The Relationship of Forgiveness and Values with Meaning in Life of Polish Students

The purpose of this article was to show the relationship of terminal values and forgiveness with meaning in life in Polish students who consider themselves faithful and practicing. The study involved youth studying at the Jesuit University Ignatianum in Krakow. It was carried out among 368 students. The age of the participants ranged between 19 and 23. Three tools were applied: Rokeach Value Survey, Forgiveness Scale by Toussaint, and the Purpose in Life Test of Crumbaugh and Maholick. The analysis of the results obtained proves that terminal values and forgiveness have a statistically significant relationship with meaning in the life of the studying youth.

Procedural difficulties during successful intubation in octogenarians: A prospective observational study

OBJECTIVE

Octogenarians undergo anatomic and physiopathologic degradation, making airway management problematic, specific to intubation, bag mask ventilation, leading to desaturation and aspiration. Our study's aim was to examine the process of airway management regarding the steps involved in intubation and any deviations or delays in the tasks.

MATERIALS AND METHODS

An institutional review board-approved difficult airway prospective observational study in older adults was conducted. Inclusion criteria included airway features indicative of difficult airway, history of failed intubation, the planned use of specialized airway devices, and/or expected airway complications due to comorbidities. Patients 80 years and older were analyzed. Demographic data collected were age, weight, BMI, gender, ASA classification, airway indices, diagnosis, and procedures. Problems with intubation (INT) (≥3 intubation attempts), laborious assisted ventilation (VEN) (2-person and/or application of CPAP>20cmH₂O), and complications with oxygenation (OXY) (SpO₂<95%) were analyzed.

RESULTS

Of the 41 patients enrolled in the study, 3 (7.3%) had all 3: problematic (INT), laborious (VEN), and desaturated (OXY); 8 (19.5%) patients experienced problematic (INT), 20 (48.8%) were described as laborious (VEN), and 14 (34.1%) experienced complications with (OXY).

CONCLUSION

In octogenarians, we found a low incidence of difficulty with INT-VEN-OXY together. However, bag mask ventilation was found to be laborious with a high incidence of desaturation. Success rate of INT as a sole metric may not accurately describe the process of the intubation. We recommend alternative airway devices and techniques and the establishment of protocols for airway management in the elderly.

Analyses of L2 Learners' Text Writing Strategy: Process-Oriented Perspective

Second language writing researchers have examined the affordances of Automated Writing Evaluation programs in providing immediate feedback that helps improve students' writing outputs. However, a little is known about tracking learners' process during writing essays and whether much/less pauses made by learners could predict good/poor quality of students' writing output. This article aims to address this issue by recording a case study of 8 postgraduate students' pauses during writing two types of text genre; descriptive and argumentative essays. Their pauses have been recorded using Keystroke logging program-Input Log 7.0 (Leijten and Van Waes in Writ Commun 30:358-392, 2013. https://doi.org/10.1177/0741088313491692) and their screen activities were captured by Active Presenter program. Findings revealed that the students' pauses were significantly higher in word boundary than in sentence and/or paragraph boundaries. Moreover, on word boundary, pauses before words were significantly higher than that after words for both types of text genre. Concerning pauses across text genre, students' pauses were significantly higher in the argumentative essay than that of the descriptive essay. Multiple regression revealed negative correlation between much pauses and poor quality of students' product in the descriptive essay while there was no correlation found in the argumentative essay.

Milk microfiltration process dataset annotated from a collection of scientific papers

Milk microfiltration process plays a key role in the dairy industry. Crossflow microfiltration of skimmed milk using a membrane with 0.1 µm mean pore size is widely used to fractionate the two main groups of dairy proteins: casein micelles (~150 nm) and serum proteins (~2-15 nm). Retentate, containing mainly casein micelles, is generally used to enrich vat milk for cheese making. Permeate, containing serum proteins, lactose and minerals, is usually ultrafiltered in order to produce protein-rich concentrate with a high nutritional value dedicated to specific populations such as infants and seniors. The great interest in these protein fractions explains the increasing number of microfiltration equipments in the dairy industry. This data article contains data associated with milk microfiltration process experiments and properties of the resulting dairy fractions annotated from a collection of scientific documents. These data are stored in INRAE public repository (see Data accessibility in the Specification Table for direct links to data). They have been structured using MILK MICROFILTRATION ontology and are replicated in @Web data warehouse providing additional querying tools (https://www6.inrae.fr/cati-icat-atweb/).

Mechanisms of change in brief treatments for borderline personality disorder: a protocol of a randomized controlled trial

BACKGROUND

Borderline personality disorder (BPD) is one of the most frequent, most debilitating and lethal mental conditions and is associated with a serious burden of disease. Treatment for patients with BPD involves structured psychotherapy, and may involve brief psychiatric treatment as first-line intervention. No controlled study has assessed the effectiveness of such brief intervention. Whereas most psychotherapy studies in patients with BPD focus on the effectiveness of the intervention, we still lack an understanding of how and why these effects are produced from a patient process perspective. It is therefore of utmost importance to study the treatment-underlying mechanisms of change. The present study plans to apply novel measurement methods for assessing change in two central psychobiological processes in BPD: emotion and socio-cognitive processing. The study uses theory-driven and ecologically valid experimental tasks, which take the patient's individual experience as the anchor, by integrating methodology from psychotherapy process and neurofunctional imagery research.

METHODS

The aim of this two-arm, randomized controlled study is to test the effects (i.e., symptom reduction) and the underlying mechanisms of change associated with a brief psychiatric treatment (10 sessions over 4 months), compared with treatment as usual. Participants (N = 80 patients with BPD) undergo assessments at four points (intake, 2 months, discharge, and 12-month follow up). In addition to symptom measures, individuals undergo a 2-step assessment for the potential mechanisms of change (i.e., emotion and socio-cognitive processing): (1) behavioral and (2) (for a sub-sample) neurofunctional. We hypothesize that change in the mechanisms explains the treatment effects.

DISCUSSION

This study uses an easy-to-implement treatment of BPD, and a sophisticated assessment procedure to demonstrate the critical role of psychobiological change in emotion and socio-cognitive processing in brief treatments. It will help increase the effectiveness of brief treatment for BPD and help diminish the societal burden of disease related to BPD, in these early stages of treatment. TRIAL REGISTRATION {2}: ClinicalTrials.gov: NCT03717818. Registered on 24 October 2018). Protocol version {3} number 2 from 9 February 2018.

Natural selection and the reference grain problem

Over the last 20 years, the concept of natural selection has been highly debated in the philosophy of biology. Yet, most discussions on this topic have focused on the questions of whether natural selection is a causal process and whether it can be distinguished from drift. In this paper, I identify another sort of problem with respect to natural selection. I show that, in so far as a classical definition of fitness includes the transmission of a type between generations as part of the definition, it seems difficult to see how the fitness of an entity, following this definition, could be description independent. In fact, I show that by including type transmission as part of the definition of fitness, changing the grain at which the type of an entity is described can change the fitness of that entity. If fitness is not grain-of-description independent, this further propagates to the process of natural selection itself. I call this problem the 'reference grain problem'. I show that it can be linked to the reference class problem in probability theory. I tentatively propose two solutions to it.

The induction and maintenance of in vitro plant morphogenesis as viewed from a new perspective, with theoretical and constructive implications

In plant tissue culture research, the non-traditional growth regulators, methylglyoxal and ascorbic acid, have been used to induce and promote in vitro morphogenesis from plant callus, generally having the initial characteristics of a type of neoplasm, and in many cases overcoming recalcitrant morphogenesis. In other investigations methylglyoxal, most likely with ascorbic acid, also promoted such morphogenesis. In the various investigations, low concentrations of methylglyoxal were used and proved to be the most effective in promoting in vitro morphogenesis. In many cases, the growth of such neoplastic-like calli was concurrently inhibited on culture media containing these chemicals. When methylglyoxal was present in high concentration, morphogenesis was also inhibited. Such chemicals, it would appear likely, allowed for the generation of cohesive forces within regions of the calli, reversing the neoplastic state in such regions, due to very low internal cohesion, and through such cohesive forces of particular magnitude, morphogenesis ensued, as an adaptive response to the stress of such cohesive forces. This would suggest a deeper, underlying biological process, with developmental features, that is perhaps universal among plants and perhaps in all biological organisms. This particular, consistent avenue and theme of plant tissue culture research, manifested over four decades and across four continents, may have revealed a unifying, dynamical process in both the biological and physical worlds, with constructive implications for agriculture and medicine.

Stewardship as process: A paradox perspective

Long-term stewardship is usually represented as a stable structural condition and portrayed as a source of competitive advantage to firms (including family businesses) that use it as a mode of governance. Less is known about how organizations engage with stewardship as a process. We embrace a process approach to report a case study about the unfolding of stewardship in a multi-business family group. We conclude that stewardship is a process marked by critical tensions and paradoxes; by exploring the nature of these we uncover further dimensions and responses to the paradoxes of stewardship.

Philosophy of nature and organism's autonomy: on Hegel, Plessner and Jonas' theories of living beings

Following the revival in the last decades of the concept of "organism", scholarly literature in philosophy of science has shown growing historical interest in the theory of Immanuel Kant, one of the "fathers" of the concept of self-organisation. Yet some recent theoretical developments suggest that self-organisation alone cannot fully account for the all-important dimension of autonomy of the living. Autonomy appears to also have a genuine "interactive" dimension, which concerns the organism's functional interactions with the environment and does not simply derive from its internal organisation. Against this background, we focus on a family of natural philosophical approaches that historically have already strongly taken in account this aspect of autonomy, notably going beyond Kant's perspective on self-organisation. We thus review Hegel, Plessner, and Jonas' different perspectives on living beings, focussing in particular on four points: the distinction between organic and inorganic, the theory of biological organisation, the processuality of the living, and the "boundary" between inside and outside, through which the organism establishes its relationship to the environment. We, then, compare the three perspectives on these four points, and finally address the question of what advantages their contribution present-especially compared to Kant's theory-with respect to the topic of organism's autonomy. This could help-we hope-to better understand what is at the stake still today.

An integrated approach to address the temporal variation of geochemistry in groundwater of an arid region

Kuwait is characterized with an arid climate and scarce freshwater sources. Variation in groundwater quality with space and time leads to sustainable development of the region. Evaluating the chemical properties of groundwater is of prime importance to ensure the longevity of this important source of water. In this study, the geochemical data for the years 2004 and 2018 were examined for 6 wells in the freshwater zones of Northern Kuwait. The aim of this study is to examine the geochemical variations, if any that occurred on the only existing freshwater aquifer in Kuwait. The chemical properties examined in this study include total dissolved solids, chloride, nitrate, bicarbonate, calcium, electric conductivity, sulfate, sodium, potassium, magnesium, and pH. The variation of the electrical conductivity in this region indicates an improvement in three wells located in the northern to central region of the study area as values decreased from 1210 to 956 (μS/cm); however, the electrical conductivity has deteriorated in the remaining three wells located in the central to southern part of the study area as values increased from 791 to 1401 (μS/cm). The geochemical facies of the groundwater were determined, indicating a migration of the groundwater facies towards more chloride dominant field in 2018. The saturation states of carbonates like aragonite, calcite, dolomite, and magnesite and those of sulfates like gypsum and anhydrite were determined. The increase in calcium in most of the wells facilitated the saturation index of calcium sulfates relatively more than calcium carbonate minerals. The principal component analysis was conducted for the data of 2004 and 2018; it extracted two main components accounting for the variability of the data; the main components indicate geogenic influences and anthropogenic pollution such as agriculture. The study indicates that there is no major variation observed in groundwater chemistry during the 15 years, as the chemical changes which occurred are minimal and do not require immediate remediation measures. Hence, if the current groundwater extraction rate remained with no extensive land use development, it would sustain the water quality of the region.

Management of medical care, a fundamental tool for resident doctors

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly poses knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.

Content and Process of Adolescent Suicide Ideation: Implications for Risk Assessment

This study examined differences in the content and process of suicide ideation between adolescents presenting with recent suicide ideation or a suicide attempt in clinical settings. Across two combined study samples, adolescents (N = 229; 79% female; 73% Hispanic/Latine), ages 12-19, presenting with a recent suicide attempt, recent suicide ideation with a past suicide attempt history, or recent suicide ideation with no past suicide attempt history were interviewed in detail about the process and content of their suicide ideation. The group with suicide ideation and a past suicide attempt more often reported that their recent ideation lasted greater than 4 h compared to those with suicide ideation but no past suicide attempt history. The suicide attempt group more often considered ingestion as their first method of attempt, compared to the other two suicide ideation groups, and less often considered "other" methods (e.g., jumping from a height or onto train/traffic, hanging). Wish to die was lower in the ideation-only group, compared to both other groups. Separate analyses from Study 2 suggested that the majority of adolescents' suicide ideation contained imagery; however, a higher proportion of adolescents with suicide ideation and a past suicide attempt reported imagery in their ideation than those with ideation but no past attempt. Understanding what adolescents think about when they consider suicide and how they think about it may be informative about risk of a suicide attempt.

Optimization of algorithms for diagnosis and treatment of small bowel obstruction

AIM: To investigate the role of multi-slice CT three-dimensional reconstruction combined with meglumine diatrizoate in the diagnosis and treatment of intestinal obstruction and to optimize the algorithms for diagnosis and treatment of small bowel obstruction.

METHODS: Clinical data for 89 patients with small bowel obstruction were prospectively collected from January 2011 to January 2012 at the First Hospital of Wuhan City. All patients were randomly divided into either a conventional therapy group or a conventional therapy plus meglumine diatrizoate group (two doses of meglumine diatrizoate via a gastric tube with a 24 h interval). The time to first flatus, indwelling time of the stomach tube, and hospitalization time were compared between the two groups. After injection of meglumine diatrizoate via the tube, the patients received gastrointestinal radiographic examination every 24 h to observe whether the contrast agent went into the colon. The therapeutic effect of meglumine diatrizoate on small bowel obstruction, and the association between whether meglumine diatrizoate could enter the colon within 24 h and surgery necessity were evaluated.

RESULTS: In patients of the conventional therapy plus meglumine diatrizoate group, the indwelling time of gastric tube was 3.0 d ± 1.1 d, the time to first flatus was 26.0 h ± 19.1 h, and the length of hospital stay was 7 d ± 2.5 d. These parameters were significantly shorter compared with those for the conventional treatment group (P < 0.05 for all). There was a significant correlation between the observation that meglumine diatrizoate could not enter the colon within 24 h and surgery necessity. Preoperative multi-slice CT three-dimensional reconstruction could help to investigate the cause and sites of obstruction and to evaluate the local conditions to ensure the surgical safety.

CONCLUSION: Meglumine diatrizoate via the gastric tube can effectively alleviate adhesive intestinal obstruction, reduce the rate of operation and provide an important reference for the timing of surgery. Preoperative multi-slice CT three-dimensional reconstruction can provide effective protection for patients undergoing operation. Sequential application of meglumine diatrizoate and multi-slice CT three-dimensional reconstruction in small bowel obstruction can greatly improve the accuracy of diagnosis and treatment effectiveness and thus can be used as the optimized algorithm for clinical diagnosis and treatment.

Eukaryotic plankton community assembly and influencing factors between continental shelf and slope sites in the northern South China Sea

Eukaryotic plankton are pivotal members of marine ecosystems playing crucial roles in marine food webs and biogeochemical cycles. However, understanding the patterns and drivers of their community assembly remains a grand challenge. A study was conducted in the northern South China Sea (SCS) to address this issue. Here, 49 samples were collected and size-fractionated from discrete depths at continental shelf and continental slope in the northern SCS over a diel cycle. From high throughput sequencing of the 18S rDNA gene V4 region, 2463 operational taxonomic units (OTUs) were retrieved. Alveolata and Opisthokonta overwhelmingly dominated the assemblages in the abundance (44.76%, 31.08%) and species richness (59%, 12%). Biodiversity was higher in the slope than the shelf and increased with depth. Temperature and salinity appeared to be the most important deterministic drivers of taxon composition. Community structure was influenced by multiple factors in the importance order of: environmental factors (temperature + salinity) > spatial factor > water depth > sampling time. Furthermore, the neutral model explained more variations in the smaller-sized (0.22-3 μm) community (24%) than larger-sized (3-200 μm) community (16%) but generally explained less variations than did deterministic processes. Additionally, our data indicated that the larger plankton might be more environmentally filtered and less plastic whereas the smaller plankton had stronger dispersal ability. This study sheds light on the differential contributions of the deterministic process and stochastic process and complexities of assembly mechanisms in shaping the community assembly of micro-nano and pico-eukaryotic biospheres in a subtropical ocean.

Development of a positron emission tomography risks map

Patient safety is an essential component of quality of care, especially when the complexity of care has reached extreme levels. Currently achieving this safety is considered a basic strategy of the National Health System. Nuclear Medicine departments have certain peculiarities that make them special in terms of patient safety, with situations that go beyond the common healthcare practice of other departments. Namely, that both encapsulated and non-encapsulated ionizing radiation is used in daily practice, and numerous groups of professionals must be coordinated to undertake positron emission tomography (PET) specifically, from the clinical management unit itself, and from other departments of the hospital (as well as companies outside the hospital itself and the Public Health System). The objective of this paper was to identify the risks to which a patient who is to be explored through PET can be exposed in a Nuclear Medicine department and draw up a risk map for the PET process. The methodology used is part of the proposal of the Ministry of Health (2007), and its practical implementation (given the limited literature available on Nuclear Medicine), follows as far as possible that of related care areas (radiodiagnosis and radiotherapy). For this purpose, a multidisciplinary team of professionals directly related to the PET process was created, using the modal analysis of faults and effects methodology to identify possible failures, their causes and the potential adverse events causing each. As a final step, a risk map was created, locating the previously identified faults at each stage of the process. This paper exposes the PET process, and describes the risks that patients might run when a PET scan is required, as well as the adverse events deriving from it. All this is shown in a risk map of the PET process.

Patients, users, caregivers, and citizens' involvement in local health technology assessment unit in Quebec: a survey

OBJECTIVES

Increasing emphasis is given on involving patients in health technology assessment (HTA). While this is mainly done at the level of regional and national HTA agencies, this tendency is also emerging in local HTA units. In this study, we provide the results of a survey conducted in local HTA units in the province of Quebec, Canada. The aim of the survey was to provide an overview of local HTA unit practices to involve patients, users, caregivers, and citizens in their process, their interest in doing so, and their information needs for this.

METHODS

The survey was conducted in 2017 with a response rate of eleven units over a possibility of twelve.

RESULTS

Three units out of eleven (27.3 percent) never involved patients or members of the public in their processes and all indicated that they will involve them in the next few years. The three most important needs for support identified in the HTA units were in: recruiting and selecting patients; integrating experiential knowledge; and knowing and implementing the best methods and practices for partnership.

CONCLUSION

Patient involvement in local HTA units is quickly evolving and that is why they urgently need tools to involve more effectively patients and members of the public in their process.

Case Examples and Process-Oriented Questions in Teletherapy with Couples and Families

This paper shares learned experiences in teletherapy (also called tele-mental-health, remote video therapy, and virtual therapy) with couples and families. It aims to enhance teletherapy practice with couples and families by providing tools for screening and coaching. The paper describes common pitfalls in teletherapy with couples and families and how to avoid or address them, describes the opportunities for added insight when engaging couples and families in teletherapy from their homes, provides concrete interventions in the form of process-focused questions which therapists can draw from, and provides case examples. The case examples and process-oriented questions focus on four areas: screening, logistical coaching of technology, using the family's meeting place to learn about the family, and avoiding pitfalls.

How is the ecosystem services concept used as a tool to foster collaborative ecosystem governance? A systematic map protocol

BACKGROUND

While the concept of ecosystem services has been widely adopted by scholars and increasingly used in policy and practice, there has been criticism of its usefulness to decision-makers. This systematic map will collect and analyse literature that frames ES as a collaboration tool, rather than as an ecosystem assessment tool, to answer the research question-how is the ecosystem services concept used as a tool to foster collaborative ecosystem governance and management?

METHODS

We will search for publications using designated keywords in Web of Science Core Collection, Scopus, grey literature and conservation practitioner databases and websites. The search strategy aims to locate all ecosystem services studies related to collaboration and joint activities. After removing duplicates, we will screen papers in two stages-first by reviewing titles and abstracts and then by reviewing full text. Both stages will screen papers according to the following inclusion criteria: (1) the study is situated in the context of or related to environmental governance or management; (2) the study focuses on ecosystem services being used as a tool for collaboration; (3) the study describes a process resulting from applying the ecosystem services concept as a tool or approach; and (4) the ecosystem services concept is used in the study in a collaboration or group process in a substantial manner. We will exclude papers that do not address the ES concept as a process tool or approach or that use the ecosystem services concept to directly influence specific decisions or policy. Eligible studies will be critically appraised to assess their reporting quality. Studies will then be reviewed to determine: (a) the type of tool or mechanism that is the primary focus or example of the paper, (b) the rationale for using the ES concept, (c) whether a tool or approach was empirically tested in the study, (d) what the study found regarding the usefulness of ES as a tool or approach, and (e) any challenges to their use, if mentioned explicitly. A standard coding spreadsheet will be used by reviewers. Relevant metadata will be extracted for each paper assessed and used to construct an open-access online database. Finally, a narrative synthesis of metadata will be reported based on eligible studies.

Risk preferences in decision-making: A construal level perspective

This study examines the impact of construal levels on preferences for risky choices in decision-making scenarios, focusing on how situational framing moderates these effects. We explored the role of construal level as a key moderator of the influence of risky-choice framing. Our findings show significant differences in preferences for risky options between gain- and loss-framing, especially in high-level construal contexts. This finding suggests that abstract thinking enhances framing effects, highlighting important implications for understanding decision-making processes and developing interventions to reduce bias. Conversely, this preference difference diminishes significantly under low-level construal, where focus on specific details, such as probability, is emphasized. The research reveals that framing influences attention allocation toward outcomes and processes in high-level construal but has a lesser effect in low-level construal. These results indicate that construal levels are crucial for shaping perception and framing effects. The study concludes with a discussion of the implications and recommendations for future research.

Determining the process components of impact assessment in health and social program implementation: A scoping review of theories, models and frameworks

OBJECTIVES

Health and social service research impact analysis play a pivotal role in demonstrating research value. Impact analysis of programs, interventions, or policies in real-world settings is complex. There are many implementation evaluation theories, models, and frameworks (TMF) and researchers find choosing one challenging. Our objective was to systematically scope TMFs, review and chart key components of the process of implementation impact analysis to identify gaps.

STUDY DESIGN

A scoping review was undertaken and reported using PRISMA-ScR guidelines.

METHODS

Systematic literature searches were conducted for impact analysis and impact assessment TMFs in MEDLINE, SCOPUS databases, hand searches, and expert directed search (2010-2024). Peer-reviewed articles were eligible for inclusion if they described an implementation evaluation TMF in English and used in the real world. Data extracted by the study team was charted in an Excel spreadsheet.

RESULTS

The review identified 71 relevant papers which included a theory (n = 6), model (n = 14), or framework (n = 51). Most considered resources and/or results, whereas only 25 % considered implementation process components. Ten frameworks were deemed comprehensive and covered at least two phases of implementation and five components. Most frameworks had not developed or tested practical tools to facilitate use of the framework.

CONCLUSIONS

No frameworks were identified that incorporated all phases of implementation, nor key components of the process in each phase of implementation research. The findings highlight the need to identify key components and develop a taxonomy, glossary and tools to assess the process components of implementation in real world settings.

Management of medical care, a fundamental tool for resident doctors

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly possess knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.

The value of mass-produced COVID-19 scenarios: A quality evaluation of development processes and scenario content

Hundreds of scenarios were developed across the world in 2020, aimed at generating forward-looking conversations, better understanding for COVID-19 transmission rates, trialling economic outcomes, and stress-testing existing systems in light of the developing pandemic. In response, Cairns & Wright (2020) questioned the value of these mass-produced scenarios created retroactively to existing crises. We address their concerns by evaluating 213 COVID-19 scenarios developed in the first wave of the pandemic. We use two yardsticks as guiding maps against which we plot each scenario's profile and test for values of high-quality process and content. Our analyses reveal various points of high and low qualities, in both process and content. Though most reported processes fell towards lower quality standards, and content largely carried generic applications, the prolific levels of exploratory narratives reflected a mixture of high and low-quality values. Together, our papers develop and reinforce the message that scenario interventions, especially in times of crisis, should reflect more proactive efforts and ensure powerful stakeholders, decision-makers, and affected community members are included in the development of scenarios.

Integration of Regulatory Guidelines into Protein Drug Product Development

The drug product development process for proteins went through its infancy in the early eighties of last century and is in its maturity today. This has been driven largely by the rapid growth of the biotechnology industry, which led to the development and issuance of many regulatory guidelines/directories, especially those through the International Conference of Harmonization (ICH). These guidelines have certainly guided different aspects of a drug product development process. On the other hand, they were issued separately on different topics and in different time periods. An integration of all relevant guidelines into the corresponding areas in drug product development would greatly facilitate the development process. The purpose of this short review is to integrate the relevant (mainly ICH) regulatory guidelines into protein drug product development and to discuss remaining issues, which may lead to further revision of existing guidelines or development of new ones. Drug product development scientists need to collect adequate and relevant development data for a successful product registration. The key is the ability to justify the final drug product in terms of choice of the drug product formulation, container closure system, and manufacturing process.

LAY ABSTRACT

The drug product development process for proteins has matured today, largely due to the rapid growth of the biotechnology industry. In this process, many regulatory guidelines/directories were developed and issued, especially through the International Conference of Harmonization (ICH). However, they were issued separately on different topics and in different time periods. An integration of all relevant guidelines into the corresponding areas in drug product development would greatly facilitate the development process. The purpose of this short review is to integrate the relevant (mainly ICH) regulatory guidelines into protein drug product development and to discuss remaining issues, which may lead to further revision of existing guidelines or development of new ones. Drug product development scientists need to collect adequate and relevant development data for a successful product registration. The key is the ability to justify the final drug product in terms of choice of the product formulation, container closure system, and manufacturing process.

Models of acute care for injured older patients-Australia and New Zealand practice

INTRODUCTION

The epidemiology of injured patients has changed, with an increasing predominance of severe injury and deaths in older (65 years and above) patients after low falls. There is little evidence of the models of care that optimise outcomes for injured older patients. This study aims to describe clinician perspectives of existing models of acute care for injured older patients in Australia and New Zealand.

METHODS

This cross-sectional online survey of healthcare professionals (HCP) managing injured older patients in Australia or New Zealand hospitals was conducted between November 2nd and December 12th, 2020. Recruitment was via survey link and snowball sampling to professional organisations and special interest groups via email and social media. HCP were asked, using a Likert scale, how likely four typical case vignettes were to be admitted to one of twelve options for ongoing care. Additional questions explored usual care components.

RESULTS

Participants (n=157) were predominantly Australian medical professionals in a major trauma service (MTS) or metropolitan hospital. The most common age defining "geriatric" was aged 65 years and older (43%). HCP described variability in the models and components of acute care for older injured patients in Australia and New Zealand. As a component of care, cognitive, delirium and frailty screening are occurring (60%, 61%, 46%) with HCP from non-major trauma services (non-MTS) reporting frailty and cognitive impairment screening more likely to occur in the emergency department (ED). Access to an acute pain service was more likely in a MTS. Participants described poor likelihood of a geriatrician (highest 16%) or physician (highest 12%) review in ED CONCLUSION: Despite a low response rate, HCP in Australia and New Zealand describe variability in acute care pathways for injured older patients. Given the change in epidemiology of injury towards older patients with low force mechanisms, models of acute injury care should be evaluated to define a cost-effective model and components of care that optimise patient-centred outcomes relevant to injured older patients. HCP described some factors they perceive to determine care, and outcomes of variability, offering guidance for future research and resource allocation in the Australia and New Zealand trauma system.

Demystifying Fogging in Lyophilized Products: Impact of Pharmaceutical Processing

A commonly encountered challenge with freeze-dried drug products is glass vial fogging. Fogging is characterized by a thin layer of product deposited upon the inner surface of the vial above the lyophilized cake. While considered to be a routine cosmetic defect in many instances, fogging around the shoulder and neck of the vial may potentially impact container closure integrity and reject rates during inspection. In this work, the influence of processing conditions i.e. vial pre-treatment, lyophilization cycle modifications and filling conditions on fogging was evaluated. A battery of analytical techniques was employed to investigate factors affecting glass vial fogging. A fogging score was used to quantify its severity in freeze-dried products. Additionally, a dye-based method was used to study solution upcreep (Marangoni flow) following product filling. Our lab-scale results indicate measurable improvement in fogging following the addition of an annealing step in the lyophilization cycle. Pre-freeze isothermal holding of the vials (at 5°C on the lyophilizer shelf) for an extended duration indicated a reduction in fogging whereas an increase in the freezing time exhibited no effect on fogging. Vial pre-treatment conditions were critical determinants of fogging for Type 1 vials whereas they had no impact on fogging in TopLyo® vials. The headspace relative humidity (RH) investigation also indicated sufficient increase in the water vapor pressure inside the vial to be conducive to the formulation of a hydration film - the precursor to Marangoni flow.