Stop Shop Research Articles

MutationalPatterns: the one stop shop for the analysis of mutational processes

BackgroundThe collective of somatic mutations in a genome represents a record of mutational processes that have been operative in a cell. These processes can be investigated by extracting relevant mutational patterns from sequencing data.ResultsHere, we present the next version of MutationalPatterns, an R/Bioconductor package, which allows in-depth mutational analysis of catalogues of single and double base substitutions as well as small insertions and deletions. Major features of the package include the possibility to perform regional mutation spectra analyses and the possibility to detect strand asymmetry phenomena, such as lesion segregation. On top of this, the package also contains functions to determine how likely it is that a signature can cause damaging mutations (i.e., mutations that affect protein function). This updated package supports stricter signature refitting on known signatures in order to prevent overfitting. Using simulated mutation matrices containing varied signature contributions, we showed that reliable refitting can be achieved even when only 50 mutations are present per signature. Additionally, we incorporated bootstrapped signature refitting to assess the robustness of the signature analyses. Finally, we applied the package on genome mutation data of cell lines in which we deleted specific DNA repair processes and on large cancer datasets, to show how the package can be used to generate novel biological insights.ConclusionsThis novel version of MutationalPatterns allows for more comprehensive analyses and visualization of mutational patterns in order to study the underlying processes. Ultimately, in-depth mutational analyses may contribute to improved biological insights in mechanisms of mutation accumulation as well as aid cancer diagnostics. MutationalPatterns is freely available at http://bioconductor.org/packages/MutationalPatterns.

Endoscopic Ultrasound-Guided Portal Pressure Gradient Measurement, Is It Ready for Prime Time?

Portal hypertension is a serious complication of advanced liver disease. Portal pressure gradient measurement accurately determines severity of portal hypertension, prognosis, and guides medical therapy. Conventionally, interventional radiology-guided hepatic venous portal gradient measures portal pressure gradient indirectly using specialized balloon catheter. Recent advances in endoscopy have paved the novel method of endoscopic ultrasound-guided direct portal pressure gradient measurement to evaluate portal hypertension with equivalent safety in both animal models and humans studies. With the expansion of Endo-Hepatology practice, a concept of “one stop shop” is becoming more popular which is a comprehensive endoscopic approach in the evaluation of chronic liver disease. During the same endoscopic procedure, patients could be evaluated for esophageal or gastric varices, portal hypertensive gastropathy, EUS-guided elastography, EUS-guided portal pressure measurement and EUS-guided liver biopsy when suspecting advanced liver disease or diagnosis remains uncertain. This article focuses on the overview of portal hypertension and EUS-guided interventions such as EUS-guided portal pressure measurement, EUS-guided elastography and EUS-guided liver biopsy in the evaluation of individuals with advanced liver disease.

POSB416: The Oscar Project: 'One Stop Shop for Clinical Research' on Danish Real World Data

Scandinavian registry data are world renown for their high validity and the ability to combine different types of health data with personal data on financials, education and employment. To retain the approval of Scandinavian citizens on data collection, Danish health data has been fiercely protected, leading to extensive processing times and limitation of use cases - especially in commercial drug development. The aim of OSCAR is to ease and increase the utilization of Danish Registry Data/Real World Data to support increased and improved personalised drug development, by introducing a secure and ethical IT platform.

One stop shop approach for the diagnosis of liver hemangioma.

Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.

Long-term retention and predictors of attrition for key populations receiving antiretroviral treatment through community-based ART in Benue State Nigeria: A retrospective cohort study.

BackgroundKey populations (KP) are disproportionately infected with HIV and experience barriers to HIV care. KP include men who have sex with men (MSM), female sex workers (FSW), persons who inject drugs (PWID) and transgender people (TG). We implemented three different approaches to the delivery of community-based antiretroviral therapy for KP (KP-CBART) in Benue State Nigeria, including One Stop Shop clinics (OSS), community drop-in-centres (DIC), and outreach venues. OSS are community-based health facilities serving KP only. DIC are small facilities led by lay healthcare providers and supported by an outreach team. Outreach venues are places in the community served by the outreach team. We studied long-term attrition of KP and virological non-suppression.MethodThis is a retrospective cohort study of KP living with HIV (KPLHIV) starting ART between 2016 and 2019 in 3 0SS, 2 DIC and 8 outreach venues. Attrition included lost to follow-up (LTFU) and death. A viral load >1000 copies/mL showed viral non-suppression. Survival analysis was used to assess retention on ART. Cox regression and Firth logistic regression were used to assess risk factors for attrition and virological non-suppression respectively.ResultOf 3495 KPLHIV initiated on ART in KP-CBART, 51.8% (n = 1812) were enrolled in OSS, 28.1% (n = 982) in DIC, and 20.1% (n = 701) through outreach venues. The majority of participants were FSW—54.2% (n = 1896), while 29.8% (n = 1040), 15.8% (n = 551) and 0.2% (n = 8) were MSM, PWID, and TG respectively. The overall retention in the programme was 63.5%, 55.4%, 51.2%, and 46.7% at 1 year, 2 years, 3 years, and 4 years on ART. Of 1650 with attrition, 2.5% (n = 41) died and others were LTFU. Once adjusted for other factors (age, sex, place of residence, year of ART enrollment, WHO clinical stage, type of KP group, and KP-CBART approach), KP-CBART approach did not predict attrition. MSM were at a higher risk of attrition (vs FSW; adjusted hazard ratio (aHR) 1.27; 95%CI: 1.14–1.42). Of 3495 patients, 48.4% (n = 1691) had a viral load test. Of those, 97.8% (n = 1654) were virally suppressed.ConclusionAlthough long-term retention in care is low, the virological suppression was optimal for KP on ART and retained in community-based ART care. However, viral load testing coverage was sub-optimal. Future research should explore the perspectives of clients on reasons for LTFU and how to adapt approach to CBART to meet individual client needs.

ANALISIS KOMPARASI KEBIJAKAN PERPAJAKAN TRANSAKSI E-COMMERCE YANG BERLAKU DI INDONESIA DENGAN NEGARA LAIN (UNI EROPA, AUSTRALIA, KOREA SELATAN, INDIA, TIONGKOK, AMERIKA SERIKAT, DAN JEPANG)

Indonesia has experienced an increase in users of e-commerce platforms, resulting in increased income for sellers, both individuals and entities, who conduct online sales transactions. Therefore, the Indonesian government sets a tax policy for online sellers. However, the Indonesian government still has several obstacles, one of which is that e-commerce transactions have an eternal nature. To answer these problems, the author compares the taxation policies on e-commerce transactions that apply in Indonesia with the tax policies on e-commerce transactions that apply in other countries, namely the European Union, Australia, South Korea, India, China, the United States, and Japan. The writing method used by the author is a literature study method. This paper shows that the taxation policy on e-commerce transactions in Indonesia, the European Union, Australia, South Korea, India, China, the United States, and Japan imposes a Value Added Tax (VAT) or the like as a consumption tax on goods. And services as well as sales tax and Income Tax. In addition, several countries have created platforms or special teams to manage taxes from e-commerce transactions, namely the platform Mini One Stop Shop (MOSS), now called OSS (European Union); Korean Fair Trade Commission (KFTC) (South Korea); Professional Team for E-Commerce Taxation (Protect) (Japan). Therefore, Indonesia needs to follow the example of the European Union, South Korea, and Japan in terms of establishing a system or team dedicated to managing tax collection from e-commerce transactions

Evaluating the feasibility of a Pre-Exercise Screening System for Young People

Introduction: No best-practice approach for pre-exercise risk management and screening of young people currently exists, highlighting a potential gap in exercise leader’s ability to ensure safe participation. Although benefits of exercise overshadow risks for most individuals, pre-exercise screening is crucial to avoid preventable harm and/or adverse events. This study evaluated the feasibility of the evidence-based Pre-exercise Screening System for Young People (PSS-YP) which was co-designed by multidisciplinary national committee, supported by governing and regulatory bodies (e.g., Exercise & Sport Science Australia, Sports Medicine Australia, Fitness Australia). Methods: A mixed methods design was employed to explore the feasibility of the PSS-YP. Quantitative statistical methods explored aspects of feasibility based on a survey of exercise professionals across Australia (n=195). Semi-structured interviews and content analytic procedures were employed to explore feasibility of the system for end users: young people 16-17yrs (n=5) and parents/guardians (n=9). Results: Most exercise professionals (86.1%) indicated a screening system is needed, and specifically that the PSS-YP system is acceptable (81.2%) and practical (91.3%). Rasch analysis identified agreement across most items, noting greater variance in response regarding medical disclosure in the absence of parent/guardian (i.e., on a 1-5 Likert scale of agreeability M=2.95 ± 1.34). Interview meaning units grouped in qualitative feedback from end users reporting main themes regarding demand (n=29), acceptability (n=138), and practicality (n=28) coincide with exercise professionals support for the tool. For example, “I like that the tool covers a lot of depth and breadth, I like the idea of a one stop shop”. Open-ended questions throughout interviews identified notable emergent themes, confidentiality and development or behaviour considerations. Discussion: The consensus amongst exercise professionals, young people and parents/guardians suggests the PSS-YP is feasible and fulfils an identified need for safe exercise participation for young people. Importantly, the PSS-YP tool seems to be taken on positively by most exercise professionals regardless of background, age, experience, and career. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Urgent elective pathway service reconfiguration facilitates increased use of surgical adjuncts, improvement in survival trends, and reduced hospital stay for glioblastoma patients

Abstract Aims Glioblastomas (GB) are the most common and aggressive of intrinsic brain tumours. Median survival with maximal therapy is reported to be 14.6 months. Service reconfiguration at the Queen Elizabeth Hospital Birmingham (QEHB) has transformed the service for high grade brain cancer patients, including GB, from a predominantly emergency pathway based system to one of planned urgent-elective admissions consisting of: A. Patient-focused, consultant-led, research orientated “one stop shop” model of integrated outpatient neurosurgical oncology clinic B. Standardisation of urgent elective pathways C. Incorporation of neuro-surgical intra-operative adjuncts (neuro-monitoring, 5-ALA) into routine surgical practice for oncology. Using this model, we have reduced hospital length of stay (with associated financial savings), improved extent of resection and achieved a trend towards increased survival. Method We retrospectively identified patients with primary histological diagnoses of GB (WHO grade IV), who underwent surgery over a six year period, from 01/01/2014 to 31/12/2019, from the QEHB pathology database. Data was collected for demographics, surgical and oncological therapy, use of intra-operative adjuncts, emergency and elective admission status, year of admission, length of stay (LOS), and extent of resection (EOR) on first post-operative MRI scan from hospital databases. Survival was analysed using the Kaplan-Meier method and independent-samples median testing for survival. Proportion of patients undergoing resective surgery and admission status was calculated by year. Overall median survival was calculated and subgroup comparisons made of patients by: age, admission status, year of admission, biopsy or resection, oncology treatment. Hospital length of stay was calculated for patients by surgical procedure, admission pathways and compared across the year. Financial data taken from averages of inpatient episode costs were used to estimate cost savings. Results 610 patients underwent primary procedures for GB, of which 64 were still alive at time of analysis (02/02/2021). Median overall survival time was 9.53 months, this was greatest in patients who underwent resection with completion of Stupp protocol: 28.67 months (n=114). From 2014 to 2019, there has been an increase in elective admission rates (28.1% to 90.3%, p<0.001) and increased proportion of resective surgery (68.4% to 81.9%, p<0.001). There is a trend of improved survival from 2014 to 2019 (median 7.95 and 11.08 months, χ2=9.249, p=0.002). Increasing use of intra-operative adjuvants improved EOR (χ2 =31.064, p<0.001). Through improved urgent-elective admission rates, hospital length of stay has decreased by five days for craniotomies and six days for biopsies. Cost analysis of three cases demonstrated that reducing the LOS by one night alone result in an average cost saving of approximately £750 per patient per night. Conclusion Switching to a system of planned and urgent elective based admission, with standardisation of neuro-oncology patient pathways, increased use of intra-operative adjuncts, earlier oncology multidisciplinary input and outpatient review, has improved the extent of GB resection, led to shorter length of hospital stay associated with significant financial savings and achieved a trend towards increased overall survival.

Evaluating the impact of a joint Clinical Nurse Specialist and Allied Health Care Professional clinic for neuro-oncology patients attending Velindre Cancer Centre, Cardiff

Abstract Aims Key governing guidelines recognise that the holistic and complex needs of neuro-oncology patients are best served by a cohesive multidisciplinary team (MDT). Achieving a joint Clinical Nurse Specialist (CNS) and Allied Healthcare Professional (AHP) clinic (including Speech and Language Therapy, Physiotherapy, Dietetics and Occupational Therapy) for neuro-oncology patients has been a longstanding vision at Velindre Cancer Centre (VCC) in Cardiff. A successful funding application to Welsh Government in July 2020 allowed the establishment of a virtual “one stop shop” clinic with CNS and AHPs available along the care trajectory to improve patient and carer quality of life. The project reports on whether this innovative clinic model successfully achieved the desired coordinated, anticipatory and holistic care. Method The project utilised service improvement methodology principles with aims inherent within quarterly timeframes. This included robust data collection on patient attendances and interventions, improving patient education and self-management and wide patient, care and staff engagement by means of questionnaires and semi-structured interviews. The mixed methods approach yielded rich quantitative and qualitative data. Results The data demonstrates an increasing demand for the joint neuro-oncology clinic indicating that additional resources may be required. From triangulation of patient, carer and wider team engagement the key benefits were perceived to be having accessibility to the team in a convenient way, the provision of support and timely information and the overall perception of enhanced holistic care. Conclusion The data demonstrates the huge successes of the joint neuro-oncology clinic so far, including improvements to patient and carer quality of life, wider VCC benefits and cost saves. The persuasive case was presented to Welsh Government, and ongoing endorsement has been achieved for the next financial year.

Are We ‘Just’ Midwives or are We All Advanced Practitioners?

Midwives in recent times have expanded their skill set beyond recognition. Where once it appeared novel to complete a newborn examination, now we are being trained in external cephalic version (ECV) and caesarean section checks on elective cases. All these additional roles come with advantages and disadvantages for both midwives and women. As midwives we may get job satisfaction, but are there not already enough pressures on our time? It feels like we are in the midst of creating a somewhat ‘super midwife’. Someone who can perform the most detailed checks on women and babies, prescribe everything and be a one stop shop.

Transformative or Tokenistic?

Transformative or Tokenistic?

Interconnected Disaster Management - Bridging the Physical and Digital Divide

ABSTRACT When a disaster strikes, major damage can occur to physical and digital collections. However a major research project, undertaken in the context of Australian national state and territory (NSLA) libraries, has uncovered that the approaches to the disaster management of physical and digital collections are largely divided and uncoordinated. The outcomes of the research project have demonstrated the benefits and feasibility of integrating disaster management across all collection formats – physical and digital, while also noting barriers and areas of disconnect. A practical application of the research has been the updating of the ALIA disaster management resources, as a ‘one stop shop’ integrated approach to managing disasters across all collection formats. Overall, at a time of elevated risk of disasters due to climate change, this research provides an important contribution to the field of disaster management with an integrated perspective that has potential application across the wider GLAM sector within Australia, and internationally, with organisations such as Blue Shield International.

Вплив цифровізації на розвиток системи оподаткування ПДВ

he article establishes that the development of e-commerce generates serious tax threats. The problem of VAT collection is exacerbated, as non-residents who carry out transactions on supplies of electronic services often fall outside the system of consumption taxation. VAT fraud also distorts competition and increases inequality in the distribution of tax burden. The OECD recommends for the countries to apply at the taxation of e-commerce the approach providing collection of VAT by the principle of country of destination including a reverse charge mechanism, which assigns obligations for payment the VAT of foreign supplier to the customer in the country of consumption. It has been found that the EU is reforming the VAT system on the following principles: tackling fraud; “One Stop Shop”, greater consistency, less red tape. The efforts of the European Commission are primarily aimed at modernizing the collection of VAT in the area of cross-border e-commerce in the B2C format, including more scope for the MOSS regime. It is concluded that in Ukraine, in order to start levying VAT from operations on supplies of electronic services to final consumers by a non-resident, it is necessary to solve the following problems: determination of potential benefits and costs from the introduction of such taxation; definition of the term “electronic services” for VAT purposes; registration of a non-resident as a VAT payer; identification of the recipient of services - the resident of Ukraine to determine the place of supply in B2C format; determination of the procedure for VAT payment; providing a non-resident - VAT payer with the opportunity to pay tax in foreign banks and submit tax reports in the electronic form; introduction of an additional procedure for verifying non-residents reporting.

MO771A DEDICATED INTERVENTIONAL NEPHROLOGY SERVICE LEADS TO BETTER RENAL SERVICE PROVISION

Abstract Background and Aims Interventional Nephrology is a renal procedural sub-speciality that provides procedures the following procedures necessary for the maintenance of dialysis access and renal diagnostics: In most centres regionally and nationally, these procedures are performed by a mix of nephrologists, radiologists and surgeons. In many centres haemodialysis catheter procedures are performed by nephrologists but without fluoroscopic guidance, with only those procedures which fail to be completed being escalated to interventional radiology. Access to real time imaging improves safety and quality of patient experience by reducing the rate of procedural failure and can the rate of serious complications. The Sunderland Diagnostic and Interventional Nephrology (SDIN) service was launched in 2018. Briefly, this is a ‘one stop shop’ for all of the above procedures with pre-procedural assessment and post-procedural recovery provided in a dedicated renal day-case area. Procedure lists run Monday to Friday, 52 weeks per year, and are provided by four interventional nephrologists. Method Data was collected retrospectively on all activity under the Sunderland Diagnostic and Interventional Nephrology service. Results The service has delivered the following benefits: Conclusion A dedicated interventional Nephrology service leads to significant benefits for the providing unit and leads to efficiency savings. Most importantly, patients receive safe and efficient care leading to improved experience and in the long term improved clinical outcomes.

"There's a lot of talent in the room but it's only really the medical talent that gets heard": a qualitative exploration of multidisciplinary clinicians' perspectives of optimal nutrition care of patients with head and neck cancer.

The high prevalence of malnutrition in patients with head and neck cancer (HNC) negatively impacts outcomes. The best-available evidence has been published in clinical nutrition guidelines; however, translation into practice has lagged. This project aimed to explore multidisciplinary team (MDT) clinicians' perspectives regarding barriers and enablers to best-practice nutrition care in order to inform the design of a new model of care. Qualitative interviews were conducted with clinicians who were purposively sampled from a major HNC tertiary referral centre in Sydney, Australia. To elicit information regarding barriers and facilitators to change, a semi-structured interview schedule was developed, interviews were transcribed verbatim and analyzed employing an inductive thematic approach. The Consolidated Framework for Implementation Research (CFIR) was used to guide data analysis and interpretation of key themes identified. Nineteen participants (11 supportive care and eight medical clinicians) representing allied health, medical, and nursing disciplines participated. Five key themes were identified: (1) acknowledgement of dietetics expertise and access to resources to deliver nutrition care; (2) proactive versus reactive nutrition care; (3) integrated and coordinated care-"The One Stop Shop"; (4) MDT favours the medical model; and (5) leadership-within disciplines, within the MDT. MDT clinicians expressed similar views regarding delivering optimal nutrition care to this high nutritional risk patient group. However, perspectives differed at times between medical and supportive care clinicians, attributable to perceptions that current service structure favours the medical model. In order to design and deliver an evidence-based model of care, specific strategies will be required to ensure: early and ongoing access to expert nutrition care; nutrition care processes are proactive; integrated and coordinated care; and leadership, both intra- and inter-disciplinary. This novel exploration of MDT clinicians' views provides supporting evidence that multi-component implementation strategies comprising individual, team and system-level approaches will be essential to leverage sustainable change.

The Future of E-Government: From One Stop Shop to No Stop Shop solution

The Future of E-Government: From One Stop Shop to No Stop Shop solution

A New (Circular) Economy: A New Special Arrangement for Second-Hand Goods!

The EU’s ambition is to achieve a fully circular economy by 2050. The aim of a circular economy is to generate as little waste as possible. A circular organization of the production and distribution chain does not fit well within the European VAT system, which takes the linear production and distribution chain as its starting point. A special VAT regime, the special arrangement for secondhand goods, is necessary to deal with the return of products from the consumer sphere to the productive sphere. Since within a circular economy goods return more often from the consumer sphere to the productive sphere, the special arrangement for secondhand goods is likely to become more important. In this article the author addresses the special arrangement for second-hand goods both in a domestic and an international situation. The author addresses issues within the current arrangement and discusses solutions to improve the special arrangement to make it a better fit for the circular economy. second-hand goods, circular economy, special arrangement, accumulation, movable property, distance sales, intra-Community acquisition, taxable dealer, profit margin, one Stop Shop

“One Stop Shop” for NMR-Based Biomoelcular Research

“One Stop Shop” for NMR-Based Biomoelcular Research

Modelling association between two Multiple Response Categorical Variables (MRCV) using generalized log-linear models: the case of urban agriculture in Mutare City

Purpose: This research aimed to apply log-linear modelling to model association between multiple response categorical variables (MRCV) on urban agriculture and enhance data analysis of the paper by Basera, Chakaipa, & Dube (2020) impetus of urban agriculture on open spaces of Mutare City. Research methodology: The research data was obtained from households and farmers in Mutare City - urban and peri-urban (inclusive of plots in Weirmouth Park and Fern Valley area in December 2020. A total of one hundred and fifteen (115) household farmers were surveyed. Results: Simultaneous Pairwise Marginal Independence (SPMI) tests revealed the presence of associations. Log-linear tests revealed a perfect fit based on small standardized Pearson residuals and a strong positive association based on observed and model-predicted odds ratios on-field agricultural activities and use of herbicides. Log-linear and further application of heterogeneity tests revealed partial and near no perfect fit in other pairs of MRCVs with a strong negative association between municipality vacant places and field agricultural activities. Limitations: The research could not carry out log-linear model associations of three or more MRCVs because files exceeded 2GB in memory on both MI.test () function for SPMI tests and genloglin regressions. Contribution: The study contributes to urban agriculture planning especially in enactment of urban agriculture laws, agriculture one stop shop business centers housing farm input supply shops, farm produce shops, and determining fit support that can be rendered to urban farmers. Keywords: Multiple Response Categorical Variables (MRCV), Association, Urban agriculture

Conservative Innovation: The Ambiguities of the China International Commercial Court

In the global development of new international commercial dispute resolution centers, the China International Commercial Court (CICC) represents a genuine innovation in China's legal history. The CICC aims to become a dispute resolution “one stop shop” (combining litigation, arbitration, and mediation) for Belt and Road Initiative (BRI) related disputes. Despite its name and ambition, however, the CICC operates more like a domestic court. The CICC's stringent jurisdictional requirements and conservative institutional design show that the CICC cannot serve its stated objective of attracting new investment opportunities or foreign parties to the Chinese forum. These defects are not fatal but will have to be addressed for the CICC to reach its full potential of hybridization of litigation and arbitration both in and beyond China.