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Jordana K McLoone,1,2 Ursula M Sansom-Daly,1,2 Alexia Paglia,1,2 Jessica Chia,1,2 Hanne Bækgaard Larsen,3 Lorna A Fern,4 Richard J Cohn,1,2 Christina Signorelli1,2 1Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia; 2Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia; 3Department for Pediatric and Adolescent Medicine, The Juliane Marie Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark & Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 4Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UKCorrespondence: Jordana K McLoone, Discipline of Paediatrics & Child Health, UNSW Medicine & Health, Randwick Clinical Campus, UNSW, Sydney, NSW, Australia, Email J.McLoone@unsw.edu.auAbstract: Childhood, adolescent, and young adult (CAYA) cancer survivors are at risk of developing late effects associated with their cancer and its treatment. Survivors’ engagement with recommended follow-up care to minimize these risks is suboptimal, with many barriers commonly reported. This scoping review aims to summarize the barriers to accessing follow-up care, using the dimensions of Levesque’s framework for accessing healthcare. We retrieved quantitative studies addressing barriers and facilitators to accessing survivorship care in CAYA survivors from PubMed, EMBASE and CINAHL. Data was categorized into the five healthcare access dimensions outlined in Levesque’s framework: i) approachability, ii) acceptability, iii) availability and accommodation, iv) affordability, and v) appropriateness. We identified 27 quantitative studies in our review. Commonly reported barriers to accessing care included a lack of survivor and provider knowledge of cancer survivorship, poor health beliefs, low personal salience to engage in follow-up care, high out-of-pocket costs and survivors living long distances from clinical services. Many studies reported increased barriers to care during the transition from paediatric to adult-oriented healthcare services, including a lack of developmentally appropriate services, lack of appointment reminders, and a poorly defined transition process. Healthcare-related self-efficacy was identified as an important facilitator to accessing follow-up care. The transition from pediatric to adult-oriented healthcare services is a challenging time for childhood, adolescent, and young adult cancer survivors. Optimizing CAYAs’ ability to access high-quality survivorship care thus requires careful consideration of the quality and acceptability of services, alongside financial and physical/practical barriers (eg distance from available services, appointment-booking mechanisms). Levesque’s model highlighted several areas where evidence is well established (eg financial barriers) or lacking (eg factors associated with engagement in follow-up care) which are useful to understand barriers and facilitators that impact access to survivorship for CAYA cancer survivors, as well as guiding areas for further evaluation.Keywords: pediatric, adolescent and young adult, cancer, survivorship care, barriers, access to care

Analyses of inequalities related to prevention and cancer therapeutics/care show disparities between countries with different economic standing, and within countries with high Gross Domestic Product. The development of basic technological and biological research provides clinical and prevention opportunities that make their implementation into healthcare systems more complex, mainly due to the growth of Personalized/Precision Cancer Medicine (PCM). Initiatives like the USA-Cancer Moonshot and the EU-Mission on Cancer and Europes Beating Cancer Plan are initiated to boost cancer prevention and therapeutics/care innovation and to mitigate present inequalities. The conference organized by the Pontifical Academy of Sciences in collaboration with the European Academy of Cancer Sciences discussed the inequality problem, dependent on the economic status of a country, the increasing demands for infrastructure supportive of innovative research and its implementation in healthcare and prevention programs. Establishing translational research defined as a coherent cancer research continuum is still a challenge. Research has to cover the entire continuum from basic to outcomes research for clinical and prevention modalities. Comprehensive Cancer Centres (CCCs) are of critical importance for integrating research innovations to preclinical and clinical research, as for ensuring state-of-the-art patient care within healthcare systems. International collaborative networks between CCCs are necessary to reach the critical mass of infrastructures and patients for PCM research, and for introducing prevention modalities and new treatments effectively. Outcomes and health economics research are required to assess the cost-effectiveness of new interventions, currently a missing element in the research portfolio. Data sharing and critical mass are essential for innovative research to develop PCM. Despite advances in cancer research, cancer incidence and prevalence is growing. Making cancer research infrastructures accessible for all patients, considering the increasing inequalities, requires science policy actions incentivizing research aimed at prevention and cancer therapeutics/care with an increased focus on patients needs and cost-effective healthcare.

Abruzzo Periadriatic Area (Central Italy) is sadly acknowledged as highly exposed to geo-hydrological hazards, with small-to-medium size catchments and urban areas strongly affected by natural phenomena. In the present work, the Pescara River basin, hit in the past by several floods and concurrent superficial landslides due to localized and intense rain events, has been studied. A screening of morphometry, land use changes, rainfall datasets, and flooding-related effects on landscape has been carried out, both at the catchment and local scales. A morphometric and geomorphological approach was applied, supported by GIS software and implemented with literature data. It allowed us to derive insights about the interaction between land use changes and geo-hydrological phenomena. Over the past 60 years, the study area underwent increases in built-up areas from ~16 km2 in 1955 to ~67 km2 in 2019 with significant sprawl at low altitude. Rainfall datasets outlined moderate-to-low annual precipitation with occasional heavy rainfall events (>100 mm/d and 30–40 mm/h). Historical and recent events (~35 events over a 100-year period) linked to landscape and geomorphological processes were also counted. Resulting data allowed to implement knowledge about the present-day geomorphological arrangement of the basin, providing information for land management in a changing environment. These findings provide valuable insights for future urban planning, policy formulation, and sustainable development initiatives, readily available to interested stakeholders.

This review discusses the challenges that hospitals face when caring for older patients in emergency departments and intensive care units. Beyond chronic diseases, the older person is often affected by acute events, which require, in addition to the typical knowledge of emergency medicine and anesthesia, the holistic and targeted approach of the comprehensive geriatric assessment in the emergency room and intensive care setting. With Italy’s health centers struggling to manage the increasing pressure of patients, the COVID-19 pandemic has highlighted the need for a geriatric approach to address this challenge. This review outlines the Geriatric 5Ms Model of Care, which addresses five domains, and the Domain Management Model, which provides acute medical management.

Carbon-phenolic ablators can efficiently protect space vehicles from the extreme temperatures typical of the reentry phase in a planet’s atmosphere. Their performances are attributed to the low thermal conductivity and to the decomposition of the phenolic resin. These phenomena are strongly influenced by the materials microstructure. In the present work, standard and polyvinylpyrrolidone (PVP)-modified carbon-phenolic ablators were manufactured and characterized: the influence of PVP on the final microstructure and chemistry of the ablators was studied through SEM-EDS, X-ray Microscopy (XRM) analysis and FTIR technique; the mechanical properties were evaluated through compression tests on virgin and charred samples while ablative performance of the ablators were evaluated with an oxyacetylene flame exposure test. Weak bonds between phenolic resin chains and PVP were observed. The microstructure of the ablators, both before and after the exposure to the oxyacetylene flame, is strongly influenced by the PVP addition, furthermore the addition of 10 and 20 %wt of PVP can guarantee a reduction of about 30 % of the back temperature during the oxyacetylene flame test with respect to the standard carbon-phenolic ablator. Compression tests on the manufactured ablators enlighten also an improvement in the mechanical properties for PVP-enriched ablators, in particular considering their charred state.

Analyses of inequalities related to prevention and cancer therapeutics/care show disparities between countries with different economic standing, and within countries with high Gross Domestic Product. The development of basic technological and biological research provides clinical and prevention opportunities that make their implementation into healthcare systems more complex, mainly due to the growth of Personalized/Precision Cancer Medicine (PCM). Initiatives like the USA‐Cancer Moonshot and the EU‐Mission on Cancer and Europe's Beating Cancer Plan are initiated to boost cancer prevention and therapeutics/care innovation and to mitigate present inequalities. The conference organized by the Pontifical Academy of Sciences in collaboration with the European Academy of Cancer Sciences discussed the inequality problem, dependent on the economic status of a country, the increasing demands for infrastructure supportive of innovative research and its implementation in healthcare and prevention programs. Establishing translational research defined as a coherent cancer research continuum is still a challenge. Research has to cover the entire continuum from basic to outcomes research for clinical and prevention modalities. Comprehensive Cancer Centres (CCCs) are of critical importance for integrating research innovations to preclinical and clinical research, as for ensuring state‐of‐the‐art patient care within healthcare systems. International collaborative networks between CCCs are necessary to reach the critical mass of infrastructures and patients for PCM research, and for introducing prevention modalities and new treatments effectively. Outcomes and health economics research are required to assess the cost‐effectiveness of new interventions, currently a missing element in the research portfolio. Data sharing and critical mass are essential for innovative research to develop PCM. Despite advances in cancer research, cancer incidence and prevalence is growing. Making cancer research infrastructures accessible for all patients, considering the increasing inequalities, requires science policy actions incentivizing research aimed at prevention and cancer therapeutics/care with an increased focus on patients' needs and cost‐effective healthcare.

BackgroundRelative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. ObjectiveThis study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. MethodsA lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. ResultsThis study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. ConclusionsThe successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. International Registered Report Identifier (IRRID)DERR1-10.2196/57329

Background The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll.Objective The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs).Methods We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs.Results We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p