Special Consideration Research Articles

Expanding access to genetic testing for pancreatic cancer.

Among individuals with pancreatic ductal adenocarcinoma (PDAC) 5-10% have a pathogenic germline variant (PGV) in a PDAC susceptibility gene. Guidelines recommend genetic testing among all individuals with PDAC. Additionally, at-risk relatives of PDAC patients benefit from their own genetic education, risk assessment, and testing. Multigene panel testing (MGPT) can identify individuals with inherited cancer risk who can benefit from early cancer surveillance and risk reduction strategies. This manuscript discusses various healthcare delivery models for MGPT including traditional in-person genetic counseling, novel integrated in-person infrastructures, telemedicine genetics care via telephone- or video-visits and direct-to-consumer testing. Barriers and facilitators to care on the individual, provider, and system level are also outlined including specific considerations for historically marginalized communities.

Exploring Barriers and Facilitators to COVID-19 Vaccination in People Planning Pregnancy, Trying to Conceive, Pregnant and Post-Partum: A Mixed Methods Study

Pregnant people are at higher risk of morbidity from COVID-19 infection, yet vaccine hesitancy remains prevalent. Our mixed-methods study utilized surveys and interviews to understand decision making regarding COVID-19 vaccination surrounding pregnancy. The most trusted source of information was health care providers. Five themes relating to vaccination barriers and facilitators were identified: 1) COVID-19 vaccine-related policies; 2) pregnancy specific considerations; 3) barriers, facilitators, and influencers to vaccination; 4) vaccination decision based on personal health considerations; 5) attitudes towards COVID-19 and other vaccines. Our study underscores the importance of receiving high-quality information from a trusted source to increase vaccination.

Comparative Study of G+6 Irregular Multistoryed Building of Different Shape of Diaphragm

Abstract: This study investigates the effectiveness of incorporating openings in the roof of re-entrant corner plan irregular buildings at different locations under earthquake loads. Five models with varying degrees of diaphragm discontinuity were analysed using STAAD Pro software. Node displacement, storey shear in X and Z directions, stress values, and maximum bending moment were evaluated to assess structural performance. Results indicate that models with higher diaphragm discontinuity exhibit increased node displacements, storey shear, and stress levels. Model M3, with 17% diaphragm discontinuity, consistently demonstrates superior performance in terms of lower displacements and stress values compared to other models. However, final model selection should consider specific project requirements and design considerations.

The Next Frontier of Security: Homomorphic Encryption in Action

Abstract: Encryption is essential in preventing unauthorized access to sensitive data in light of the growing concerns about data security in cloud computing. Homomorphic encryption promises to enable secure calculations on encrypted data without the need for decryption, particularly for cloud-based operations. To evaluate the effectiveness and applicability of several homomorphic encryption algorithms for safe cloud computing, we compare and contrast them in this research paper. Partially homomorphic encryption (PHE), somewhat homomorphic encryption (SHE), and fully homomorphic encryption (FHE) are the three basic homomorphic encryption subtypes that we examine. The implications of this study can aid cloud service providers and organizations in selecting the most appropriate homomorphic encryption scheme based on their specific security requirements and performance considerations. The research contributes to the ongoing efforts to enhance data privacy in cloud computing environments, opening new possibilities for secure data processing in an increasingly connected digital world. The exploration of homomorphic encryption schemes in this study opens new avenues for research and development in the field of cryptographic techniques. As technology continues to evolve, so too must our approaches to safeguarding data. This research serves as a catalyst for further innovations in homomorphic encryption algorithms, enabling even more efficient and robust methods for secure data processing in cloud environments and beyond. The insights derived from this research paper not only empower cloud service providers and organizations to make informed decisions about selecting the most appropriate homomorphic encryption scheme but also contribute to the broader mission of fortifying data privacy and security in cloud computing.

Comparative Study of G+6 Irregular Multistoryed Building of L Shape of Diaphragm Discontinuity

Abstract: This study investigates the effectiveness of incorporating roof openings in re-entrant corner plan irregular buildings at various locations under earthquake loads. Three models L-shaped diaphragm discontinuity were analyzed using STAAD Pro software. Node displacement and storey shear in both the X and Z directions were evaluated to assess structural performance. The results indicate that models with square diaphragm discontinuity exhibit increased node displacements and storey shear compared to those with L-shaped diaphragm discontinuity. The model with L-shaped diaphragm discontinuity consistently demonstrates superior performance in terms of lower displacements and shear stress values. However, the final model selection should take into account specific project requirements and design considerations.

Considerations for medical nutrition therapy management of the critically ill patient with hematological malignancies: A narrative review.

Patients with hematological malignancies (HMs) are more frequently admitted now than in the past to the intensive care unit (ICU) due to more aggressive approaches in primary therapy of HMs and the need for critical care support. Pathophysiological alterations derived from HMs and the different hematological therapies, such as chemotherapy, negatively affect gastrointestinal (GI) function, metabolism, and nutrition status. Further, malnutrition strongly influences outcomes and tolerance of the different hematological therapies. In consequence, these critically ill patients frequently present with malnutrition and pathophysiological alterations that create challenges for the delivery of medical nutrition therapy (MNT) in the ICU. Frequent screening, gauging tolerance, and monitoring nutrition status are mandatory to provide individualized MNT and achieve nutrition objectives. The present review discusses how HM impact GI function and nutrition status, the importance of MNT in patients with HM, and specific considerations for guidance in providing adequate MNT to these patients when admitted to the ICU.

Humanitarian Aeromedical Retrieval using a Long-Range Commercial Aircraft: A Field Report.

This field report presents the planning and execution of a large-scale aeromedical refugee retrieval operation amid the on-going Russia-Ukraine crisis. The retrieval was coordinated by the Italian Department of Civil Protection and led by the Centrale Remota Operazioni Soccorso Sanitario (CROSS), a governmental facility overseeing medical assistance. An Airbus A320 was chosen for its capacity of 165 passengers, with one emergency stretcher maintaining maximum seating. The aircraft was equipped with an Advanced Life Support kit, and specific considerations for medical equipment compliance were made. Special cases, including patients with on-going chemotherapy and end-stage kidney disease, underwent fit-to-fly screening. The boarding process in Lublin, Poland involved triage and arrangements for passengers with gastroenteric symptoms. Notably, 22 passengers with recent episodes of illness were isolated. The successful operation, demonstrating the viability of evacuating vulnerable individuals via commercial airlines, underscores the importance of precise planning and coordination in crisis situations.

Positive psychology and the search for happiness at work

Positive psychology and the search for happiness at work

The Burden for High-Quality Online Data Collection Lies With Researchers, Not Recruitment Platforms.

A recent article in Perspectives on Psychological Science (Webb & Tangney, 2022) reported a study in which just 2.6% of participants recruited on Amazon's Mechanical Turk (MTurk) were deemed "valid." The authors highlighted some well-established limitations of MTurk, but their central claims-that MTurk is "too good to be true" and that it captured "only 14 human beings . . . [out of] N = 529"-are radically misleading, yet have been repeated widely. This commentary aims to (a) correct the record (i.e., by showing that Webb and Tangney's approach to data collection led to unusually low data quality) and (b) offer a shift in perspective for running high-quality studies online. Negative attitudes toward MTurk sometimes reflect a fundamental misunderstanding of what the platform offers and how it should be used in research. Beyond pointing to research that details strategies for effective design and recruitment on MTurk, we stress that MTurk is not suitable for every study. Effective use requires specific expertise and design considerations. Like all tools used in research-from advanced hardware to specialist software-the tool itself places constraints on what one should use it for. Ultimately, high-quality data is the responsibility of the researcher, not the crowdsourcing platform.

Training physiotherapy students in basic wheelchair provision. Experiences at two universities in Colombia

Wheelchair provision training is essential to overcome barriers related to the lack of knowledge of health professionals on this topic. Appropriate knowledge of the service provision process may lead to higher quality service and products, and thus be more likely to help people with mobility impairments achieve the fundamental human right of personal mobility. This study aimed to describe a training intervention for two groups of future physiotherapists in Colombia, assess cohort differences in performance on a knowledge test, and explore their post-training perceptions. A quantitative retrospective study with a historical, descriptive-comparative design was conducted. 525 sixth-semester participants completed the International Society of Wheelchair Professionals Wheelchair Service Provision – Basic Test online in Spanish after curriculum modifications were implemented. The test assesses knowledge in seven domains: Assessment; Prescription; Products; Fitting; User training; Follow-up, maintenance, and repairs; and Process. The training intervention was successfully implemented with Physiotherapy students from two institutions, resulting in a 57% increase in test approval rates. Participants demonstrated increased knowledge, satisfaction with the course content, and application of learning to their current work. These results suggest implications for what pedagogical approach to employ, when curricular change may be warranted, and specific considerations for the Colombian context. Furthermore, identifying the minimal knowledge basis for undergraduate programs and facilitating its dissemination can support interprofessional education and enhance professionals’ capacity to support wheelchair provision services.

Adaptive design trials in eating disorder research: A scoping review.

This scoping review sought to map the breadth of literature on the use of adaptive design trials in eating disorder research. A systematic literature search was conducted in Medline, Scopus, PsycInfo, Emcare, Econlit, CINAHL and ProQuest Dissertations and Theses. Articles were included if they reported on an intervention targeting any type of eating disorder (including anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorders), and employed the use of an adaptive design trial to evaluate the intervention. Two independent reviewers screened citations for inclusion, and data abstraction was performed by one reviewer and verified by a second. We identified five adaptive design trials targeting anorexia nervosa, bulimia nervosa and binge-eating disorder conducted in the USA and Australia. All employed adaptive treatment arm switching based on early response to treatment and identified a priori stopping rules. None of the studies included value of information analysis to guide adaptive design decisions and none included lived experience perspectives. The limited use of adaptive designs in eating disorder trials represents a missed opportunity to improve enrolment targets, attrition rates, treatment outcomes and trial efficiency. We outline the range of adaptive methodologies, how they could be applied to eating disorder research, and the specific operational and statistical considerations relevant to adaptive design trials. Adaptive design trials are increasingly employed as flexible, efficient alternatives to fixed trial designs, but they are not often used in eating disorder research. This first scoping review identified five adaptive design trials targeting anorexia nervosa, bulimia nervosa and binge-eating disorder that employed treatment arm switching adaptive methodology. We make recommendations on the use of adaptive design trials for future eating disorder trials.

Polling Mechanisms for Industrial IoT Applications in Long-Range Wide-Area Networks

LoRaWAN is a low-power wide-area network (LPWAN) technology that is well suited for industrial IoT (IIoT) applications. One of the challenges of using LoRaWAN for IIoT is the need to collect data from a large number of devices. Polling is a common way to collect data from devices, but it can be inefficient for LoRaWANs, which are designed for low data rates and long battery life. LoRaWAN devices operating in two specific modes can receive messages from a gateway even when they are not sending data themselves. This allows the gateway to send commands to devices at any time, without having to wait for them to check for messages. This paper proposes various polling mechanisms for industrial IoT applications in LoRaWANs and presents specific considerations for designing efficient polling mechanisms in the context of industrial IoT applications leveraging LoRaWAN technology.

[Application of seamless phase Ⅱ/Ⅲ design in vaccine clinical trials].

The seamless phase Ⅱ/Ⅲ design integrates independent phase Ⅱ and phase Ⅲ clinical trials into a continuous, phased adaptive clinical trial design. Compared with traditional independent phase Ⅱ and phase Ⅲ clinical trials, the seamless design offers significant advantages in accelerating drug or vaccine development and improving clinical trial efficiency. Currently, the application of this design in anti-tumor drug research is becoming increasingly mature, and it is gradually expanding to clinical trials of vaccines, including the 9-valent human papillomavirus vaccine, sabin strain inactivated polio vaccine, and others. This paper aims to clarify the seamless phase Ⅱ/Ⅲ design concept and offer valuable insights into its implementation. It accomplishes this by presenting a clinical trial example featuring a phase Ⅱ/Ⅲ seamless design for a 9-valent human papillomavirus vaccine. The article delves into the specific considerations and potential challenges related to implementing the seamless design, aiming to provide valuable insights for optimizing vaccine clinical trials within our country.

Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary.

Blood Sampling Guidelines have been developed totarget European emergency medicine-related professionals involved in the blood sampling process (e.g.physicians, nurses, phlebotomists working in the ED), as well as laboratory physicians and other related professionals. Theguidelines population focus on adult patients. The development of these blood sampling guidelines for the EDsetting isbased on the collaboration of three European scientific societies that have a role toplay in the preanalytical phaseprocess: EuSEN, EFLM, and EUSEM. The elaboration of the questions was doneusing the PICO procedure, literature search and appraisal was based on the GRADE methodology. The final recommendations were reviewed by an international multidisciplinary external review group. The document includes the elaborated recommendations for the selected sixteen questions. Three in pre-sampling, eight regarding sampling, three post-sampling, and two focus on quality assurance. In general, the quality ofthe evidence is very low, and the strength of the recommendation in all the questions has been rated as weak. The working group in four questions elaborate the recommendations, based mainly on group experience, rating as good practice. The multidisciplinary working group was considered one of the major contributors to this guideline. The lack of quality information highlights the need for research in this area of the patient care process. The peculiarities of the emergency medical areas need specific considerations to minimise the possibility of errors in the preanalytical phase.

First Trimester Preeclampsia Screening and Prevention: Perspective in Chinese Mainland

Abstract Preeclampsia (PE), a multisystem disorder in pregnancy, is one of the leading causes of perinatal morbidity and mortality that poses financial and physical burdens worldwide. Preterm PE with delivery at <37 weeks of gestation is associated with a higher risk of adverse maternal and perinatal outcomes than term PE with delivery at ≥37 weeks of gestation. A myriad of first trimester screening models have been developed to identifying women at risk of preterm PE. In fact, the Fetal Medicine Foundation (FMF) first trimester prediction model has undergone successful internal and external validation. The FMF triple test enables the estimation of patient-specific risks, using Bayes theorem to combine maternal characteristics and medical history together with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. Establishing a quality control process for regular monitoring and to ensure data standardization, reliability, and accuracy is key to maintaining optimal screening performance. The rate of preterm PE can be reduced by 62% by using the FMF prediction model, followed by the administration of low-dose aspirin. Recent evidence has also demonstrated that metformin has the potential for preventing PE in patients at high-risk of the disorder. In this article, we will summarize the existing literature on the different screening methods, different components of risk assessment, therapeutic interventions, and clinical implementation of the first trimester screening and prevention program for PE with specific considerations for Chinese mainland.

Subjective well-being of female football players in the German Women’s Bundesliga and 2nd Women’s Bundesliga with special consideration of educational status

ABSTRACT The article analyses factors which are influencing the well-being of elite female footballers. With the educational status, sport-specific factors as well as socio-demographic and socio-economic factors, aspects of the current life circumstances of female footballers are focused. For data generating, an online survey was conducted among women’s Bundesliga and 2nd Women’s Bundesliga footballers. A total of n = 200 questionnaires (German: = 191; English: n = 9) were included in the analysis, which corresponds to approx. 29.6% of the addressed population. The results underline the importance of educational status, the number of injuries/illnesses and the subjectively perceived satisfaction with football-specific income as factors influencing subjective well-being. This study addresses both the gender-bias and the neglect of the educational aspect in previous studies on the well-being of elite athletes and provides implications for the support of dual careers, the need for injury management and the importance of adequate payment in women’s football.

Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies.

Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.

Developing a process to measure actual harm from medication errors in paediatric inpatients: From design to implementation.

The potential harm associated with medication errors is widely reported, but data on actual harm are limited. When actual harm has been measured, assessment processes are often poorly described, limiting their ability to be reproduced by other studies. Our aim was to design and implement a new process to assess actual harm resulting from medication errors in paediatric inpatient care. Prescribing errors were identified through retrospective medical record reviews (n =26 369 orders) and medication administration errors through direct observation (n =5137 administrations) in a tertiary paediatric hospital. All errors were assigned potential harm severity ratings on a 5-point scale. Multidisciplinary panels reviewed case studies for patients assigned the highest three potential severity ratings and determined the following: actual harm occurrence and severity level, plausibility of a link between the error(s) and identified harm(s) and a confidence rating if no harm had occurred. Multidisciplinary harm panels (n =28) reviewed 566 case studies (173 prescribing related and 393 administration related) and found evidence of actual harm in 89 (prescribing = 22, administration = 67). Eight cases of serious harm cases were found (prescribing = 1, administration = 7) and no cases of severe harm. The panels were very confident in 65% of cases (n =302) where no harm was found. Potential and actual harm ratings varied. This harm assessment process provides a systematic method for determining actual harm from medication errors. The multidisciplinary nature of the panels was critical in evaluating specific clinical, therapeutic and contextual considerations including care delivery pathways, therapeutic dose ranges and drug-drug and drug-disease interactions.

Digital Transformation Formulation AT PT. Rohto Laboratories Indonesia

Accelerating digital transformation has become one of the main focuses for facing global challenges and competition. Companies must adopt a holistic approach and build an integrated strategy to succeed in transformation. There are three categories needed to implement digital transformation, namely involving the use of technology, competent human resources, and management or process changes. This study aims to formulate digital transformation at PT. Rohto Laboratories Indonesia. This research uses a mixed methods case study design, combining qualitative and quantitative methods. Next, a purposive sampling technique was chosen to determine the data source sample based on specific considerations and objectives. This research consists of five stages in formulating digital transformation. These five stages refer to the digital transformation strategy development guidelines from Albukhitan (2020). The final result of this research is a digital transformation roadmap for PT. Rohto Laboratories Indonesia obtained data from the four previous stages. The roadmap is divided into two parts: the first part is dominated by the management/process and people categories, while the second part is dominated by technology. Suggestions for further research are to conduct a broader exploration by comparing the application of digital transformation in more than one industrial sector.

Pulmonary Hypertension in Women.

Pulmonary arterial hypertension (PAH) is a rare devastating disease characterized by elevated pulmonary artery pressure and increased pulmonary vascular resistance. Females have a higher incidence of PAH, which is reflected globally across registries in the United States, Europe, and Asia. However, despite female predominance, women had better outcomes compared with male patients, a finding that has been labeled the "estrogen paradox." Special considerations should be given to women with PAH regarding sexual health, contraception, family planning, and treatment before, during, and after pregnancy. Pregnant women with PAH should be referred to a pulmonary hypertension care center; a multidisciplinary team approach is recommended, and Cesarean section is the preferred mode of delivery. While pregnancy outcomes have improved over the years with PAH-specific therapy, pregnancy portends a high-risk for those with PAH. Continued research is needed to tailor PAH treatment for women.