Inborn errors of immunity (IEI) are a group of inherited conditions caused by damaged monogenic variants that result in impairment and/or dysregulation within the immune system. IEI are typically diagnosed in infancy or early childhood, with clinical presentations that include increased susceptibility to infections, immune dysregulation, autoinflammation, bone marrow failure, and/or malignancy. Historically, transitions of care experienced by patients with IEI have not been well described in the literature. However, with treatment advances extending the long-term survival of patients, this has become a primary area of research. It is crucial to establish guidelines and recommendations specific to the transition of patients with IEI. Transitions may include patients who naturally progress from pediatric to adult care, from inpatient to outpatient settings, or from their established health care team to a new team (ie, moving from one geographic area to another). This narrative review summarizes the current data on transitions of care and describes the health care challenges and patient-related barriers impacting transitions of care. Frameworks with practical guidance on how health care practitioners can better manage care transitions faced by patients with IEI are presented.

Healthcare-associated infections (HAIs) represent a major global health burden, which necessitate effective frameworks to identify potential risk factors and estimate the corresponding direct economic disease burden. In this article, we proposed a framework designed to address these needs through a case study conducted in a Tuberculosis (TB) hospital in Hubei Province, China, using data from 2018 to 2019. A comprehensive multistep procedure was developed, including ethical application, participant inclusion, risk factor identification, and direct economic disease burden estimation. In the case study, ethical approval was obtained, and patient data were anonymized to ensure privacy. All TB hospitalized patients over the study period were included and classified into groups with and without HAIs after screening the inclusion and exclusion criteria. Key risk factors, including gender, age, and invasive procedure were identified through univariate and multivariate analyses. Then, propensity score matching was employed to select the balanced groups with similar characteristics. Comparisons of medical expenditures (total medical expenditure, medicine expenditure, and antibiotics expenditure) and hospitalization days between the balanced groups were calculated as the additional direct economic disease burden measures caused by HAIs. This framework can serve as a tool for not only hospital management and policy-making, but also implementation of targeted infection prevention and control measures. Moreover, it has the potential to be applied in various healthcare settings at local, regional, national, and international levels to identify high-risk areas, optimize resource allocation, and improve hospital management and governance, as well as inter-organizational learning. Challenges to implement the framework are also raised, such as data quality, regulatory compliance, considerations on unique nature of communicable diseases and other diseases, and training need for professionals.

The illegal trade in totoaba (Totoaba macdonaldi) is causing adverse social, ecological, and economic impacts. This illegal activity is accelerating the overexploitation of totoaba and pushing the critically endangered vaquita (Phocoena sinus) closer to extinction. Despite extensive efforts to recover vaquita populations, scant attention has been given to the totoaba trade as an independent issue. As a result, data on the totoaba trade are limited, which hampers robust analyses and development of effective interventions to reduce illegal harvesting. We used a previously developed framework specifically designed to examine dynamics of illegal markets and guide measures to mitigate illegal use of totoaba. This framework separates markets into 3 analytical levels: characterization of participating actors (e.g., fishers, intermediaries); examination of how actors interact within the market (e.g., organization of supply chains); and assessment of the overall market dynamics that result from these interactions (e.g., factors determining price and quantity). We reviewed existing literature (108 initial articles) and interviewed key market actors, academics, and nongovernmental organization experts (14) to obtain data for this framework. Our findings offer an overview of the totoaba illegal market operation, highlighting intervention points (e.g., customs agents) and areas where additional information is required to decrease information gaps (e.g., US local market). We describe the structure and complexity of this market, emphasizing the influential role of organized crime in shaping its dynamics (e.g., controlling prices paid to fishers and stockpiling). By providing a systematic and in-depth understanding of the market operation, we aimed to establish a benchmark for effective interventions and future research aimed at reducing uncertainties. Our results provide a crucial step toward addressing this critical issue and can help facilitate development of effective strategies to combat the illegal totoaba trade and promote biodiversity conservation more broadly.
Evaluación de las intervenciones potenciales para reducir el mercado ilegal de la totoaba Resumen El mercado ilegal de totoaba (Totoaba macdonaldi) causa impactos sociales, ecológicos y económicos adversos. Esta actividad ilegal acelera la sobreexplotación de la totoaba y acerca a la extinción a la vaquita marina (Phocoena sinus), especie en peligro crítico de extinción. A pesar de los grandes esfuerzos por recuperar las poblaciones de vaquita, el comercio de totoaba recibe poca atención como problema independiente. Como resultado, los datos sobre este comercio son limitados, lo que dificulta el análisis sólido y el desarrollo de intervenciones eficaces para reducir la captura ilegal. Utilizamos un marco desarrollado previamente y diseñado específicamente para examinar la dinámica de los mercados ilegales y orientar las medidas para mitigar el uso ilegal de la totoaba. Este marco separa los mercados en tres niveles analíticos: caracterización de los actores participantes (por ejemplo, pescadores, intermediarios); análisis de cómo interactúan los actores dentro del mercado (por ejemplo, organización de las cadenas de suministro); y evaluación de la dinámica general del mercado que resulta de estas interacciones (por ejemplo, factores que determinan el precio y la cantidad). Revisamos la bibliografía existente (108 artículos iniciales) y entrevistamos a actores clave del mercado, académicos y expertos de organizaciones no gubernamentales (14) para obtener datos para este marco. Nuestras conclusiones ofrecen una visión general del funcionamiento del mercado ilegal de totoaba y destacan los puntos de intervención (por ejemplo, los agentes aduanales) y las áreas en las que se requiere información adicional para reducir los vacíos informativos (por ejemplo, el mercado local estadunidense). Describimos la estructura y complejidad de este mercado, destacando el influyente papel de la delincuencia organizada en la configuración de su dinámica (por ejemplo, controlando los precios pagados a los pescadores y el almacenamiento). Al proporcionar una comprensión sistemática y en profundidad del funcionamiento del mercado, pretendemos establecer un punto de referencia para intervenciones eficaces y futuras investigaciones encaminadas a reducir las incertidumbres. Nuestros resultados suponen un paso crucial para abordar esta cuestión crítica y pueden ayudar a facilitar el desarrollo de estrategias eficaces para combatir el comercio ilegal de totoaba y promover la conservación de la biodiversidad de forma más amplia.
加利福尼亚湾石首鱼 (Totoaba macdonaldi) 的非法贸易正在造成负面的社会、生态和经济影响。这种非法活动加速了对石首鱼的过度开发利用, 并使极度濒危的小头鼠海豚 (Phocoena sinus) 更加濒临灭绝。尽管人们已为恢复小头鼠海豚种群付出了大量努力, 但却很少将石首鱼贸易作为一个独立问题加以关注。因此, 有关石首鱼贸易的数据非常有限, 这阻碍了稳健分析并制定有效干预措施来减少非法捕捞。本研究利用一个已建立的框架, 该框架专门用于研究非法市场动态并指导减少石首鱼非法利用的措施。该框架将市场划分为三个分析层面:参与方 (如渔民、中间商) 的特征、参与方在市场内的互动分析 (如供应链的组织), 以及这些互动产生的整体市场动态的评估 (如决定价格和数量的因素) 。我们查阅了现有文献 (108篇原始文献), 并采访了主要市场参与者、学者和非政府组织专家 (14人), 以获取本框架所需数据。我们的研究结果提供了石首鱼非法市场运作的概况, 强调了干预节点 (如海关代理) 和需要额外信息以减少信息空缺的领域 (如美国本地市场) 。我们描述了这一市场的结构和复杂性, 强调了有组织犯罪在塑造市场动态方面的影响作用 (如控制支付给渔民的价格和囤积货物) 。通过对市场运作进行系统而深入的了解, 我们希望能够为有效干预和旨在减少不确定性的未来研究建立基准。我们的研究结果为解决这一重要问题迈出了关键一步, 有助于推动制定有效策略, 打击石首鱼非法贸易, 并更广泛地促进生物多样性保护。【翻译: 胡怡思; 审校: 聂永刚】.

Currently, chemicals and waste are recognized as key drivers of habitat degradation and biodiversity loss in aquatic ecosystems. To ensure vibrant habitats for aquatic species and maintain a sustainable aquatic food supply system, Japan promulgated its Environmental Quality Standards for the Conservation of Aquatic Life (EQS-CAL), based on its own aquatic life water quality criteria (ALWQC) derivation method and application mechanism. Here we overview Japan\'s EQS-CAL framework and highlight their best practices by examining the framework systems and related policies. Key experiences from Japan\'s EQS-CAL system include: (1) Classifying six types of aquatic organisms according to their adaptability to habitat status; (2) Using a risk-based chemical screening system for three groups of chemical pollutants; (3) Recommending a five-step method for determining ALWQC values based on the most sensitive life stage of the most sensitive species; (4) Applying site-specific implementation mechanisms through a series of Plan-Do-Check-Act loops. This paper offers scientific references for other jurisdictions, aiding in the development of more resilient ALWQC systems that can maintain healthy environments for aquatic life and potentially mitigate ongoing threats to human societies and global aquatic biodiversity.

暂无摘要。

The team is a fundamental and structuring dimension of care, founded on the principles of complementarity, interdependence, and shared objectives and responsibilities towards the patient. As a result of the pandemic and the rationalization of public hospitals, teams are faced with changes in the role of supervisors and the arrival of new figures such as advanced practice nurses. While these changes can bring new dynamism and questioning of practices, they can also be destabilizing. The institution must preserve the role of the team and its members.

Telehealth presents both the potential to improve access to care and to widen the digital divide contributing to health care disparities and obliging health care systems to standardize approaches to measure and display telehealth disparities. Based on a literature review and the operational experience of clinicians, informaticists, and researchers in the Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT)-Clinical and Translational Science Awards (CTSA) Network, we outline a strategic framework for health systems to develop and optimally use a telehealth equity dashboard through a 3-phased approach of (1) defining data sources and key equity-related metrics of interest; (2) designing a dynamic and user-friendly dashboard; and (3) deploying the dashboard to maximize engagement among clinical staff, investigators, and administrators.

BACKGROUND: High-quality health information handovers are critical to optimal patient care and trainee education. The purposes of this study were to assess the feasibility of implementing an emergency general surgery (EGS) morning handover and to explore its impact upon markers of clinical care.
METHODS: This prospective feasibility study was conducted at a single academic tertiary-care medical center following implementation of a novel EGS morning handover process. We assessed organizational perspective through a two-part anonymous survey delivered to the EGS service staff (n = 29) and collected feasibility metrics daily at the morning handover meetings. Exploratory clinical metrics of quality improvement were compared between parallel 5-month periods preimplementation and postimplementation of the handover. Data were compared by descriptive statistics.
RESULTS: One hundred and seventeen patients from March 1, 2022, to July 31, 2022, and 185 patients from March 1, 2023, to July 31, 2023, were identified prehandover and posthandover implementation, respectively, with an increase in time to operating room posting by 49% (95% confidence interval [CI]: 1.03-2.14) and no statistically significant change in length of stay. The average duration of the formalized EGS morning handover was 14 min (95% CI: 12:18-15:42) having an average of 12 questions asked (95% CI: 9.98-14.02) and an average attendance of 70% from essential personnel. Eighty-four percent of postimplementation survey responses indicated positive regard toward the new EGS handover.
CONCLUSIONS: The implementation of an EGS morning handover is feasible, necessitating further studies to define the impact of the EGS morning handover upon clinical outcomes.

This study presents a framework for determining the prioritization of vaccine introduction in the National Immunization Program (NIP) of the Republic of Korea, with a focus on case examples assessed in 2021 and 2023. We describe the predefined criteria for evaluating the prioritization of vaccines in the NIP and the established process in the Republic of Korea. These criteria included disease characteristics, vaccine characteristics, rationality and efficiency of resource allocation, and the acceptance of immunization. The process of prioritizing NIP introduction involved several sequential steps: a demand survey, evidence collection, preliminary evaluation, priority evaluation, and decision making. In 2021 and 2023, 14 and 25 committee members participated in evaluating the prioritization of vaccines in the NIP, respectively. Overall, 13 and 19 NIP vaccine candidates were included in the 2021 and 2023 evaluations, respectively. Through the Delphi survey and consensus processes, the priority order was determined: vaccination against Rotavirus infection was the top priority in 2021, while Influenza 4v (for chronic disease patients) took precedence in 2023. This study demonstrates an evidence-based decision-making process within the healthcare field. The outlined approach may provide valuable guidance for policymakers in other countries seeking to prioritize the inclusion of new vaccines in their NIP.

Side channels are unintended pathways within target systems that leak internal target information. Side-channel sensing (SCS) is the process of exploiting side channels to extract embedded target information. SCS is well established within the cybersecurity (CYB) domain, and has recently been proposed for medical diagnostics and monitoring (MDM). Remaining unrecognised is its applicability to human-computer interaction (HCI), among other domains (Misc). This article analyses literature demonstrating SCS examples across the MDM, HCI, Misc, and CYB domains. Despite their diversity, established fields of advanced sensing and signal processing underlie each example, enabling the unification of these currently otherwise isolated domains. Identified themes are collating under a proposed domain-agnostic SCS framework. This SCS framework enables a formalised and systematic approach to studying, detecting, and exploiting of side channels both within and between domains. Opportunities exist for modelling SCS as data structures, allowing for computation irrespective of domain. Future methodologies can take such data structures to enable cross- and intra-domain transferability of extraction techniques, perform side-channel leakage detection, and discover new side channels within target systems.