Preceptorship: Creating an Educational Framework for Histotechnology

https://openworks.mdanderson.org/edwk22/1004/thumbnail.jp

How COVID-19 has Impacted Digital Transformation – From the Perspective of C-Suite Professionals

The present study is aimed at understanding how COVID-19 has impacted the digital transformation of businesses globally. The study considered numerous sub-aspects related to the digital transformation of businesses, including drivers to digital transformation, impact on people and society, and the impact of COVID-19. The research was based on the interpretivist paradigm using a qualitative research approach and interview method where data was collected from the C-suite category of selected businesses from Canada, India, Germany, Austria, and Switzerland. The study's results have identified COVID-19 as the most significant challenging factor for transforming businesses where lack of coherence among employees and inability of people to adapt to the technological interventions might demotivate them and cause disrupted operational activities of businesses. The study's results also suggested for businesses to focus on training and development of employees to capacitate them to adapt to the new normal working environment

Digital Transformation Frameworks - Applicable for Disruptive Technologies?

This paper has a two-fold aim to analyze the need of the digital transformation framework, and to understand the its impact on disruptive technologies by means of a structured review of the literature. The results of this research reveal that the digital transformation demand has developed a lot and there is seen a growing interest of its implementation in digital era of business and technology. However, results derived from an in-depth review show that there is a dire need for DT in developing countries and for more collaboration between researchers and practitioners. The paper highlights that business and digital marketing is fragmented due to disruptive technologies and shared platforms and furthermore outlines the strategies of digital transformation as a tool to be implemented among all new enabling technologies. To sum up all, it is concluded that without any doubt digital transformation is proven as tailored strategic option to impact creation, value and delivery of products and projects in almost every industry. These impacts have led to the improvement of digital marketing strategies, online business world along with employment of a variety of new successful business models, crucial to be successful in today’s and future competitive digital era demanding for innovation

A Call to Action for Anticoagulation Stewardship to Address Suboptimal Thromboprophylaxis Practices for at-Risk Non-Orthopedic Surgical Patients in Vietnam: An Explanatory Sequential Mixed-Methods Study

Thuy Thi Thu Nguyen,1 Huyen Thanh Tong,2 Huong Thi Lien Nguyen,1 Trung Duc Nguyen2 1Department of Clinical Pharmacy, Faculty of Pharmacology - Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam; 2Department of Pharmacy, 108 Military Central Hospital, Hanoi, VietnamCorrespondence: Trung Duc Nguyen, Department of Pharmacy, 108 Military Central Hospital, 1 Tran Hung Dao Street, Hai ba Trung District, Hanoi, 10000, Vietnam, Email [email protected]: This study aimed to investigate the current practices of VTE prophylaxis in patients undergoing abdominal-pelvic surgery (PAS) and to identify the factors that influence surgeons’ practice of VTE prophylaxis.Patients and Methods: This two-phase explanatory sequential mixed-method study used chart audits followed by semi-structured interviews based on the theoretical domain framework (TDF). During Phase I, quantitative data from 240 medical records of patients with PAS in April 2023 were audited to measure adherence rates to the standard thromboprophylaxis guidelines. In Phase II, in-depth interviews with 16 surgeons were conducted and analyzed using thematic content analysis based on the TDF framework to understand the determinants of thromboprophylaxis in patients with PAS.Results: Audits of 240 medical records of patients showed the rate of appropriate prophylactic methods was low (11.7%). For patients on anticoagulant prophylaxis, adherence rates regarding drug selection and dosage were high (100% and 89.3%, respectively), whereas adherence rates regarding time of initiation and length of prophylaxis were low (50% and 28.6%, respectively). A qualitative analysis identified 12 theoretical domains relevant to thromboprophylaxis practices among surgeons. The most encountered barriers included concerns about bleeding risk, resource issues, low beliefs about preventive benefits for certain patients with PAS, inadequate knowledge and training, and a lack of protocol and policy. The most encountered enablers included positive beliefs in prophylaxis benefits, mandatory policy and computerized supportive tools, thromboprophylaxis set as patient safety goals, leadership and multidisciplinary working, and training.Conclusion: Significant quality gaps were present in VTE prevention practice for abdominal-pelvic surgical patients, and multiple coexisting factors prevented the full adoption of practice standards. The implementation of an anticoagulation stewardship program is essential for addressing practical issues.Keywords: venous thromboembolism prevention, abdominopelvic surgery, guideline adherence, influencing factors, mixed-methods study, anticoagulant stewardshi

Deep sequencing reveals the complex and coordinated transcriptional regulation of genes related to grain quality in rice cultivars

<p>Abstract</p> <p>Background</p> <p>Milling yield and eating quality are two important grain quality traits in rice. To identify the genes involved in these two traits, we performed a deep transcriptional analysis of developing seeds using both massively parallel signature sequencing (MPSS) and sequencing-by-synthesis (SBS). Five MPSS and five SBS libraries were constructed from 6-day-old developing seeds of Cypress (high milling yield), LaGrue (low milling yield), Ilpumbyeo (high eating quality), YR15965 (low eating quality), and Nipponbare (control).</p> <p>Results</p> <p>The transcriptomes revealed by MPSS and SBS had a high correlation co-efficient (0.81 to 0.90), and about 70% of the transcripts were commonly identified in both types of the libraries. SBS, however, identified 30% more transcripts than MPSS. Among the highly expressed genes in Cypress and Ilpumbyeo, over 100 conserved <it>cis </it>regulatory elements were identified. Numerous specifically expressed transcription factor (TF) genes were identified in Cypress (282), LaGrue (312), Ilpumbyeo (363), YR15965 (260), and Nipponbare (357). Many key grain quality-related genes (i.e., genes involved in starch metabolism, aspartate amino acid metabolism, storage and allergenic protein synthesis, and seed maturation) that were expressed at high levels underwent alternative splicing and produced antisense transcripts either in Cypress or Ilpumbyeo. Further, a time course RT-PCR analysis confirmed a higher expression level of genes involved in starch metabolism such as those encoding ADP glucose pyrophosphorylase (AGPase) and granule bound starch synthase I (GBSS I) in Cypress than that in LaGrue during early seed development.</p> <p>Conclusion</p> <p>This study represents the most comprehensive analysis of the developing seed transcriptome of rice available to date. Using two high throughput sequencing methods, we identified many differentially expressed genes that may affect milling yield or eating quality in rice. Many of the identified genes are involved in the biosynthesis of starch, aspartate family amino acids, and storage proteins. Some of the differentially expressed genes could be useful for the development of molecular markers if they are located in a known QTL region for milling yield or eating quality in the rice genome. Therefore, our comprehensive and deep survey of the developing seed transcriptome in five rice cultivars has provided a rich genomic resource for further elucidating the molecular basis of grain quality in rice.</p

A review of modelling methodologies for flood source area (FSA) identification

Flooding is an important global hazard that causes an average annual loss of over 40 billion USD and affects a population of over 250 million globally. The complex process of flooding depends on spatial and temporal factors such as weather patterns, topography, and geomorphology. In urban environments where the landscape is ever-changing, spatial factors such as ground cover, green spaces, and drainage systems have a significant impact. Understanding source areas that have a major impact on flooding is, therefore, crucial for strategic flood risk management (FRM). Although flood source area (FSA) identification is not a new concept, its application is only recently being applied in flood modelling research. Continuous improvements in the technology and methodology related to flood models have enabled this research to move beyond traditional methods, such that, in recent years, modelling projects have looked beyond affected areas and recognised the need to address flooding at its source, to study its influence on overall flood risk. These modelling approaches are emerging in the field of FRM and propose innovative methodologies for flood risk mitigation and design implementation; however, they are relatively under-examined. In this paper, we present a review of the modelling approaches currently used to identify FSAs, i.e. unit flood response (UFR) and adaptation-driven approaches (ADA). We highlight their potential for use in adaptive decision making and outline the key challenges for the adoption of such approaches in FRM practises

Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050

Background Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. Methods We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. Findings In 2021, we estimated 4·71 million (95% UI 4·23–5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00–1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000–372 000] and 57 200 attributable deaths [34 100–80 300] in 1990, to 550 000 associated deaths [500 000–600 000] and 130 000 attributable deaths [113 000–146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000–834 000) in 1990, to 1·03 million associated deaths (909 000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171 000) in 1990, to 216 000 (168 000–264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56–2·26) deaths attributable to AMR and 8·22 million (6·85–9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2–69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5–89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (–6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8–102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08–13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths. Interpretation This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050. Funding UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust

Prevalence and determinants of asthma, COPD and allergy to common airborne allergens in northern Vietnam [Elektronisk resurs]

Introduction: While a large amount of data about the epidemiology of asthma, allergy, COPD, chronic bronchitis and respiratory symptoms are available from developed countries, the information about these diseases and conditions in developing countries in south-east Asia are scarce. There are, however, several reports indicating an increase in asthma and allergy parallel to urbanization in developing countries. The proportion of smoking men in south-east Asia including Vietnam is large. Aim: The aim of this thesis was to assess the prevalence of obstructive airway diseases and symptoms and their relation with demographic data including smoking habits among adults in rural and urban Vietnam. Special interest was paid to asthma, rhinitis, allergic sensitization and COPD. Methods: The study was conducted in two parts. A random sample of subjects aged 21 -70 years were invited; 3008 subjects living in an inner city area of Hanoi, Hoankiem, and 4000 in a rural area of Bavi in northern Vietnam. An internationally used questionnaire was delivered by field workers to the study subjects. From the questionnaire responders, a randomly selected sample of 750 subjects from each of the two areas was invited to the second part of the study. The second part consisted of clinical examinations including structured interview, dynamic spirometry, skin prick testing (SPT) and bronchial provocation testing with methacholine. The SPT panel included ten common indoor and outdoor allergens. For the structured interview a modified GA2LEN study questionnaire was used. The spirometry followed the American Thoracic Society guidelines and East Asian reference values were used. COPD was defined by using the fixed ratio of FEV1/FVC < 0.7. Results: The response rate to the questionnaire was 92% in Bavi and 70% in Hoankiem. Of men in Bavi 67.8% (Hoankiem 49.7%; p < 0.001) were smokers, while of women 4.2% were smokers in Hoankiem (Bavi 1.2%; p < 0.001). The prevalence of ever having had asthma was in Hoankiem 5.6% (Bavi 3.9%; p = 0.003) with no major gender difference. The most common symptom was longstanding cough (Hoankiem 18.1%, Bavi 12.0%; p < 0.001) followed by sputum production, while the prevalence of symptoms common in asthma was considerably lower. Respiratory symptoms were slightly more common in men than women. Allergic rhinitis ever or chronic nasal symptoms were reported by 50.2%. The prevalence of allergic rhinitis was considerably higher in the urban area compared to the rural, 29.6% vs. 10.0% (p<0.001). Allergic rhinitis ever and chronic nasal symptoms were both significantly associated with asthma and respiratory symptoms (p<0.001). Exposure to gas, dust or fumes at work was significantly associated with all rhinitis conditions. No major gender differences were found, and smoking was not significantly associated with the nasal conditions. The participation rate in the clinical part was 46%. The representativeness of the participants was good as no statistical difference in prevalence of symptoms was found between the participants and all responders in the questionnaire survey. Of men 36.9% and of women 31.0% (n.s.) had positive SPT to at least one allergen. The most common sensitizer was the storage mite, Blomia tropicalis (men 27.7%; women 18.7%, p = 0.013). Sensitization to mites and cockroach were common (26.1%; 13.2%), and was strongly associated with allergic rhinitis. Young age, male sex and occupational exposure to gas, dust and fumes were risk factors for allergic sensitization to mites or cockroach. A significant positive association between the number of positive SPT reactions and airway hyper-reactivity was found. The overall prevalence of COPD was 7.1% (men 10.9%; women 3.9%), and the prevalence increased considerably by age. The distribution of COPD by disease severity was 12.5% severe or very severe COPD (FEV1<50% of predicted), 40% moderate COPD (50≤ FEV1 <80% of pred.) and 47.5% mild COPD (FEV1≥80% of pred.). Among men with COPD all but one was current or ex-smokers, while the women with COPD were all never smokers. Among men, COPD was strongly related to the number of pack-years of tobacco consumption and a half of smokers aged ≥60 years had developed COPD. Conclusions: The prevalence of asthma in adults may have increased in both urban and rural Vietnam, as the few previous estimates have found 2% of adults having asthma. The majority of men were smokers versus a few percent of women. A half of the studied population had rhinitis conditions with allergic rhinitis being more common in the urban area, however, a disparity in the knowledge about what allergy is may have contributed to this urban-rural difference. The pattern and prevalence of allergic sensitizers conforms to results from other areas with a similar climate. Taking into account the young population of Vietnam, the prevalence of COPD must be considered as high particularly among smoking men. Except increasing age and a previous history of asthma, no other risk factors for COPD among women could be demonstrated