Changes In System Research Articles

Informed consent in gynecological oncology: a JAGO/NOGGO survey on real-world practices in daily clinical routine.

Informed consent is a quintessential element of contemporary medicine, reflecting the fundamental right of patients to participate in decision-making regarding their health. Despite its critical importance, there is a lack of data on real-world practices regarding patient informed consent in the context of modern, high-pressure medical environments. Weconducted a multinational multicentric survey from February 24, 2022, to September 14, 2022, investigating the practices and challenges surrounding informed consent in hospitals across Germany, Austria, and Switzerland with the use of a specifically developed questionnaire. Drawing on over 200 responses from gynecologists, the survey shows a critical need for structured training in conducting informed consent discussions with over 80% of participants expressing interest in courses addressing this aspect. Notably, a considerable portion of the physicians (59.9%) reported conducting discussions on procedures they had never personally witnessed. Significant disparities between types of hospitals and professional groups were observed in the frequency of informed consent discussions, with limitations arising from factors such as time constraints, language barriers, and insufficient resources for patient education. Moreover, the psychological burden experienced by physicians after informed-consent discussions underscores the need for systemic changes to alleviate concerns regarding patient safety, legal repercussions, and patient satisfaction. This study serves as a call to action, emphasizing the need of enhancing resources and support for medical professionals to uphold the principles of empathic and comprehensive patient information and shared decision-making. DRKS00028295, 25.07.2024.

Transactional dynamics in hyperledger fabric: A stochastic modeling and performance evaluation of permissioned blockchains

Blockchain, often integrated with distributed systems and security enhancements, has significant potential in various industries. However, environmental concerns and the efficiency of consortia-controlled permissioned networks remain critical issues. We use a Stochastic Petri Net model to analyze transaction flows in Hyperledger Fabric networks, achieving a 95% confidence interval for response times. This model enables administrators to assess the impact of system changes on resource utilization. Sensitivity analysis reveals major factors influencing response times and throughput. Our case studies demonstrate that block size can alter throughput and response times by up to 200%, underscoring the need for performance optimization with resource efficiency.

Volatilome is Inflammasome- and Lipidome-dependent in Ischemic Heart Disease.

Ischemic heart disease (IHD) is a pathology of global interest because it is widespread and has high morbidity and mortality. IHD pathophysiology involves local and systemic changes, including lipidomic, proteomic, and inflammasome changes in serum plasma. The modulation in these metabolites is viable in the pre-IHD, during the IHD period, and after management of IHD in all forms, including lifestyle changes and pharmacological and surgical interventions. Therefore, these biochemical markers (metabolite changes; lipidome, inflammasome, proteome) can be used for early prevention, treatment strategy, assessment of the patient's response to the treatment, diagnosis, and determination of prognosis. Lipidomic changes are associated with the severity of inflammation and disorder in the lipidome component, and correlation is related to disturbance of inflammasome components. Main inflammasome biomarkers that are associated with coronary artery disease progression include IL-1β, Nucleotide-binding oligomerization domain- like receptor family pyrin domain containing 3 (NLRP3), and caspase-1. Meanwhile, the main lipidome biomarkers related to coronary artery disease development involve plasmalogen lipids, lysophosphatidylethanolamine (LPE), and phosphatidylethanolamine (PE). The hypothesis of this paper is that the changes in the volatile organic compounds associated with inflammasome and lipidome changes in patients with coronary artery disease are various and depend on the severity and risk factor for death from cardiovascular disease in the time span of 10 years. In this paper, we explore the potential origin and pathway in which the lipidome and or inflammasome molecules could be excreted in the exhaled air in the form of volatile organic compounds (VOCs).

Postoperative Outcome And Complications Among Peritoneal Carcinomatosis Patients

Introduction: Peritoneal carcinomatosis is a recurrence pattern in gastric cancer, commonly complicating the postoperative course, especially in high-risk individuals. These complications adversely affect quality of life, increase mortality, and have immediate postoperative clinical implications. Surgery is the best treatment for early-stage tumors, despite its associated risks, including mortality. Aim: To evaluate the impact of postoperative complications on the clinical outcomes of patients undergoing peritoneal cancer surgery. Methods: This cross-sectional observational study was conducted at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh, over twenty-one months from July 2017 to March 2019. Forty-two patients were selected based on inclusion and exclusion criteria and diagnosed clinically, radiologically, and histopathologically. Data were collected using a structured case record form and analyzed using SPSS-22. Results: The mean age of participants was 66.19 ± 10.38 years, with 33.3% aged 56-65 years. The cohort included 64.3% males and 35.7% females, with 52.4%, 40.5%, and 7.1% having a BMI of 18.5-24.9 kg/m², 25- 30 kg/m², and >30 kg/m², respectively. Smoking and betel leaf use were common (61.9% and 83.3%, respectively), with 69% from the middle class. Tumors primarily involved the proximal and distal stomach, with a mean size of 6.20 ± 1.86 cm, predominantly Type 3 and Type 4, and stages T4a and N2. No metastasis was observed. Total and lower radical gastrectomies were performed, with complications occurring in 9.5% (chest infection) and 14.3% (wound infection), while 76.2% had no complications. Conclusion: Complications can serve as indicators of postoperative clinical outcomes. The findings highlight the need for systemic changes in healthcare to reduce postoperative morbidity and mortality, thereby decreasing hospital stays.

Detection of Incidents and Anomalies in Software-Defined Network – Based Implementations of Critical Infrastructure Resulting in Adaptive System Changes

Detection of Incidents and Anomalies in Software-Defined Network – Based Implementations of Critical Infrastructure Resulting in Adaptive System Changes

Implementation and outcomes of a dementia-friendly training program in five hospitals

Background: Hospitalized patients living with dementia (PLWD) age 65+ generally experience poor outcomes. This study's purpose was to implement dementia-friendly training with staff, track patient outcomes, and implement sustainable system changes.Methods: We conducted a prospective study in five hospitals. The hospitals adopted HealthCare Interactive's CARES® Dementia 5-Step Method for Hospitals Online Training and Certification Program . After on-line modules completion, a didactic session was offered, and a retrospective pre/post survey was completed. Patient falls, length of stay, and readmission rates were collected.Results: 1,836 (41 %) staff completed the training. Positive changes in staff ratings from pre- to post- intervention were observed. Number of falls and readmissions did not change. The average number of stays per patient decreased by .24 (p=0.01). Hospitals made system changes including innovative identification for PLWD.Conclusions: Dementia-friendly hospital training is effective in improving staff recognition of the symptoms and needs of PLWD, and responding appropriately.

Changes of the Urothelial Barrier System in the Cyclophosphamide‐Induced Cystitis in Rats by Using a Newly Established “Inside‐Out” Urinary Bladder Preparation

ABSTRACTObjectivesThe study was aimed to establish the “inside‐out” preparation with the urothelium and investigate the changes in urothelial permeability of the cyclophosphamide (CYP)‐induced cystitis model in rats.MethodsIn female rats with or without CYP injection, the isolated whole bladder was utilized as an “inside‐out” preparation with the urothelium, which was created by reversing the bladder from a top portion. The preparation was fixed in the organ bath, and instilled with a Krebs solution (0.5 mL) through the bladder neck. After it was kept under an isovolumetric condition, high K+ (KCl: 50 mM) or acetylcholine (ACh: 10 μM) was added into the organ bath.ResultsIn the normal bladder, the intravesical pressure of the inside‐out preparation with the urothelium did not change with the addition of KCl or ACh. Contrarily, in the CYP‐injected bladder 24 or 48 h after injection of CYP, the intravesical pressure of the inside‐out preparation increased with the addition of KCl or ACh. Histological examinations showed a denuded and/or cracked surface of the urothelial layer, and the intensity of uroplakin III staining of the urothelial layer decreased in the CYP‐injected rats.ConclusionsThe study demonstrated the bladder urothelium has robust barrier mechanisms for preventing the absorption of water (urine) under the normal condition. However, these barrier mechanisms were disrupted in the CYP‐induced cystitis, suggesting that water and urine insults can be permeabilized into the urinary bladder, specifically to the smooth muscle layer.

Immunological reactivity and natural resistance in patients with tuberculosis, toxocariasis and tuberculosis associated with toxocariasis

Introduction. Parasitic diseases continue to affect the population of many countries of the world. About 2 billion people on the planet are infected with helminths, including Toxocara canis. Invasion with Toxocara canis represents a strong endogenous factor in the formation of the regulatory imbalance of the immune system. The integral evaluation of these indices serves as an important criterion in the diagnosis of toxocarosis and the effectiveness of the applied therapy. In the context of the above, information about research on immune reactivity and natural resistance of tuberculosis patients in association with toxocariasis is of interest. Material and methods. This article is a systematic review of the relevant literature between the year 2001 and 2022. The material for the study was electronic sources published through the web Medline, EMBASE, Global Health, Scopus and Web of science; PubMed; crossref; Google Scholar and others. The following keywords were used “immunological reactivity”, “natural resistance”, “parasitic diseases”, “toxocara canis”, “tuberculosis and toxocariasis”, “immunity”, “helminthiasis”, “toxocariasis”. Bibliographic resources have been systematized by subject and content. The results were grouped and systematized according to the relevant criteria and the level of scientific evidence. Results. Parasites, in particular, Toxocara canis and M. tuberculosis use different mechanisms to alter the immune response, but these mechanisms can interact with significant consequences for the immunological reactivity of each infection. Chronic helminthic infection causes a wide range of changes in the immune system. Conclusion. The immune reactivity and natural resistance of tuberculosis patients in association with toxocarosis is insufficiently elucidated.

Full life cycle assessment of insect biomass allows estimation of bioflows across water, air, and land

AbstractAs global environmental change continues, animals face uncertain habitat availability and quality that influences life cycle phenology and population dynamics. For decades, the population abundance and emergence patterns of burrowing mayflies have been used as a sentinel for water quality changes in large freshwater systems around the world. Despite reduced point source pollutants, evidence is mounting that the interactions among habitat loss, contaminants, and changing climate could be causing declines in mayfly production and shifts in emergence timing. We combined radar observations with traditional field measures to identify changes in mayfly populations from nymph to adult. We studied Hexagenia sp. secondary production in a large reservoir, Lake Seminole, which has contrasting water sources and land use on each arm that could contribute to differences in emergence patterns. We predicted that mayfly secondary production would be higher, and emergence would be earlier in the Chattahoochee arm versus the Flint arm because of differences in available nutrients and temperature. Benthic declines in abundance and biomass followed radar observations of emergence. Mean annual water temperature was similar, with the Flint arm having less seasonal variation. Mayfly growth was similar across the lake, but production was higher in the upper Flint arm, perhaps because of temperature stability, higher nutrient concentrations, and more lotic conditions. The natural abundance of nitrogen‐stable isotopes in mayflies showed distinct patterns between the arms and from nymph to adult. Linking benthic sampling with radar observations verified our capability to track mayfly biomass across the landscape and begin to calibrate previous measures of production with radar‐derived abundance. Coupling radar observations with stable isotope and tissue nutrient measurements allowed us to further quantify the subsidies moving from aquatic to terrestrial ecosystems, setting the framework to examine both historic and future population changes and mayfly contributions to cross‐ecosystem subsidies.

When thinking about pain contributes to suffering: the example of pain catastrophizing

Abstract The extensive literature on the potent role negative thoughts about pain have on the experience of pain and pain-related suffering has documented associations with important neurobiological processes involved in amplifying nociceptive signals. We focus this review on pain catastrophizing (pCAT)— appraisals of pain as threatening, overwhelming, and unmanageable— and review the evidence that these thoughts are learned in childhood through experience and observation of others, particularly caretakers and parents. For children who have learned pCAT, repeated exposures to pain over time activate pCAT and likely contribute to further amplification of pain through changes in the neurobiological pain regulatory systems, which overlap with those regulating the stress response. We propose that repeated pain and stress exposures throughout childhood, adolescence, and into adulthood alter the neurobiology of pain via a repetitive positive feedback loop that increases risk for heightened pain sensitivity over time with repeated exposures. At some point, often precipitated by an acute episode of pain and possibly influenced by allostatic load, pCAT contributes to persistence of episodic or acute pain and exacerbates pain-related suffering. This developmental trajectory is not inevitable, as the impact of pCAT on pain and pain-related suffering can be influenced by various factors. We also present future directions for work in this area.

Carbohydrate Research Mini-review Relationships between bacteria and the mucus layer

The mucus layer on epithelial cells is an essential barrier, as well as a nutrient-rich niche for bacteria, forming a dynamic, functional and symbiotic ecosystem and first line of defense against invading pathogens. Particularly bacteria in biofilms are very difficult to eradicate. The extensively O-glycosylated mucins are the main glycoproteins in mucus that interact with microbes. For example, mucins act as adhesion receptors and nutritional substrates for gut bacteria. Mucins also play important roles in immune responses, and they control the composition of the microbiome, primarily due to the abundance of complex O-glycans. In inflammation or infection, the structures of mucin O-glycans can change and thus affect mucin function, impact biofilm formation and the induction of virulence pathways in bacteria. In turn, bacteria can support host cell growth, mucin production and can stimulate changes in the host immune system and responses leading to healthy tissue function. The external polysaccharides of bacteria are critical for controlling adhesion and biofilm formation. It is therefore important to understand the relationships between the mucus layer and microbes, the mechanisms and regulation of the biosynthesis of mucins, of bacterial surface polysaccharides, and adhesins. This knowledge can provide biomarkers, vaccines and help to develop new approaches for improved therapies, including antibiotic treatments.

Maternal obesity induces sex-specific changes in the endocannabinoid system of the hypothalamus and dorsal hippocampus of offspring associated with anxiety-like behavior in adolescent female rats

Maternal obesity during perinatal period increases the risk of metabolic and behavioral deleterious outcomes in the offspring, since it is critical for brain development, maturation, and reorganization. These processes are highly modulated by the endocannabinoid system (ECS), which comprises the main lipid ligands anandamide and 2-arachidonoylglycerol, cannabinoid receptors 1 and 2 (CB1R and CB2R), and several metabolizing enzymes. The ECS is overactivated in obesity and it contributes to the physiological activity of the hypothalamus-pituitary-adrenal (HPA) axis, promoting stress relief. We have previously demonstrated that maternal high-fat diet during gestation and lactation programmed the food preference for fat in adolescent male offspring and adult male and female offspring. In the present study, we hypothesized that maternal diet-induced obesity would induce sex-specific changes of the ECS in the hypothalamus and dorsal hippocampus of rat offspring associated with dysregulation of the HPA axis and stress-related behavior in adolescence. Rat dams were fed a control (C) or an obesogenic high-fat high-sugar diet (OD) for nine weeks prior to mating and throughout gestation and lactation. Maternal obesity differentially altered the CB1R in the hypothalamus of neonate offspring, with significant increase in male but not in female pups, associated with decreased CB2R prior to obesity development. In adolescence, maternal obesity induced anxiety-like behavior only in adolescent females which was associated with increased content of CB1R in the dorsal hippocampus. Our findings suggest that the early origins of anxiety disorders induced by maternal exposome is associated with dysregulation of the brain ECS, with females being more susceptible.

Right bundle branch block in suspected acute coronary syndromes: Diagnostic challenges, treatment and prognosis

BackgroundThere is still conflicting evidence regarding the prognostic implications of right bundle branch block (RBBB) in the general population but also in patients with heart diseases like acute coronary syndromes (ACS). In accordance with current guidelines, RBBB in ACS patients is considered as STEMI equivalent. However, recent studies indicate that further differentiation is necessary in this group, as we will outline below. Methods and resultsA literature search was conducted in PubMed and Google Scholar.In previous studies, RBBB in the general population were mostly considered benign changes of the electrical conduction system. However, recent studies indicate that both complete and incomplete RBBB are associated with increased cardiovascular morbidity and mortality. In addition, among unselected patients with suspected ACS presenting to the emergency department, the prevalence of RBBB was 3 % and it was associated with elevated mortality. The subsequent angiographic identification of a culprit coronary artery stenosis leading to stent implantation was similar at approximately 2 % regardless of the initial ECG presentation with narrow QRS complexes, left bundle branch block (LBBB), or RBBB.Finally, in a group of high-risk patients for ST-elevation myocardial infarction (STEMI), the prevalence of RBBB was 12 %. While RBBB was associated with poor outcome compared to non-BBB and LBBB patients, diagnostic accuracy of STEMI criteria was not affected by the presence of RBBB. However, RBBB patients without distinct STEMI signs in ECG often showed acute STEMI on angiography indicating a potential benefit from immediate transfer to the cardiac catheterization laboratory. ConclusionIn the general population, patients with RBBB and risk factors may need further evaluation. Regarding ACS patients, recent studies support current guidelines that recommend acute invasive evaluation for high-risk ACS patients with RBBB, regardless of ST-T deviations. However, in an unselected group of ACS patients, differential diagnoses should also be investigated through additional diagnostic procedures.

Exploring the Spatially Compounding Multi‐Sectoral Drought Vulnerabilities in Colorado's West Slope River Basins

AbstractThe state of Colorado's West Slope Basins are critical headwaters of the Colorado River and play a vital role in supporting Colorado's local economy and natural environment. However, balancing the multi‐sectoral water demands in the West Slope Basins while maintaining crucial downstream deliveries to Lake Powell is an increasing challenge for water managers. Internal variability of the hydroclimatic system and climate change complicate future vulnerability assessments. This work contributes a detailed accounting of multi‐sectoral drought vulnerability in the West Slope Basins and the impacts of drought on downstream deliveries. We first introduce a novel multi‐site Hidden Markov Model (HMM)‐based synthetic streamflow generator to create an ensemble of streamflows for all West Slope basins that better characterizes the region's drought extremes. We capture the effects of climate change by perturbing the HMM to generate an ensemble of streamflows reflecting plausible changes in climate. We then route both ensembles through StateMod, Colorado's water allocation model, to evaluate spatially compounding drought impacts across the West Slope Basins. Our results illustrate how drought events emerging from the system's stationary internal variability in the absence of climate change can significantly impact local water uses and deliveries to Lake Powell, exceeding extreme conditions in the historical record. Further, we find that even modest climate change can cause a regime shift where historically low downstream delivery volumes and extreme drought impacts become routine. These results can inform future Colorado River planning efforts, and our methodology can be expanded to other snow‐dominated regions that face persistent droughts.

Research on Whether Quality Policies Can Promote the High-Quality Development of China’s Manufacturing Industry and Its Configuration Paths in the Context of Sustainable Development

High-quality development enhances economic quality and resource allocation efficiency through various effective and sustainable means, with particularly notable results in the manufacturing sector. Quality policies, through establishing standards, norms, and incentive measures, aim to foster technological innovation, efficient resource utilization, and quality improvement in manufacturing, thereby supporting its high-quality development. This study explores the impact of quality policies on high-quality development in manufacturing and their configurational pathways, providing theoretical foundations and practical guidance for optimizing policy combinations and promoting sustainable development. This analysis is based on quality policies released from 2013 to 2022 and sample data from 30 Chinese provinces. The findings reveal that quality policies significantly promote high-quality development in manufacturing, particularly through incentive, capacity building, and system changing instruments, while command instruments may exert certain pressures on high-quality development. Configuration analysis further indicates that a single instrument is insufficient to support high-quality development in manufacturing fully; the synergistic effect of multiple policy instruments is essential, and regions should optimize policy combinations according to their characteristics. This study provides valuable insights for sustainable development, offering a deeper understanding of the complex causal relationship between quality policies and high-quality development in manufacturing.

Pregnancy as an important risk factor for the progression of diabetic retinopathy

Diabetic retinopathy, also defined as diabetic eye disease is one of the main causes of eye complications and blindless in the world therefore leads to irreversible vision disorder and vision loss. A pregnant women as a patient is always a real challenge for doctors of various specialties. During this period, numerous systemic changes occur, such as increased blood pressure in the third trimester, increased blood volume insulin resistance with worsening glycemic control and excessive coagulation. The above complication may be reflected in the image of the fundus of the eye. Pregnancy may induce retinal disease such as diabetic retinopathy. This review article presents the incidence, pathogenesis and risk factors associated with diabetic retinopathy during pregnancy. More over in the following paper discussed management of diabetic retinopathy in pregnancy and guidelines are recommended based on the achievable evidence.

Integrated Community Development to Alleviate Poverty and Social Problems: Case Study of DesaBerdaya (Empowered Village) Rumah Zakat

This research explores the community empowerment model implemented by Rumah Zakat through the DesaBerdaya program to reduce poverty and social issues in Indonesia. The program uses an integrated approach encompassing economic, educational, health, environmental, and disaster mitigation sectors, aiming to improve the quality of human resources through local empowerment. The program also supports the achievement of the Sustainable Development Goals (SDGs), particularly in poverty alleviation, good health, quality education, and access to clean water and sanitation. The research findings indicate positive systemic changes in various villages that have received interventions from this program, both in social and economic aspects. Significant improvements in community welfare have been observed, with the program running sustainably at the local level. The program successfully empowered communities to become self-reliant and created long-term impacts on village development in Indonesia.

A study on the changes of China's parenting labor system from the perspective of legal culture theory (1949-1957)

In the early years of the founding of the People’s Republic of China (PRC), the Communist Party then referred to as CPC implemented a series of equality policies in favor of women. This type of policy is reflected in the allocation of childcare labor resources, emphasizing the construction of women’s social welfare. However, China’s women’s welfare policies are influenced by overall political decision making and exhibit an unstable state. This study discusses the changes in the CPC’s childcare norms from 1949 to 1957. Using the laws and regulations issued by the CPC government from 1949 to 1957 and the news materials published from 1949 to 1957, this study classifies and discusses these first hand historical materials in different periods using the method of literature analysis. This study uses Friedman’s legal culture theory to analyze the interaction between the internal legal culture of the government representatives of the CPC and the external legal culture of the people’s representatives. This study finds that by exploring the process of the construction of women’s welfare policy of the PRC from 1949 to 1957, it can be clearly seen that under the condition of limited financial capacity, women’s welfare work is easily abolished due to other more important national socio-economic work. From these results, this study finally concludes that women’s liberation become a tool to serve the national construction under the discourse construction of the CPC.

Future directions for deep ocean climate science and evidence-based decision making

IntroductionA defining aspect of the Intergovernmental Panel on Climate Change (IPCC) assessment reports (AR) is a formal uncertainty language framework that emphasizes higher certainty issues across the reports, especially in the executive summaries and short summaries for policymakers. As a result, potentially significant risks involving understudied components of the climate system are shielded from view.MethodsHere we seek to address this in the latest, sixth assessment report (AR6) for one such component—the deep ocean—by summarizing major uncertainties (based on discussions of low confidence issues or gaps) regarding its role in our changing climate system. The goal is to identify key research priorities to improve IPCC confidence levels in deep ocean systems and facilitate the dissemination of IPCC results regarding potentially high impact deep ocean processes to decision-makers. This will accelerate improvement of global climate projections and aid in informing efforts to mitigate climate change impacts. An analysis of 3,000 pages across the six selected AR6 reports revealed 219 major science gaps related to the deep ocean. These were categorized by climate stressor and nature of impacts.ResultsHalf of these are biological science gaps, primarily surrounding our understanding of changes in ocean ecosystems, fisheries, and primary productivity. The remaining science gaps are related to uncertainties in the physical (32%) and biogeochemical (15%) ocean states and processes. Model deficiencies are the leading cited cause of low certainty in the physical ocean and ice states, whereas causes of biological uncertainties are most often attributed to limited studies and observations or conflicting results.DiscussionKey areas for coordinated effort within the deep ocean observing and modeling community have emerged, which will improve confidence in the deep ocean state and its ongoing changes for the next assessment report. This list of key “known unknowns” includes meridional overturning circulation, ocean deoxygenation and acidification, primary production, food supply and the ocean carbon cycle, climate change impacts on ocean ecosystems and fisheries, and ocean-based climate interventions. From these findings, we offer recommendations for AR7 to avoid omitting low confidence-high risk changes in the climate system.

Perioperative Myocardial Infarction and Successful Revascularization in Patient With Primary Metasynchronic Rectal, Gastric and Bladder Cancer

The article presents a clinical case of perioperative non-ST-segment elevation myocardial infarction in a patient with primary metasynchronous cancer of the rectum, stomach and bladder, which developed during simultaneous surgical intervention in the volume of proximal gastrectomy and abdominoperineal extirpation of the rectum. Fluctuations in blood pressure and imbalance in the hemostasis system at the stages of anesthesia and surgery in a patient with severe systemic atherosclerosis caused the development of myocardial ischemia in the area of significant coronary stenosis. Emergency coronary angiography detected subtotal stenosis of the anterior descending artery; stenting of the affected area of the coronary artery was performed. Monitoring of hemodynamic parameters and changes in the hemostasis system during the optimal antianginal therapy allowed to bring the patient out of critical condition and discharge him from the hospital on the 18th day.