Working Group Research Articles

Report of the German Society for Pathology Cytopathology Working Group

Report of the German Society for Pathology Cytopathology Working Group

Report of the German Society for Pathology Dermatopathology Working Group

Report of the German Society for Pathology Dermatopathology Working Group

The Current State of Biotransformation Science - Industry Survey of In Vitro and In Vivo Practices, Clinical Translation, and Future Trends.

Embedded within the field of drug metabolism and pharmacokinetics (DMPK), biotransformation is a discipline that studies the origins, disposition, and structural identity of metabolites to provide a comprehensive safety assessment, including the assessment of exposure coverage in toxicological species. Spanning discovery and development, metabolite identification (metID) scientists employ various strategies and tools to address stage-specific questions aimed at guiding the maturation of early chemical matter into drug candidates. During this process, the identity of major (and minor) circulating human metabolites is ascertained to comply with the regulatory requirements such as the Metabolites in Safety Testing (MIST) guidance. Through the International Consortium for Innovation and Quality in Pharmaceutical Development (IQ), the "Translatability of MetID In Vitro Systems Working Group" was created within the Translational and ADME Sciences Leadership Group. The remit of this group was to objectively determine how accurate commonly employed in vitro systems have been with respect to prediction of circulating human metabolites, both qualitatively and quantitatively. A survey composed of 34 questions was conducted across 26 pharmaceutical companies to obtain a foundational understanding of current metID practices, preclinically and clinically, as well as to provide perspective on how successful these practices have been at predicting circulating human metabolites.The results of this survey are presented as an initial snapshot of current industry-based metID practices, including our perspective on how a harmonized framework for the conduct of in vitro metID studies could be established. Future perspectives from current practices to emerging advances with greater translational capability are also provided.

Pseudospin-polarized slow light waveguides with large delay-bandwidth product

Delay-bandwidth product (DBP) is a key metric in slow light waveguides, requiring a balance between a large group index and broad bandwidth—two parameters that often involve a trade-off. Here, we propose and demonstrate a slow light waveguide with large DBP using a pseudospin-polarized transverse electromagnetic mode. This waveguide features a folded edge configuration that supports a 200% relative bandwidth from quasistatic limit (zero frequency) and an arbitrarily large group index. Owing to the pseudospin-polarized design, the dense folding would not introduce backscattering and the associated group velocity dispersion (GVD). The resulting gapless linear dispersion and pulse transmission behavior in folded edge waveguide are observed in microwave experiments. Our scheme provides a way to overcome the trade-off between group index and working bandwidth in slow light waveguide, which has potential applications in broadband optical buffering, light-matter interaction enhancement, terahertz radiation source and time domain processing.

The admission and integration model: first‑hand experiences of staff admitted to a mental health ward

Background/Aims Over a period of 6 months, four staff members were admitted on separate occasions to a male acute mental health ward for 1 day. The purpose was for participants to gain personal insight into the experiences of patients on the ward. This study aimed to explore the experiences of staff admitted onto the ward and provide a conceptual model to describe the admission process. Methods Feedback was obtained from the study participants via pre- and post-admission questionnaires and a focus group discussion. These qualitative data were thematically analysed to generate the steps in the admission and integration model. Results Admission to the mental health ward was a useful learning experience for staff members in terms of improving empathy for their patients. A model of ward admission and integration based on these experiences was also developed. The model adhered to Maslow's hierarchy of need, where participants had to re-establish deficiency needs following admission onto the ward. Conclusions The study findings have been shared with other hospital staff, and will be used by a new working group to implement improvements in patient care.

Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care.

Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees' experiences of implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed.

Health Anxiety, Sleep Quality in Healthcare Workers Under Critical Conditions of Emerging Diseases

Background: One of the crises recently affecting human society is an emerging pandemic that has had a significant psychological impact on healthcare workers. Studies have shown that staff experience psychological disorders such as anxiety, depression, and insomnia when exposed to crises. Objectives: This study aimed to determine the association between health anxiety and the sleep quality of healthcare workers during crisis conditions. Methods: This cross-sectional, correlational descriptive-analytical study was conducted from late February 2019 to late March 2020. Using convenient sampling, 382 healthcare workers from medical universities in Golestan province participated in the survey. Data were collected via an internet link shared with participants through WhatsApp working groups. The instruments used in this research included demographic information, sleep quality, and health anxiety inventories. The data were analyzed using SPSS-21 with descriptive and analytical statistics. Results: Of the participants, 77.2% were women, 65.4% were single, 60.7% were nurses, and 64.4% had a bachelor's degree. The results revealed that 72.7% of the staff experienced moderate to high levels of anxiety. Regarding sleep quality, 28.3% (n = 108) of healthcare workers reported good sleep quality, while 71.7% (n = 274) reported poor sleep quality. Additionally, the results indicated a significant correlation between health anxiety scores and sleep quality scores (r = 0.129, P = 0.01). Conclusions: The results of this study showed that the critical conditions caused by emerging diseases have led to health anxiety among healthcare workers, negatively affecting their sleep quality. Therefore, medical center officials must address such psychological issues and implement preventive measures to maintain the mental health of healthcare workers.

Working group summary of the 2023 full update of the Finnish national guidelines for paediatric lower respiratory tract infections.

The first evidence-based Finnish guidelines for paediatric lower respiratory tract infections (LRTIs) were published in 2014 and completely updated in 2023. This paper, by the interdisciplinary working group that developed the 2023 guidelines, summarises the main recommendations. The 2023 guidelines were produced after a systematic review. Strong evidence was at least two separate, high-quality studies, moderate evidence was at least one high-quality study and weak evidence was at least one satisfactory study. The authors have now summarised the key points. There was strong evidence that antitussives and beta-sympathomimetics were not effective for bronchitis-related cough and that laryngitis should be treated with oral corticosteroids, with adrenaline inhalations added in severe cases. Also, that amoxicillin for 5 days provided sufficient treatment for paediatric community-acquired pneumonia and that children with apparent viral pneumonia could be observed without antimicrobial therapy. There was moderate evidence that corticosteroids or inhaled agents were not effective for bronchiolitis and that administering salbutamol with a holding chamber could relieve symptoms of wheezing bronchitis. Also, pertussis should be considered for unvaccinated infants with coughs. The 2023 guidelines aim to improve acute evidence-based treatment of LRTIs, through appropriate antibiotics, inhaled drugs, corticosteroids, radiology and laboratory testing.

Quality appraisal of clinical guidelines for peripherally inserted central catheter-related thrombosis prophylaxis in patients: a systematic review.

To evaluate and analyse the quality of clinical practice guidelines for Peripherally Inserted Central Catheter-related thrombosis (PICC-related thrombosis) to identify the most current and effective prophylactic measures recommended in the guidelines. Scoring and analysis of the guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Cochrane Library, PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Chinese databases (China National Knowledge Infrastructure and Wan Fang) and the relevant websites of the guideline were searched through 8 August 2024. Studies that primarily clinical practice guidelines on the prevention of PICC-related thrombosis were included. Two reviewers independently screened the searched items and extracted data and scored documents using AGREE II. Findings were summarised in Grading of Recommendation, Assessment, Development and Evaluation (GRADE) evidence profiles and synthesised qualitatively. The analysis incorporated a total of nine guidelines, all rated as 'recommended' or 'recommended with modifications'. Standardised scores revealed elevated performance in the domains of Scope and Purpose, Clarity of Presentation and Editorial Independence. Conversely, the Stakeholder Involvement and Applicability domains yielded the lowest average standardised scores. Disparities in standardised scores across guidelines were particularly evident in the domains of Rigour of Development, Stakeholder Involvement and Applicability. The agreement between the two appraisers was almost perfect (intraclass correlation coefficients higher than 0.80). A considerable proportion of recommendations relied on evidence of low-quality, in certain instances, were derived from expert opinions within working groups. The review reveals that a significant portion of recommendations relies on low-quality evidence. Guideline developers are urged to prioritise methodological quality, with a specific focus on refining Stakeholder Involvement and Applicability domains. Addressing these aspects will enhance the overall quality and reliability of PICC-related thrombosis prevention guidelines. One potential way to mitigate these challenges is to endorse a standardised approach to guideline development and to synthesise reliable clinical evidence to reduce variation in recommendations. CRD42023495519.

Active Methodologies In Higher Education

Active methodologies are the educational conception that enables the higher education student to be the protagonist of his learning. The present study aims to analyze the active methodologies that can be used in the context of higher education, aiming to facilitate and qualify the learning of students. In this sense, some of these methodologies considered innovative today are presented, as well as the flipped classroom, problem-based learning and project-based learning, through a qualitative-bibliographic-research. The work had as theoretical foundation some current and relevant books and articles, which were found in the "Google Scholar" database. The selected materials were analyzed and interpreted for the preparation of the article. With this study, it was found that active methodologies allow the teaching and learning process to be developed through significant and useful pedagogical practices for the students' lives. Thus, in this perspective, such a process can favor critical and reflective thinking, autonomy, problem-solving skills, group work and the active participation of students during classes. Therefore, it is understood that the flipped classroom, problem-based learning and project-based learning are modalities of active methodologies that can be used in Higher Education. These can promote participating, collaborative subjects and producers of their knowledge, aiming to facilitate and qualify students' learning.

Real-world experience with glucagon-like peptide 2 analogues in patients with short bowel syndrome and chronic intestinal failure: results from an international survey in expert intestinal failure centers.

Background and AimsGlucagon-like peptide 2 (GLP-2) analogues are the first available disease-modifying treatments for patients with intestinal failure (IF) due to short bowel syndrome (SBS). Efficacy in terms of reduction of parenteral support (PS) has been demonstrated in multiple studies and real-world reports. However, it remains unclear how many patients are eligible to receive the treatment, when treatment is started after intestinal resection, how treatment efficacy is assessed outside of clinical trials, and how the treatment is modified in case of non-response or adverse events. The aim of this study was to investigate the real-world management of patients treated with GLP-2 analogues in expert centers around the world. MethodsA survey questionnaire was developed by a multidisciplinary working group consisting of 52 questions related to various aspects of multidisciplinary care of SBS-IF patients. The 17 questions related to the use of GLP-2 analogues in clinical practice were analyzed for this study. The online survey was sent to 33 participating centers in a phase 3 study of a long-acting GLP-2 analogue. Only responses from countries with access to commercially available GLP-2 analogues were included in the study. A descriptive analysis was performed for each question. Results are presented as median (interquartile range). ResultsThe responses from the 19 expert IF centers with access to GLP-2 analogues indicated that 10 (10-20) % of patients with SBS-IF were treated with a GLP-2 analogue, which was less than the number of eligible patients (30 (25-40) %). In most centers (10 centers, 53%), GLP-2 therapy was started 6-12 months after the last intestinal resection, with 5 centers (26%) starting later (12-24 months). Multiple parameters were used in combination to determine the response to GLP-2 analogues of which the three most common were >20% decrease in PS (95%), at least 1 day of PS reduction per week (84%) and increased urinary output (68%). In non-responders GLP-2 therapy was stopped within the first year by 67% of the centers. Finally, strategies in case of significant adverse events include stopping the GLP-2 analogue (used by 79% of experts), dose reduction (67%) and temporary treatment interruption (62%). ConclusionThe results of this survey completed by expert IF centers show the real-life use of GLP-2 analogues in clinical practice. Key learning points identified include the accounting for a period of intestinal adaptation before starting GLP-2 analogues and not stopping the treatment too early in case of non-response. The best strategy in case of adverse effects should be studied further.

Endocrine management of transgender adolescents: Expert consensus of the french society of pediatric endocrinology and diabetology working group

Endocrine management of transgender adolescents: Expert consensus of the french society of pediatric endocrinology and diabetology working group

Results of a National Delphi consensus on the outpatient management of pediatric psychogenic nonepileptic seizures in the United States

Background and objectivesThe purpose of this study was to develop national consensus based on expert opinion on the optimal outpatient care model of pediatric psychogenic nonepileptic seizures (PNES). MethodsA core working group (CWG) within the PNES special interest group of the Pediatric Epilepsy Research Consortium was established. The CWG developed a rigorous scoring rubric to select experts in pediatric PNES within the United States of America and a three-round Delphi study was conducted to assess consensus on key components of the management of pediatric PNES in the outpatient setting. ResultsEighteen experts representing neurology, psychology, psychiatry, social work and nursing participated in the study. Strong consensus was reached that the multidisciplinary clinic (MDC) model is the gold standard for the outpatient management of pediatric PNES. Consensus was obtained that a neurologist, psychologist and social worker are essential members of the MDC and in the setting of unlimited resources, psychiatry and nursing are also recommended. Further consensus was established on the roles of specific personnel, structure of the clinic, billing practices, trainee inclusion, patient inclusion and exclusion, and end of visit management. While consensus was reached that a new term should be developed for this diagnosis, consensus was not reached on the ideal term. DiscussionExpert consensus was established for the multidisciplinary management of pediatric PNES in the outpatient setting. Specific recommendations were provided that can facilitate the development and implementation of MDCs in other institutions. Further prospective studies are warranted to validate this practice model.

Summary of the National Advisory Committee on Immunization (NACI) Seasonal Influenza Vaccine Statement for 2024-2025.

The National Advisory Committee on Immunization (NACI) reviews the evolving evidence on influenza immunization and provides annual recommendations regarding the use of seasonal influenza vaccines. The NACI Statement on Seasonal Influenza Vaccine for 2024-2025 updates the NACI recommendations from the previous year. To summarize the 2024-2025 NACI seasonal influenza vaccine recommendations and to highlight new and updated information. For the development of the Statement on Seasonal Influenza Vaccine for 2024-2025, the NACI Influenza Working Group applied the NACI evidence-based process to assess available evidence and formulate recommendations. These recommendations underwent a thorough evaluation and were approved by NACI based on the available evidence. Key updates for the 2024-2025 influenza season include updated immunization recommendations reflecting changes in influenza epidemiology and revised guidance for vaccine administration during pregnancy and in older adults. The National Advisory Committee on Immunization recommends that any age-appropriate quadrivalent or trivalent influenza vaccine should be used for individuals six months of age and older who do not have contraindications or precautions. NACI reaffirms the importance of influenza vaccination with inactivated or recombinant influenza vaccines in pregnancy. Finally, NACI recommends that inactivated high-dose (IIV-HD), inactivated adjuvanted (IIV-Adj) or recombinant influenza vaccine (RIV) should be offered, when available, over other influenza vaccines for adults 65 years of age and older.

Aerospace Medical Association Proposed Research Priorities for Mental Health and Safety in Aviation

INTRODUCTION: Aviation safety sensitive personnel (SSP) function in highly complex environments. SSP mental health is thought to support safety, efficiency, and overall health. Research is needed to identify how to optimize and screen mental health across aviation SSP, but no consensus exists on the research priorities that need to be met. METHODS: The Aerospace Medical Association established the Mental Health Research Subgroup within the Mental Health Working Group comprising 53 aviation and aerospace medicine professionals representing 9 countries. A five-round Delphi method was employed to generate research priorities. RESULTS: Research priorities were identified under the following six topic areas: 1) Safety and Performance; 2) Mental Health Initiatives, Education, and Peer Support Programs; 3) Clinical Care, Pharmacology, and Return to Duty; 4) Epidemiology and Natural History; 5) Screening, Monitoring, and Emerging Technology; and 6) Special Considerations and Underrepresented Populations [Aerospace Medical Association Mental Health Research Subgroup Research Priorities Version 1.0 (current as of January 1, 2024)]. DISCUSSION: Research is needed to identify how to optimize and screen mental health across aviation SSP. This effort identified six key research priorities to achieve that aim. Hoffman WR, Tvaryanas A, Snyder Q, Spyropoulos BP, Garcia D, Schroeder D, Fahnenbruck G, Trottier K, Overbo S, Santilhano W, Brinks E, Ndoye A, Bongers H, O’Shaughnessy R, Miranda E; Aerospace Medical Association Mental Health Research Subgroup. Aerospace Medical Association proposed research priorities for mental health and safety in aviation. Aerosp Med Hum Perform. 2024; 95(11):845–850.

A new carbon-negative hydrogen production cycle for better sustainability

Carbon dioxide removal is considered by many as an essential piece to achieve global net zero targets which was also mentioned by the third working group of Intergovernmental Panel on Climate Change. On top of this, green hydrogen is badly needed to achive carbon-free society long-term sustainability. This study proposes a new five-step sodium hydroxide thermochemical cycle for simultaneous hydrogen production and carbon dioxide removal, which is driven by the heat at least 400 °C. The proposed integrated cycle can be driven by clean energy sources that can be utilized to generate heat at required temperatures. The proposed system is designed and analyzed by using energy and exergy approaches of thermodynamics. A case study is also developed in order to understand the effects of changing parameters on system performance. A thermochemical hydrogen production cycle is designed with an unequilibrium reaction where the respective heat capacity calculation models are employed. According to the calculations, more than half of the energy content of process heat can be converted into hydrogen, where maximum energy and exergy efficiencies of the thermochemical cycle are found as 50.05% and 76.61% when the separation reaction is carried out at 400 °C. According to the case study results, a parabolic trough collector type concentrated solar energy system with 295 kW of heat sink capacity, can generate 5216.65 kg of hydrogen and capture 19,991.97 kg of carbon dioxide in a location where 1500.11 kWh of solar energy is reached per m2 of area in a typical year.

Prognostic Value of Sarcopenia Definitions and Outcomes Consortium Criteria in Older Patients With Heart Failure

ObjectivesThe Asian Working Group for Sarcopenia in 2019 (AWGS 2019) emphasized muscle mass measurements. In contrast, the Sarcopenia Definitions and Outcomes Consortium (SDOC) prioritizes functional strength and mobility. Therefore, this study aimed to compare the prognostic utility of the SDOC and AWGS 2019 criteria for all-cause mortality in older patients with heart failure. DesignA post hoc analysis of the FRAGILE-HF study, a prospective, multicenter, observational study. Setting and ParticipantsPatients ≥65 years of age hospitalized for heart failure across 15 hospitals in Japan. MethodsSarcopenia was diagnosed according to the AWGS 2019 and SDOC definitions. According to the SDOC criteria and by integrating insights from previous research, patients were categorized into nonsarcopenia, possible sarcopenia, and sarcopenia groups. The primary outcome was 2-year mortality. ResultsOf the 1282 study patients, possible sarcopenia and sarcopenia were diagnosed in 357 and 786 individuals, respectively. Kaplan–Meier analysis revealed a significant difference between the groups. Adjusted Cox proportional hazards analysis indicated a significant stepwise association between sarcopenic status and mortality risk (possible sarcopenia: hazard ratio, 1.22; 95% CI, 0.66–2.28; P = .525; sarcopenia: hazard ratio, 1.89; 95% CI, 1.08–3.34; P = .027). When sarcopenia defined by the SDOC and AWGS 2019 criteria was added to the model incorporating conventional risk factors, no significant difference was observed in the prognostic capabilities between the 2 models (net reclassification improvement, −0.009; 95% CI, −0.193 to 0.174; P = .920, with areas under the receiver operating characteristic curve of 0.697 for SDOC and 0.703 for AWGS 2019; P = .675). Conclusions and ImplicationsAmong older patients with heart failure, the SDOC criteria for sarcopenia diagnosis are useful for risk stratification and provide prognostic capabilities equivalent to those of the AWGS 2019 criteria.

Digital tools in primary total knee arthroplasty-Prevalence in the German-speaking region

Digital tools are being increasingly used worldwide in primary knee arthroplasty. This study aimed to analyze the utilization density of digital tools, the preferred alignment strategies, and the obstacles and benefits of implementing these technologies in German-speaking countries. An online survey with 57questions about digital tools in primary knee arthroplasty and their usage was conducted among members of the Arthroplasty Working Group (AE). The survey included questions on navigation, robotics, patient-specific instruments, individualized implants, and augmented reality. The survey revealed that 18% of hospitals use navigation and 17% use robotic systems in primary total knee arthroplasty surgery. The main reasons for not implementing supportive technologies were high acquisition and ongoing costs, as well as longer surgical duration. Patient-specific instruments and individualized implants currently play aminor role. Patient-specific alignment strategies, such as kinematic (navigation: 35%; robotics: 44%) and functional alignment (navigation: 15%; robotics: 35%), are preferred in this context. With conventional instrumentation predominantly mechanical alignment was applied (79%). The results indicate arelatively high utilization density of digital tools, which are mainly used to perform personalized alignment strategies in primary knee arthroplasty in German-speaking countries. This was particularly evident in high-volume hospitals. Economic aspects were the main reasons for not using these technologies. Future developments should aim to simplify the systems and thus achieve improved cost efficiency.

An International Delphi Consensus on the Management of Pollen–Food-Allergy Syndrome: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee

Pollen-food-allergy syndrome (PFAS) is common among patients with allergic rhinitis. Treatment recommendations for patients with PFAS remain variable. To develop consensus recommendation statements for managing patients with PFAS. An international panel of allergists, researchers, and nutritionists with an interest in PFAS from 25 different institutions across 11 countries convened and a list of statements was written by 3 authors. The RAND/University of California Los Angeles methodology was adopted to establish consensus on the statements. After 2 Delphi rounds, a consensus was reached on 14 statements. The panel agreed that patients with PFAS would benefit from counseling on the nature and basis of PFAS and the rare chance of more severe systemic reactions and their recognition. The panel agreed on avoiding the raw food responsible for the index reaction, but not potentially cross-reactive fruits/vegetables based on the responsible food of the index reaction. Epinephrine autoinjectors should be recommended for patients with PFAS who experienced severe symptoms (beyond the oropharynx) or for patients considered at risk for severe reactions. The panel agreed that the benefit of allergen immunotherapy remains unclear and that PFAS should not be considered the primary indication for such intervention. We developed consensus statements regarding counselling patients about the nature and severity of PFAS, potential risk factors, dietary avoidance, epinephrine autoinjector prescription, and allergen immunotherapy consideration for patients with PFAS.

Does Firms’ Corporate Social Responsibility Reduce Crime?

This study examines the impact of firms’ corporate social responsibility (CSR) on state crime rates in the U.S. from 2004 to 2020. Our research bolsters the expanding work under the Law and Political Economy Project out of Yale University and Economics of Crime Working Group of National Bureau of Economic Research (NBER). Our empirical results show that states with domiciled firms having better CSR performance exhibit significantly lower crime rates. This lower crime incidence is driven by the environmental, social, and governance dimensions of CSR. Our study is the first to document the societal impact of CSR by analyzing state crime rates, and we conclude that CSR activities have positive externalities on society.