Special Information Research Articles

Infliximab for Immune Checkpoint Inhibitor Therapy-Related Toxicities

What Is the Issue? Immune checkpoint inhibitor (ICI) therapy has become a treatment option for various types of advanced cancer, resulting in significant improvement in disease outcomes. However, ICIs can overstimulate the immune system leading to various side effects known as immune-related adverse events (irAEs) that can occur in any organ system. Administration of corticosteroids is the initial mainstay treatment of irAEs. However, there is little evidence of how to treat steroid-resistant irAEs. Treatment of steroid-resistant irAEs includes holding ICI and starting immunosuppressive therapy. Decision-makers are interested in understanding the use of infliximab, a selective immunosuppressive drug, for the treatment of steroid-resistant irAEs affecting various organs. What Did We Do? We identified and summarized the literature regarding the efficacy and safety of infliximab for the treatment of steroid-resistant irAEs. Due to the limitation of evidence, we included studies of any design, including case reports and case series. A research information specialist conducted a literature search of peer-reviewed and grey literature sources published between January 1, 2019 and April 8, 2024. One reviewer screened citations for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? The evidence presented in this report was based on 2 systematic reviews of case reports and case series, 1 retrospective cohort study, and 40 additional publications consisting of 29 case reports and 11 case series. We identified 4 main irAEs, which were colitis, hepatitis, pneumonitis, and myocarditis. Very low-quality evidence, which was mainly derived from case reports and case series, suggests that infliximab may be effective for the treatment of steroid-resistant immune-induced colitis, while there are concerns regarding its use for the treatment of hepatitis due to potential hepatotoxicity and infectious complications. There is mixed evidence regarding the use of infliximab for the treatment of immune-induced pneumonitis and myocarditis. Recent consensus guidelines recommend the use of infliximab as first-line treatment for steroid-resistant immune-induced colitis, while its use for hepatitis is not recommended due to potential hepatotoxicity and infectious complications. The use of infliximab for the treatment of pneumonitis is an option, while its use for myocarditis remains to be determined. The usual dose of infliximab was 5 mg/kg, administered by IV. A higher dose of 10 mg/kg was seen in some cases. The number of infusions, the period between infusions and the length of treatment varied depending on the responsiveness of infliximab and the type and severity of irAEs. Treatment with infliximab as compared with vedolizumab resulted in comparable immune-induced colitis response rates, higher recurrent rate of colitis, and more hospitalizations despite a shorter time to clinical response. What Does This Mean? The very low-quality evidence identified suggests the potential benefits of infliximab in the management of immune-induced colitis due to its efficacy and fast response. When using the clinical evidence and recommendations summarized in this report to inform decisions, decision-makers should consider that the evidence is of very low quality, mainly derived from case reports and case series. Large prospective and comparative studies are needed to verify the findings and to determine the role of infliximab in the treatment of other irAEs.

Pengaruh Inovasi Promosi Media Sosial Instagram dan Tiktok untuk Menarik Pelanggan Baru pada Bube Boba Café

In today’s digital age, social media has become one of the most effective tools for marketing a variety of, including the food and beverage industry. Platforms like Instagram and TikTok provide a great opportunity for to interact directly with their customers like Bube Boba Cafe. As a result, BubeBoba Cafe must maximize both of these platforms in its marketing strategy. The type of research used is qualitative descriptive method. This method is used to provide a more detailed description of the impact of Instagram and TikTok's social media promotion innovations on the recruitment of new customers at Bube Boba Cafe. The sample used in this study is a BubeBoba Cafe customer who uses social media Instagram and tikTok to learn information about products and promo cafes. The data collection technique used in this study is with interviews and study of libraries or written sources such as books, previous research, papers, data collected and then analyzed to find out the impact of Instagram and TikTok social media promotion innovations on the recruitment of new customers at Bube Boba Cafe. Data analysis is carried out using descriptive qualitative analysis techniques to obtain a more detailed description and detail of the results of the research. To run a strategy using social media touch. Bube Cafe uses promotional tools in carrying out its promotional activities, as follows: 1. Advertising The advertising media on the social media of TikTok is the tikTok ads, from which there are several types of ads such as pre-roll asd is the video ad that is started when the user opens tiktok, in-feed ads is the advertising video that appears when the users of tiktok menscroll feed, promoted hastag challenges is video that encourages the users to use special tags, and last branded effects is the filter of special effects to be used by the creators of content in video, these effects are similar to the filters that exist in snapchat and instagram but which is the differentiator is this filter displays special information. 2. Direct marketing is like making interactive videos.

Jurisprudential Discernment and Protection Path of Personal Biological Information in the Context of Metaverse

元宇宙是借助数字技术打造的沉浸式全息虚拟社会，其实现需要依靠增强现实（AR）、虚拟现实（VR）等沉浸式技术设备获得用户的动态，在此过程中需要大量收集用户的身体特征数据、手势动作、眼球位置信息等广义的“个人生物信息”。当前，我国《个人信息保护法》对于广义上的“个人生物信息”并无明确定义，仅将“个人生物识别信息”列举为“特殊个人敏感信息”的七种情形之一。结合个人生物信息在元宇宙中的技术中立、平台管理、跨国利用、去中心化追责风险，应拓宽“个人生物识别信息”的法律概念，将“可识别”纳入其概念范畴内，以回应个人生物信息的广义内涵。此外，还需要建立去中心化身份认证系统，完善 “My Data” 数据模式，并强化代码与法律的互补，以构建更加全面和有效的个人生物信息保护机制，在技术发展的同时确保个人隐私不受侵害，构建安全、公正、有序的元宇宙环境。 Metaverse is an immersive holographic virtual society created with the help of digital technology, the realisation of which needs to rely on immersive technological devices such as Augmented Reality (AR) and Virtual Reality (VR) to obtain the dynamics of the user, and in the process needs to collect a large number of user’s physical characteristics data, gestures, eye position information and other broadly-defined “personal bio-information”. Currently, China’s Personal Information Protection Law does not have a clear definition of “personal biological information” in the broad sense, and only lists “personal biometric information” as one of the seven types of “special personal sensitive information”. It only lists “personal biometric information” as one of the seven cases of “special personal sensitive information”. Taking into account the risks of technological neutrality, platform management, transnational use and decentralisation of personal biometric information in the meta-universe, the legal concept of “personal biometric information” should be broadened to include “identifiable” in its conceptual scope, in order to respond to the broad connotation of personal biometric information. The legal concept of “personal biometric information” should be broadened to include “identifiable” in order to respond to the broader meaning of personal biometric information. In addition, it is also necessary to establish a decentralised authentication system, improve the “My Data” data model, and strengthen the complementarity between code and law, in order to build a more comprehensive and effective protection mechanism for personal biometric information, to ensure that personal privacy is not infringed upon while the technology develops, and to build a safe, just and orderly meta-universe environment.

Pharmacological Effects of Polygonati Rhizoma on "Tonifying the Kidney" and Its Development Status in the Field of Health Care

Polygonati Rhizoma has traditional effects of tonifying the kidney, with a wide clinical application. The record of Polygonati Rhizoma can be traced back to Miscellaneous Records of Famous Physicians, where Polygonati Rhizoma was catalogued "to mainly tonify and replenish qi, and long-time administration can make the body agile, prolong life and relieve hunger". In modern times, Pharmacopoeia of the People’s Republic of China 2020 also records its effect of tonifying the kidney. In this study, the records of the related functions of Polygonati Rhizoma mainly in three aspects, "prolonging life", "tonifying essence and marrow", and "strengthening muscles and bones", were first sorted out in ancient and modern classics. This study also collected relevant prescriptions, such as Polygonati Rhizoma pill, and Polygonati Rhizoma and Radix Rehmanniae pill, with kidney-tonifying effects from 8 medical books including Arcane Essentials from the Imperial Library, Formulas from Benevolent Sages Compiled during the Taiping Era, Comprehensive Recording of Divine Assistance, etc. Through further retrieval of literature and analyses, it was confirmed that the pharmacological effects of Polygonati Rhizoma on "tonifying the kidney" contain improvement of arthritis and osteoporosis, anti-aging, immunoregulation, anti-fatigue, improvement of renal injury, improvement of reproductive function and anti-hypertension. The search and statistical analyses of special food information in State Administration for Market Regulation revealed that there are 409 kinds of health-care foods, with Polygonati Rhizoma as the main raw material, which have 15 kinds of health-care functions. Among them, "kidney-tonifying" health-care products that can enhance immunity, resist fatigue, elevate bone density or delay aging accounts over 80%. The last part of this study discussed and analyzed the pharmacological research progression of Polygonati Rhizoma on "tonifying the kidney" and its development status in the field of health care, so as to provide reference for in-depth development and application of Polygonati Rhizoma.

Use of large language models to optimize poison center charting

Introduction Efficient and complete medical charting is essential for patient care and research purposes. In this study, we sought to determine if Chat Generative Pre-Trained Transformer could generate cogent, suitable charts from recorded, real-world poison center calls and abstract and tabulate data. Methods De-identified transcripts of real-world hospital-initiated poison center consults were summarized by Chat Generative Pre-Trained Transformer 4.0. Additionally, Chat Generative Pre-Trained Transformer organized tables for data points, including vital signs, test results, therapies, and recommendations. Seven trained reviewers, including certified specialists in poison information and board-certified medical toxicologists, graded summaries using a 1 to 5 scale to determine appropriateness for entry into the medical record. Intra-rater reliability was calculated. Tabulated data was quantitatively evaluated for accuracy. Finally, reviewers selected preferred documentation: original or Chat Generative Pre-Trained Transformer organized. Results Eighty percent of summaries had a median score high enough to be deemed appropriate for entry into the medical record. In three duplicate cases, reviewers did change scores, leading to moderate intra-rater reliability (kappa = 0.6). Among all cases, 91 percent of data points were correctly abstracted into table format. Discussion By utilizing a large language model with a unified prompt, charts can be generated directly from conversations in seconds without the need for additional training. Charts generated by Chat Generative Pre-Trained Transformer were preferred over extant charts, even when they were deemed unacceptable for entry into the medical record prior to the correction of errors. However, there were several limitations to our study, including poor intra-rater-reliability and a limited number of cases examined. Conclusions In this study, we demonstrate that large language models can generate coherent summaries of real-world poison center calls that are often acceptable for entry to the medical record as is. When errors were present, these were often fixed with the addition or deletion of a word or phrase, presenting an enormous opportunity for efficiency gains. Our future work will focus on implementing this process in a prospective fashion.

What is known about the role of external facilitators during the implementation of complex interventions in healthcare settings? A scoping review

ObjectiveTo synthesise current knowledge about the role of external facilitators as an individual role during the implementation of complex interventions in healthcare settings.DesignA scoping review was conducted. We reviewed original...

The Dynamics of the ICT Workforce and the Effects on the Use of Artificial Intelligence Technologies in the European Union

Abstract This paper represents an analysis made using statistical methods of the influence of the number of Information and Communication Technology (ICT) specialists on the number of businesses that use and invest in technologies based on artificial intelligence (AI). Throughout the article, the authors analyze two sets of statistical data collected by Eurostat: the share of ICT specialists in the overall active population and the number of companies that use and invest in AI technologies, both datasets referring to the European Union. Using several statistical methods, such as normality tests, correlation analysis and regression analysis on the datasets, the results show that the relation between the number of ICT specialists and the number of businesses that use and invest in AI technologies is a positive one, which means that the bigger the share of ICT specialists in the overall active population, the more businesses will adopt and use AI technologies. Therefore, the conclusions emphasize the important role that ICT specialists play when discussing about raising the rate of adoption of newer technologies, based on AI and the content of the paper underlines the fact that the more businesses and companies use and invest in AI, the more these technologies will be used in other industries as well, such as finance and education, the least playing a critical role in forming the next generation of ICT specialists with a strong knowledge in the AI field. The role these specialists play in growing the rate of adoption of AI technologies is also confirmed by the literature review. Moreover, the paper also presents a series of conclusions relevant to entrepreneurs and teachers that are willing to include these kind of technologies into their daily activities and also a series of measures to stimulate the rate of adoption of artificial intelligence based technologies in the European Union.

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Global, regional, and national cancer burdens of respiratory and digestive tracts in 1990–2044: A cross-sectional and age-period-cohort forecast study

BackgroundUnderstanding the current status and future trends of cancer burdens by systems provides important information for specialists, policymakers, and specific risk populations. MethodsThe aim of this study was to compare the current and future cancer burdens of the gastrointestinal (GI) and respiratory tracts in terms of their magnitude and distribution. Data from a total of eight cancers of the digestive and respiratory tracts in the Global Burden of Disease (GBD) database were collected. The age-standardized incidence/death rates (ASIR/ASDRs), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) were analyzed. Future trends were predicted with Bayesian age-period-cohort (BAPC) and NORDPRED models. ResultsIn 2019, there was a significant increase in DALY for both digestive and respiratory tract cancers compared to 1990. Meanwhile, ASIR increased slightly and ASDR decreased notably. In 2019, the global cancer burdens of respiratory and digestive tracts were 38568363.53 and 66912328.72 in DALY, 34.28 and 55.32 in ASIR, and 656.82 and 808.22 in ASDR per 100,000 population with changes of +54.63% and +43.93%, +2.92% and +5.65%, and −17.39% and −26.83% compared to those in 1990, respectively. Significant cross-regional differences in the cancer burdens were observed among the regions. Compared to four representative chronic diseases, the burden of cancers showed less remission and greater global inequalities. The burdens of both digestive and respiratory tract cancers were higher in males than in females in terms of the ASIR, ASDR, and DALY. The incidence and mortality rates of respiratory tract cancers were up to 3–4 times higher in males than in females, whereas the difference between male and female rates of digestive tract cancers was relatively smaller. The main risk factor associated with all kinds of digestive and respiratory tract cancers is tobacco, leading to 18.5 in ASDR and 3.38×107 in DALY for respiratory tract cancers; 8.29 in ASDR and 1.60×107 in DALY for digestive tract cancers, in 2019. Additionally, alcohol use contributes to most digestive and respiratory tract cancers (1.23/1.03 in ASDR and 1.60×106/2.57×106 in DALY for respiratory tract cancers; 4.19/3.82 in ASDR and 4.49×106/8.06×106 in DALY for digestive tract cancers), except for stomach cancer and tracheal, bronchus, and lung cancer. The cancer burdens of respiratory and digestive tracts are likely to decrease substantially between 2020 and 2044. For most metrics, except for the ASIR and male-to-female ratios of ASDR and ASDALY in digestive tract cancers, the worldwide variances of burden metrics have been decreasing in the past decades and will possibly maintain stable trends in the future. ConclusionsThe epidemiology of respiratory and GI tract cancers has common features and individual characteristics that are reflected in geography, age characteristics, and risk factors. Current epidemiological status, future trends, and the globalization of these disease burdens are important factors for making scientific planning of resources to minimize the cancer burden metrics and their cross-regional inequalities.

Faktor Relationship Benefits yang Meningkatkan Positive Word of Mouth di Toko Buku Impor X

This study aims to analyze the effect of relationship benefits on the creation of positive Word of Mouth (WOM) in imported bookstore X. In the context of increasingly competitive marketing, Word of Mouth has become a strategic focus for companies as an effective and economical alternative in influencing consumer behavior. The research method used Purposive Sampling with 200 respondents aged 18-45 years who had shopped at imported bookstore X. The majority of respondents were women (59.5%), aged 25-34 years (39.5%), and S1 graduates (56.5%). The analysis is carried out using the Structural Equation Modeling (SEM) method to examine the relationship between variables. The study involved 9 variables, including trust benefits, special treatment benefits, social benefits, information benefits, sharing benefits, functional quality, technical quality, relationship quality, and word of mouth. The results of the analysis show that Confidence Benefit and Sharing Benefit have a significant influence in increasing the sense of security and desire to share from store employees. Relationship Quality is also important to increase customer trust and satisfaction. Word of Mouth becomes a major factor in improving sales perception and reputation. This research provides a deep understanding of the role of Relationship Benefits in creating positive Word of Mouth in the retail environment, providing strategic implications for companies in designing effective WOM-based marketing programs to influence consumer preferences.

A practical introduction to radio frequency electronics for NMR probe builders

In this tutorial paper, we describe some basic principles and practical considerations for designing probe circuits for NMR or MRI. The goal is building a bridge from material that is familiar from undergraduate physics courses to more specialized information needed to put together and tune a resonant circuit for magnetic resonance. After a brief overview of DC and AC circuits, we discuss the properties of circuit elements used in an NMR probe and how they can be assembled into building blocks for multi-channel circuits. We also discuss the use of transmission lines as circuit elements as well as practical considerations for improving circuit stability and power handling.

#1103 Delayed initiation or reduced initial dose of calcineurin-inhibitors for kidney transplant recipients: a systematic review and meta-analysis

Abstract Background and Aims Delayed graft function (DGF) is more common in donors after cardiac death, especially expanded criteria donors and those with longer cold ischaemia time, older or with an increased serum creatinine. There is no agreement on the optimal immunosuppressive approach in patients at increased risk of DGF, with strategies including a delayed introduction of calcineurin inhibitors (CNI) or initial low dose CNI. Our aim was to evaluate the benefits and harms of delayed initiation of CNI or reduced CNI dose as initial immunosuppression therapy for kidney transplant (KT) recipients at high risk of DGF. Method We searched the Cochrane Kidney and Transplant Register of Studies up to 07 March 2023 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. We included all randomized controlled trials (RCTs) and quasi-RCTs evaluating early vs delayed initiation of CNI or reduced vs standard initial dose of CNI in kidney transplant (KT) recipients at high risk of DGF. Three authors independently assessed study eligibility, and two assessed the risk of bias, certainty of evidence, extracted the data, and performed the analysis. Results were reported as risk ratios with 95% confidence intervals for dichotomous outcomes and as mean difference with 95% CI for continuous outcomes. Statistical analysis was performed using the random-effects model. Risk of bias was assessed with RoB2 and the certainty of the evidence according to GRADE methods. Results Thirteen studies were included (2386 randomized participants). Incidence of DGF (RR 1.09, 95% CI 0.89 to 1.32; I2 = 18%) and acute rejection (RR 0.98, 95% CI 0.72 to 1.33; I2 = 54%) were similar between early and delayed introduction of CNI, as well as between low vs standard dose of CNI (DGF: RR 1.16, 95% CI 0.90 to 1.50; I2 = 9%; acute rejection: RR 0.70, 95% CI 0.43 to 1.14; I2 = 58%). There were also no differences in secondary outcomes such as graft function, graft loss, risk of death, or infection. Conclusion In patients at high risk of DGF, the strategy of delaying CNI introduction or starting at a lower dose does not reduce the risk of DGF.

#165 Substantial variation in the evaluation of kidney transplant recipient candidates prior to waitlisting: a worldwide scoping review

Abstract Background and Aims Before patients with end stage kidney disease can undergo kidney transplantation, their suitability is assessed through a transplantation work-up. Several international guidelines have outlined the most important factors in determining patient suitability for kidney transplantation, but there is little agreement among them and it is unclear whether their recommendations have been adopted into clinical practice. Variation in the evaluation of kidney transplant recipient candidates could contribute to inefficiency and inequality in accessing the transplant waiting list and kidney transplantation. Therefore, the standardization of pre-waitlisting practice patterns is desirable and in line with recommendations from Europe [1] and the US [2]. An overview of publications on pre-waitlisting practices for kidney transplantation is needed to increase the transparency of kidney transplant recipient candidacy evaluation and is a first step towards the standardization of pre-waitlisting procedures. To date, such an overview has not been performed. Therefore, our aim was to conduct a scoping review on the evaluation of kidney transplant recipient candidates prior to waitlisting, investigating: (a) the content of the transplantation work-up; (b) contraindications to waitlisting; and (c) the organization of the transplantation work-up. Method A systematic search was conducted in Ovid Medline and Ovid EMBASE in collaboration with a medical information specialist. Studies reporting practice patterns on the evaluation of adults receiving their first kidney graft from a deceased donor were included. Studies were excluded if they only reported: on pediatric patients; from the perspective of the patients; practice patterns following waitlisting; COVID-19-related changes to practice patterns; and results from novelty screening methods used to evaluate kidney transplant recipient candidates without evidence that these methods were also used in clinical practice. Results Results from 40 studies were summarized, of which a majority were conducted in Europe (n = 11) and the US (n = 21). The content of the transplantation work-up varied widely between studied centers. Results show that the presence of a written transplantation work-up was common in the US, UK, and Norway, while in other countries, the presence of a written transplantation work-up protocol was not reported. Common domains within the transplantation work-up included screening for infections, heart disease, peripheral artery disease, and malignancy. A wide range of contraindications to waitlisting were reported. The criteria for contraindications related to obesity and age/frailty varied between studied centers and appear to have changed over time. In general, the organization of the transplantation work-up (e.g. the referral process, the transplant care team, and the use of multidisciplinary meetings) was comparable across studied centers, but differences were observed in the way the transplantation work-up was carried out. Conclusion This is the first review summarizing practice patterns related to the evaluation of kidney transplant recipient candidates prior to waitlisting. Results showed substantial variation in the evaluation of kidney transplant recipient candidates and pre-waitlisting practice patterns globally. These findings contribute to increasing the transparency of pre-waitlisting practice patterns, as was endorse by EU and US recommendations. In turn, this may aid in standardizing criteria used to evaluate kidney transplant recipient candidates prior to waitlisting, which could improve kidney transplantation access and outcomes.

Rapid reviews methods series: guidance on rapid qualitative evidence synthesis

This paper forms part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group and addresses rapid qualitative evidence syntheses (QESs), which use modified systematic, transparent and...

Interventions for preventing haemodialysis dysequilibrium syndrome.

Dialysis dysequilibrium syndrome (DDS) refers to neurological symptoms usually seen during or after new initiation or following reinitiation of haemodialysis (HD) after missing multiple sessions. DDS is associated with death and morbidity. We studied interventions aimed at preventing DDS. To evaluate the benefits and harms of different types of interventions for preventing DDS. We contacted the information specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 8 May 2024 using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. We included randomised controlled trials (RCTs) that compared any intervention against standard care, including individuals initiated on HD, regardless of age. Two authors independently determined study eligibility, assessed quality and extracted data. Data were collected on methods, interventions, participants, and outcomes (DDS incidence, severe DDS, death, adverse events). Risk ratios (RR) and confidence intervals (CI) were calculated. Study quality was assessed using the Cochrane Risk of Bias 2 (ROB2) tool. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We included two RCTs, enrolling 32 adult participants. Interventions included were slow dialysis, sodium modelling, standard sodium dialysate, and high sodium dialysate. The risk of bias was of some concern to high risk of bias in both studies. Slow dialysis compared to sodium modelling (1 study, 15 participants) may result in little to no difference in DDS, severe DDS, and death (low certainty evidence) and has uncertain effects on adverse events (RR 1.33, 95% CI 0.15 to 11.64; very low certainty evidence). Standard sodium dialysate compared to high sodium dialysate (1 study, 17 participants) has uncertain effects on the incidence of DDS (RR 0.07, 95% CI 0.00 to 1.12), severe DDS (RR 0.47, 95% CI 0.02 to 10.32), and adverse events (RR 0.29, 95% CI 0.08 to 1.02) (very low certainty evidence). In HD patients, sodium modelling, compared to slow dialysis, may result in little to no difference in DDS and death (low certainty evidence) and has uncertain effects on adverse events (very low certainty evidence). The evidence is very uncertain for the effect of high-sodium dialysate and standard sodium dialysate on DDS, death and adverse events (very low certainty evidence).

Don’t Go for Different! Developing Specialized Information Services for Researchers from Distinct Subject Areas

Digital library services are frequently designed for specific user groups with very specific usage needs. This article presents a qualitative comparative analysis of findings derived from six user and usability studies in four different specialized subject information services. Rather than postulating hypotheses regarding variations in needs and behaviors among user groups, this article explores similarities among researchers’ requirements for specialized information service portals. The findings suggest that distinct subject areas may no longer require separate information systems tailored to each field’s specific needs. With the rise of interdisciplinary research, researchers increasingly favor the adoption of a unified system or multiple systems with consistent operation.

Interoperability Structure of Smart Water Conservancy Based on Internet of Things

Massive smart water conservancy object (WCO) need to be connected for real-time monitoring and control, which produces massive data. Unfortunately, heterogeneous data structures and semantics lead to low interoperability between WCO and management systems. To address this challenge, we propose a novel interoperability structure for a smart water conservancy system based on the Internet of Things (IoT), and the key design includes a smart WCO terminal, interoperability network, special interoperability protocol, WCO information model, and cloud platform. Universal terminal and network are the base of interoperability hardware, and special interoperability protocol and information model for interconnection of WCO are designed for smart water conservancy management system. WCO can be connected to a water conservancy Big Data processing cloud platform for interoperability applications. The application results demonstrate that our proposed WCO’s interoperability structure has obvious advantages than the general IoT at WCO interoperability. The interoperability protocol is reliable, the information model can ease interoperability and security, and the semantic dictionary is very rich and covers all semantic services of WCO.

Newborn Screening for Congenital Cytomegalovirus

What Is the Issue? Congenital cytomegalovirus (cCMV) is estimated to affect between 0.2% and 2.4% of newborns worldwide, and may cause long-term effects, including hearing loss and neurodevelopmental disability. Newborn screening for cCMV can identify affected neonates and provide an opportunity for early treatment, which may reduce any long-term effects from infection. We wanted to know if universal newborn screening is a clinically effective and cost-effective intervention for identifying and managing cCMV. What Did We Do? We identified and summarized published literature comparing the clinical effectiveness and cost-effectiveness of universal newborn screening with either targeted newborn screening or no screening for congenital cytomegalovirus in neonates. We also identified and summarized published, evidence-based guidelines that make recommendations concerning the use of newborn screening for congenital cytomegalovirus to help inform decisions considering the use of this intervention. An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2014, and March 19, 2024. The search was limited to English-language documents. One reviewer screened articles for eligibility based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? Evidence from 1 prospective cohort study in the US found that, compared to universal newborn screening for cCMV, targeted newborn screening failed to identify a significant proportion of neonates who developed hearing loss associated with infection. Three cost-effectiveness evaluations concluded that universal newborn screening for cCMV was cost-effective when compared to targeted newborn screening or no screening. None of these analyses were specific to the Canadian context. While 1 of 3 evidence-based guidelines identified by this review makes a recommendation favouring universal newborn screening for cCMV, 2 evidence-based guidelines recommend against the implementation of universal newborn screening for cCMV (including 1 from the Canadian context), generally citing a lack of sufficient clinical evidence. What Does This Mean? The included cost-effectiveness studies and evidence-based guidelines in this report emphasize that limited clinical evidence is currently available to inform decision-making concerning newborn screening for cCMV. Jurisdictions where universal newborn screening for cCMV has been implemented provide an opportunity for clinical research to support and inform future decision-making. The current limitation of available clinical data describing newborn screening for cCMV will require decision-makers to draw from a broader set of inputs and sources than those available from empirical studies.

Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients.

The risk of cytomegalovirus (CMV) infection in solid organ transplant recipients has resulted in the frequent use of prophylaxis to prevent the clinical syndrome associated with CMV infection. This is an update of a review first published in 2005 and updated in 2008 and 2013. To determine the benefits and harms of antiviral medications to prevent CMV disease and all-cause death in solid organ transplant recipients. We contacted the information specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 5 February 2024 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. We included randomised controlled trials (RCTs) and quasi-RCTs comparing antiviral medications with placebo or no treatment, comparing different antiviral medications or different regimens of the same antiviral medications for CMV prophylaxis in recipients of any solid organ transplant. Studies examining pre-emptive therapy for CMV infection are studied in a separate review and were excluded from this review. Two authors independently assessed study eligibility, risk of bias and extracted data. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This 2024 update found four new studies, bringing the total number of included studies to 41 (5054 participants). The risk of bias was high or unclear across most studies, with a low risk of bias for sequence generation (12), allocation concealment (12), blinding (11) and selective outcome reporting (9) in fewer studies. There is high-certainty evidence that prophylaxis with aciclovir, ganciclovir or valaciclovir compared with placebo or no treatment is more effective in preventing CMV disease (19 studies: RR 0.42, 95% CI 0.34 to 0.52), all-cause death (17 studies: RR 0.63, 95% CI 0.43 to 0.92), and CMV infection (17 studies: RR 0.61, 95% CI 0.48 to 0.77). There is moderate-certainty evidence that prophylaxis probably reduces death from CMV disease (7 studies: RR 0.26, 95% CI 0.08 to 0.78). Prophylaxis reduces the risk of herpes simplex and herpes zoster disease, bacterial and protozoal infections but probably makes little to no difference to fungal infection, acute rejection or graft loss. No apparent differences in adverse events with aciclovir, ganciclovir or valaciclovir compared with placebo or no treatment were found. There is high certainty evidence that ganciclovir, when compared with aciclovir, is more effective in preventing CMV disease (7 studies: RR 0.37, 95% CI 0.23 to 0.60). There may be little to no difference in any outcome between valganciclovir and IV ganciclovir compared with oral ganciclovir (low certainty evidence). The efficacy and adverse effects of valganciclovir or ganciclovir were probably no different to valaciclovir in three studies (moderate certainty evidence). There is moderate certainty evidence that extended duration prophylaxis probably reduces the risk of CMV disease compared with three months of therapy (2 studies: RR 0.20, 95% CI 0.12 to 0.35), with probably little to no difference in rates of adverse events. Low certainty evidence suggests that 450 mg/day valganciclovir compared with 900 mg/day valganciclovir results in little to no difference in all-cause death, CMV infection, acute rejection, and graft loss (no information on adverse events). Maribavir may increase CMV infection compared with ganciclovir (1 study: RR 1.34, 95% CI: 1.10 to 1.65; moderate certainty evidence); however, little to no difference between the two treatments were found for CMV disease, all-cause death, acute rejection, and adverse events at six months (low certainty evidence). Prophylaxis with antiviral medications reduces CMV disease and CMV-associated death, compared with placebo or no treatment, in solid organ transplant recipients. These data support the continued routine use of antiviral prophylaxis in CMV-positive recipients and CMV-negative recipients of CMV-positive organ transplants.

Anticytokine Therapy and Corticosteroids for Cytokine Release Syndrome and for Neurotoxicity Following T-Cell Engager or CAR T-Cell Therapy

What Is the Issue? Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are the most common toxicities secondary to T-cell engager or chimeric antigen receptor (CAR) T-cell therapy. The US FDA and Health Canada approved tocilizumab, an anti-interleukin-6 receptor antagonist, for the management of severe or life-threatening cases of CRS. Corticosteroids also play an important role in CRS management and are the mainstay of ICANS management. Decision-makers are interested in understanding the use of anticytokine drugs (i.e., tocilizumab, anakinra, siltuximab) and/or corticosteroids in the management of CRS and ICANS following T-cell engager or CAR T-cell therapy. What Did We Do? We identified and summarized the literature comparing the clinical effectiveness and safety of anticytokine therapy and/or corticosteroids with alternative care or treatment as usual for treating and preventing of CRS and ICANS. We also searched for evidence-based recommendations for the use of anticytokine therapy and/or corticosteroids to treat and prevent CRS and ICANS. A research information specialist conducted a literature search of peer-reviewed and grey literature sources published between January 1, 2019 and February 26, 2024 for CRS; and between January 1, 2019 and March 4, 2024 for ICANS. One reviewer screened citations for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? This report presents evidence-based findings on 3 retrospective chart review studies, 2 prospective cohort studies, and 4 consensus guidelines. Limited and low-quality clinical evidence from studies with a high risk of bias suggested that early use of tocilizumab or corticosteroids, or prophylactic use of tocilizumab or anakinra may reduce the risk of a high-grade CRS without a negative impact on neurotoxicity or immunotherapy treatment outcomes. The included guidelines recommend the use of tocilizumab for treatment of higher-grade CRS, or for treatment of grade 1 CRS if symptoms persist for 3 days or more. Corticosteroids could be added in conjunction if there is no improvement or persistent symptoms after tocilizumab therapy. For the management of ICANS in the absence of concurrent CRS, supportive care is the preferred treatment option for grade 1 ICANS, while corticosteroids are recommended for the management of grade 2 to 4 ICANS. In the presence of concurrent CRS, guidelines recommend tocilizumab therapy as per management of CRS, and corticosteroids should be continued until improvement to grade 1. We did not identify any clinical evidence regarding the clinical efficacy and safety of anticytokine therapy and/or corticosteroids for treatment of CRS and ICANS compared with alternative treatment or treatment as usual. We also did not identify any guidelines for the use of prophylactic anticytokine therapy, corticosteroids, or both for the prevention of CRS and ICANS. What Does This Mean? Despite limited and low-quality evidence, the findings suggest some potential benefits of prophylactic or early use of anticytokine therapy and corticosteroids for the management of immunotherapy-related toxicities. Guidelines offer guidance on the management of CRS, ICANS and other less common toxicities related to immunotherapy based on the available low-quality evidence. When using the clinical evidence and recommendations summarized in this report to inform decisions, decision-makers should consider that the evidence is limited and of low quality. To improve the certainty of findings, there is a need for more robust prospective clinical trials with larger sample sizes, and lower risk of bias.