Task Force Research Articles

Saudi National Clinical Practice Guidelines for Management of Adult Systemic Lupus Erythematosus.

To provide evidence-based clinical practice recommendations for managing Systemic Lupus Erythematosus (SLE) in Saudi Arabia. This EULAR-adapted national guideline in which a multidisciplinary task force utilized the modified Delphi method to develop 31 clinical key questions. A systematic literature review was conducted to update the evidence since the EULAR publication. After reaching a consensus agreement, two rounds of voting and group discussion were conducted to generate consolidated recommendations/statements. A significant number of patients in Saudi Arabia experience delays in accessing rheumatologists, highlighting the significance of timely referral to SLE specialists or rheumatologists to ensure accurate diagnosis and prompt treatment. The primary goal of Glucocorticoid (GC) therapy in SLE patients is to establish disease control with a minimum dose and duration. Steroid-sparing agent utilization facilitates steroid-sparing goals. Hydroxychloroquine is recommended for all SLE patients, though physicians must carefully monitor toxicity and prioritize regular medication adherence assessment. SLE management during pregnancy starts from preconception time by assessing disease activity, major organ involvement, hypercoagulability status, and concomitant diseases that may negatively impact maternal and fetal outcomes. Multidisciplinary care with close monitoring may optimize both maternal and fetal outcomes. For patients with antiphospholipid antibodies, low-dose aspirin prophylaxis is recommended. Also, Long-term anticoagulant medications are fundamental to prevent secondary antiphospholipid syndrome due to high thrombosis recurrence. This Saudi National Clinical Practice guidelines for SLE management provide evidence-based recommendations and guidance for healthcare providers in Saudi Arabia who are managing patients with SLE. These guidelines will help to standardize healthcare service, improve provider education, and perhaps lead to better treatment outcomes for SLE patients.

Study fenomenologi: Intervensi Sosial Untuk Mereduksi Stigma Terhadap WUS Dalam Memutus Mata Rantai Penularan Covid-19

Social stigma can encourage people to hide their illness so that they are not discriminated against, prevent them from seeking medical assistance immediately, and prevent them from carrying out healthy lifestyle behaviors without realizing it will cause more transmission to others. The aim of the study was to carry out a phenomenological survey of social interventions to reduce the stigma against WUS in breaking the chain of transmission of Covid-19 in the working area of the Medan Helvetia Health Center. The target to be achieved from this research is the formation of cooperation in tackling the transmission of Covid-19 which involves all community leaders, especially WUS. The research was carried out in Helvetia District, the working area of the Helvetia Health Center, Medan City. The research method was carried out using a qualitative approach. The qualitative approach used is participatory action research. The research procedures to be carried out are engagement/intake, data collection and need assessment (phenomenological survey), model formulation, intervention and monitoring and evaluation and termination. Data collection methods were carried out by sharing, in-depth interviews, (FGD) and questionnaires. Interactive model analysis is used to analyze qualitative data on phenomenological surveys and the process of conducting participatory action research. The results of the research, the phenomenological survey generally closed oneself when exposed to Covid-19, did not tell neighbors, friends or family but after recovering they were told, with the aim of not being ostracized or avoided by the local community. The FGD was conducted to look at the problems found in the phenomenological survey, and the results of the discussion resulted in a social intervention, namely the training of the Covid-19 Task Force as counselees in reducing the stigma of Covid-19, carried out for 3 days. Implementation of participatory action research requires a long time to be able to see changes in behavior and social change, for this reason further research is needed to see the persistence of interventions carried out by the Covid-19 Task Force.

Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement.

Among all US women, breast cancer is the second most common cancer and the second most common cause of cancer death. In 2023, an estimated 43 170 women died of breast cancer. Non-Hispanic White women have the highest incidence of breast cancer and non-Hispanic Black women have the highest mortality rate. The USPSTF commissioned a systematic review to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, screening interval, modality, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review. Cisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer. The USPSTF concludes with moderate certainty that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older and the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or magnetic resonance imaging (MRI), regardless of breast density. The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement).

Improving humanitarian health responses for children through nurturing care

Children are disproportionately impacted by humanitarian disasters, which cause toxic stress. When a crisis overwhelms the capacity of health and social systems to meet the needs of a population, external crisis response teams working in a range of sectors may offer support to save lives and meet the affected populations' basic needs. Gaps have been identified in health sector interventions for children in humanitarian contexts, including lack of routine interventions to protect and promote early child development (ECD). To address this gap and improve the quality of humanitarian responses for girls and boys, the Global Health Cluster, Child Health Task Force, and the Inter-Agency Network for Education in Emergencies held a webinar series on Strengthening Nurturing Care in Humanitarian Response. It concluded that incorporating interventions to support nurturing care for ECD into health responses in acute phase emergencies is lifesaving. In crisis contexts, even simple interventions can be the difference between life and death, and when systematically applied, they can dramatically improve a child's life opportunities as well as national recovery and economic growth.

Contextualized Online Document Management System

This study aimed to develop online document management system that could generate documents faster and accurate. It covered the design, development and evaluation of the system intended for course program accreditation. The Rapid Application Development (RAD) model of system development was used to emphasized the development cycle using a component based construction approach. The developed contextualized online document management system was evaluated by the selected IT Expert, Accreditation task force and Office staff. It utilized a descriptive research design which employs a questionnaire to evaluate the functionality, efficiency, and usability of the developed system. The results revealed that the respondents consider the online document management system a highly acceptable software application. Thus, it is recommended for utilization during Online Course Program Accreditation for fast, easy access, and efficient document profiling.

Smart Health Village in Improving Disaster Preparedness

Background: Disaster-prone areas are areas that have the potential for natural disasters such as earthquakes, mountain eruptions, landslides caused by activity or movement from the base of the earth. Understanding the potential for natural disasters in each region as one of the anticipatory steps to minimize the number of victims of natural disasters. Precise and accurate information is needed for disaster management. The slope of the area is quite steep, and road access to villages and tourist attractions is vulnerable to landslides. The current disaster incident information reporting system still applies the conventional model. The community also experiences difficulties in receiving information and submitting reports regarding village conditions. Purpose: This research aims to analyze the effectiveness of smart health villages in improving disaster preparedness. Method: The research design used a pre-experiment with a pre-test and post-test design approach with a sample size of 64 volunteers who were taken using purposive sampling. The independent variable in this study is Smart Health Village and the dependent variable is the voluntary task force's ability to preparedness disaster. The research instrument used a questionnaire for each variable. Data analysis in this study is the Wilcoxon Signed Rank Test. The implementation of this activity consists of the design stage, application creation, system design, socialization and training, and trial. Results: The research results showed that the voluntary task force's preparedness was in a good category as much as 88% and as enough as 12% with p value = 0.000. This application system smart health village based on the web allows both the community (users), admin (task force), and verifiers (village officials) to access anywhere and at any time, thus increasing the capability and quality of human resources in disaster preparedness and disaster-prone areas. Conclusion: Based on the results it can be concluded that smart health village can improve ability in preparedness of disaster in disaster- prone areas thus reducing impact of anxiety and and panic due to disaster.

Evaluation of the Knowledge and Awareness of Firefighters in Turkey in Disaster Risk Management

Firefighters stand as one of the most effective task forces, striving to minimize losses incurred during disasters. Clarifying the present status of disaster risk management for firefighters can offer insights into the factors influencing response during disasters and how preparedness for such events can be enhanced. The aim of this study is to assess the current status of fire and rescue services, actively engage in crisis management during disaster risk management, to identify areas for improvement that enhance their involvement in preparatory stages, and to bolster their effectiveness in crisis management. This descriptive, cross-sectional study involved 772 firefighters who had prior experience in disaster response. The findings of this study revealed that firefighters who had undergone first aid training demonstrated the ability to anticipate hazardous situations and behaviors, regularly inspected their equipment, showed awareness of work-related accidents and occupational diseases, and scored statistically higher on the scales. These findings are expected to assist fire departments in establishing a sustainable and comprehensive disaster management cycle.

Examining How Macroeconomic Variables Influence Regional Autonomy: An Examination of Local Taxing Power

The Indonesian Central Government has granted local governments greater autonomy and authority in resource management, a process called decentralization. The impact of macroeconomic factors on regional autonomy in Jambi Province following fiscal decentralization explores how decentralization empowers local governments to optimize local income. The Financial Relations Law (UU HKPD) underscores the importance of local taxing Power for local administrations. Methodologically, this study utilizes panel data regression to investigate the influence of macroeconomic variables on regional autonomy. The qualitative analysis method is also employed to formulate policy strategies for enhancing local taxing Power. Results reveal some macroeconomic variables have a significant effect on regional autonomy. These are some recommendations to strengthen regional autonomy in Jambi Province, such as the identification of leading sectors regarding income tax, enhancement of supervision and law enforcement, taxpayer education, improvement of public service quality, the establishment of tax collection task forces, and innovation in tax administration.

The European Academy of Neurology NeuroCOVID-19 Task Force: A lesson for the future.

The COVID-19 pandemic has made its mark on world history forever causing millions of deaths, and straining health systems, economies, and societies worldwide. The European Academy of Neurology (EAN) reacted promptly. A special NeuroCOVID-19 Task Force was set up at the beginning of the pandemic to promote knowledge, research, international collaborations, and raise awareness about the prevention and treatment of COVID-19-related neurological issues. Activities carried out during and after the pandemic by the EAN NeuroCOVID-19 Task Force are described. The main aim was to review all these initiatives in detail as an overarching lesson from the past to improve the present and be better prepared in case of future pandemics. During the pandemic, the Task Force was engaged in several initiatives: the creation of the EAN NEuro-covid ReGistrY (ENERGY); the launch of several surveys (neurological manifestations of COVID-19 infection; the pandemic's impact on patients with chronic neurological diseases; the pandemic's impact of restrictions for clinical practice, curricular training, and health economics); the publication of position papers regarding the management of patients with neurological diseases during the pandemic, and vaccination hesitancy among people with chronic neurological disorders; and the creation of a dedicated "COVID-19 Breaking News" section in EANpages. The EAN NeuroCOVID-19 Task Force was immediately engaged in various activities to participate in the fight against COVID-19. The Task Force's concerted strategy may serve as a foundation for upcoming global neurological emergencies.

Exploring actors' collaborations and involvement in the Namibian learner pregnancy policy

IntroductionThe Namibia Education Sector Policy on the Prevention and Management of Learner Pregnancy (ESPPMLP) aims to reduce the cases of learners falling pregnant and increase learner-parent completion of education. The ESPPMLP addresses the fact that learner pregnancy and school drop-out are collaborative efforts between parents, the community, schools, and non-governmental organizations. However, Namibia continues to have had a problem with the high rate of learner pregnancy and school drop-out for many years. Previous studies reported the absences and limitations of both internal and external actors' collaboration in its implementation. This paper aims to clarify the lack of stakeholder involvement and cooperation in the ESPPMLP activities within selected rural schools in Namibia.MethodsUsing the qualitative approach mixed with phenomenological and content data analysis, the study conducted 19 individual interviews with schoolteachers, one school board member, one NGO representative, and six focus group discussions with 27 parents.Results and findingsAmong others, results show the limited life skills of teachers in schools, the attitude of the community toward schoolteachers, making them feel devoid of influence in collaborations, and the lack of sexual reproductive activities programs in school settings. The findings reveal the reliance of the activities of prevention and management of learner pregnancy on donor-driven initiatives, the lack of task forces at the community level, the shortage of knowledge and understanding about the ESPPMLP and the lack of policy implementation guidelines. Establish learner pregnancy leadership structures at the community level for coordination, introduce community parenting, and execute partnership of monitoring activities to boost stakeholder collaborations.

Gender-Affirming Hormone Therapy and Cervical Cancer Screening Rates in Transgender Men and Nonbinary People: A Cross-Sectional Study from a Boston Community Health Center.

Purpose: Clinical monitoring for patients receiving gender-affirming hormone therapy (GAHT) has the potential to facilitate their receipt of preventive health services. We aimed to determine whether GAHT is associated with increased utilization of cervical cancer screening among transgender men (TM) and nonbinary persons assigned female at birth (NB-AFAB). Methods: We conducted a cross-sectional observational study of a single community health center in Boston. Persons of all gender identities eligible for cervical cancer screening during 2008-2019 were assessed. The outcome of interest was receipt of cervical cancer screening based on U.S. Preventive Services Task Force recommendations. We compared the proportion of persons who received cervical cancer screening by prescription of GAHT. Results: We identified 13,267 eligible persons. This cohort included 10,547 (79.5%) cisgender women, 1547 (11.7%) TM, and 1173 (8.8%) NB-AFAB persons. Among all persons eligible for cervical cancer screening, TM and NB-AFAB persons were less likely to receive screening than cisgender women (56.2% and 56.1% vs. 60.5% respectively; odds ratio [OR] = 0.84; 95% confidence interval [CI] = 0.75-0.93; OR = 0.84; 95% CI = 0.74-0.94, respectively). Among TM, those prescribed testosterone were more likely to receive cervical cancer screening than those not prescribed testosterone (57.9% vs. 48.2%, OR = 1.47; 95% CI = 1.14-1.92). Among NB-AFAB adults, those prescribed testosterone were more likely to receive cervical cancer screening than those not prescribed testosterone (61.9% vs. 51.5%, OR = 1.53; 95% CI = 1.21-1.93). Conclusions: The benefits of engagement in care to access GAHT may extend beyond the hormonal intervention to preventive health services.

A new groin hernia classification with clinical relevance.

Groin hernia is one of the most commonly managed surgical diseases around the world. The typical question asked by patients is "Does my hernia require urgent surgery?". The currently available classifications are insufficient to stratify patients into different groups. We propose a new classification that incorporates diverse clinical elements together with anatomical and other vital information, which allows us to stratify patients into different groups. A task force was formed by the Hong Kong Hernia Society, working with international expert hernia surgeons. The framework of the classification system was formulated. Clinical elements that are important in groin disease stratification were identified. A comprehensive literature review was conducted using PubMed. Those which dictate the severity of the disease were selected and compiled to form the new proposed classification. Application of this classification model to a single hernia surgeon's registry in The Hong Kong Adventist Hospital Hernia Centre was done for initial evaluation. This new classification incorporates important clinical characteristics forming a total of nine grades of differentiation, together with the anatomical details and special information. This comprehensive system allows the stratification of patients into different groups based on disease severity. It also enables more accurate data collection for future audits, comparisons of disease progression over time, and the effect of different management strategies for different-stage patients. This is the first classification system which incorporates essential clinical parameters, which allows the stratification of groin hernia into different stages. Further studies and validation should be performed to evaluate the usefulness and value of this classification in groin hernia management.

SAGES White Paper on the importance of diversity in surgical leadership: creating the fundamentals of leadership development (FLD) curriculum.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has long recognized and championed increasing diversity within the surgical workplace. SAGES initiated the Fundamentals of Leadership Development (FLD) Curriculum to address these needs and to provide surgeon leaders with the necessary tools and skills to promote diversity, equity, and inclusion (DEI) in surgical practice. In 2019, the American College of Surgeons issued a request for anti-racism initiatives which lead to the partnering of the two societies. The primary goal of FLD was to create the first surgeon-focused leadership curriculum dedicated to DEI. The rationale/development of this curriculum and its evaluation/feedback methods are detailed in this White Paper. The FLD curriculum was developed by a multidisciplinary task force that included surgeons, education experts, and diversity consultants. The curriculum development followed the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional design model and utilized a problem-based learning approach. Competencies were identified, and specific learning objectives and assessments were developed. The implementation of the curriculum was designed to be completed in short intervals (virtual and in-person). Post-course surveys used the Kirkpatrick's model to evaluate the curriculum and provide valuable feedback. The curriculum consisted of interactive online modules, an online discussion forum, and small group interactive sessions focused in three key areas: (1) increasing pipeline of underrepresented individuals in surgical leadership, (2) healthcare equity, and (3) conflict negotiation. By focusing on positive action items and utilizing a problem-solving approach, the curriculum aimed to provide a framework for surgical leaders to make meaningful changes in their institutions and organizations. The FLD curriculum is a novel leadership curriculum that provided surgeon leaders with the knowledge and tools to improve diversity in three areas: pipeline improvement, healthcare equity, and conflict negotiation. Future directions include using pilot course feedback to enhance curricular effectiveness and delivery.

Guideline on the use of predeposit autologous donation prepared by the BSH Blood Transfusion Task Force.

Guideline on the use of predeposit autologous donation prepared by the BSH Blood Transfusion Task Force.

A standard lexicon of terms for area-based conservation version 1.0.

Target 3 in the Kunming-Montreal Global Biodiversity Framework (GBF) calls for protecting at least 30% of the world's lands and waters in area-based conservation approaches by 2030. This ambitious 30×30 target has spurred great interest among policy makers, practitioners, and researchers in defining and measuring the effectiveness of these types of approaches. But along with this broad interest, there has also been a proliferation of terms and their accompanying abbreviations used to describe different types of conservation areas and their governance, planning, management, and monitoring. The lack of standard terms is hindering the use and assessment of area-based approaches to conserve the world's biodiversity. It is difficult to track progress toward GBF Target 3 or to share learning with other practitioners if different groups of people are using different words to describe the same concept or similar words to talk about different concepts. To address this problem, the International Union for Conservation of Nature's World Commission on Protected Areas commissioned a task force to review existing terms and recommend a standard English-language lexicon for this field based on key criteria. The results were definitions of 37 terms across 6 categories, including types of protected and additional conservation areas (e.g., protected area, additional conservation area), sets of these areas (protected area network, protected area system), their governance and management (governance, rightsholders), assessment (effectiveness, equitability), spatial planning (key biodiversity area), and action planning (value, outcome, objective). Our standard lexicon can provide a common language for people who want to use it and a shared reference point that can be used to translate various terms used by different groups. The common understanding provided by the lexicon can serve as a foundation for collaborative efforts to improve the policies, implementation, assessments, research, and learning about this important set of conservation approaches.

P106 Do high rheumatoid factor titres impact response to tumour necrosis factor inhibitors? Comparison of certolizumab pegol and adalimumab in patients with rheumatoid arthritis and high titres of rheumatoid factor: a post hoc analysis of a phase 4 trial.

Abstract Background/Aims In patients with rheumatoid arthritis (RA), high rheumatoid factor (RF) titres are considered a poor prognostic factor and are associated with higher disease activity, risk of radiographic progression and decreased response to TNF inhibitors (TNFis). Recent data suggests that patients with RA and high RF titre may achieve and maintain greater clinical improvement with TNFis without a crystallisable fragment (Fc) compared to TNFis with an Fc. In this analysis of the EXXELERATE trial, we assessed efficacy outcomes of certolizumab pegol (CZP), a PEGylated Fc-free TNFi, versus adalimumab (ADA; Fc-containing TNFi) in patients with RA and high RF titres. Methods The phase 4 EXXELERATE trial (NCT01500278) compared the efficacy and safety of CZP to ADA. Patients were randomised 1:1 to CZP 200 mg every two weeks (Q2W) plus methotrexate (MTX) or ADA 40 mg Q2W plus MTX. At Week 12 (Wk), patients were classified as responders or non-responders; non-responders were switched to the other TNFi with possible follow-up to Wk104. Here, we report drug plasma concentrations, mean disease activity score (DAS)28-CRP score and proportion of patients achieving low disease activity (LDA; threshold: DAS28-CRP ≤2.7) to Wk104. Results are stratified by RF titre quartile (≤Q3: ≤203 IU/mL; >Q3: >203 IU/mL; measured by Roche Tina-quant®) and reported as observed data. Results Baseline data by RF quartile were available for 453 CZP-randomised patients (≤Q3: n = 334; >Q3: n = 119) and 454 ADA-randomised patients (≤Q3: n = 347; >Q3 n = 107). Baseline characteristics were similar between CZP- and ADA-randomised patients across the RF titre quartiles. At Wk12, 66 CZP-treated patients switched to ADA and 59 ADA-treated patients switched to CZP. At Wk104, mean ADA concentrations were 22.9% lower in patients with RF >Q3 (mean [SD] 4.8 [3.0]) vs those with RF ≤Q3 (6.2 [4.0]); in CZP-treated patients, this difference was smaller (13.0%) in patients with RF >Q3 (23.3 [15.4]) vs those with RF ≤Q3 (26.7 [13.1]). For patients in RF ≤Q3, mean DAS28-CRP scores were similar between CZP- and ADA-treated patients through Wks0-104 (mean [SD] DAS28 at Wk104: 2.48 [1.18] CZP vs 2.49 [1.14] ADA). However, for patients in RF >Q3, mean [SD] DAS28-CRP scores were nominally lower in CZP- vs ADA-treated patients (Wk104: 2.50 [1.18] CZP vs 2.93 [1.22] ADA). A similar pattern was observed for the proportion of patients achieving LDA at Wk104 (≤Q3: 64.8% CZP vs 65.1% ADA; >Q3: 65.7% CZP vs 48.3% ADA). Conclusion CZP-treated patients with RA and high titre RF had similar drug concentrations and clinical responses to patients with RA and low titre RF, a pattern not observed in ADA-treated patients. These data, together with previous reports where CZP showed consistent efficacy irrespective of baseline RF titre, suggest CZP may be a suitable therapy for patients with RA and high RF titre. Disclosure J.S. Smolen: Honoraria; AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celgene, Celltrion, Chugai, Gilead, ILTOO, Janssen, Lilly, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, R-Pharma, Roche, Samsung, Sanofi, and UCB Pharma. Grants/research support; AbbVie, AstraZeneca, Eli Lilly, Novartis and Roche. Other; Editor of Annals of the Rheumatic Diseases, Co-editor of Rheumatology 7E/8E, Convenor of EULAR Task Forces and T2T Task Forces. P.C. Taylor: Consultancies; AbbVie, Biogen, Eli Lilly, Fresenius, Galapagos, Gilead, GSK, Janssen, Nordic Pharma, Pfizer, Sanofi and UCB Pharma. Grants/research support; Galapagos. Y. Tanaka: Honoraria; AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Chugai, Eisai, Eli Lilly, Gilead, GSK, Pfizer, Taiho, Taisho. Member of speakers’ bureau; AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Chugai, Eisai, Eli Lilly, Gilead, GSK, Pfizer, Taiho and Taisho. Grants/research support; Chugai, Eisai, Mitsubishi-Tanabe, Taisho. C. Cara: Shareholder/stock ownership; UCB Pharma. Other; Employee of UCB Pharma. B. Lauwerys: Shareholder/stock ownership; UCB Pharma. Other; Employee of UCB Pharma. R. Xavier: Consultancies; AbbVie, AstraZeneca, Janssen, Organon, UCB Pharma. Member of speakers’ bureau; AbbVie, AstraZeneca, Janssen, Organon, and UCB Pharma. J.R. Curtis: Consultancies; AbbVie, Amgen, BMS, Corrona, Crescendo, Genentech, Janssen, Pfizer, Roche, UCB Pharma. Grants/research support; AbbVie, Amgen, BMS, Corrona, Crescendo, Genentech, Janssen, Pfizer, Roche, UCB Pharma. T.R. Mikuls: Consultancies; Horizon Therapeutics, Pfizer, Sanofi, UCB Pharma. Royalties; Elsevier, Wolters Kluwer Health (UpToDate). Grants/research support; Horizon Therapeutics. M. Weinblatt: Consultancies; AbbVie, Aclaris, Amgen, Aqtual, BMS, CorEvitas, Eli Lilly, GSK, Gilead, Horizon, Johnson and Johnson, Prometheus, Pfizer, Rani, Revolo, Sanofi, Scipher, Sci Rhom, Set Point, UCB Pharma. Grants/research support; AbbVie, Aqtual, BMS, Janssen.

Age- and height-dependent bias of underweight and overweight assessment standards for children and adolescents.

Precision in evaluating underweight and overweight status among children and adolescents is paramount for averting health and developmental issues. Existing standards for these assessments have faced scrutiny regarding their validity. This study investigates the age and height dependencies within the international standards set by the International Obesity Task Force (IOTF), relying on body mass index (BMI), and contrasts them with Japanese standards utilizing the percentage of overweight (POW). We scrutinized a comprehensive database comprising 7,863,520 children aged 5-17 years, sourced from the School Health Statistics Research initiative conducted by Japan's Ministry of Education, Culture, Sports, Science, and Technology. Employing the quantile regression method, we dissected the structure of weight-for-height distributions across different ages and sexes, quantifying the potentially biased assessments of underweight and overweight status by conventional criteria. Applying IOFT criteria for underweight assessment revealed pronounced height dependence in males aged 11-13 and females aged 10-11. Notably, a discernible bias emerged, wherein children in the lower 25th percentile were classified as underweight five times more frequently than those in the upper 25th percentile. Similarly, the overweight assessment displayed robust height dependence in males aged 8-11 and females aged 7-10, with children in the lower 25th percentile for height deemed obese four or five times more frequently than their counterparts in the upper 25th percentile. Furthermore, using the Japanese POW criteria for assessment revealed significant age dependence in addition to considerably underestimating the percentage of underweight and overweight cases under the age of seven. However, the height dependence for the POW criterion was smaller than the BMI criterion, and the difference between height classes was less than 3-fold. Our findings underscore the intricacies of age-dependent changes in body composition during the growth process in children, emphasizing the absence of gold standards for assessing underweight and overweight. Careful judgment is crucial in cases of short or tall stature at the same age, surpassing sole reliance on conventional criteria results.

Perencanaan Strategi Bisnis Usaha Online: UMKM

The development of micro, small and medium enterprises (MSMEs) requires a joint role in the environment from both regulators and other companies. The Business Competition Supervisory Commission (KPPU) together with the Ministry of Cooperatives and SMEs signed a memorandum of understanding to form a task force to monitor partnerships established between SMEs and large industries. This article explores the programs organized by the Ministry of Cooperatives and Small and Medium Enterprises for the development of MSMEs. Through literature and online research about company programs, researchers can compare them with government policy programs to analyze the accuracy of expert programs. The research results show that the joint Business Competition Supervisory Commission (KPPU) program can fulfill the policies of the Ministry of Cooperatives and SMEs stipulated in the 2020-2024 Strategic Plan.

Implementation of the E-Ticket System in the Prosecution of Traffic Violations in Cirebon City

This study aims to analyze the application of the E-Tilang system in the enforcement of traffic violations in Cirebon City. The research method used was a qualitative method with data collection techniques through observation, interviews, and documentation. The informant in this study was the Head and Member of the Cirebon City Police Task Force. The results showed that E-Tilang in Cirebon City has not run optimally. Some of the obstacles faced are accountability such as limited human resources in the police which only has 22 Satlantas members, lack of socialization to the community and the large number of ordinary people in technology so that E-Tilang is considered complicated. In terms of centralization, such as the lack of installed E-Tilang camera devices, and inaccurate vehicle ownership data that has not been reversed. The security of violators' data is an important concern. E-Tilang camera devices are planned to be reused in the future, along with the improvement of the mobile E-Tilang system.

The Impact of Disinformation on the Functioning of the Rule of Law and Democratic Processes in the Eu

Disinformation and propaganda are based on the fact that the information: i) is designed to be totally or partially false, manipulated or misleading or uses unethical persuasion techniques; ii) concern a matter of public interest; (iii) is intended to generate insecurity, hostility or polarization or attempt to undermine democratic processes; iv) is disseminated and/or amplified using automatic and aggressive tools, such as social bots, artificial intelligence, micro-targeting or paid human trolls, often with the aim of increasing the public visibility of the content. Especially the systematic dissemination of disinformation by active politicians, parties or authorities is a clear and immediate threat to democracy and is disrespectful of the values of the European Union according to Article 2 TEU, because the trust in such authoritative persons is a value choice which cannot be changed by rational arguments. Moreover, deepfakes (algorithmically generated messages flooding recipients to give a false impression of political consensus) present a significant challenge for democracy, because they may sow uncertainty which may, in turn, reduce trust in news on social media and hinder civic participation in online debates. Finally, a study commissioned by the European External Antion Service, published in 2021, has focused on two more categories of disinformation: 'influence operations' by third countries, aimed at influencing a target audience using a range of illegitimate and deceptive means, and 'foreign interference', aimed at disrupting the free formation and expression of political will. Therefore, among the many issues dealt with by the EP resolution of 1 June 2023 on foreign interference in all democratic processes in the European Union, it must be mentioned the fact that foreign interference, including disinformation, is a national and cross-border security threat. Consequently, the EP has stressed the need for solidarity between the Member States so that such activities can be effectively combated, also amending Article 222 TFEU (the solidarity clause) by including foreign interference. In fact, with respect to disinformation a process of securitization is being promoted, consisting of applying security tools and discourses upon an object that was previously not identified as such. An example of this trend is represented by the specific task force set up within the European External Action Service in order to address Russia's ongoing disinformation campaigns. Another example, showing that disinformation has become a CFSP issue, is the Council regulation (EU) 2022/350 of 1 March 2022, based on Council decision (CFSP) 2022/351, concerning restrictive measures in view of Russia's actions destabilizing the situation in Ukraine. However, when determining the focus and political actions of the EU against disinformation, two opposing logics – securitization and self-regulation – coexist and compete. As a result, the EU is promoting a discourse linking disinformation to security, exceptionality and geopolitical strategies, but being lax at the same time with the obligations and responsibilities of the digital platform companies. Received: 25 December 2023 / Accepted: 25 February 2024 / Published: 23 April 2024