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Flag of convenience (FOC) refers to the practice of registering ships in foreign countries to benefit from lax regulations. While FOC offers several short-term cost advantages to ship owners and FOC countries, it poses significant threats to critical international interests, including environmental protection and marine habitat preservation. Despite global outrage and concerns over FOC's environmental impact, the number of FOC ships have continued to rise. Using game theory, we illustrate how individual rationality - opting for FOC to maximize economic benefits - leads to adverse outcomes for the common good, resulting in increased marine pollution, that we refer to as the tragedy of the commons. Our findings have implications for understanding the strategic behaviour of key players in the maritime transportation, revealing the dark side of globalization and stressing the need for stronger international cooperation to shift these behaviours., Competing Interests: Declaration of competing interest We wish to confirm that there are no known conflicts of interest and there has been no financial support provided for this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Effective management of international wildlife trade is crucial to ensure sustainability. Quotas are a common trade management tool and specify an annual number of individuals to be exported, yet at present there is no global assessment of quota coverage and compliance. Using over 7,000 country-year specific reptile quotas established under the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) covering 343 species, we quantify quota coverage, compliance, trade trends pre-quota and post-quota setting and whether quotas likely represent adaptive management. Quotas predominantly concerned live wild-sourced reptiles, with only 6.6% of live non-zero quotas exceeded and 4.5% of zero quotas subverted. For 62.3% of species, quotas were established higher than pre-quota trade, with traded volumes post-quota mainly unchanged or higher than pre-quota establishment, thus potentially facilitating sustainable trade. Over 38% of quota series of species remained at the same level each year, with the longest-running quotas proportionately updated the least, indicating that many quotas do not change adaptively in response to changing threats to species through time. Greater specificity in exactly what quotas cover, justification for unchanged quotas and transparency over quota determination are needed to ensure that high compliance equates to sustainable use., (© 2024. The Author(s).)

Objective: To evaluate variations in management of therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) among international clinical sites and to identify areas for harmonization., Study Design: An electronic survey was sent to Children's Hospitals Neonatal Consortium site sponsors, Canadian Neonatal Network site investigators, members of the Newborn Brain Society, and American Academy of Pediatrics Neonatology chiefs., Results: One hundred five sites responded, with most from high-income regions (n = 95). Groupings were adapted from the United Nations regional groups: US (n = 52 sites); Canada (n = 20); Western Europe and other states excluding Canada and US Group (WEOG, n = 18); and non-WEOG (central and eastern Europe, Asia, Africa, Latin America, and Caribbean, n = 15). Regional variations were seen in the eligibility criteria for TH, such as the minimum gestational age, grading of HIE severity, use of electroencephalography, and the frequency of providing TH for mild HIE. Active TH during transport varied among regions and was less likely in smaller volume sites. Amplitude-integrated electroencephalogram and/or continuous electroencephalogram to determine eligibility for TH was used by most sites in WEOG and non-WEOG but infrequently by the US and Canada Groups. For sedation during TH, morphine was most frequently used as first choice but there was relatively high (33%) use of dexmedetomidine in the US Group. Timing of brain magnetic resonance imaging and neurodevelopmental follow-up were variable. Neurodevelopmental follow occurred earlier and more frequently, although for a shorter duration, in the non-WEOG., Conclusions: We found significant variations in practices for TH for HIE across regions internationally. Future guidelines should incorporate resource availability in a global perspective., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Engagement in CME/CPD has a positive impact on healthcare professionals' (HCPs) knowledge, skills, and performance, and on patient outcomes, therefore it is critical to better understand the components of CME/CPD systems that foster engagement, high-quality education, and impact., Methods: An assessment of CME/CPD systems was conducted using a mixed-methods approach that included interviews with in-country subject matter experts and qualitative and quantitative data from practicing in-country physicians., Results: Results demonstrate areas of consistency in CME/CPD systems across world regions that included: types of educational providers; types of credit; educational formats; self-tracking of participation; high-degree of compliance when education is mandatory; overall satisfaction with available education; strong support for interprofessional education; and lack of alignment or evaluation of engagement in education with population health outcomes. Areas of variation included: whether engagement in education is required as a condition to practice medicine; whether regulations are uniformly applied; if mechanisms to ensure independence existed; and physician perceptions of independence., Conclusion: Results of this assessment maybe used by a variety of different stakeholders to assess how well country-level CME/CPD systems are meeting the needs of practicing physicians and determine what, if any, changes might need to be implemented to improve outcomes.

Digital technologies are a significant additional powerhouse for corporate internationalization and competitiveness. The existing research has not effectively distinguished the breadth and depth of internationalization, and there are also inadequate context considerations of how much digital technology applications influence enterprise internationalization. To bridge this gap, this paper has selected 203 valid questionnaires from manufacturing enterprises in Zhejiang Province, China, then elaborates and constructs a theoretical model based on existing studies, and using multiple linear regression analysis, finally to empirically assess and further explain the mechanisms of digital technologies' influence on corporate internationalization. The results reveal that utilizing digital technologies has positive influence on both internationalization breadth and depth. Moreover, centralizing decision power negatively moderates the relationship between enterprises' digital applications and their internationalization breadth (or depth), while internationalization experience has opposite influence, with these two factors jointly moderating such relationship. Finally, this research can contribute to better understanding of leveraging digital technologies to upgrade corporate internationalization and provides reasonable theoretical insights for enhancing deeper and more diversified enterprise internationalization., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Despite abundant clinical innovation and burgeoning scientific investigation, pulmonary embolism (PE) has continued to pose a diagnostic and management challenge worldwide. Aging populations, patients living with a mounting number of chronic medical conditions, particularly cancer, and increasingly prevalent health care disparities herald a growing burden of PE. In the meantime, navigating expanding strategies for immediate and long-term anticoagulation, as well as advanced therapies, including catheter-based interventions for patients with more severe PE, has become progressively daunting. Accordingly, clinicians frequently turn to evidence-based clinical practice guidelines for diagnostic and management recommendations. However, numerous international guidelines, heterogeneity in recommendations, as well as areas of uncertainty or omission may leave the readers and clinicians without a clear management pathway. In this review of international PE guidelines, we highlight key areas of consistency, difference, and lack of recommendations (silence) with an emphasis on critical clinical and research needs., Competing Interests: Funding Support and Author Disclosures Outside of the submitted work, Dr Bikdeli is supported by a Career Development Award from the American Heart Association and VIVA Physicians (#938814); was supported by the Scott Schoen and Nancy Adams IGNITE Award; is supported by the Mary Ann Tynan Research Scientist award from the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital, and the Heart and Vascular Center Junior Faculty Award from Brigham and Women’s Hospital; was a consulting expert, on behalf of the plaintiff, for litigation related to 2 specific brand models of IVC filters (he has not been involved in the litigation in 2022-2024 nor has he received any compensation in 2022-2024); is a member of the Medical Advisory Board for the North American Thrombosis Forum; serves in the Data Safety and Monitory Board of the NAIL-IT trial funded by the National Heart, Lung, and Blood Institute, and Translational Sciences; and is a collaborating consultant with the International Consulting Associates and the U.S. Food and Drug Administration in study to generate knowledge about utilization, predictors, retrieval, and safety of IVC filters. Dr Barco has received institutional research support from Boston Scientific, Medtronic, Bayer, and Sanofi; and has received personal fees/honoraria from Boston Scientific, Penumbra, and Viatris. Dr Giannakoulas has received fees for lectures and/or consultations from Actelion/Janssen, Bayer, Boehringer Ingelheim, ELPEN Pharmaceuticals, Ferrer-Galenica, GlaxoSmithKline, Gossamer-Bio, Merck Sharp and Dohme, Pfizer, Lilly, and United Therapeutics. Dr Jimenez has served as a speaker for Bristol Myers Squibb, ROVI, and Sanofi. Dr Lang, in addition to being an investigator in trials involving these companies, has relationships including consultancy service, research grants, and membership of scientific advisory boards for drug companies including AOP-Health, Actelion-Janssen, Merck Sharp and Dohme, United Therapeutics, Medtronic, Neutrolis, and Novo Nordisk; has served as a consultant for AOP Health, Merck Sharp and Dohme, PULNOVO, United Therapeutics, and Janssen; has received grants from AOP Health; and has served on the Speakers Bureau for Merck Sharp and Dohme and Janssen. Dr Klok has received research funding from Bayer, Bristol Myers Squibb, BSCI, AstraZeneca, Merck Sharp and Dohme, Leo Pharma, Actelion, Farm-X, the Netherlands Organisation for Health Research and Development, The Dutch Thrombosis Foundation, The Dutch Heart Foundation, and the Horizon Europe Program, all outside of this work and paid to his institution. Dr Weitz holds the Canada Research Chair (Tier 1) in Thrombosis and the Heart and Stroke Foundation J.F. Mustard Chair in Cardiovascular Research. Dr Piazza has received research grants (paid to his institution) from Bristol Myers Squibb/Pfizer, Janssen, Alexion, Bayer, Amgen, BSC, Esperion, and the National Institutes of Health (1R01HL164717-01); and has received consulting fees for advisory roles from BSC, Amgen, PERC, NAMSA, Bristol Myers Squibb, Janssen, Penumbra, and Thrombolex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Prior to the coronavirus disease 2019 (COVID-19) pandemic, Central Asia and Eastern Europe saw a significant rise in international medical student enrollment, driven by competitive tuition fees, prestigious institutions, and culturally diverse environments. The pandemic forced a rapid shift to online learning, disrupting student mobility and compromising clinical training quality. Online education for international medical students during the COVID-19 pandemic has proven beneficial, though low- and middle-income countries struggled with access to information infrastructure and resources. While 64% of students preferred online learning, challenges like limited internet access and lack of in-person interaction persisted, making a blended approach of online and traditional methods most effective. Despite a rebound in post-pandemic enrollment, persistent challenges such as linguistic obstacles, psychological stress, and cultural adaptation issues remain. Active research engagement during undergraduate studies is essential for skill development. Integrating research into education curricula and fostering motivation are crucial for enhancing academic outcomes. Critical thinking and cultural competence are vital, necessitating explicit instruction and collaborative learning strategies. Addressing language barriers through comprehensive support systems for both instructors and students is imperative. Tailored strategies and robust institutional support are essential to enhancing the educational experiences and success of international medical students., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

Background: Integrated care can be broadly defined as the delivery of high-quality and safe care for patients as they cross organizational boundaries or when care is delivered with multiple health care teams, professions, or organizations. Successful integration of care services is contingent on multiple and complex factors across macro, meso, and micro levels of health and social care systems in lower-, middle-, and higher-income countries. Previous priorities for the future development of integrated care have focused on designing and implementing models or approaches to integrated care rather than establishing the research needed to underpin them. This study aimed to address this evidence gap by developing a consensus on international research priorities related to integration of care and cross-boundary working., Methods: We conducted a sequential electronic Delphi (eDelphi) study from September 2023 to December 2023. The eDelphi process consisted of initial priority generation followed by two rounds of consensus development via an online survey. Sixty-six priorities were generated by 19 delegates at an international conference workshop titled, 'Priority setting for future research on integration of care and cross-boundary working'. Workshop delegates then identified other experts in integrated care and cross-boundary working from their networks. In each eDelphi round, participants then provided item-by-item responses using a seven-point Likert scale, with consensus defined a priori as ≥80% agreement (strongly agree or agree). Priorities that reached consensus were conceptually grouped into topics., Results: Twenty-five of 66 unique (37.9%) research priorities achieved consensus after two eDelphi rounds. In Round 1, 63/85 (74.1%) experts from 10 countries across 4 continents achieved consensus on 12/66 (18.2%) priorities. In Round 2, 51/63 (81.0%) experts achieved consensus on a further 13/54 (24.1%) priorities. From the 25 priorities, we derived six conceptual groupings that represent broad topics for future research on integrated care and cross-boundary working: (i) access to care, (ii) data sharing and technology, (iii) measurement of care quality, (iv) patient experience and satisfaction, (v) service design, integration and governance, and (vi) teamwork and leadership., Conclusion: Integrating care services and improving cross-boundary working is important for improving the quality of care provided to patients, regardless of country. Therefore, the conceptual topics and individual priorities identified in this study can inform policymakers, practitioners, and researchers when designing or evaluating integrated care services across the world in pursuit of improved integrated care systems., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Quality in Health Care.)

Objective: To describe the adoption of international travel measures during the first year of the COVID-19 pandemic., Methods: To comprehensively analyze the measures adopted, we constructed a dataset based on the WHO's Public Health and Social Measures (PHSM) database, which covered 252 countries, territories, or other areas (CTAs), including all 194 WHO Member States, from December 31, 2019, to December 31, 2020. We examined the adoption of measures by type, over time, and by the implementing and targeted CTA, including their levels of income., Findings: We identified 11,431 international travel measures implemented during the first year of the pandemic. The adoption of measures was rapid and widespread: over 60% of Member States had adopted a travel measure before the WHO declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020. Initially, health screening and travel restrictions were the most adopted measures; however, quarantine and testing became more widely adopted over time. Although only a small portion of the total measures adopted constituted full border closure, approximately half of all Member States implemented this measure. Many travel measures targeted all CTAs but were unlikely to have been adopted universally enough to provide public health benefits. Low-income countries relied more on more universal measures, including full border closure, and were slower in scaling up testing compared to higher-income countries., Conclusion: The adoption of international travel measures during the first year of the COVID-19 pandemic varied across jurisdictions and over time. Lower-income countries used a different mix and scaled-up measures slower than higher-income countries. Understanding what measures were used is crucial for assessing their effectiveness in controlling the spread of COVID-19, reviewing the usefulness of the International Health Regulations, and informing future pandemic preparedness and response activities., (© 2024. The Author(s).)

The global attention on industrial policy's effectiveness spans across various sectors, particularly in international trade where the focus is on enhancing the quality of foreign trade, which is crucial to understand how research hotspots and key issues can synergize. We consider the 2018 "new round" of Sino-US trade friction as an external event and analyze panel data from 2009 to 2022 comprising 1141 Chinese A-share listed enterprises. Our empirical research unequivocally demonstrates that industrial policy has significantly propelled China's foreign trade towards high-quality development by 1.8240%. We conducted rigorous tests for robustness, heterogeneity, and endogeneity. Additionally, our results reveal that inhibitory influences arising from industrial policy on total assets or R&D investment attenuate this promotion effect; There exists a diminishing promotion effect between total assets and R&D investment. Our paper provides valuable insights into understanding their logical relationship while offering guidance for enterprises, markets, and governments in overcoming challenges collectively., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Leihua, Fan. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In 2012, representatives of the 44 International Federation of Nurse Anesthetists (IFNA) member countries were surveyed about their scope of practice. Ten years later, the researchers repeated the study to evaluate the professional development of nonphysician anesthesia providers. The survey was prepared by the IFNA Practice Committee and explored demographics, training, anesthesia team members, and daily activities of the nonphysician anesthesia providers (NPAPs). The online survey was sent to all IFNA Country National Representatives. In 2022, 22 out of 44 countries had more than one type of NPAP including five countries that had anesthesia technicians. NPAPs work in operating theatres (94.4%), postanesthesia care units (81.9%), intensive care units (46%), acute (51%), chronic pain (28%), air ambulance (28%), resuscitation (69%), or trauma team (42%), preoperative screening (57%). Formal recognition of the profession and the requirement of licensure to practice has increased. Education levels have increased substantially, which resulted in more indirect supervision. Direct supervision by physicians is related to education levels and limited scope of practice. The NPAP workforce is growing toward IFNA standards, but it has become a more diversely educated workforce. NPAPs who are educated at a bachelor or higher level and require officially recognized licensure to practice, have an extensive scope of practice., Competing Interests: Name: Vera Meeusen, PhD, MBA, FACPAN, RN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: James R. Walker, DNP, CRNA, FNAP, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Jakob Ibsen Vedtofte, MeD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. At the time of this research project, the authors were members of the IFNA Practice Committee., (Copyright © 2024 by the American Association of Nurse Anesthesiology.)

In response to intense pressure, technology companies have enacted policies to combat misinformation 1-4 . The enforcement of these policies has, however, led to technology companies being regularly accused of political bias 5-7 . We argue that differential sharing of misinformation by people identifying with different political groups 8-15 could lead to political asymmetries in enforcement, even by unbiased policies. We first analysed 9,000 politically active Twitter users during the US 2020 presidential election. Although users estimated to be pro-Trump/conservative were indeed substantially more likely to be suspended than those estimated to be pro-Biden/liberal, users who were pro-Trump/conservative also shared far more links to various sets of low-quality news sites-even when news quality was determined by politically balanced groups of laypeople, or groups of only Republican laypeople-and had higher estimated likelihoods of being bots. We find similar associations between stated or inferred conservatism and low-quality news sharing (on the basis of both expert and politically balanced layperson ratings) in 7 other datasets of sharing from Twitter, Facebook and survey experiments, spanning 2016 to 2023 and including data from 16 different countries. Thus, even under politically neutral anti-misinformation policies, political asymmetries in enforcement should be expected. Political imbalance in enforcement need not imply bias on the part of social media companies implementing anti-misinformation policies., (© 2024. The Author(s).)

Competing Interests: Declaration of Competing Interest None to report.

Introduction: Use of albumin is suggested for some patients with shock, but preferences for its use may vary among intensive care unit (ICU) physicians., Methods: We conducted an international online survey of ICU physicians with 20 questions about their use of albumin and their opinion towards a randomised trial among adults with shock comparing the use versus no use of albumin., Results: A total of 1248 respondents participated, with a mean response rate of 37%, ranging from 18% to 75% across 21 countries. Respondents mainly worked in mixed ICUs and 92% were specialists in intensive care medicine. The reported use of albumin in general shock varied as 18% reported 'almost never', 22% 'rarely', 34% 'occasionally', 22% 'frequently' and 4% 'almost always' using albumin. In septic shock, 19% reported 'almost never', 22% 'rarely', 29% 'occasionally', 22% 'frequently' and 7% 'almost always' using albumin. Physicians' preferences were more consistent for haemorrhagic- and cardiogenic shock, with more than 45% reporting 'almost never' using albumin. While the reported use of albumin for other purposes than resuscitation was infrequent (40%-85% reported 'almost never' for five other indications), the most frequent other indications were low serum albumin levels and improvement of the efficacy of diuretics. Most respondents (93%) would randomise adult ICU patients with shock to a trial of albumin versus no albumin., Conclusions: In this international survey, the reported preferences for the use of albumin in adult ICU patients with shock varied considerably among surveyed ICU physicians. The support for a future randomised trial was high., (© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Reptiles and amphibians are popular in the exotic pet trade, where Australian species are valued for their rarity and uniqueness. Despite a near-complete ban on the export of Australian wildlife, smuggling and subsequent international trade frequently occur in an unregulated and unmonitored manner. In 2022, Australia listed over 100 squamates in Appendix III of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) to better monitor this trade. We investigated current trade and assessed the value of this Australian CITES listing using web-scraping methods to monitor the online pet trade in Australian reptiles and amphibians, with additional data from published papers, trade databases, and seizure records. Despite the export ban, we identified 170 endemic herpetofauna (reptile and amphibian) species in international trade, 33 of which were not recorded previously in the international market, including 6 newly recorded genera. Ninety-two traded species were included in CITES appendices (59 added in 2022), but at least 78 other traded species remained unregulated. Among these, 5 of the 10 traded threatened species were unlisted, and we recommend they be considered for inclusion in CITES Appendix III. We also recommend the listing of all Diplodactylidae genera in Appendix III. Despite this family representing the greatest number of Australian species in trade, only one genus (of 7 traded) was included in the recent CITES amendments. Overall, a large number of Australian reptile and amphibian species are traded internationally and, although we acknowledge the value of Australia's recent CITES listing, we recommend the consideration of other taxa for similar inclusion in CITES., (© 2024 The Author(s). Conservation Biology published by Wiley Periodicals LLC on behalf of Society for Conservation Biology.)

Trade in undomesticated ornamental animals has rapidly expanded beyond brick-and-mortar retail stores to now include growing numbers of internet marketplaces. The growing volume, diversity, and origins of invasive non-native species in trade challenge already weak national biosecurity policies. Despite widespread focus on vertebrates, many knowledge gaps exist regarding the online global trade of ornamental invertebrates. We conducted the first global assessment of the online trade in and associated invasion risk of freshwater crayfishes, which are increasingly popular aquarium animals. We systematically examined e-commerce marketplaces in multiple languages, scrapping information that included species identity, price, quantity, and shipping designation from each crayfish listing. Next, we combined geographic pathways of shipping associated with online trade (introduction risk) and environmental suitability modeling (establishment risk) to estimate global risk of non-native crayfish invasion risk. We identified hundreds of online marketplaces and thousands of sale listings in 33 countries (5 continents) involving 60 species and representing a selling value of ∼US$1.5 million. Invasion risk of non-native crayfish in trade was widespread, with geographic hotspots coinciding with both elevated opportunities for introduction (greater shipping offerings) and establishment. Precise characterization of the online species trade is fundamental to support new and reformed biosecurity policies, build industry partnerships, and design educational campaigns to prevent species invasions through trade. We found that the taxonomy, geography, and economics of the global online ornamental crayfish trade are vast and require greater attention., (© 2024 The Author(s). Conservation Biology published by Wiley Periodicals LLC on behalf of Society for Conservation Biology.)

This research investigates the intricate relationships between economic variables and how they affect South Asian nation's ability to develop sustainably. Given the growing concerns about climate change and global warming brought on by emissions of greenhouse gases, this study looks into the connection between emissions of CO 2 , green energy, industrialization, foreign direct investment, economic globalization, and financial development from 1995 to 2022. Second-generation panel techniques were employed in this study to look at the relationship between variables because of the potential of residual cross-sectional dependency and heterogeneity. The empirical outcomes display that green energy, economic globalization, and financial development reduce CO 2 emissions by 1.839%, 1.223%, and 3.902% respectively. Industrialization and foreign direct investment degrade the environment by 4.302% and 1.893% respectively. A bidirectional causality link between green energy, industrialization, economic globalization, and CO 2 emissions was found by Dumitrescu and Hurlin (D-H). Based on our findings, we recommend legislative support for renewable energy, cleaner technologies, and strict environmental regulations, aligning with the Sustainable Development Goals (SDGs). Encouraging FDI, sustainable practices, and financial development can drive economic growth while preserving the environment. As we approach COP28, this holistic approach to sustainable development becomes increasingly vital for South Asian countries to achieve their SDG targets and combat climate change., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The extent of loneliness differs internationally. Especially in the developed welfare states of Northern Europe, loneliness levels in the population are comparatively low. However, the increase in loneliness in many countries shows that existing concepts are not sufficient to provide effective protection against loneliness. Younger people also need to be strengthened so that they do not withdraw when they experience social exclusion and loneliness. This requires qualified specialists in kindergartens, schools, sports clubs, and other leisure facilities who help children and young people to establish social contacts. Friendship and neighborhood models have proven to be successful when it comes to strategies to combat loneliness. Greater identification with the neighborhood and a feeling of security help build social networks and reduce loneliness. For older people it is important to be able to stay in their usual social environment and maintain their social contacts. To this end, accessible public spaces must be combined with home care and support services that are tailored to the needs and wishes of older people., (© 2024. The Author(s).)

Purpose: The Joint Commission standards for titrated infusions require specification of maximum rates of infusion. This practice has led to the development of protocolized maximum doses that can be overridden by provider order ("soft maximums") and to dose caps that cannot be superseded ("hard maximums"). The purpose of this study was to determine the prevalence of and attitudes towards dose capping of norepinephrine. Methods: A 20-item cross-sectional survey assessing norepinephrine dose capping practices, perceptions of norepinephrine protocols, and respondent and practice site demographics was distributed electronically to the mailing list of an international medical podcast. Responses were stratified according to use of weight-based dosing (WBD) or non-WBD of norepinephrine. The primary objective was to characterize norepinephrine dosing practices including protocolized maximum doses and/or dose capping. Categorical and continuous variables were compared using the Chi-square test and Mann-Whitney U test, respectively, with P < .05 indicating statistical significance. Results: The survey was completed by 586 physicians, nurses, pharmacists, and advanced practice providers. WBD was used by 51% and non-WBD by 47%. A standardized titration protocol was reported by 65% and dose capping was reported by 19%. The protocolized maximum dose ranged from 20-400 mcg/min for respondents using non-WBD (median [interquartile range] 30 [30-50]) and ranged from .2-10 mcg/kg/min for respondents using WBD (1 [.5-3]). The dose cap was 50 (40-123) mcg/min with non-WBD and 2 (1-3) mcg/kg/min with WBD. Conclusions: An international, multi-professional survey of critical care and emergency medicine clinicians revealed wide variability in norepinephrine dosing practices including maximum doses allowed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Science integrity initiatives require specific recommendations for randomised clinical trials (RCT)., Objective: To prepare a set of statements for RCT integrity through an international multi-stakeholder consensus., Methods: The consensus was developed via multi-country multidisciplinary stakeholder group composition and engagement; evidence synthesis of 55 systematic reviews concerning RCT integrity; anonymised two-round modified Delphi survey with consensus threshold based on the average percent of majority opinions; and, a final consensus development meeting., Results: There were 30 stakeholders representing 15 countries from 5 continents including trialists, ethicists, methodologists, statisticians, consumer representative, industry representative, systematic reviewers, funding body panel members, regulatory experts, authors, journal editors, peer-reviewers and advisors for resolving integrity concerns. Delphi survey response rate was 86.7% (26/30 stakeholders). There were 111 statements (73 stakeholder-provided, 46 systematic review-generated, 8 supported by both) in the initial long list, with 8 additional statements provided during the consensus rounds. Through consensus the final set consolidated 81 statements (49 stakeholder-provided, 41 systematic review-generated, 9 supported by both). The entire RCT life cycle was covered by the set of statements including general aspects (n=6), design and approval (n=11), conduct and monitoring (n=19), reporting of protocols and findings (n=20), post-publication concerns (n=12), and future research and development (n=13)., Conclusion: Implementation of this multi-stakeholder consensus statement is expected to enhance RCT integrity., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Purpose: There have been significant advancements in toric soft contact lens design and manufacturing technology, and increased product availability, over the past half a century. The purpose of this work is to update earlier surveys by describing international trends in toric soft lens fitting between 2000 and 2023, inclusive., Method: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 220,934 standard soft daily wear single vision lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of toric soft lens fitting., Results: Overall, toric soft lens prescribing almost doubled over the time-course of this survey, from 24.4 % of standard soft daily wear single vision lens fits in 2000 to 46.2 % in 2023 (p < 0.0001). There were significant differences between countries in toric soft lens prescribing (p < 0.0001). Of all standard soft daily wear single vision contact lenses prescribed to males, 32.0 % were toric soft lenses, compared with 28.7 % for females (p < 0.0001). The mean age of toric soft lens wearers was 30.5 ± 12.5 years, compared to 27.9. ± 12.1 years for spherical soft lens wearers (p < 0.0001). Analysis of 13,582 recent toric soft lens fits (2019-2023, inclusive), in terms of material type and replacement frequency, revealed the following proportions: reusable silicone hydrogel - 51 %; daily disposable silicone hydrogel - 27 %; daily disposable hydrogel - 12 %; and reusable hydrogel - 10 %., Conclusion: There has been a substantial increase in toric soft lens fitting throughout the 24 years of this survey, to a point whereby almost all clinically significant astigmatism is being corrected among those wearing standard soft daily wear single vision lenses., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nathan Efron: Over the past three years Nathan Efron has received honoraria from CooperVision. Philip Morgan: Over the past three years Philip Morgan’s research group or he personally has received funding or honoraria from: Alcon, Clearlab, CooperVision, Daysoft, Johnson & Johnson Vision, Menicon, and Visco Vision. He is a director of M-Optometry Limited. Craig Woods: Over the past three years Craig Woods has acted as a consultant for the Brien Holden Vision Institute and Zeiss Vision Care. Deborah Jones: Over the past three years Debbie Jones has received honoraria from Hoya, Essilor, CooperVision, Alcon and SightGlass. Lyndon Jones: Over the past three years, Lyndon Jones’ research group (CORE) or he personally has received research support or lectureship honoraria from Alcon, Azura Ophthalmics, Bausch & Lomb, CooperVision, Essilor, Hoya, iMed Pharma, Integral Biosystems, Johnson & Johnson Vision, Menicon, Novartis, Ophtecs, Ote Pharma, Santen, SightGlass Vision, SightSage, Topcon and Visioneering. Dr Jones is also a consultant and/or serves on an advisory board for Alcon, CooperVision, Johnson & Johnson Vision, Novartis and Ophtecs. Jason Nichols: Jason Nichols has nothing to report. Also, Kelly Nichols is the spouse of Jason Nichols, extending her declarations to him. In the past 12 months, Kelly Nichols has consulted for and received honoraria from: Abbvie, Alcon, Aldeyra, Azura, Bausch + Lomb, Bruder, Cavalry, Dompe, HanAll Bio, Harrow, Novartis, Novaliq, Oyster Point Pharma/Viatris, Sydnexis, Tarsus, TearSolutions, Thea, Topcon, and Trukera. She has received research funding from: Aramis, Kowa, Science Based Health, Sylentis, and TearScience., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Biosecurity is a major concern in the global pig production. The separation in time of semen collection, processing and insemination in the pig farm is a few days for chilled semen but it can be indefinite when using cryopreserved semen. Field fertility results of boar cryopreserved semen are close to chilled semen, which makes it a valuable resource for the establishment of semen genebanks, long-distance semen trade, and the implementation of other technologies such as the sex-sorted semen. But cryopreserved semen is far from being routine in pig farms. The most recent research efforts to facilitate its implementation include the use of additives before freezing, or in the thawing extender. Long-term preserved semen trade is a biosecurity challenge. To harmonize international trade of germplasm, the World Organization of Animal Health (WOAH) established a regulatory framework for all member countries. The present paper aims to review the latest advances of boar semen cryopreservation with special focus on the benefits of its inclusion as a routine tool in the pig industry. We also review recently reported field fertility results of cryopreserved semen, its international trade compared to chilled semen, and the regulatory framework involved. Boar cryopreserved semen is a valuable tool to control biosecurity risk, implement other technologies, and facilitate international trade. Research already demonstrated good field fertility results, but it still represents less than 0.1 % of the international trade. As boar cryopreserved semen gets closer to implementation, the correspondent authorities are reviewing the trade rules., Competing Interests: Declaration of Competing Interest Alfonso Bolarin and Jodi Berndtson work in AcuFast, a swine genetic company with activity in America and Asia. Other authors declare no conflict of interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Rigid contact lenses have an important role in contact lens practice. The purpose of this work is to update earlier surveys by describing global trends in rigid lens fitting between 2000-2023., Method: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023. Data relating to 342,500 fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of rigid lens fitting, defined as the fitting of any design of a contact lens manufactured in a rigid material., Results: Overall, rigid lens prescribing increased slightly over time, from 14.2 % of lens fits in 2000 to 15.2 % in 2023 (p < 0.0001). However, post-hoc analysis shows that the change over time is best described as a decline between 2000 and 2012, followed by a steady increase subsequently. There were significant differences in rigid lens prescribing between countries (p < 0.0001). The difference between the percentage of males fitted with rigid lenses, as a proportion of all contact lenses (12.7 %), and females (12.0 %) is significant (p < 0.0001), although not clinically meaningful. Rigid lens wearers are older at fitting than soft lens wearers (38.7 vs 31.3 years, respectively) (p < 0.0001). Analysis of 5,994 rigid lens fits prescribed currently (2019-2023) were categorised as: corneal sphere - 30 %; scleral and corneo-scleral - 28 %; corneal myopia control/orthokeratology - 21 %; and corneal complex (including toric, multifocal and monovision) - 16 %., Conclusion: There has been a slight increase in rigid lens fitting during the second decade of this century. This increase is apparently due to a 'repurposing' of rigid lenses, with the growth of scleral/corneo-scleral and myopia control/orthokeratology lens fits essentially replacing conventional spherical corneal lens fits., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nathan Efron: Over the past three years Professor Efron has received honoraria from CooperVision. Philip B. Morgan: Over the past three years Professor Morgan’s research group or he personally has received funding or honoraria from: Alcon, Clearlab CooperVision, Daysoft, Johnson & Johnson Vision, Menicon, and Visco Vision. He is a director of M-Optometry Limited. Craig Woods: Over the past 3 years Prof Woods has acted as a consultant for the Brien Holden Vision Institute and Zeiss Vision Care. Deborah Jones: Over the past 3 years Dr Jones has received honoraria from Hoya, Essilor, CooperVision, Alcon and SIghtglass. Lyndon Jones: Over the past three years, Dr Jones’ research group (CORE) or he personally has received research support or lectureship honoraria from Alcon, Azura Ophthalmics, Bausch & Lomb, CooperVision, Essilor, Hoya, iMed Pharma, Integral Biosystems, Johnson & Johnson Vision, Menicon, Novartis, Ophtecs, Ote Pharma, Santen, SightGlass, SightSage, Topcon and Visioneering. Dr Jones is also a consultant and/or serves on an advisory board for Alcon, CooperVision, Johnson & Johnson Vision, Novartis and Ophtecs. Over the last 12 months, Jason Nichols: Dr Jason Nichols has nothing to report. Also, Dr. Kelly Nichols is the spouse of Dr. Jason Nichols, extending her declarations to him. In the past 12 months, Dr Kelly Nichols has consulted for and received honorarium from: Abbvie, Alcon, Alderya, Azura, Bausch + Lomb, Bruder, Cavalry, Dompe, HanAll Bio, Harrow, Novartis, Novaliq, Oyster Point Pharma/Viatris, Sydnexis, Tarsus, TearSolutions, Thea, Topcon, and Trukera. She has received research funding from: Aramis, Kowa, Science Based Health, Sylentis, and TearScience., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

More than 15% of all vascular plant species may remain scientifically undescribed, and many of the > 350 000 described species have no or few geographic records documenting their distribution. Identifying and understanding taxonomic and geographic knowledge shortfalls is key to prioritising future collection and conservation efforts. Using extensive data for 343 523 vascular plant species and time-to-event analyses, we conducted multiple tests related to plant taxonomic and geographic data shortfalls, and identified 33 global diversity darkspots (those 'botanical countries' predicted to contain most undescribed and not yet recorded species). We defined priority regions for future collection according to several socio-economic and environmental scenarios. Most plant diversity darkspots are found within global biodiversity hotspots, with the exception of New Guinea. We identify Colombia, Myanmar, New Guinea, Peru, Philippines and Turkey as global collection priorities under all environmental and socio-economic conditions considered. Our study provides a flexible framework to help accelerate the documentation of global plant diversity for the implementation of conservation actions. As digitisation of the world's herbaria progresses, collection and conservation priorities may soon be identifiable at finer scales., (© 2024 The Author(s). New Phytologist © 2024 New Phytologist Foundation.)

We analyze in this article the effects of personality on attitudes toward foreign policy through a comprehensive aspect-level approach. We claim that previous observed null domain-level effects are the product of the aspect-level effects of opposing signs. By and large, we show that some personality effects are of comparable size or bigger than demographics studied in the literature, and that some of these effects are unique and independent of demographic covariates. Our results show that openness, orderliness, and compassion render people to be more supportive of cooperation. Assertiveness is the primary driver of support for the use of military force, whereas politeness and withdrawal ground reverse effects. Volatility roots isolationism postures, whereas industriousness, enthusiasm, and compassion show strong opposing effects. Moving beyond the Big Five personality domain approach provides us with a deeper and more nuanced understanding of how personality is associated with attitudes toward international issues., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The global nursing workforce is confounded by shortages of nurses, faculty, and academic nursing leaders. Nursing academic leaders influence faculty recruitment and retention influencing the enrollment pipeline to fill nurse workforce capacity., Objective: To identify leadership qualities nursing faculty prefer in nursing academic leaders globally., Design: A multi-country exploratory design employed a three-round Delphi process including Demographic Data and open-ended questions., Setting: An online Qualtrics survey was emailed to schools of nursing selected from seven global regions: United States (North America), Mexico (Latin America/ Caribbean), South Africa (Africa), Saudi Arabia (Middle East), Korea (Asia), Sweden (Europe), and Australia (Oceania)., Participants: A convenience sample of faculty members employed in schools of nursing in the seven countries., Method: A 43-item Qualtrics survey developed from literature review of leadership qualities of nursing academic leaders was distributed to nursing faculty who participated in three Delphi rounds using descriptive statistics to analyze each round. Open-ended questions were analyzed using qualitative descriptive analysis., Results: In Round 1, 54 faculty rated the 43 leadership qualities using a Likert Scale, identified the top 10, and added additional qualities not in the list. In Round 2, 26 of the original participants rated the resulting 29 leadership qualities. In Round 3, 16 of the original participants ranked their top 8 leadership qualities: mutual trust and respect; clear communication; creating a cohesive culture; assuring diversity, equity, and inclusivity; integrity; developing effective team structure; effective decision-making; and leading by example. In Round 3 participants rated nurses' preparedness for academic leadership. Open-ended questions identified 1) Strategies to prepare nurses for academic leadership roles and 2) Essential characteristics for effective academic leaders., Conclusion: Developing key leadership skills can increase the leadership capacity of nursing academic leaders, enhancing work environments, faculty recruitment and retention, helping mitigate a global challenge., Competing Interests: Declaration of competing interest There is no conflict of interest to declare and authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Robotic surgery has expanded internationally at pace. There are multiple local robotic training pathways but there is inconsistency in standardisation of core common components for curricula internationally. A framework is required to define key objectives that can be implemented across robotic training ecosystems. This Delphi consensus aimed to provide recommendations for core considerations in robotic training design across diverse training environments internationally. A literature search was performed and an international steering committee (AG, KL, JW, HM, TC) proposed key components for contemporary robotic training design and a modified Delphi approach was used to gather stakeholder opinion. The outcomes were then discussed at a face-to-face international expert consensus at the IMRA educational session at the Society of Robotic Surgery (SRS) meeting and final voting was conducted on outstanding items. Stakeholders included robotic surgeons, proctors, trainees and robotic surgical training providers. There was consensus achieved in 139 statements organised into 15 themes. There was 100% agreement that standardised themes in robotic curricula may improve patient safety. Key take-home messages include-training curricula should be multiplatform, non-technical skills are an important component of a robotic curriculum as well as console and bedside skills, clinically relevant performance metrics should be used for assessment where available, the reliance on cadaveric and live animal models should be reduced as high-fidelity synthetic models emerge, and stepwise component training is useful for advanced procedural training. These consensus recommendations are intended to guide design of fit for purpose contemporary robotic surgical curricula. Integration of these components into robotic training pathways internationally is recommended., (© 2024. The Author(s).)

Competing Interests: Competing interests: None declared.

Background: Dietary habits are pivotal for population health and well-being, yet remain a pressing global issue, particularly in Sub-Saharan Africa (SSA), where economic instability and institutional challenges exacerbate dietary problems. Despite extensive research, there is a notable gap in the literature regarding the direct and interactive effects of institutional quality and inflationary shocks on dietary habits., Methods: This study delves into these complex interplays across 44 SSA nations from 2002 to 2022. Employing an innovative entropy method (EM) and the generalized autoregressive conditional heteroskedasticity (GARCH) modeling, the study introduces an inclusive institutional quality index and an inflationary shock predictor as crucial determinants of dietary habits in the literature., Results: The results from the panel-corrected standard error (PCSE) method and feasible generalized least squares (FGLS) model reveal that per capita GDP, school enrollment rate, government expenditures, globalization index, and urbanization are positively associated with population dietary habits, while inflationary shock, food insecurity, and unemployment rate exert negative influences. Notably, institutional quality acts as a catalyst, amplifying the positive effects of the former group and absorbing the negative impacts of the latter on population dietary habits. Additionally, a dynamic panel causality analysis confirms a bidirectional causality nexus between population dietary habits and all variables, except for inflationary shocks, which demonstrate a unidirectional causality link., Conclusions: These findings carry significant policy implications, underscoring the complex dynamics between institutional quality, inflationary shocks, and dietary habits in the region. The bidirectional causality highlights the need for holistic interventions that address economic, social, and institutional factors simultaneously. Moreover, the unidirectional causality of inflationary shocks on dietary habits suggests that stabilizing inflation is critical to protecting dietary habits. These results provide critical insights for policymakers to design targeted interventions aimed at improving nutrition, bolstering institutional frameworks, and ensuring public health resilience in the face of economic and social shocks.

Aquatic foods are highly traded, with nearly 60 million tonnes exported in 2020, representing 11% of global agriculture trade by value. Despite the vast scale, basic characteristics of aquatic food trade, including species, origin, and farmed vs wild sourcing, are largely unknown due to the reporting of trade data. Consequently, we have a coarse picture of aquatic food trade and consumption patterns. Here, we present results from a database on species trade that aligns production, conversion factors, and trade to compute apparent consumption for all farmed and wild aquatic foods from 1996 to 2020. Over this period, aquatic foods became increasingly globalized, with the share of production exported increasing by 40%. Importantly, trends differ across aquatic food sectors. Global consumption also increased by 19.4% despite declining marine capture consumption, and some regions became increasingly reliant on foreign-sourced aquatic foods. To identify sustainable diet opportunities among aquatic foods, our findings, and underlying database enable a greater understanding of the role of trade in rapidly evolving aquatic food systems., (© 2024. The Author(s).)

Environmental issues have gradually become a key concern for society. The public has been paying increasing attention to corporate environmental disclosure and performance. With the "go global" trend, more and more enterprises are looking to overseas markets for new technologies and resources. Multinational enterprises (MNEs) are facing more challenges than domestic enterprises. To remain competitive and sustainable, enterprises from developing countries need to gain a foothold in developed countries. We explore how MNEs' internationalization impacts environmental disclosure, specifically focusing on the role of green investors as stakeholders. We draw evidence from Chinese-listed MNEs, with a total of 4,709 panel data observations. For the main analysis, we use a fixed effect model. The findings suggest that a higher level of internationalization can improve both the willingness and quality of environmental disclosure for MNEs, and this relationship is further strengthened by green investors. A heterogeneity analysis reveals that the positive effect of internationalization on environmental disclosure is mainly present in state-owned enterprises (SOEs) and developed host countries. We find that external pressure from host countries motivates MNEs to increase environmental disclosure willingness and quality. This study provides valuable insights for MNEs from emerging economies on how to achieve legitimacy and a positive reputation in overseas markets through environmental disclosure strategies. This study proposes the importance of green investors on environmental disclosure issues from a stakeholder perspective and provides new theoretical insights for environmental policy reform in developing countries such as China., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 He, Yang. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This paper presents an examination of the relationship between international operations and corporate R&D investment. Using a large sample of Chinese listed firms for the 2009-2022 period and the ordinary least squares method, we find that international operations have a positive effect on corporate R&D investment. The finding remains valid after a battery of robustness tests. Mechanism tests show that international operations increase corporate R&D investment by diversifying product demand instead of increasing firms' international knowledge acquisition. This paper provides new evidence on the role of international operations in innovation activities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Caregivers face various difficulties that put a huge burden on them, especially when dealing with immobilized elderly patients. This study aimed to compare caregivers' burdens and coping mechanisms during the care of immobilized elderly patients., Materials and Methods: The descriptive comparative design was adopted for this study in Najran City, Saudi Arabia, and Damanhour City, Egypt, in 2022. A total of 104 caregivers were conveniently selected over 3 months of data collection using the following tools: Elderly Patient Caregivers' Knowledge, Elderly Caregivers' Practice, The Lazarus Coping Strategies Questionnaire, and Zarit Burden Inventory. The authors used descriptive statistics (mean, frequencies, and standard deviation) and inferential statistics (Chi-square, t -test, Pearson correlation, Spearman correlation) to analyze the data., Results: In Najran, 57.70% of caregivers experienced a mild level of burden compared to 30.80% in Damanhour, indicating a significant difference in the total level of burden between the two groups (X 2 = 7.90, df = 2, p = 0.01). The mean coping mechanism score among caregivers in Najran is significantly higher than the mean among caregivers in Damanhour. The duration of providing the care significantly influenced the total level of burden, the total level of practice, the coping mechanism, the income, the availability of health care, and the presence of additional caregivers, with all p values <0.05., Conclusions: It is essential to integrate nurses and caregivers into educational programs to help them cope effectively with the challenging duties they undertake. Based on the findings of this study, interventional studies to reduce the burden and improve coping among caregivers are recommended., Competing Interests: Nothing to declare., (Copyright: © 2024 Iranian Journal of Nursing and Midwifery Research.)

Total metabolic tumor volume (TMTV) is prognostic in lymphoma. However, cutoff values for risk stratification vary markedly, according to the tumor delineation method used. We aimed to create a standardized TMTV benchmark dataset allowing TMTV to be tested and applied as a reproducible biomarker. Methods: Sixty baseline 18 F-FDG PET/CT scans were identified with a range of disease distributions (20 follicular, 20 Hodgkin, and 20 diffuse large B-cell lymphoma). TMTV was measured by 12 nuclear medicine experts, each analyzing 20 cases split across subtypes, with each case processed by 3-4 readers. LIFEx or ACCURATE software was chosen according to reader preference. Analysis was performed stepwise: TMTV1 with automated preselection of lesions using an SUV of at least 4 and a volume of at least 3 cm 3 with single-click removal of physiologic uptake; TMTV2 with additional removal of reactive bone marrow and spleen with single clicks; TMTV3 with manual editing to remove other physiologic uptake, if required; and TMTV4 with optional addition of lesions using mouse clicks with an SUV of at least 4 (no volume threshold). Results: The final TMTV (TMTV4) ranged from 8 to 2,288 cm 3 , showing excellent agreement among all readers in 87% of cases (52/60) with a difference of less than 10% or less than 10 cm 3 In 70% of the cases, TMTV4 equaled TMTV1, requiring no additional reader interaction. Differences in the TMTV4 were exclusively related to reader interpretation of lesion inclusion or physiologic high-uptake region removal, not to the choice of software. For 5 cases, large TMTV differences (>25%) were due to disagreement about inclusion of diffuse splenic uptake. Conclusion: The proposed segmentation method enabled highly reproducible TMTV measurements, with minimal reader interaction in 70% of the patients. The inclusion or exclusion of diffuse splenic uptake requires definition of specific criteria according to lymphoma subtype. The publicly available proposed benchmark allows comparison of study results and could serve as a reference to test improvements using other segmentation approaches., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Negotiations for a global treaty on plastic pollution 1 will shape future policies on plastics production, use and waste management. Its parties will benefit from a high-resolution baseline of waste flows and plastic emission sources to enable identification of pollution hotspots and their causes 2 . Nationally aggregated waste management data can be distributed to smaller scales to identify generalized points of plastic accumulation and source phenomena 3-11 . However, it is challenging to use this type of spatial allocation to assess the conditions under which emissions take place 12,13 . Here we develop a global macroplastic pollution emissions inventory by combining conceptual modelling of emission mechanisms with measurable activity data. We define emissions as materials that have moved from the managed or mismanaged system (controlled or contained state) to the unmanaged system (uncontrolled or uncontained state-the environment). Using machine learning and probabilistic material flow analysis, we identify emission hotspots across 50,702 municipalities worldwide from five land-based plastic waste emission sources. We estimate global plastic waste emissions at 52.1 [48.3-56.3] million metric tonnes (Mt) per year, with approximately 57% wt. and 43% wt. open burned and unburned debris, respectively. Littering is the largest emission source in the Global North, whereas uncollected waste is the dominant emissions source across the Global South. We suggest that our findings can help inform treaty negotiations and develop national and sub-national waste management action plans and source inventories., (© 2024. The Author(s).)

Climate change resulting from increasing emissions has become a pressing concern in North African countries due to its significant environmental and socio-economic impacts. There is a need for extensive research on this topic to raise global awareness of the associated dangers. This study investigates the dynamic impact of economic growth, military expenditure, globalization, renewable energy, manufacturing, tourism, capital formation, and labor on CO 2 emissions in North African countries from 1995 to 2021. The long-term results of the ARDL model reveal that globalization, renewable energy and capital formation have a negative impact on CO 2 emissions, whereas economic growth, manufacturing, and tourism exhibit a positive impact. Pairwise Granger causality evidence indicates unidirectional causality from economic growth, globalization, military expenditure, manufacturing, tourism, and capital formation to CO 2 emissions. These findings provide policymakers with critical insights to shape evidence-based interventions that promote renewable energy investments and globalization, enhance capital formation and high-skilled labor, and implement regulations to mitigate the environmental impacts of economic growth, military expenditure, manufacturing, and tourism. This guidance will help the region transition to a more environmentally friendly economic system., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This paper explores how what I call 'administrative categories' have been adopted by the Japanese government and experts in autism support and what roles these categories have played in local settings. Since support practices for children and adults with autism began in the 1950s in Japan, the Japanese government and people engaging in autism support have used Japanese-specific administrative categories, instead of relying on a medical concept of autism, such as 'severe moving disabilities' (SMD), 'emotional disturbance', and 'extremely disruptive behavioural disorders' (EDBD). To understand the emergence of these three autism-related administrative categories in Japan, historical materials published from the 1950s to the 1990s by Japanese authors (doctors, psychologists, teachers, educationalists, welfare workers, government officials, and parents) and interview data with 19 leading experts of autism in Japan were collected and analysed thematically. The analysis revealed that the governmental ministries aimed to focus on establishing administrative support by avoiding engaging in aetiological debates among doctors, and to describe the political agenda more vividly. Administrative categories filled the gap between local interests and international medical concepts, enabling the concept of autism to be rooted in Japan's administrative systems. Three roles of administrative categories were identified: i) separation from medicine, ii) describing local problems, and iii) claimsmaking to wider actors and the public. I concluded that looking purely at medical and specifically diagnostic concepts limits our understanding of the formation of practices regarding disabilities, and thus more focus should be placed on categorisation practices outside of medicine. In addition, to the literature on the globalisation of Euro-American psychiatric concepts, this study contributes to our knowledge of a form of locality that has not been central in the exploration of the influence of globalisation on local settings and the relationships between the local and the global., Competing Interests: Declaration of competing interest The author declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

Internationalization in higher education is essential, and although active learning methodologies are increasing and allow students to develop transversal skills, most still have a very local scope. In this context, the Collaborative Online International Learning (COIL) methodology is an interesting approach to benefit the students' development. It consists of an online program that involves creating multicultural teams to develop a specific learning project. Although this methodology is expanding, its use in physiology is still scarce. This paper aims to show an example of applying COIL methodology in physiology topics to enhance higher-education students' innovation and business skills. Our example project developed a sports-assessment service concept focused on physiology and biomechanics assessments. The program involved teams from Brazil, Germany, and Spain, comprising undergraduate and master students. Over 7 weeks, these teams, mentored by professors and researchers, engaged in workshops covering COIL methodology, business model design, executive summary planning, economic analyses, and communication techniques. Key outcomes included learning new concepts, developing soft skills, building confidence in innovative solution proposals, and experiencing diverse cultures. Challenges faced were language barriers, scheduling, task complexity, and logistical issues. This experience confirms the effectiveness of incorporating programs using COIL methodology into educational curriculums. Doing so exposes physiology students to innovation, entrepreneurship, and business creation while strengthening their professional connections and opening up postgraduation opportunities. NEW & NOTEWORTHY Although the Collaborative Online International Learning (COIL) methodology is expanding, its use in physiology is still scarce. Our example COIL project of 7 weeks developed a sports-assessment service concept focused on physiology and biomechanics assessments. The program involved teams from Brazil, Germany, and Spain, comprising undergraduate and master's students. Students perceived extracurricular activities in this format as beneficial. Coaches also expressed positive views about such initiatives, noting benefits for students and their development.

Globalization and international migration movements have massively changed the population structure of most industrial nations in recent decades. The ever-increasing proportion of people with a migration background also poses a challenge for the medical sector. A particular problem is the stressful phase of the menopausal transition, which - although not a pathological phenomenon but part of the female life history - can lead to psychological and physical symptoms due to hormonal changes, which significantly impair the quality of life of the women affected. However, treatment concepts, as well as access to medical facilities and information, are geared towards Western women from high-income countries. Women with a history of voluntary or forced migration originating from non-Western countries represent a particularly vulnerable group. To enable personalized treatment, studies on menopausal transition in women with a migration background are required. The present review shows that studies on menopausal women with a migration background have been conducted primarily in classic immigration countries such as the USA, Australia, or the UK, but that there is a lack of such studies in countries with no long tradition as an immigration country, such as Austria or Germany. This is becoming a growing problem, as the number of menopausal women with a migration background is increasing., Competing Interests: Declaration of competing interest The author declares that there is no competing interest., (Copyright © 2024 The Author. Published by Elsevier B.V. All rights reserved.)

This analysis assessed the effectiveness and tolerability of brivaracetam (BRV) in older (≥65 years of age) and younger (≥16 to <65 years of age) adults with epilepsy. This was a subgroup analysis from EXPERIENCE/EPD332, a pooled analysis of individual patient records from multiple independent, non-interventional studies of patients with epilepsy starting BRV in Australia, Europe, and the United States. Included patients had ≥6 months of follow-up data. Outcomes included responders (≥50 % reduction from baseline in seizure frequency), seizure freedom (no seizures within 3 months before the time point), and continuous seizure freedom (no seizures from baseline) at 12 months; BRV discontinuation during the whole study follow-up; and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Patients with missing data after BRV discontinuation were deemed non-responders/not seizure-free. Analysis populations included the Full Analysis Set (FAS; patients who received ≥1 BRV dose and had seizure type and age documented at baseline) and the modified FAS (FAS patients who had ≥1 seizure recorded during baseline). The FAS was used for all outcomes except seizure reduction. The FAS included 147 (8.9 %) patients aged ≥65 years and 1497 (91.1 %) aged ≥16 to <65 years. Compared with the younger subgroup, patients aged ≥65 years had a longer median epilepsy duration (33.0 years [n = 144] vs 17.0 years [n = 1460]) and lower median seizure frequency at index (2.0 seizures/28 days [n = 129] vs 4.0 seizures/28 days [n = 1256]), and less commonly had >1 prior antiseizure medication (106/141 [75.2 %] vs 1265/1479 [85.5 %]). At 12 months, a numerically higher percentage of patients aged ≥65 years versus the younger subgroup achieved ≥50 % seizure reduction (46.5 % [n = 71] vs 36.0 % [n = 751]), seizure freedom (26.0 % [n = 100] vs 13.9 % [n = 1011]), and continuous seizure freedom (22.0 % [n = 100] vs 10.7 % [n = 1011]). During the whole study follow-up, 43/147 (29.3 %) patients aged ≥65 years and 508/1492 (34.0 %) aged ≥16 to <65 years discontinued BRV. The incidence of TEAEs since the prior visit was similar in both subgroups at 3 months (≥65 years vs ≥16 to <65 years: 38/138 [27.5 %] vs 356/1404 [25.4 %]), 6 months (19/119 [16.0 %] vs 176/1257 [14.0 %]), and 12 months (8/104 [7.7 %] vs 107/1128 [9.5 %]). This real-world analysis suggests BRV was effective in patients aged ≥65 years and ≥16 to <65 years, with numerically higher effectiveness in the older subgroup. BRV was well tolerated in both subgroups., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: E. Faught has received research funding from Xenon and UCB Pharma, and consulting fees from Aucta, Azurity, Biogen, the Centers for Disease Control and Prevention, LivaNova, Neurelis the State of Georgia, SK Life Science and Trevena, is on the editorial board of the Annals of Neurology and the executive board of The Epilepsy Consortium H. Besson, D. Bourikas, T. Daniels, F. Floricel, and C. Laloyaux are employees of UCB Pharma. W. D’Souza’s salary is part-funded by The University of Melbourne; he has received travel, investigator-initiated, scientific advisory board, and speaker’s honoraria from UCB Pharma Australia & Global; investigator-initiated, scientific advisory board, travel, and speaker’s honoraria from Eisai Australia & Global; advisory board honoraria from LivaNova and Tilray; educational grants from Novartis, Pfizer, and Sanofi-Synthélabo; educational, travel, and fellowship grants from GSK Neurology Australia; and honoraria from SciGen Pharmaceuticals; he has an equity interest in the device company EpiMinder. P. Klein has served as a consultant for Abbott, Arvelle Therapeutics, Neurelis, and SK Life Science; as a consultant, advisory board member, and speaker for Aquestive, Eisai, Sunovion, and UCB Pharma; is a member of the medical advisory board of Stratus and the scientific advisory board of OB Pharma; is the CEO of PrevEp; and has received research support from CURE and Department of Defense/Lundbeck. M. Reuber receives payment from Elsevier as editor-in-chief of Seizure; and has received research grants and speaker’s fees from Eisai, LivaNova, and UCB Pharma. F. Rosenow reports personal fees from Angelini Pharma, Arvelle Therapeutics, Eisai GmbH, and GW Pharmaceuticals; personal fees and other from Novartis; personal fees and grants from UCB Pharma; and grants from the Detlev-Wrobel-Fonds for Epilepsy Research Frankfurt, Deutsche Forschungsgemeinschaft, the European Union, and the State of Hessen outside the submitted work. J. Salas-Puig has received grants from Bial and UCB Pharma; and reports personal fees from Bial, Eisai, Esteve, Sanofi, and UCB Pharma outside the submitted work. V. Soto Insuga has received speaker honoraria from Bial, Eisai, and UCB Pharma. B.J. Steinhoff has received speaker’s honoraria from Al-Jazeera, Desitin, Eisai, GW Pharmaceuticals, Hikma, Novartis, Sandoz, and UCB Pharma; and has served as a consultant for Arvelle Therapeutics, B. Braun, Bial, Desitin, Eisai, GW Pharmaceuticals, and UCB Pharma. A. Strzelczyk reports personal fees and grants from Angelini Pharma, Biocodex, Desitin Arzneimittel, Eisai, GW/Jazz Pharmaceuticals, Marinus Pharma, Precisis, Takeda, UCB Pharma, UNEEG medical, and Zogenix. He is editor-in-chief of Clinical Epileptology and section editor of Neurological Research and Practice. J.P. Szaflarski has received research funding from Biogen, the Department of Defense, Eisai, GW Pharmaceuticals companies, National Institutes of Health, National Science Foundation, NeuroPace, Serina Therapeutics, Shor Foundation for Epilepsy Research, State of Alabama General Funds, and UCB Pharma; has served as a consultant or advisory board member for Elite Medical Experts, GW Pharmaceuticals, LivaNova, Lundbeck, Medical Association of the State of Alabama, NeuroPace, Serina Therapeutics, SK Life Science, and UCB Pharma; has served as an investigator on GW Research Ltd trials; and is an editorial board member for Epilepsy & Behavior, Epilepsy & Behavior Reports (associate editor), Epilepsy Currents (contributing editor), Folia Medica Copernicana, Journal of Epileptology (associate editor), and Journal of Medical Science. D. Friesen is an independent contractor for UCB Pharma. V. Villanueva has served as a consultant or on an advisory board for Arvelle Therapeutics, Bial, Eisai, Esteve, GW Pharmaceuticals, Novartis, and UCB Pharma; has received research grants from Bial, Eisai, and UCB Pharma; and has received speaker’s honoraria from Bial, Eisai, Esteve, GW Pharmaceuticals, Novartis, and UCB Pharma., (Copyright © 2024 Elsevier Inc. All rights reserved.)