying regime is directly related to the diffusion-limited evaporation from the bulk liquid water, while the second drying time is influenced also by other factors such as the adsorption and desorption of water on the insulation material fibres. The findings have implications for how time of wetness, used in CUI risk-based inspection methods, can be obtained from humidity sensor data. The new insights into water transport in insulation enables a paradigm shift towards predictive CUI maintenance using humidity spot sensors.

Social Norms: A Missing Ingredient of Programs Seeking to Foster Nutrition Agency

BackgroundSocial expectations play a crucial role in shaping dietary practices among women and children. However, despite significant attention to promoting social and behavioral change in nutrition-focused programs and research, the influence of social norms on women’s agency in enhancing nutrition practices is often overlooked. In this perspective, we advocate for a paradigm shift by incorporating a “norms aware” approach. This underscores the importance of recognizing, measuring, and addressing the societal constraints and barriers that women and children encounter in their journey to improved nutrition. ObjectivesDrawing on insights from the United States Agency for International Development-funded Kulawa project in Niger, we highlight the implications of using social norms diagnosis tools to understand the contextual dynamics within child-feeding practices, informing intervention design, and targeted populations. Integrating a norms perspective into nutrition programming and research does not require an overhaul, but rather a nuanced application of understanding of contextual drivers, such as social norms and agency, that have been underemphasized. MethodsWe delve into the role of the socio-ecologic system, underscore the importance of addressing power imbalances related to gender and social hierarchy, and emphasize that programs targeting norms should aim for community rather than individual-level change. We provide guidance for programs and research integrating a norms perspective, as well as examples of how tools, such as the Social Norms Exploration Tool and Social Norms Analysis Plot framework, can be applied to identify and prioritize social norms, facilitating the design of “norms aware” programs. Additionally, we highlight the critical role of community engagement and discuss the value of using qualitative and quantitative approaches to document the process and outcomes of social norms research, program design, and implementation. ConclusionsWhen we recognize the role of social norms in nutrition as a missing ingredient in nutrition research, programming, and social and behavior change strategies, we create opportunities for more effective and contextually relevant research and interventions that address the complexities of enhancing nutrition practices among women and children.