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Palliative radiation therapy (pRT) is an effective tool for people with incurable cancer, in the treatment of many cancer-related symptoms such as pain, bleeding and dyspnea. As utilization rates for palliative radiation therapy increase, the demands on the healthcare system continue to grow. Radiation Therapists with advanced knowledge, skills and judgements began demonstrating their ability to practice autonomously in 2004, with the development of the Clinical Specialist Radiation Therapist (CSRT) role. Since this time, CSRTs with a specific focus in pRT (pCSRT) have been increasing in both numbers as well as their positive effects on the cancer care system. Integrating a pCSRT into the existing pRT system has resulted in increased access to and quality of pRT being delivered to palliative cancer patients. The benefits of the addition of pCSRTs to the cancer care system include increasing system capacity and increasing quality of care. This white paper provides information related to the improvements that can be realized in a RT program related to the care and treatment of its palliative patients by adding a pCSRT to the interprofessional healthcare team and suggest it as one of many strategies that can be undertaken to make improvements to access and quality of care.

Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work-up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.

Allergo journal international 30(5), 155-168 (2021). doi:10.1007/s40629-021-00178-2, Published by Urban & Vogel, München

The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective.

Physical paper puppets are inanimate objects, but when we’re speaking in terms of the production of traditional paper cut out animation, they become the actors and the souls that drive the movie. When shooting and animating traditional paper cut out animation, the puppets are laid flat on a surface so they can only move in limited directions compared to conventional 2D or 3D animation. As we know, each character in animated movie has its own personality and unique to each other. The challenge lays in bringing out the characteristics and personality of the character through the limited medium of paper puppet. In this qualitative research, puppet movements will be applied to quadruped cat characters in a public service announcement titled “Spay & Neuter”. The puppet along with the visual design, segmentations, and joints were done in previous research. Qualitative observations and audio-visual materials are used to collect the data for references. Literature review will study the characteristics of cats, body language, behaviour, and principles of animation especially timing and exaggeration. Observation is conducted by studying the movements of real cats from online videos and direct observations and also studying how other animators animate cat characters in animated films. In the exploration stage, paper puppets will be animated according to the movement design while experimenting with the timing and frame rate of the stop motion to achieve the final results.

Human trafficking is a pandemic human rights violation with an emerging paradigm shift that reframes an issue traditionally seen through a criminal justice lens to that of a public health crisis, particularly for children. Children and adolescents who are trafficked or are at risk for trafficking should receive evidence-based, trauma-informed, and culturally responsive care from trained health care providers (HCPs). The purpose of this article was to engage and equip pediatric HCPs to respond effectively to human trafficking in the clinical setting, improving health outcomes for affected and at-risk children. Pediatric HCPs are ideally positioned to intervene and advocate for children with health disparities and vulnerability to trafficking in a broad spectrum of care settings and to optimize equitable health outcomes.

Introduction Muscular dystrophies present a group of inherited degenerative disorder that are characterized by progressive muscular weakness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. The aim of the paper is to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for people with muscular dystrophies. Evidence acquisition A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. Evidence synthesis The systematic literature review is reported together with thirty-three recommendations resulting from the Delphi procedure. Conclusions The role of the PRM physician is to assess the functional status of persons with muscular dystrophy and to plan, monitor and lead PRM program in an interdisciplinary setting within a multiprofessional team.

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.

The transperineal approach is preferred to reduce prostate biopsy (PB)-related infections. Fluoroquinolones are suspended for prophylaxis of PB in the European Union; therefore, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal PB.

Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of healthcare facilities with home and everyday life settings barely addressed.\ud \ud As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms.\ud \ud This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in healthcare settings requires a mirrored reduction in the community.\ud \ud The authors call upon national and international policy makers, health agencies and healthcare professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.

Emergency Medical Services provider agencies and programs for systems of care for time-sensitive conditions in many communities and regions struggle with hospitals to obtain feedback data regarding patient outcomes and hospital processes relevant to EMS quality programs. EMS provider agencies also have issues in providing information to hospitals at the time of patient transfer to support continuity of care. The paper presents a position statement and supporting rationale from the National EMS Management Association on the bi-lateral exchange of data between EMS and hospitals. It examines the underlying issues and offers recommendations for how the various barriers to bi-lateral information exchange can be resolved.

Background: Asia Pacific Initiative on Reproduction (ASPIRE) aims to improve knowledge and awareness of Assisted Reproductive Technology (ART) and infertility-related services, with the aim of improving the quality of patient care. Methods: A survey was developed and responded by a group of 10 ASPIRE board members to gather in-depth information about current practices, recommendations, and perceptions about SARS-CoV-2 and ART. The collected data were summarized and individual responses pooled among questions requiring voting. The overall rates were computed by response category. The group discussed the summary evidence, until a consensus was reached concerning a series of recommendation on how to make decisions concerning ART service provision during the current (and any future) pandemic. A two-tier recommendation was developed based on agreement rate and implementation priority. Tier 1 comprises recommendations in which the rate of “absolutely agree” responses were [Formula: see text]60%, whereas tier 2 refers to recommendations in which the rate of “absolutely agree” plus “agree” was >60%, but the rate of “absolutely agree” was [Formula: see text]50%. Results: The survey was responded by all participants between July 24 and July 30, 2020. Nine tier 1 and five tier 2 recommendations are provided concerning prevention, testing, personal protective equipment, informed consent, and quality management. The former indicates the situations in which most individuals should receive the intervention/procedure, whereas the latter relates to those that may be suitable for individual clinics and patients. Conclusions: This document provides the ASPIRE viewpoint on better managing infertile patients seeking ART during the COVID-19 pandemic. This expert opinion guide aims to help both competent authorities and healthcare providers to deliver quality and safe ART.

Coronavirus disease 2019 (COVID‐19) first emerged in China in November 2019. Most governments have responded to the COVID‐19 pandemic by imposing a lockdown. Some evidence suggests that a period of isolation might have led to a spike in alcohol misuse, and in the case of patients with alcohol use disorder (AUD), social isolation can favour lapse and relapse. The aim of our position paper is to provide specialists in the alcohol addiction field, in psychopharmacology, gastroenterology and in internal medicine, with appropriate tools to better manage patients with AUD and COVID‐19,considering some important topics: (a) the susceptibility of AUD patients to infection; (b) the pharmacological interaction between medications used to treat AUD and to treat COVID‐19; (c) the reorganization of the Centre for Alcohol Addiction Treatment for the management of AUD patients in the COVID‐19 era (group activities, telemedicine, outpatients treatment, alcohol‐related liver disease and liver transplantation, collecting samples); (d) AUD and SARS‐CoV‐2 vaccination. Telemedicine/telehealth will undoubtedly be useful/practical tools even though it remains at an elementary level; the contribution of the family and of caregivers in the management of AUD patients will play a significant role; the multidisciplinary intervention involving experts in the treatment of AUD with specialists in the treatment of COVID‐19 disease will need implementation. Thus, the COVID‐19 pandemic is rapidly leading addiction specialists towards a new governance scenario of AUD, which necessarily needs an in‐depth reconsideration, focusing attention on a safe approach in combination with the efficacy of treatment., All health care systems need to be reorganized during and after the COVID‐19 pandemic, and also the CAATs in order to combine operator safety with patient safety and care. The multi‐disciplinary intervention involving experts in the treatment of AUD and ALD with specialists in the treatment of COVID‐19 disease will need implementation and the contribution of the family and of care‐givers in the management of AUD and ALD patients will play a significant role.

Recent research breakthroughs have emerged from applied basic research throughout all scientific areas, including adult and paediatric gastroenterology, hepatology and nutrition (PGHAN). The research landscape within the European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN) is also inevitably changing from clinical research to studies involving applied laboratory research. This position paper aims to depict the current status quo of basic science and translational research within ESPGHAN, and to delineate how the society could invest in research in the present and future time. The paper also explores which research areas in the field of PGHAN represent the current and future priorities, and what type of support is needed across the ESPGHAN working groups (WGs) and special interest groups (SIGs) to fulfil their research goals.

Resumen Introduccion La pandemia por COVID-19 ha conllevado la suspension de la actividad programada en la mayoria de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscopica electiva de forma eficiente y segura. Material y metodos Se formulo una serie de preguntas consideradas de relevancia clinica y logistica. Para la elaboracion de las respuestas, se realizo una busqueda bibliografica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Publica y de endoscopia digestiva. Las recomendaciones finales se consensuaron por via telematica. Resultados Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) la reevaluacion y priorizacion de la indicacion; 2) la restructuracion de espacios, agendas y del personal sanitario; 3) el cribado de la infeccion, y 4) las medidas de higiene y los equipos de proteccion individual. Conclusion La AEG y la SEED recomiendan reiniciar la actividad endoscopica de forma escalonada, segura, adaptada a los recursos locales y a la situacion epidemiologica de la infeccion por SARS-CoV-2.

Coronavirus disease 2019 (COVID‐19), a respiratory tract infection caused by a novel human coronavirus, the severe acute respiratory syndrome coronavirus 2, leads to a wide spectrum of clinical manifestations ranging from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Given the huge influence caused by the overwhelming COVID‐19 pandemic affecting over three million people worldwide, a wide spectrum of drugs is considered for the treatment in the concept of repurposing and off‐label use. There is no knowledge about the diagnosis and clinical management of the drug hypersensitivity reactions that can potentially occur during the disease. This review brings togetherall the published information about the diagnosis and management of drug hypersensitivity reactions due to current and candidate off‐label drugs andhighlights relevant recommendations. Furthermore, it gathers all the dermatologic manifestations reported during the disease for guiding the clinicians to establish a better differential diagnosis of drug hypersensitivity reactionsin the course of the disease.

Contains fulltext : 229587.pdf (Publisher’s version ) (Open Access) In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points* Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.* Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.* Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".* Strict algorithms define the exact management of screen-detected nodules and incidental findings.* For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.

The clinical, educational, and research facets of lung transplantation have advanced significantly since the first lung transplant in 1963. The formation of the International Society for Heart and Lung Transplantation (ISHLT) and subsequent Registry has forged a precedent of collaborative teamwork that has significantly affected current lung transplantation outcomes. The Society for the Advancement of Anesthesia (SATA) is dedicated to developing educational platforms for all facets of transplant anesthesia. Additionally, we believe that the anesthetic training for lung transplantation has not kept pace with other advances in the field. As such, SATA presents for consideration these educational milestones and competencies for anesthetic fellowship training in the field of lung transplantation. The proposed milestones were designed on the framework of 6 core competencies created by the Accreditation Council on Graduate Medical Education. The milestones were identified by combining the expert opinion of our Thoracic Transplant Committee, our experience as educators, and literature review. We offer this White Paper to the anesthesiology and transplant communities as a starting point for the discussion and evolution of perioperative anesthetic care in the field of lung transplantation.

Developmental pharmacology describes the impact of maturation on drug disposition (pharmacokinetics, PK) and drug effects (pharmacodynamics, PD) throughout the paediatric age range. This paper, written by a multidisciplinary group of experts, summarizes current knowledge, and provides suggestions to pharmaceutical companies, regulatory agencies and academicians on how to incorporate the latest knowledge regarding developmental pharmacology and innovative techniques into neonatal and paediatric drug development. Biological aspects of drug absorption, distribution, metabolism and excretion throughout development are summarized. Although this area made enormous progress during the last two decades, remaining knowledge gaps were identified. Minimal risk and burden designs allow for optimally informative but minimally invasive PK sampling, while concomitant profiling of drug metabolites may provide additional insight in the unique PK behaviour in children. Furthermore, developmental PD needs to be considered during drug development, which is illustrated by disease- and/or target organ-specific examples. Identifying and testing PD targets and effects in special populations, and application of age- and/or population-specific assessment tools are discussed. Drug development plans also need to incorporate innovative techniques such as preclinical models to study therapeutic strategies, and shift from sequential enrolment of subgroups, to more rational designs. To stimulate appropriate research plans, illustrations of specific PK/PD-related as well as drug safety-related challenges during drug development are provided. The suggestions made in this joint paper of the Innovative Medicines Initiative conect4children Expert group on Developmental Pharmacology and the European Society for Developmental, Perinatal and Paediatric Pharmacology, should facilitate all those involved in drug development. ispartof: BRITISH JOURNAL OF CLINICAL PHARMACOLOGY vol:88 issue:12 pages:4965-4984 ispartof: location:England status: published

The number of citations a peer-reviewed article receives is often used as a measure of its importance and scientific impact. This paper identifies, describes and categorizes the highly cited papers in addiction research on cannabis, heroin, cocaine and psychostimulants. Highly cited papers were identified in the Web of Science Core Collection database. Several bibliometric indicators were calculated. Social network analysis was applied to draw groups of authors and institutions with the greatest number of collaborations and co-words. The number of citations for the top 100 cited articles ranged from 649 to 4,672. The articles were published in 40 journals. The subject category Substance Abuse included 10 papers. The United States was the most productive country (79 papers), followed by the United Kingdom (9). The main funding institutions were the National Institutes of Health in the United States. The network of collaboration between authors distributes the 352 researchers into 53 groups. The three most cited works address the neural basis of drug craving as an incentive-sensitization theory of addiction, the clinical and research uses of the Addiction Severity Index, and the neurocircuitry of addiction. Scientific literature on addictions is widely dispersed both in multidisciplinary and specific journals of neurology, psychiatry and addictions, with relatively few publications providing most of the citations. An ongoing challenge for this field is the concentration of highly cited papers coming from a select number of countries, with the United States being the research hub of the world, with the highest volume of publications and total citations., This work have been funding by Servicio de Drogodependencias (PMD/UPCCA-València). Concejalía de Sanidad y Consumo. Ajuntament de València.

EMS personnel in the U.S. continue to be overwhelmingly Caucasian and male, with 75% being male and 85% identifying as nonminority. While the population of the United States becomes more diverse in ethnicity, religion, and race, the EMS workforce remains largely homogenous and does not reflect the diversity of the population it serves. Given the growing diversity across the country, EMS personnel will increasingly be responding to calls for service involving patients with different cultural backgrounds than their own. This growing gap between providers and the population they serve may exacerbate already existing disparities in care.

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.

Objective This study collected randomized controlled trials (RCTs) published in the social sciences in China and assessed their risk of bias and reporting quality. Study Design and Setting Three databases were systematically searched for publications from January 2000 to June 2020 for RCTs in the social sciences published by Chinese researchers. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool (CCRBT), and reporting quality was assessed using the Consolidated Standards of Reporting Trials for Social and Psychological Interventions (CONSORT-SPI). Results A total of 316 RCTs were identified, including 204 articles in English and 112 articles in Chinese. The most frequently researched interventions focused on education (33.9%), and the most frequently studied population were students (32.9%). Eighty-seven percent of RCTs had intermediate reporting quality. Twenty-four of the 43 CONSORT-SPI sub-items had a compliance rate of less than 50%. Most RCTs had an unclear risk of bias for blinding outcome assessors (84.5%), blinding participants and personnel (82.9%), allocation concealment (73.1%), and random sequence generation (68.0%). A low proportion of CONSORT-SPI items were reported and, high proportion of the papers had unclear risk of bias. Conclusion The quality and reporting of RCTs in the social sciences needs improvement in China, especially for reporting methods and results. Most studies had an unclear risk of bias as they lacked important methodological information.

Purpose Administration of questionnaires to assess the diffusion of disordered eating behaviours via the web is becoming common today. The aim of this study is to assess whether two different approaches of administering a test to assess traits of eating disorders (EDs), orthorexia nervosa (ON) and muscle dysmorphia (MD) by email recruitment and online completion (web-based survey—WBS) and by in person recruitment and paper-and-pencil completion (paper-based survey—PBS), gives different results. Methods During 2 consecutive academic years, a self-reported questionnaire consisting of questions about personal characteristics and three tests for the evaluation of ON (ORTO-15), MD (MDDI-ITA), and EDs (EAT-26) were administered to two groups of undergraduates, respectively, as a WBS and a PBS. Results The WBS response rate was 6.7% (N = 137), and the PBS response rate was 86.5% (N = 372). The WBS group showed a statistically significant higher prevalence of students with eating disordered behaviours (21.2% vs 5.4%) and registered a higher mean score on the EAT-26 test (13.5 ± 11.1 vs 6.0 ± 8.0); no differences between the two groups emerged for ON and MD prevalence and test scores. Moreover, in the WBS group, the number of students with one or more tests with test scores above the cut-off values was significantly higher (46.0% vs 32.3%). Conclusion The choice of the approach to administer a questionnaire to assess the diffusion of EDs and related issues must take into account all the factors that can result in selection bias and that can affect the reliability of the results. Level of evidence Level V, descriptive cross-sectional survey.

Background and purpose Spirometry is often technically challenging for patients. Previous studies have demonstrated the potential benefits of spirometry in the community pharmacy setting. This study compared pharmacy students' perceptions and attitudes toward performing spirometry, as well as implementing spirometry in clinics and community pharmacies through experiencing spirometry first-hand versus completing paper-based active learning exercises. Educational activity and setting First-year (N = 102) and second-year (N = 70) pharmacy students were provided with the same pre-class materials to learn about the spirometry process. During class, first-year (P1) students performed spirometry tests, while second-year (P2) students completed paper-based active learning exercises about spirometry without performing the test. A survey was provided to each group at the end of the class to: (1) compare students’ perception of the difficulty of performing spirometry, and (2) identify patient, clinic, and pharmacy barriers to implementing spirometry testing. Findings P1 students perceived performing spirometry as significantly more difficult compared to P2 students. Both P1 and P2 students perceived correct posture and breathing technique, and patient discomfort as the most difficult parts of performing spirometry. Significantly more P1 students (91.1%) perceived spirometry as a “helpful and noninvasive tool to screen for pulmonary diseases” than P2 students (54.1%). Summary Students who experienced spirometry perceived it to be more difficult than those who completed paper-based active learning exercises. Incorporating spirometry into a pharmacy curriculum could be an opportunity to increase students’ insight of the difficulty of performing spirometry and their appreciation for the clinical services pharmacists can provide.

To date, very few treatments have been demonstrated to reduce the burden of morbidity and mortality from COVID-19. Although corticosteroids have been proven to reduce mortality in severe disease, there has been little convincing evidence on interventions that may prevent disease, reduce hospitalizations, and reduce the numbers of people progressing to critical disease and death. Ivermectin is a well-known medicine that is approved as an antiparasitic by the World Health Organization and the US Food and Drug Administration. It is widely used in lowand middle-income countries to treat worm infections. Also used for the treatment of scabies and lice, it is one of the World Health Organization’s Essential Medicines.1 With total doses of ivermectin distributed apparently equalling one-third of the present world population,1 ivermectin at the usual doses (0.2–0.4 mg/kg) is considered extremely safe for use in humans.1 In addition to its antiparasiticactivity, it has been noted to have antiviral and anti-inflammatory properties, leading to an increasing list of therapeutic indications. South African authorities approved the use of a drug used to control parasites in humans and livestock to treat coronavirus patients. Additionally, in January 2021, the South African Health Products Regulatory Authority (SAHPRA) announced that ivermectin, would be allowedfor use on compassionate grounds in a controlled-access program. Ivermectin locally has been used for the prevention and/or management of Covid-19 infection. This has resulted in a huge black market trade of ivermectin in South Africa as many health professionals and others have taken to social media and other platforms to profile this drug as an effective treatment for the covid-19 viral infection. Roman and colleagues (2021)1 conducted a systematic review and meta-analysis to evaluate treatment effects of Ivermectin (IVM) on clinical outcomes and adverse events (AEs) in people with COVID-19.

With the deepening of cultural and artistic exchanges in various countries, many local arts actively or passively absorb the nutrients of foreign art, but the folk paper-cut art of northern Shaanxi and Mexico completely preserve the regional cultural characteristics of the nation. This paper studies the difference and connection between northern Shaanxi paper-cut and Mexican paper-cut by means of semantic analysis and contrastive demonstration. This paper analyzes the theme expression and art types of paper-cut and Mexican paper-cut in northern shaanxi, and collates the rich connotation culture contained in paper-cut patterns and the paper-cut culture of the sustainable development of northern shaanxi and Mexico bearing the message of ancient tu Teng worship, showing a unique artistic connotation. The precipitation of experienced also reflects the application and inheritance in today’s society.

Chinese folk paper-cutting has a long history of development, and it is a major folk art form created by the working people of all ages in our country in order to meet the needs of material and spiritual life, and Return lived in it. It has become a design art rooted in the folk, and it is entrusted with the beautiful expectation of the broad working group from life. Plane composition is a very important part of modern design foundation. Points, lines and surfaces are not only the basic elements of plane composition, but also create a colorful environment atmosphere through the artistic treatment of points, lines and surfaces in different indoor environment designs. Many artistic inspirations of modern design come from folk paper-cutting, and we get creative inspiration and enlightenment from the structure and composition of paper-cutting. By studying the comparison between folk paper-cut art and modern graphic design, this paper tries to provide an innovative way for modern graphic design.

The greatest challenge for European drug policies is how to effectively respond to the dynamic and constantly changing market for new psychoactive substances (NPS). Even small modifications in the chemical structure of substances often allow circumventing existing laws. Also in prison, the consumption of NPS is rising and there is growing evidence that NPS are responsible for a large share of drug-related problems. Ion mobility spectrometry (IMS) is the technique of choice for trace analysis of illicit drugs or explosives at security points, for example airports. Currently, databases of the reduced mobility (K0 ) values are limited to classical drugs and should be completed with data of emerging NPS. In this article, K0 values, LODs (0.7-3.6 ng) and drift times of 25 synthetic cannabinoids were evaluated. The data were added to existing databases of IMS which were then applied for fast screening in prison. The detection capability of the portable IMS technique was evaluated by the determination of intra-day (0.089%) and inter-day precision (0.004% to 0.14%), systematic error (0.19%), and separation capability for structurally related NPS. The applicability of the methodology was demonstrated by the successful analysis of 12 different pieces of paper impregnated with synthetic cannabinoids, 7 different cosmetics, and 5 food samples (liquids), spiked with a mixture of narcotic drugs and a synthetic cannabinoid. In addition, 14 herbal mixtures and 36 different casework samples from prisons were analyzed provided by the State Office of Criminal Investigation Rhineland-Palatinate (Germany).

The food packaging industry generally uses papers and paperboards (PPBs) especially for disposable products. According to the Framework Regulation (EC) No. 1935/2004 of the European Union, no transfer of contamination should occur from food packaging material to the food items. The aim of this study was to determine the presence, numbers, source and different kinds of bacteria present in food packaging PPBs with various contents of pulp fiber. The samples were randomly collected from popular confectioners and fast food restaurants in Saharanpur, India. The results indicated the presence of bacteria in all the samples, ranging from 1.3 × 102 to 6.1 × 103 cfu/g. Most of the samples contained bacteria in more than the permitted concentration of 2.5 × 102 cfu/g as set by Food and Drug Administration (FDA). The detected bacteria were from genera Bacillacea, Staphylococcus and Pseudomonas. According to the FDA declaration, pathogenic bacteria such as B. cereus and S. aureus have been associated with food borne diseases (FBD). Some contaminants in food packaging PPBs were found to be B. subtilis and P. aeroginosa, which produce enzymes like peroxidases and lipoxygenases that are odor generating enzymes.

Introduction. Drug checking services for harm reduction and overdose prevention have been implemented in many jurisdictions as a public health intervention in response to the opioid overdose crisis. This study demonstrates the first on-site use of paper spray mass spectrometry for quantitative drug checking to address the limitations of current on-site drug testing technologies. Methods. Paper spray mass spectrometry was used to provide on-site drug checking services at a supervised consumption site in the Downtown Eastside of Vancouver, British Columbia, Canada during a 2-day pilot test in August 2019. The method included the targeted quantitative measurement of 49 drugs and an untargeted full scan to assist in identifying unknown/unexpected components. Results. During the pilot, 113 samples were submitted for analysis, with 88 (78%) containing the client expected substance. Fentanyl was detected in 45 of 59 expected fentanyl samples, and in 50 (44%) samples overall at a median concentration of 3.6% (w/w%). The synthetic precursor of fentanyl, 4-anilino-N-phenethyl-piperidine (4-ANPP), was found in 74.0% of all fentanyl samples at a median concentration of 2.2%, suggesting widespread poor manufacturing practices. Etizolam was detected in 10 submitted samples anticipated to be fentanyl at a median concentration of 2.5%. No clients submitting these samples expected etizolam or a benzodiazepine in their sample. In three instances, it was co-measured with fentanyl, and in seven cases it was detected alone. Discussion and Conclusions. The quantitative capabilities and low detection limits demonstrated by paper spray mass spectrometry offer distinct benefits over existing on-site drug checking methods and harm reduction services. This work was supported by the Natural Science and Engineering Research Council of Canada Discovery Grant Program funding (RGPIN-2016-05380), Vancouver Island University and the Health Canada Drug Checking Technology Challenge. This article was originally published as: Borden, S.A., Saatchi, A., Vandergrift, G.W., Palaty, J., Lysyshyn, M., & Gill, C.G. (2021). A new quantitative drug checking technology for harm reduction: Pilot study in Vancouver, Canada using paper spray mass spectrometry. Drug and Alcohol Review, 1-8. https://doi.org/10.1111/dar.13370 This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. https://viurrspace.ca/bitstream/handle/10613/24515/Gill2021.pdf?sequence=3

Objective To identify key papers in urology using a novel bibliometric index called the disruption score. Methods A PubMed search was conducted to identify papers published in Journal of Urology, European Urology, Urology, Urologic Oncology, Journal of Endourology, and BJU International, Nature Reviews Urology. Selected urology papers published in other medical journals were also included. Using a validated dataset of disruption scores for all papers published in 1954-2014, the top 100 most-disruptive urology papers, as well as the top 100 most-cited papers, were identified. Comparisons between both lists and across journals were investigated. Results A total of 72,623 published articles were included. Journal of Urology had the most articles in the most-disruptive papers list (n = 69) followed by BJU International (n = 16). New England Journal of Medicine had the most papers in the most-cited papers list (n = 26) followed by Journal of Urology (n = 23). Only 7 papers were common to both the most-disruptive papers and most-cited papers lists. Oncology was highly represented among the most-cited papers (n = 60), whereas the most-disruptive papers included a broader representation of urology. The most common study design among the most disruptive papers was small case-series/case reports, whereas the most common study design among the most-cited papers was randomized controlled trials. Conclusion The disruption score identified landmark papers in urology that have introduced innovative ideas. Disruption score captures a unique profile of scientific impact that may be used in combination with other bibliometric indices to identify scholarly achievements in urology.

The impact of COVID‐19 has underlined the need for reliable information to guide clinical practice and policy. This urgency has to be balanced against disruption to journal handling capacity and the continued need to ensure scientific rigour. We examined the reporting quality of highly disseminated COVID‐19 research papers using a bibliometric analysis examining reporting quality and risk of bias (RoB) amongst 250 top scoring Altmetric Attention Score (AAS) COVID‐19 research papers between January and April 2020. Method‐specific RoB tools were used to assess quality. After exclusions, 84 studies from 44 journals were included. Forty‐three (51%) were case series/studies, and only one was an randomized controlled trial. Most authors were from institutions based in China (n = 44, 52%). The median AAS and impact factor was 2015 (interquartile range [IQR] 1,105–4,051.5) and 12.8 (IQR 5–44.2) respectively. Nine studies (11%) utilized a formal reporting framework, 62 (74%) included a funding statement, and 41 (49%) were at high RoB. This review of the most widely disseminated COVID‐19 studies highlights a preponderance of low‐quality case series with few research papers adhering to good standards of reporting. It emphasizes the need for cautious interpretation of research and the increasingly vital responsibility that journals have in ensuring high‐quality publications.

Objective The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P

Objectives Unlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers’ professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field. Key findings Danish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n = 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n = 60/144; 41.7%). Conclusion By changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession. Implications for practice Regardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients.

Older adults account for 25% of all emergency department (ED) patient encounters. One in five Americans will be 65 or older by 2030. In response to this need, geriatric emergency medicine (GEM) has developed into a robust area of academic and clinical interest, with extensive evidence-based research and guidelines, including clear undergraduate and postgraduate GEM competencies. Despite these developments, GEM content remains underrepresented in curricula and licensing examinations. The complex reasons for these deficits include a perception that care of older adults is not a core emergency medicine (EM) competency, a disjunction between traditional definitions of expertise and the GEM perspective, and lack of curricular capacity. This White Paper, prepared on behalf of the Academy of Geriatric Emergency Medicine, describes the state of GEM education, identifies the challenges it faces, and reviews innovations, including research presented at the 2018 Society for Academic Emergency Medicine (SAEM) Annual Scientific Meeting. The authors propose a number of recommendations. These include recognizing GEM as a core educational priority in EM, enhancing academic support for GEM clinician-educators, using social learning and practical problem solving to teach GEM concepts, emphasizing a whole-person multisystem approach to care of older adults, and identifying ageist attitudes as a hurdle to safe and effective GEM care.

It is the position of the International Nurses Society on Addictions that all nurses, in all settings, should be prepared to provide care to patients with alcohol use problems, especially for women of childbearing age.

The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research.

Research Objectives To identify optimal manual wheelchair configuration for people who self-propel for full-time wheeled mobility. To identify new evidence on how prescribing an ultralight weight manual wheelchair can minimize secondary complications in the body functions, promote functional independence with mobility related activities of daily living, and provide opportunities to participate in life roles Design This position paper was written following a scoping literature review process, open review period through RESNA and peer-review process. Setting This position paper is relevant to any prescribers or clinicians recommending manual wheelchairs. The results of the scoping review is applicable to treatment settings where people use a manual wheelchair for primary mobility, from pediatrics to long term care. Participants N/A. Interventions The RESNA Paper on the Application of Ultralight Manual Wheelchairs was published in 2012 and sought to provide evidence to support the application of fully customizable manual ultralight weight wheelchairs. Since that time, new developments in clinical research in our understanding of manual wheelchair considerations have prompted a revision of this foundational document. Main Outcome Measures The presentation will describe the intention of the revision and review new evidence based topics incorporated into the new position paper including: Manual wheelchair configuration, wheelchair training and wheelchair skills relating to function, rolling resistance and propulsion effort, various propulsion styles and considerations for overuse injuries in all extremities. Results The results of the scoping literature review and position paper will provide supportive evidence for the need for ultralight weight manual wheelchair configuration and the impact on body functions and structures, activities of daily living, and participation. Conclusions This scoping review and position paper will allow the clinician and practitioner to have supportive evidence for equipment recommendation for their patients who use a manual wheelchair full-time for mobility. Author(s) Disclosures Jennith Bernstein is a full-time employee of Permobil, Inc.; however, this work is presented on behalf of an entire work group of clinicians, engineers, and professors.

Social interactions have large effects on individual physiology and fitness. In the immediate sense, social stimuli are often highly salient and engaging. Over longer time scales, competitive interactions often lead to distinct social ranks and differences in physiology and behavior. Understanding how initial responses lead to longer-term effects of social interactions requires examining the changes in responses over time. Here we examined the effects of social interactions on transcriptomic signatures at two times, at the end of a 45-minute interaction and 4 hours later, in female Polistes fuscatus paper wasp foundresses. Female P. fuscatus have variable facial patterns that are used for visual individual recognition, so we separately examined the transcriptional dynamics in the optic lobe and the non-visual brain. Results demonstrate much stronger transcriptional responses to social interactions in the non-visual brain compared to the optic lobe. Differentially regulated genes in response to social interactions are enriched for memory-related transcripts. Comparisons between winners and losers of the encounters revealed similar overall transcriptional profiles at the end of an interaction, which significantly diverged over the course of 4 hours, with losers showing changes in expression levels of genes associated with aggression and reproduction in paper wasps. On nests, subordinate foundresses are less aggressive, do more foraging and lay fewer eggs compared to dominant foundresses and we find losers shift expression of many genes in the non-visual brain, including vitellogenin, related to aggression, worker behavior, and reproduction within hours of losing an encounter. These results highlight the early neurogenomic changes that likely contribute to behavioral and physiological effects of social status changes in a social insect., Author summary Aggressive interactions often create inequalities–some individuals win while others lose. Winning versus losing can lead to large physiological differences between individuals, including different neurogenomic profiles between winners and losers. How this information about contest outcome leads to distinct neurogenomic profiles is poorly understood. Here we examine gene expression in response to aggressive social encounters in paper wasps, which naturally form dominance hierarchies on their nests in the wild. Shortly following encounters winners and losers have similar expression profiles, likely because similar mechanisms are engaged by social experiences. Four hours later, we find divergent neurogenomic profiles between winners and losers, with losers showing larger shifts in expression compared to winners. Many of the most dynamically expressed genes have been previously associated with dominance and caste differences in paper wasps showing how a single interaction can engage many of the same genomic networks that are involved in mediating more dramatic differences in queen-worker behavioral differences are also involved in responses shortly following social interactions.

One minute Paper is the quick and simple classroom assessment tool. It is benefited to both students and teacher to understand the must know learning points. This tool was applied to the undergraduate students to assess the understanding on the content of lecture as per learning objective, their feedback and perception on one minute paper. At the end of the session, one minute given to answer -What are the most important things you learned today from lecture? What question (s) do you still have in your mind? and Is there anything you did not understand? More than 90 percent were responded for one minute paper. Sixty eight percent of the students appreciated that it was done nicely and fairly done. Thirty two of the students perceived the technique of one minute paper utilization as learner centred and 11.6% as thinking centred. Few apparent responses that were obtained were the liberty to ask questions (15.9%), better understanding of the topic (26.1%) and mutually beneficial (15.9%). One minute paper is an inexpensive, instant, insightful and informative classroom assessment tool. Involvement of students in the teaching learning process with active participation were the learning outcome. The writing activity in the form of one minute paper focused the students to give their thoughts, perspective and pinpoint their questions before leaving the class. Keywords: One minute paper, Class room assessment, Faculty effectiveness, Students learning.

Adults with mild stroke face substantial challenges resuming valued roles in the community. The term "mild" provides false representation of the lived experience for many adults with mild stroke who may continue to experience persistent challenges and unmet needs. Rehabilitation practitioners can identify and consequently intervene to facilitate improved independence, participation, and quality of life by facilitating function and reducing the burden of lost abilities among adults with mild stroke. The Health and Wellness Task Force identified 2 important, and often interdependent, goals that frequently arise among adults living with mild stroke that must be addressed to facilitate improved community reintegration: (1) return to driving and (2) return to work. Adults with mild stroke may not be receiving adequate rehabilitative services to facilitate community reintegration for several reasons but primarily because current practice models are not designed to meet such needs of this specific population. Thus, the Health and Wellness Task Force convened to review current literature and practice trends to (1) identify opportunities based on the evidence of assessment and interventions, for return to driving and return to work; and (2) identify gaps in the literature that must be addressed to take advantage of the opportunities. Based on findings, the task force proposes a new interdisciplinary practice model for adults with mild stroke who are too often discharged from the hospital to the community without needed services to enable successful return to driving and work.

Authors of the paper are writing about a wonderful person, scientist, Professor Mateev Musa Asypbekovich and his contribution to the plastic and reconstructive surgery.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility; however, whether women with PCOS and spontaneous or drug-induced ovulatory cycles have the same reproductive potential as non-PCOS controls is a matter of debate. In the present opinion paper, the author takes the opportunity to summarize the collective evidence supporting the hypothesis of reduced fertility potential in women with PCOS, regardless of ovulatory status, and speculate that reduced reproductive potential may be caused by altered oocytes, embryo and endometrial competence, and infertility-related co-morbidities as well as an increased risk of pregnancy complications.

BACKGROUND: The authors aim to publish the results of their studies in peer-reviewed targeted international journals with a high impact-factor as possible, but they are also exposing to “predatory” publishers. AIM: The aim of the study was to offer some advices for authors to help to identify relevant medical journals, avoid “predatory” journals and publishers, use intermediary services, know a journal policy, and expectations of good journal editor(s). RECOMMENDATIONS: During the publication process authors should find suitable journals, assume a risk to encounter “predatory” or “hijacked” journals, know the advantages and disadvantages of using intermediary publishing services, understand expectations of editor(s), and make payment for article processing. CONCLUSIONS: The advices can help many researchers to publish their papers in relevant journals with cited indexes, and avoid many problems within the publication process.

This discussion focuses on one aspect of Farber’s work: the birth of the tango (this issue). The tango was created as a fusion of African and European immigrant culture in Argentina between the second half of the nineteenth century and the first twenty years of the twentieth century. The tango was one of the tools used by immigrants to socialize the pain of the loss of common roots, the lack of identity, and the sense of loneliness. The author reflects on the overlaps between tango and relational psychoanalysis, and muses on the impact of the loss of hugs and embraces in this worldwide pandemic caused by Covid and the collective trauma that it entails.

A current osteopathic tenet inherited from Native American principles involves viewing each person as a dynamic interaction of body-mind-spirit (BMS). Because of its traditional medicine heritage and current evidence-based approach, the osteopathic profession is, arguably, uniquely positioned to promote evidence-informed person-centered approaches that transcend improvements in pain and musculoskeletal function. It may be particularly relevant in the context of integrating the BMS tenet into osteopathic care according to the diversity of patients’ values and sociocultural assumptions towards health, symptoms, and subsequent care, which range from the typical Western to complementary and alternative medicine perspectives. There is currently a lack of robust clinical practice frameworks in this area, confusing patients and practitioners and blurring professional identities. The current commentary provides an opportunity to initiate discussions in the profession with a rationale for creating a roadmap to develop an evidence-informed framework for osteopathic care that integrates the BMS tenet.