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Executive SummaryThe EC Directive 2013/59/Euratom states in article 56 that exposures of target volumes in nuclear medicine treatments shall be individually planned and their delivery appropriately verified. The Directive also mentions that medical physics experts should always be appropriately involved in those treatments. Although it is obvious that, in nuclear medicine practice, every nuclear medicine physician and physicist should follow national rules and legislation, the EANM considered it necessary to provide guidance on how to interpret the Directive statements for nuclear medicine treatments.For this purpose, the EANM proposes to distinguish three levels in compliance to the optimization principle in the directive, inspired by the indication of levels in prescribing, recording and reporting of absorbed doses after radiotherapy defined by the International Commission on Radiation Units and Measurements (ICRU): Most nuclear medicine treatments currently applied in Europe are standardized. The minimum requirement for those treatments is ICRU level 1 (“activity-based prescription and patient-averaged dosimetry”), which is defined by administering the activity within 10% of the intended activity, typically according to the package insert or to the respective EANM guidelines, followed by verification of the therapy delivery, if applicable. Non-standardized treatments are essentially those in developmental phase or approved radiopharmaceuticals being used off-label with significantly (> 25% more than in the label) higher activities. These treatments should comply with ICRU level 2 (“activity-based prescription and patient-specific dosimetry”), which implies recording and reporting of the absorbed dose to organs at risk and optionally the absorbed dose to treatment regions. The EANM strongly encourages to foster research that eventually leads to treatment planning according to ICRU level 3 (“dosimetry-guided patient-specific prescription and verification”), whenever possible and relevant. Evidence for superiority of therapy prescription on basis of patient-specific dosimetry has not been obtained. However, the authors believe that a better understanding of therapy dosimetry, i.e. how much and where the energy is delivered, and radiobiology, i.e. radiation-related processes in tissues, are keys to the long-term improvement of our treatments.

The ability to use dry blood spots (DBSs) on filter paper for the analysis of urea levels could be an important diagnostic tool for areas that have limited access to laboratory facili- ties. We developed a method for the extraction and quantifi cation of urea from DBSs that were stored on 3M Whatman fi lter paper and investigated the effect of long-term storage on the level of urea in DBSs. DBSs of 4.5 mm in diameter were used for our assay, and we determined the urea levels in blood using a commercially available enzymatic kit (UV GLDH-method; Randox laboratories Ltd., UK). The DBSs on fi lter discs were stored at 4°C or at 37°C for 120 days. The mean intra- and inter-assay coeffi cient of variance for our method of urea extraction from dried blood was 4.2% and 6.3%, respectively. We collect- ed 75 fresh blood samples and compared the urea content of each fresh sample with the urea content of DBSs taken from corresponding fresh blood samples. Regression analysis reported a regression coeffi cient (r) value of 0.97 and a recovery of urea from dried spots was 102.2%. Urea concentrations in DBSs were stable for up to 120 and 90 days when stored at 4°C and 37°C, respectively. Our results show that urea can be stored and quanti- tatively recovered from small volumes of blood that was collected on fi lter paper.

Since the establishment of the academic society in 1972, Korean allergists have made continuous efforts to elucidate pathogenic mechanisms and therapeutic advances for allergic diseases. The present study aimed to summarize recent progress and explore future prospects of research performance by Korean allergists. We performed a comprehensive bibliometric analysis for research papers published in the Science Citation Index (SCI) or SCI-expanded journals by Korean allergists between 2009 and 2013. Research performance was quantitatively analyzed for the numbers of papers by publication year, research type, and main topic. In addition, the performance was also examined for qualitative indices, such as impact factor and citation number. A total of 1,091 papers were identified. The number of publication increased continuously, with an annual increase rate of 12.3%. Clinical and basic studies were the most frequent types of research, and recently the number of epidemiological studies has increased. By research topic, asthma was the most commonly studied, accounting for 20.9% of the total number of publications. Notably, the amount of rhinitis/rhinosinusitis research has risen steeply in 2013. Qualitative analyses also indicated continuous progress; the median impact factor of published journals increased from 1.918 in 2009 to 2.746 in 2013, yielding an annual increase rate of 7.4%. In conclusion, the present analyses identified a continuous increase in the research performance of Korean allergists over a recent 5 year period (2009-2013), both quantitatively and qualitatively. A more significant contribution is expected in the forthcoming era.

Conventional automated slaughter lines for pigs are organised as disassembly lines with many specialised machines. High costs and capacities make them relevant only for large scale meat production. The ambition with the novel Meat Factory Cell (MFC) concept is to provide the meat industry with a robust and flexible automation platform that is also relevant for smaller scale production. The MFC process deviates radically from conventional processing of pig carcasses after singeing. In MFC, the limbs are removed first. Then the dorsal muscles along the spinal axis from tail to head are removed with the column and rind in one meat cut, followed by removal of the viscera. Finally, the cut ribs and belly are removed. Such approaches to automation in pig abattoirs and cutting plants are highly needed in smaller scale production, and they should produce meat and offal as hygienically as conventional factories. This case study reports the evisceration of 37 pigs in 9 trials performed in 2019. Several approaches were tested with a prototype carcass holding unit. Evisceration could be undertaken without the need to cut through the gastrointestinal tract from tongue to rectum, reducing the probability of accidental faecal contamination of pork carcasses from the gut content. The Meat Factory Cell procedure is an advance towards automated evisceration of pig carcasses which is both simple and hygienic. The traditional separation of internal organs into a pluck set and a set of stomach and bowels was more prone to leakages.

Functional magnetic resonance imaging (fMRI) is a fundamental tool to investigate human brain networks. However, the cellular mechanisms underlying fMRI signals are not fully understood. One hypothetical mechanism is the putative vascular control exerted by cytosolic calcium in perivascular astrocytes. We have performed combined fMRI-electrophysiology experiments in mice lacking the inositol 1,4,5-triphosphate-type-2 receptor, with the primary pathway of cytosolic calcium increase eliminated into astrocytes. Our results show that evoked electrophysiologic activity and fMRI signals acquired during either transient or sustained neuronal activations occur independently of these large calcium signals. This result challenges the suggested intermediary role of astrocytic calcium surges in fMRI-signal generation.

Many working parents experienced a double burden of fulltime employment and increased childcare obligations during the COVID-19 (coronavirus disease 2019) pandemic. This paper explores how this twofold burden affected leisure time sports and exercise (LTSE). Following a gender inequality perspective, it is assumed that the level of LTSE of working mothers are more negatively affected by the pandemic than LTSE levels of working fathers. Using the nation-wide representative SPOVID survey, the paper analyses data of all respondents in fulltime employment (N = 631). Data collection took place in October and November 2020 in collaboration with Forsa, a leading corporation for public opinion polls in Germany. Results show that the pandemic led to a reduction of LTSE levels, but with considerable variation between working mothers and fathers. Fulltime working mothers reduced their LTSE by a substantial margin (54 min per week), but not working fathers. It is concluded that the double burden of work demands and childcare duties in the pandemic was largely shouldered by mothers, who then faced greater difficulties to remain active.

Around the world, many ambitious environmental conventions and regulations have been implemented over recent decades. Despite this, the environment is still deteriorating. An increase in the volume and diversity of chemicals is one of the main drivers of this deterioration, of which biodiversity loss is a telling indicator. In response to this situation, in October 2020, a chemicals strategy for sustainability (CSS) was published in the EU. The CSS is the first regional framework aiming to address chemical pollution in a holistic manner. The CSS covers the complete lifecycle of a chemical, including the design of better substances and remediation options, to remove chemicals from the environment. The strategy contains terms, such as a “toxic‐free environment,” for which no clear definition exists, potentially hampering the implementation of the CSS. In this paper, a definition for a “toxic‐free environment” is proposed on the basis of a survey and a discussion held at the 2020 SETAC Europe Annual Meeting. In addition, key issues that are absent from the CSS but are considered to be key for the realization of a toxic‐free environment are identified. To achieve the policy goals, it is recommended to align the definition of risk across the different chemical legislations, to establish a platform for open data and data sharing, and to increase the utility and use of novel scientific findings in policymaking, through the development of a strong science to regulation feedback mechanism and vice versa. The paper concludes that environmental scientists have the tools to address the key challenges presented in the CSS. However, an extra step is needed by both policymakers and scientists to develop methods, processes and tools, to increase the robustness and transparency of deliberation processes, and the utility of science. Integr Environ Assess Manag 2021;17:1105–1113. © 2021 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., KEY POINTS A definition for a ‘toxic‐free environment’ is proposed based on an analysis of a survey and a discussion held at the 2020 SETAC Europe Annual Meeting.Key issues are identified based on discussions that are absent from the European Commission's chemicals strategy for sustainability but are considered to be key for the realisation of a toxic‐free environment.Scientists have the tools to address key environmental challenges, but an extra step is needed by both policymakers and scientists to make these applicable.

Health and biomedical informatics graduate-level degree programs have proliferated across the United States in the last 10 years. To help inform programs on practices in teaching and learning, a survey of master’s programs in health and biomedical informatics in the United States was conducted to determine the national landscape of culminating experiences including capstone projects, research theses, internships, and practicums. Almost all respondents reported that their programs required a culminating experience (97%). A paper (not a formal thesis), an oral presentation, a formal course, and an internship were required by ≥50% programs. The most commonly reported purposes for the culminating experience were to help students extend and apply the learning and as a bridge to the workplace. The biggest challenges were students’ maturity, difficulty in synthesizing information into a coherent paper, and ability to generate research ideas. The results provide students and program leaders with a summary of pedagogical methods across programs.

An application (app) for the Severe Respiratory Insufficiency Questionnaire (SRI) has been designed and developed for mobile devices. In a randomised controlled trial comprising 60 patients with chronic respiratory failure, the app was compared with the classic paper SRI. Thereby, it was shown that the SRI app is a practical tool that is well accepted. Missing values can be completely avoided by using the SRI app. Finally, reliability, convergent and discriminant validities were established. Accordingly, for the individual SRI subscales, Cronbach’s alpha ranged between 0.56 and 0.81 (app) and between 0.54 and 0.83 (paper), respectively. The multilingual SRI app is accessible free of charge for non-profit research purposes.

BACKGROUND፡ Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. This study aimed to address the preventive procedures to protect healthcare workers at hospital to avoid COVID-19, and infection control procedures to protect dental professionals in dental office.METHODS: We conducted a search of published articles from PubMed, google scholar databases using key words such as COVID-19, healthcare worker, infection control, and dental practice. Relevant articles were identified and reviewed. Most published papers were clinical reports and case studies. We have selected some of the current published papers written in English in 2020.RESULTS: Infection control procedures to protect health workers at hospitals, and dental professionals at dental office were summurised and presented. Infection control procedures for healthcare workers at hospitals include Personal protective equipment, Korea filter (KF)94 respirator, goggles, face protector,disposable waterproof long-arm gown, and gloves, and others. Extra-protection procedures should be taken with old and vulnerable healthcare workers. Dental professionals should evaluate patients in advance before starting dental treatment. Aerosols generating procedures should be avoided and personal protective equipment should be used. Dental treatment should be restricted to emergency cases only.CONCLUSION: Old medical staff should be in safer distance to avoid infection, but young physicians and nurses should work at frontline as their immunity is better than their colleagues at old age. Screening patients and measurement of the body temperature are essential measures before dental treatment.

A recent paper by Martiny argues that “high proportions” of bacteria in diverse Earth environments have been cultured. Here we reanalyze a portion of the data in that paper, and argue that the conclusion is based on several technical errors, most notably a calculation of sequence similarity that does not account for sequence gaps, and the reliance on 16S rRNA gene amplicons that are known to be biased towards cultured organisms. We further argue that the paper is also based on a conceptual error: namely, that sequence similarity cannot be used to infer “culturability” because one cannot infer physiology from 16S rRNA gene sequences. Combined with other recent, more reliable studies, the evidence supports the conclusion that most bacterial and archaeal taxa remain uncultured.

The present report provides an overview of terminology studies in audiology including topics and study characteristics, as well as categorizing the main issues. The goals are to improve the understanding of the current issues for terminology in audiology and to provide some basic information that will be useful to develop an international standard. Search procedures were completed over two phases. Phase 1 included a systematic electronic searches using MEDLINE (PubMed), Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and International Organization for Standardization with keywords related to terminology of audiology. The studies were initially identified according to the titles of 2921 publications following careful abstract examination. Of these, whole texts of 16 publications were retrieved. Five papers met the inclusion criteria were further investigated. In phase 2, a manual search was conducted to collect additional publications with keywords related to terminology project in audiology. A total of 16 papers were found. The essential terminology issues classified included 'appropriateness,' 'classification/framework,' 'inconsistency of terminology,' 'multilingual and international aspects,' and 'service quality/delivery including communication and accessibility.' This was indicative of the paucity of terminology research in audiology, despite recurring terminology issues. Establishment of standardized terminology in audiology may minimize current challenging terminology issues by improving appropriateness and consistency of terminology as well as communication among relevant stakeholders at national and international levels.

Clinical pharmacogenomics (PGx) has the potential to make pharmacotherapy safer and more effective by utilizing genetic patient data for drug dosing and selection. However, widespread adoption of PGx depends on its successful integration into routine clinical care through clinical decision support tools, which is often hampered by insufficient or fragmented infrastructures. This paper describes the setup and implementation of a unique multimodal, multilingual clinical decision support intervention consisting of digital, paper-, and mobile-based tools that are deployed across implementation sites in seven European countries participating in the Ubiquitous PGx (U-PGx) project.

In a recent publication in Nature, Wagner & Jonkers (2017) report that public R&D funding is only weakly correlated with the citation impact of a nation's papers as measured by the field-weighted citation index (FWCI; defined by Scopus). On the basis of the supplementary data, we upscaled the design using Web-of-Science data for the decade 2003-2013 and OECD funding data for the corresponding decade assuming a two-year delay (2001-2011). Using negative binomial regression analysis, we find very small coefficients, but the effects of international collaboration are positive and statistically significant, whereas the effects of government funding are negative, an order of magnitude smaller, and statistically non-significant (in two of three analyses). In other words, international collaboration improves the impact of average research papers, whereas more government funding tends to have a small adverse effect when comparing OECD countries.

The continuing debate between Persson and Savulescu and myself over moral enhancement concerns two dimensions of a very large question. The large question is: what exactly makes something a moral enhancement? This large question needs a book length study and this I provide in my How to be Good, Oxford 2016. (JH 2016). In their latest paper Moral Bioenhancement, Freedom and Reason take my book as their point of departure and the first dimension of the big question they address is one that emphasizes a distinction, not highlighted in their original 2008 paper, between a moral enhancement that will ensure an improvement in morality and one that will simply make people more motivated to be moral. The second issue concerns whether anything that would be a “moral enhancement” properly so called, could involve denying moral agents the very possibility of autonomously choosing to try to be good. In this response, although P&S cover a number of other related issues, I shall concentrate on these two points.

We found the recent paper by Bedi et al.1 simultaneously exciting, heartening and, sadly, a bit discouraging. It shows that modern, statistical natural language processing (NLP) and machine-learning (ML) techniques can potentially be useful as a component of diagnosis, here predicting who among those at risk will eventually transition to full-blown psychosis. This result follows closely our own and others observations of the value of these techniques in, for example, discriminating patients with schizophrenia from controls,2 discriminating schizophrenia probands, first-degree relatives and unrelated healthy controls,3 differentiating those at high risk of psychosis from unrelated putatively healthy participants4 and in a candidate gene study linking language in general to underlying neurobiology,5 all quite encouraging outcomes. Our disappointment is not directly with the Bedi et al.1 paper itself, but that we as a field are, after this long proving period, still at the ‘promising’ stage. This inertia arises from two primary factors. The first is owing to the use of small, often second-hand data sets produced for other studies, which severely constrains the NLP techniques that can be applied and the generality of the obtained results. The second is that the methodologies applied must become sufficiently assimilated into the field to be used effectively in analyses so as to provide valid, reliable measures of the constructs of interest. This understanding permits better linking of the appropriate features of language to the underlying etiologies of interest. To realize the potential of the transformative next steps, we must routinely and systematically strive to obtain larger data sets containing multiple language samples from participants collected over time. This will allow quantifying the joint time course of the disease(s) and changes in language. Increased sample size further improves the methodologies, permitting moving beyond the less-reliable cross-validation to the use of the gold-standard for validating ML results, which is a ‘hold-out’ data set. In such an approach all modeling is conducted blind to the hold-out set, and when modeling is completed, the model is run on the held-out set to measure expected performance in the larger population, thereby ensuring generalization while lowering the risk of overfitting. At least as importantly, realistically sized data sets allow the application of larger combinations of more sophisticated NLP/ML techniques that move beyond the often used simple word-count features. This permits deeper characterization of more important aspects of language, such as semantic structures, discourse organization, as well as acoustic characteristics.6 From our perspective, Figure 3 from Bedi et al.1 is a beautiful, low-dimensional, small, incremental step toward our vision, which is that of a truly high-dimensional language-feature space with the potential to align with the aspirational goals of the NIMH Research Domain Criteria by employing language to locate and pinpoint those with severe mental illness at coordinates within this space. Once localized, the features that define the resulting hypothesized clusters can potentially be calibrated for use in early detection, continuously evaluating treatment and providing links to the biology underlying these diseases, simultaneously superseding our existing diagnostic categories. But this vision is only achievable with purpose-designed studies containing sufficiently large populations with a mix of both healthy participants and individuals sampled across multiple categories of diagnostic groups. Our field must become versed in the use of more powerful applications of NLP/ML techniques and offer more reproducible methodologies. These results, taken with others, are sufficiently encouraging so that it is now time for us to move beyond ‘promising’.

Obesity is now recognized as a chronic disease by many international medical societies. However, its comprehensive assessment is still a challenge in most clinical settings. This paper describes a novel practical approach to assess the barophenotype of a given individual. The word barophenotype is a portmanteau of “baro,” which means weight, and phenotype, which reflects an external expression of a trait. This can be easily assessed using an ABCDE framework, encompassing the Adipose topography, Barophenotypic Behavior, Comorbidity assessment, Dysfunctionality, and Expectations. Furthermore, the utility of this framework in determining an appropriate person-centric therapeutic plan has also been described.

A prevalent symptom of Parkinson’s disease (PD) is hypomimia — reduced facial expressions. In this paper, we present a method for diagnosing PD that utilizes the study of micro-expressions. We analyzed the facial action units (AU) from 1812 videos of 604 individuals (61 with PD and 543 without PD, with a mean age 63.9 y/o, sd. 7.8) collected online through a web-based tool ( www.parktest.net ). In these videos, participants were asked to make three facial expressions (a smiling, disgusted, and surprised face) followed by a neutral face. Using techniques from computer vision and machine learning, we objectively measured the variance of the facial muscle movements and used it to distinguish between individuals with and without PD. The prediction accuracy using the facial micro-expressions was comparable to methodologies that utilize motor symptoms. Logistic regression analysis revealed that participants with PD had less variance in AU6 (cheek raiser), AU12 (lip corner puller), and AU4 (brow lowerer) than non-PD individuals. An automated classifier using Support Vector Machine was trained on the variances and achieved 95.6% accuracy. Using facial expressions as a future digital biomarker for PD could be potentially transformative for patients in need of remote diagnoses due to physical separation (e.g., due to COVID) or immobility.

The patient portal is a web service which allows patients to view their electronic health record, communicate online with their care teams, and manage healthcare appointments and medications. Despite advantages of the patient portal, registrations for portal use have often been slow. Using a secure video system on our existing exam room electronic health record displays during regular office visits, the authors showed patients a video which promoted use of the patient portal. The authors compared portal registrations and portal use following the video to providing a paper instruction sheet and to a control (no additional portal promotion). From the 12 050 office appointments examined, portal registrations within 45 days of the appointment were 11.7%, 7.1%, and 2.5% for video, paper instructions, and control respectively (p

In 2020, it is estimated that 73,750 kidney cancer cases were diagnosed, and 14,830 people died from cancer in the United States. Preoperative multi-phase abdominal computed tomography (CT) is often used for detecting lesions and classifying histologic subtypes of renal tumor to avoid unnecessary biopsy or surgery. However, there exists inter-observer variability due to subtle differences in the imaging features of tumor subtypes, which makes decisions on treatment challenging. While deep learning has been recently applied to the automated diagnosis of renal tumor, classification of a wide range of subtype classes has not been sufficiently studied yet. In this paper, we propose an end-to-end deep learning model for the differential diagnosis of five major histologic subtypes of renal tumors including both benign and malignant tumors on multi-phase CT. Our model is a unified framework to simultaneously identify lesions and classify subtypes for the diagnosis without manual intervention. We trained and tested the model using CT data from 308 patients who underwent nephrectomy for renal tumors. The model achieved an area under the curve (AUC) of 0.889, and outperformed radiologists for most subtypes. We further validated the model on an independent dataset of 184 patients from The Cancer Imaging Archive (TCIA). The AUC for this dataset was 0.855, and the model performed comparably to the radiologists. These results indicate that our model can achieve similar or better diagnostic performance than radiologists in differentiating a wide range of renal tumors on multi-phase CT.

As of August 30, 2020, Brazil ranked second among countries with the highest number of COVID-19 cases, with the city of São Paulo as the national epidemic epicenter. Local public healthcare institutions were challenged to respond to a fast-growing hospital demand, reengineering care provision to optimize clinical outcomes and minimize intra-hospital coronavirus infection. In this paper we describe how the largest public hospital complex in Latin America faced this unprecedented burden, managing severe COVID-19 cases while sustaining specialized care to patients with other conditions. In our strategic plan a 900-bed hospital was exclusively designated for COVID-19 care and continuity of care to those not infected with coronavirus ensured in other inpatient facilities. After 152 days, 4241 patients with severe COVID-19 were hospitalized, 70% of whom have already been discharged, whereas the remaining Institutes of the complex successfully maintained high complexity inpatient and urgent/emergency care to non-COVID-19 patients.

Bulbar deterioration in amyotrophic lateral sclerosis (ALS) is a devastating characteristic that impairs patients’ ability to communicate, and is linked to shorter survival. The existing clinical instruments for assessing bulbar function lack sensitivity to early changes. In this paper, using a cohort of N = 65 ALS patients who provided regular speech samples for 3–9 months, we demonstrated that it is possible to remotely detect early speech changes and track speech progression in ALS via automated algorithmic assessment of speech collected digitally.

Free-living amoebas (FLAs) can cause severe disease in humans and animals when they become infected. However, there are no accurate survey reports on the prevalence of FLAs in Korea. In this study, we collected 163 tap water samples from buildings, apartments, and restrooms of highway service areas in 7 Korean provinces with high population density. All these buildings and facilities have water storage tanks in common. The survey was separated into categories of buildings, apartments, and highway service areas. Five hundred milliliters of tap water from each building was collected and filtered with 0.2 µm pore filter paper. The filters were incubated in agar plates with heated E. coli at 25°C. After axenization, genomic DNA was collected from each FLA, and species classification was performed using partial 18S-rDNA PCR-sequencing analysis. We found that 12.9% of tap water from buildings with storage tanks in Korea was contaminated with FLAs. The highway service areas had the highest contamination rate at 33.3%. All of the FLAs, except one, were genetically similar to Vermamoeba vermiformis (Hartmannella vermiformis). The remaining FLA (KFA21) was very similar to Acanthamoeba lugdunensis (KA/E26). Although cases of human infection by V. vermiformis are very rare, we must pay attention to the fact that one-third of tap water supplies in highway service areas have been contaminated.

Human infection with Echinostoma aegyptica Khalil and Abaza, 1924 (Trematoda: Echinostomatidae) is extremely rare. In this study, we confirmed E. aegyptica infection in 5 riparian residents living along the Mekong River in Savannakhet Province, Lao PDR. The patients revealed eggs of Opisthorchis viverrini/minute intestinal flukes, echinostomes, and other parasites in fecal examinations using the Kato-Katz technique. Following treatment with praziquantel 30-40 mg/kg and pyrantel pamoate 10-15 mg/kg in a single dose and purging with magnesium salts, adult specimens of various helminth species were collected. Among the trematodes, echinostome flukes of 4.5-7.6 mm in length (n = 134; av. 22.3 specimens per case) were of taxonomic interest and subjected in this study. The flukes were morphologically characterized by having total 43-45 collar spines arranged in 2 alternating rows (corner spines usually 5 on each side) and compatible with previous descriptions of E. aegyptica. The patients were mixed-infected with other helminths, so specific clinical manifestations due to this echinostome fluke were difficult to determine. The present paper describes for the first time human E. aegyptica infections in Lao PDR. This is the second report of human infection (2nd-6th cases) with E. aegyptica in the world following the first one from China.

In the United States when presenting case reports or research results, or when using related information for secondary purposes, the use of social security numbers of patients is restricted along with 18 items identified by the Health Insurance Portability and Accountability Act (HIPAA) Guidelines which must be kept anonymous [1]. In Japan, the Surgery Society Federation has established "Guidelines for protection of patient privacy in case reports, medical papers, and research meetings [2]" which prohibits even the use of patients' initials. Addresses must be recorded only by prefecture and city name and the event must be recorded only by the year and month, not by the date. The following is an excerpt from an acceptable case report. "A male patient, in his 70s, visited our hospital in November 2007. His HbA1c test result was 7.4. He was diagnosed with diabetes and given voglibose. Two to three months later, he was retested and the HbA1c value was 5.9."(The details have been altered to protect the patient's privacy). Hamamatsu University School of Medicine has a clinical information retrieval system D*D [3] which searches 10 years worth of records at high speed. The data include prescription/injection orders, laboratory test results, disease name registration, and basic patient information (385,815 persons, 73,709,298 total events as of June, 2008). This system searches the data according to time sequence or context. For example, a search for "Pravastatin (any titer, including generic drug) prescribed and an AST > 150 recorded within two weeks" took 112 seconds to compile a list of 83 patient hits. A search using the information in the previously mentioned example case report resulted in identification of only ONE individual among 385,815 Hamamatsu University Hospital patients. We used this system and increased the degree of anonymity of information. We omitted the month of November and included test results with a range of "6.6-8.0" and "5.9-6.5" as defined by the Japan Diabetes Society to describe the seriousness of disease. The content of the search was as follows: "A male patient, in his 70's, visited our hospital in 2007. His HbA1c test result was (6.6-8.0). He was diagnosed with diabetes and given voglibose. Two to three months later, he was retested and the result was (5.9-6.5)." A search with this information identified 47 patients. The national morbidity rate of diabetes is approximately 5%. Even for this rate, the content of search results must be ambiguous as exemplified above. For a case report of a very rare disease, e.g., one patient per tens of thousands of inhabitants, then the content of the search must be even more ambiguous to ensure the same degree of anonymity of information. As a result, the description becomes meaningless as a medical paper while conversely, the fact is that a highly identifiable case report for a rare disease is medically more meaningful. One countermeasure to address this problem is to decrease the number of persons who have access to such papers; however, it is a historical fact that restricting information inhibits the advancement of science. Therefore, this countermeasure is impractical. Furthermore, in the present-day environment, it would be practically impossible to restrict access to internet published journals. Therefore, to protect patient privacy, it is necessary to further ensure the confidentiality of information that may ultimately identify an individual, such as the names and addresses of patients. But healthcare ID numbers (the insurance number, patient hospital ID number, etc.) must be linked very carefully with identifiable information (a social security number, taxpayer ID number, etc.). The level of privacy is determined by the least protected ID information. For this reason, it is necessary to numerically evaluate the degree of anonymity of information, considering associated factors, for example, the morbidity rate of the disease.

Covid-19 has changed the way medical services are being delivered all around the world. Otolaryngology as a speciality is anecdotally associated with high risk of infection. Endoscopies can be associated with aerosolization of particles due to cough or sneeze which may be induced. An overhaul of endoscopy and associated procedures is necessary keeping in mind the prevailing situations. This paper aims at a review of the on-going research and development of a road map for safe endoscopies—both for patients and heath care workers.

There is often the risk of confusing pollen grains with helminth eggs from archaeological sites. Thousands to millions of pollen grains can be recovered from archaeological burial sediments that represent past ritual, medication and environment. Some pollen grain types can be similar to parasite eggs. Such a confusion is represented by the diagnosis of enterobiasis in ancient Iran. The authors of this study confused a joint-pine (Ephedra spp.) pollen grain with a pinworm egg. This paper describes the specific Ephedra pollen morphology that can be confused with pinworm eggs.

Adult specimens of Echinochasmus caninus n. comb. (Verma, 1935) (Trematoda: Echinostomatidae) (syn. Episthmium caninum Yamaguti, 1958) were recovered from 11 riparian people who resided along the Mekong River in Khammouane Province, Lao PDR. In fecal examinations done by the Kato-Katz technique, the cases revealed eggs of Opisthorchis viverrini/minute intestinal flukes, hookworms, and in 2 cases echinostome eggs. To recover the adult helminths, praziquantel 30–40 mg/kg and pyrantel pamoate 10–15 mg/kg in a single dose were given and purged with magnesium salts. Various species of trematodes (including O. viverrini and Haplorchis spp.), cestodes, and nematodes were recovered from their diarrheic stools. Among the trematodes, small echinostome flukes (n=42; av. 3.8 specimens per case) of 0.7–1.2 mm in length are subjected in this study. They are morphologically characterized by having 24 collar spines interrupted dorsally and anterior extension of vitellaria from the cirrus sac or genital pore level to the posterior end of the body. Particularly based on this extensive distribution of vitellaria, the specific diagnosis was made as Echinochasmus caninus. The cases were co-infected with various other helminth parasites; thus, clinical manifestations specific for this echinostome infection were difficult to determine. The present paper describes for the first time human E. caninus infections in Lao PDR. Our cases marked the 4–14th human infections with this echinostome around the world following the 3 previous cases reported from Thailand.

In 2016, the United Nations declared the need for urgent action to combat the global threat of antimicrobial resistance (AMR). In support of this effort, the pharmaceutical industry has committed to measures aimed at improving the stewardship of antibiotics both within and outside the clinic. Notably, a group of companies collaborated to specifically address concerns related to antibiotic residues being discharged from manufacturing sites. In addition to developing a framework of minimum environmental expectations for antibiotic manufacturers, science‐based receiving water targets were established for antibiotics discharged from manufacturing operations. This paper summarizes the holistic approach taken to derive these targets and includes previously unpublished, company‐generated, environmental toxicity data., Key Points A recommended approach for assessing the risks from antibiotic manufacturing discharges is presented that considers both environmental endpoints and antimicrobial resistance.Also included are previously unpublished industry data on environmental toxicity of antibiotics.

Children with preschool wheeze regularly attend UK emergency departments. There is no international consensus on any specific personalised management approach. This paper describes the first attempt to co-design patient-centred outcomes with families. Preschool wheezers’ parents participated in semi-structured interviews and focus-group discussions to air their concerns and identify potential additional support. Fifty-seven families participated in these interviews. From these, themes were defined through qualitative content analysis. Parental experience was mapped to the patient pathway and seven important personalised outcomes were described. These can be used to inform a tool which following further validation could potentially support management of children with preschool wheeze and provide an additional patient focused clinical outcome measure in audit and research.

The rapid increase of the coronavirus disease 2019 pandemic from mid-February 2020 has led the anatomy department of the Korea University College of Medicine to cease the dissection laboratory. However, the hands-on anatomy laboratory experience is paramount to maximizing learning outcomes. In this paper, we share the experiences and lessons learned through the face-to-face cadaveric dissection experience during this disruptive situation. To minimize infection risks, the following strategies were applied: first, students' on-campus attendance was reduced; second, body temperatures and symptoms were checked before entering the laboratory, and personal protective equipment was provided to all participants; and third, a negative pressure air circulation system was used in the dissection room. We suggest that conducting face-to-face cadaveric anatomy dissection is feasible when the daily count of newly infected cases stabilizes, and there is ample provision of safety measures to facilitate hands-on education., Graphical Abstract

Background The coronavirus disease 2019 (COVID-19) global pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. Researchers around the world are aggressively working to develop a vaccine. One of the vaccines approved against COVID-19 is Oxford–AstraZeneca chimpanzee adenovirus vectored vaccine ChAdOx1 nCoV-19. Case report We described a patient who developed four limb distal paraesthesia, postural instability, and facial diplegia, ten days after vaccination with ChAdOx1 nCoV-19 (ABW1277). The electrophysiological findings were compatible with acute demyelinating motor polyneuropathy (Guillain-Barrè syndrome). Discussion We therefore want to describe a temporal correlation between administration of ChAdOx1 nCoV-19 (ABW1277) vaccine and GBS without evidence of other predisposing infectious or autoimmune factors. This paper aims to highlight the importance of pharmacovigilance and subsequent reports will be needed to evaluate the possible correlation between these two events.

This paper complements recent considerations of specific protection goals (SPG) to inform risk assessments for non‐target terrestrial plants (NTTP) in the European Union. The SPG options in‐field appear to be of the most disruptive potential from agronomic perspective and are therefore investigated in more detail. Overarching prerequisites have been identified that need to be accounted for to ensure that any of the potential SPG options remain operational in a sustainable agricultural context. As soon as crop production is considered a desired ecosystem service for the in‐field, its specific requirements in the context of sustainable agriculture have to be factored in. Good agricultural practices (GAPs), potential ecosystem disservices (e.g. weeds, pests and diseases) and supporting and regulating services need to be considered to ensure a successful and sustainable delivery of the ecosystem service crop production. Concerning in‐field SPG options for NTTP specifically GAPs related to integrated weed management (IWM) require detailed assessment, as they individually and in combination have the purpose of weed control. Therefore, they result in specific implications to the environment, ecosystem services and biodiversity within the context of sustainable agricultural production. When diverging in‐field ecosystem services are considered for the same context, the protection goals options require an additional assessment of synergies and trade‐offs between the relevant ecosystem services (e.g. crop production, climate regulation and aesthetic values), a corresponding weighing and prioritization. Similarly, for biodiversity conservation, the trade‐offs and synergies between sustainable crop production and specific habitat requirements need to be accounted for. Consequently, an interdisciplinary approach can ensure that SPG are operational by integrating a broad understanding of cropping systems, the environmental impact of the tools a farmer uses and the link between habitat availability, the impact of any of the applied tools on habitat quality and the broader landscape context. Integr Environ Assess Manag 2021;17:905–910. © 2021 Bayer AG, BASF SE and Syngenta. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., KEY POINTS An interdisciplinary approach can ensure that specific protection goals for environmental risk assessments for crop protection products are operational and realistic in a sustainable agricultural context.Tools and management strategies used within sustainable agriculture and the natural environment interact with each other and can exert both positive and negative effects, respectively, thus requiring a holistic approach for setting specific protection goals.In particular, the sustainable delivery of the ecosystem service “crop production” comes with agronomical and environmental constraints that both need to be accounted for when defining in‐field specific protection goals for crop protection.Ecosystem services delivery and biodiversity conservation also have inherent trade‐offs and synergies that need to be considered and prioritized within the derivation of specific protection goals.

Aim Skin and soft tissue infections are classified into cellulitis and necrotizing fasciitis, which are difficult to distinguish. Necrotizing fasciitis has a poor prognosis and requires immediate intensive care. The diagnostic gold standard is to incise the lesion to determine whether necrosis has reached the fascia. We aimed to show that these infections can be differentiated using near‐infrared spectroscopy. Methods We describe two cases in an observational study about the utility of near‐infrared spectroscopy. Case 1 involved a 77‐year‐old man with a chief complaint of pain, redness, and swelling in the right lower leg for 1 week. Computed tomography of his legs showed no gas formation. Case 2 involved an 82‐year‐old man. He visited another hospital because of pain, redness, and swelling in the right thigh. Based on the X‐ray examination, necrotizing fasciitis was suspected, and he was transferred to our hospital. Results In Case 1, the regional oxygen saturation value was lower on the lesion side (41%) than on the healthy side (55%). We confirmed the depth of invasion by incision, leading to a diagnosis of necrotizing fasciitis. In Case 2, the thigh’s regional oxygen saturation was higher on the affected side (76%) than on the healthy side (61%). An incision was made for diagnosis, but the fascia was not necrotized. Thus, we diagnosed cellulitis and provided conservative treatment using antibiotics. Conclusion Near‐infrared spectroscopy can be utilized to measure tissue blood flow, and it could be useful as a non‐invasive diagnostic tool for skin and soft tissue infections., Currently, the diagnosis of necrotizing fasciitis is made by surgical incision. In this paper we report on a new diagnostic tool for Skin and soft tissue infections.

Purpose: Point of care ultrasound (POCUS) brings high-quality patient care to the bedside but continues to be an expensive training to implement in a residency program. There are multiple resources available to train providers in ultrasound, but they are all associated with significant cost. The Accreditation Council for Graduate Medical Education (ACGME) mandates anesthesiology residents to be competent in diagnostic and therapeutic uses of ultrasound. In this paper, we describe how an academic anesthesiology department implemented a POCUS curriculum for resident training. Methods: An anesthesiologist intensivist directed program was created to train residents in POCUS. We started by training a group of seven critical care trained anesthesiologists with the guidance of cardiologists. These anesthesiologists participated in the training of our anesthesiology residents. A hybrid curriculum consisting of a simulator as well as hands-on scanning of patients was created. We recorded the time that personnel spent in the training program as well as the money spent in acquiring equipment. Results: Seven faculty utilized a total of 270 hours of scanning and teaching time to train 48 residents who rotated through the ICU between July 2017 and June 2018. Simulation technicians used 48 hours to guide residents through simulation scenarios. The education administrator used 24 hours to coordinate sessions for residents. The technician and coordinator were both employees of the department with no additional cost for their responsibilities. The cost of equipment, including the ultrasound machine and simulator, was $45,000. An additional charge of $3500 was incurred for technician training time. Conclusion: Implementing a robust, sustainable POCUS curriculum requires a significant investment of time and money. Simulators and e-learning can allow efficiency in resource allocation and control cost in orienting new students to ultrasound. Having residents go through the simulator decreased the time that faculty would otherwise have spent going over basics with the students while allowing students to master these skills at their own pace. Advances in ultrasound technology have created newer, more affordable machines which can decrease cost considerably. It would serve departments well to consider alternatives and plan for resources when deciding to implement POCUS curriculum for resident training.

The coronavirus disease 2019 (COVID-19) pandemic mandated rapid, flexible solutions to meet the anticipated surge in both patient acuity and volume. This paper describes one institution's emergency department (ED) innovation at the center of the COVID-19 crisis, including the creation of a temporary ED-intensive care unit (ICU) and development of interdisciplinary COVID-19-specific care delivery models to care for critically ill patients. Mount Sinai Hospital, an urban quaternary academic medical center, had an existing five-bed resuscitation area insufficiently rescue due to its size and lack of negative pressure rooms. Within 1 week, the ED-based observation unit, which has four negative pressure rooms, was quickly converted into a COVID-19-specific unit, split between a 14-bed stepdown unit and a 13-bed ED-ICU unit. An increase in staffing for physicians, physician assistants, nurses, respiratory therapists, and medical technicians, as well as training in critical care protocols and procedures, was needed to ensure appropriate patient care. The transition of the ED to a COVID-19-specific unit with the inclusion of a temporary expanded ED-ICU at the beginning of the COVID-19 pandemic was a proactive solution to the growing challenges of surging patients, complexity, and extended boarding of critically ill patients in the ED. This pandemic underscores the importance of ED design innovation with flexible spacing, interdisciplinary collaborations on structure and services, and NP ventilation systems which will remain important moving forward.

A new disease called coronavirus disease 2019 (COVID‐19), caused by the severe acute respiratory syndrome coronavirus‐2 (SARS‐COV‐2) virus, was discovered in the city of Wuhan in China in December 2019, and has reached, quickly and progressively, several countries on different continents. Even before the World Health Organization recognized the COVID‐19 epidemic as a pandemic, the Brazilian Ministry of Health had already declared COVID‐19 a national public health emergency due to the confirmation of cases in Brazil. In this scenario, the educational sector was one of the first to suffer the effects of the pandemic soon after the announcement of social distancing as a way to prevent the collapse of the Unified Health System. The aim of this paper is to report how Brazilians dental schools are leading with the new coronavirus pandemic.

Pyometra is a very uncommon disease principally occurring in postmenopausal women. It is characterized by the accumulation of purulent material within the uterine cavity. This paper presents the clinical history of a 35-year-old premenopausal woman with otherwise normal menstruation who developed heavy menstruation and was diagnosed with a benign pyometra of indeterminate etiology in March 2017. The patient underwent repeated ultrasound-guided drainage, dilation and curettage, and antibiotic therapy. Biopsies of the pelvic sidewall revealed endometriosis in June 2017. The heavy menstruation and suppurative fluid in the uterus of the patient persisted in which intramuscular leuprolide acetate was prescribed to address the endometriosis and heavy menstrual bleeding. Ultimately, the leuprolide acetate effectively resolved the patient’s bleeding and pyometra. The medication was concluded after 12 months of supervision and the patient is currently symptom free. Pyometra is an unusual condition rarely identified in premenopausal women. Drainage and antibiotic therapy are routinely employed; however, one may consider gonadotropin-releasing hormone agonist medication to potentially confer a beneficial patient outcome in rare cases where endometriosis and bleeding are intractable.

In the spring of 2010, it was discovered that a large proportion of broilers in Sweden were colonized with Escherichia coli producing extended-spectrum beta-lactamases (ESBL) or plasmid mediated AmpC (pAmpC). It was hypothesized that the high prevalence was due to transfer from an upper level in the production pyramid and sampling upwards in the production pyramid was initiated. From 2010 to 2019, all shipments (n = 122) of broiler breeders were screened on arrival to Sweden for the occurrence of ESBL- or pAmpC-producing E. coli using selective methods. Samples of paper linings from shipments of breeders were cultured on MacConkey agar supplemented with cefotaxime (1 mg/L) after pre-enrichment in either MacConkey broth with cefotaxime (1 mg/L), or from late June 2015 in buffered peptone water without antibiotics. ESBL- or pAmpC-producing E. coli was isolated from 43 (35%) of these. Over the years, the proportion of positive imports have decreased and during 2018 and 2019 all imports were negative. In conclusion, the occurrence of ESBL- or pAmpC-producing E. coli in broiler breeders on arrival to Sweden has decreased. Such bacteria have not been detected in any shipments since 2017.

WOS:000431829000017 PubMed: 29453415 Amyotrophic lateral sclerosis (ALS) is a late-onset motor neuron disease with mostly dominant inheritance and a life expectancy of 2-5 years; however, a quite common occurrence of atypical forms of the disease, due to recessive inheritance, has become evident with the use of NGS technologies. In this paper, we describe a family with close consanguinity for at least four generations, suffering from a slowly progressive form of ALS. Spastic walking is observed since teenage years, while bulbar symptoms start much later, at the fifth or sixth decade of life. Patients usually die because of respiratory failure. Using whole-exome sequencing, we identified a novel homozygous p.(Val94Ala) (c.281T>C) (NG_052910.1) (NM_006459) variation in the endoplasmic reticulum lipid raft associated protein 1 (ERLIN1) gene, which segregates with the disease in the family. Here we suggest that ERLIN1 variants, previously shown in juvenile hereditary spastic paraplegia cases, may also be the cause of a slowly progressive early-onset ALS, starting with upper motor neuron features and developing into classical ALS with the addition of lower motor neuron dysfunction. We also demonstrate that ATP-binding cassette subfamily C member 2 (ABCC2) gene, responsible for hyperbilirubinemia, is linked to ERLIN1.

ObjectivesDigital tools for decision-support and health records can address the protracted process of guideline adoption at local levels and accelerate countries’ implementation of new health policies and programmes. World Health Organization (WHO) launched the SMART Guidelines approach to support the uptake of clinical, public health, and data recommendations within digital systems. SMART guidelines are a package of tools that include Digital Adaptation Kits (DAKs), which distill WHO guidelines into a format that facilitates translation into digital systems. SMART Guidelines also include reference software applications known as digital modules.MethodsThis paper details the structured process to inform the adaptation of the WHO antenatal care (ANC) digital module to align with country-specific ANC packages for Zambia and Rwanda using the DAK. Digital landscape assessments were conducted to determine potential integrations between the ANC digital module and existing systems. A multi-stakeholder team consisting of Ministry of Health technical officers representing maternal health, HIV, digital health, and monitoring and evaluation at district and national levels was assembled to review existing guidelines to adapt the DAK.ResultsThe landscape analysis resulted in considerations for integrating the ANC module into the broader digital ecosystems of both countries. Adaptations to the DAK included adding national services not reflected in the generic DAK and modification of decision support logic and indicators. Over 80% of the generic DAK content was consistent with processes for both countries. The adapted DAK will inform the customization of country-specific ANC digital modules.ConclusionBoth countries found that coordination between maternal and digital health leads was critical to ensuring requirements were accurately reflected within the ANC digital module. Additionally, DAKs provided a structured process for gathering requirements, reviewing and addressing gaps within existing systems, and aligning clinical content.

This brief communication responds to the paper by Jeong and Cho (Qual Life Res 26(4):903–911, 2017) that has described activity pacing in limited terms of adjusting activities through going at a slower rate and taking breaks. Activity pacing was reported as not involving goal setting, in comparison to other strategies for long-term conditions such as Acceptance and Commitment Therapy. This brief communication aims to challenge this limited perception of activity pacing in light of numerous studies that recognise pacing to be a more complex strategy. Pacing is considered to be a multifaceted coping strategy, including broad themes of not only adjusting activities, but also planning activities, having consistent activity levels, acceptance of current abilities and gradually increasing activities, and one that includes goal setting as a key facet. It is essential that pacing is both defined and measured as a multifaceted strategy in order to assess the outcomes of pacing, and for meaningful comparisons with other strategies regarding efficacy for the management of long-term conditions.

Biallelic mutations in ECHS1, encoding the mitochondrial enoyl‐CoA hydratase, have been associated with mitochondrial encephalopathies with basal ganglia involvement. Here, we describe a novel clinical presentation consisting of dystonia‐ataxia syndrome with hearing loss and a peculiar torsional nystagmus observed in two adult siblings. The presence of a 0.9‐ppm peak at MR spectroscopy analysis suggested the accumulation of branched‐chain amino acids. Exome sequencing in index probands identified two ECHS1 mutations, one of which was novel (p.V82L). ECHS1 protein levels and residual activities were reduced in patients’ fibroblasts. This paper expands the phenotypic spectrum observed in patients with impaired valine catabolism.

This paper proposes a novel controller to control position, amplitude and frequency of periodic firing activity in Hindmarsh–Rose model based on Hopf bifurcation theory which is composed of linear control gain and nonlinear control gain. First, we select the activation of the fast ion channel as control parameter. Based on explicit criterion of Hopf bifurcation, a series of conditions are obtained to derive the linear gains of controller responsible for control of the location where the periodic firing activity occurs. Then, based on the control parameter, a series of conditions are obtained to derive the nonlinear gains of controller responsible for controlling the amplitude and frequency of periodic firing activity by using center manifold and normal form. Finally, the numerical experiments show that our controller can make the periodic firing activity occur at designed value and control the amplitude and frequency of periodic firing activity by adjusting nonlinear control gain of controller.

ObjectiveThe objective of this paper is to share challenges, recommendations, and lessons learned regarding the development and implementation of a Patient Safety Learning Laboratory (PSLL) project, an innovative and complex intervention comprised of a suite of Health Information Technology (HIT) tools integrated with a newly implemented Electronic Health Record (EHR) vendor system in the acute care setting at a large academic center.Materials and MethodsThe PSLL Administrative Core engaged stakeholders and study personnel throughout all phases of the project: problem analysis, design, development, implementation, and evaluation. Implementation challenges and recommendations were derived from direct observations and the collective experience of PSLL study personnel.ResultsThe PSLL intervention was implemented on 12 inpatient units during the 18-month study period, potentially impacting 12,628 patient admissions. Challenges to implementation included stakeholder engagement, project scope/complexity, technology/governance, and team structure. Recommendations to address each of these challenges were generated, some enacted during the trial, others as lessons learned for future iterative refinements of the intervention and its implementation.ConclusionDesigning, implementing, and evaluating a suite of tools integrated within a vendor EHR to improve patient safety has a variety of challenges. Keys to success include continuous stakeholder engagement, involvement of systems and human factors engineers within a multidisciplinary team, an iterative approach to user-centered design, and a willingness to think outside of current workflows and processes to change health system culture around adverse event prevention.

NKX2-1 mutations have been usually associated with a non-progressive neurological disease. Recent reports revealed a vast variability regarding its clinical expressivity. Aim of this work was widening the Benign Hereditary Chorea neurological, cognitive and behavioral phenotype through the description of a child and her family pedigree. Molecular analysis focused on NKX2-1 gene revealed a novel frameshift mutation in the three-generation members described. Cognitive scales detected a relevant developmental delay, and the clinical observation and Autism Diagnostic Observation Schedule -2 administration allowed the diagnosis of autism spectrum disorder in the proband. Microarray testing, further executed to exclude a double hit contextually provoking the complex neurodevelopmental disorder, revealed the 22q11.2 Duplication Syndrome. This paper may contribute to enlarge Benign Hereditary Chorea variable expressivity and, together with other studies reported in the literature, underlines the need to reconsider the term “benign,” verifying the opportunity of more a complex diagnosis.

Recognized as information intensive, healthcare requires timely, accurate information from many different sources generated by health information systems (HIS). With the availability of information technology in today's world and its integration in healthcare systems; the term “Public Health Informatics (PHI)” was coined and used. The main focus of PHI is the use of information science and technology for promoting population health rather than of individuals. PHI has a disease prevention rather than treatment focus in order to prevent chain of events or disease spread. Moreover, PHI often operates at the level of government rather than at the private sector. This review article provides an overview of the field of PHI and compares between paper based surveillance system and Public Health Information Networks (PHIN). The current trends and future challenges of applying PHI systems in KSA were also reported.

BKV and JCV belong to the Polyomaviridae family and are opportunistic agents associated with complications in immunocompromised individuals. Although a single screening assay for both viruses would be convenient, the diversity of BKV and JCV serotypes and genotypes is a methodological challenge. In this paper, we developed a PCR method able to detect and segregate BKV and JCV, despite these genetic discrepancies. A duplex semi-nested PCR (duplex snPCR) was designed to target a conserved region (639nt-1516nt) within the VP2 gene. In the first PCR, a primer set common to all BKV and JCV serotypes/ genotypes was used, followed by a semi-nested PCR with internal primers for BKV and JCV segregation. The limit of detection of the duplex snPCR was as low as 10 copies of BKV or JCV plasmids/μL. Specific products were observed when JCV and BKV plasmids were mixed in the same reaction. In field sample testing, the duplex snPCR detected and distinguished both viruses in different biological samples. Results were confirmed by Sanger's sequencing. The geographical complexity of BKV and JCV serotypes and genotypes imposes limits to a simple and universal method that could detect each virus. However, we describe here a sensitive and reliable PCR technique for BKV and JCV diagnosis that overcomes these limitations and could be universally applied.

Organoid is an in vitro multicellular form mimicking in vivo organ. Its similarity to human organ including cellular organization, molecular expression patterns, as well as genetic signatures enables to study the characteristics of infectious agents and host-pathogen interaction. For the features of organoid, this system also can be potentially used to cultivate currently uncultivable viruses of vaccine candidates. This paper will briefly describe problems in the current culture system for virus production and the possibility of organoid as culture system for viral vaccine and their current limitations that should be solved to meet the goal.