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Inadequately cleaned transport vehicles can act as reservoirs for pathogens jeopardizing pigs’ health status. Although effective cleaning and disinfection (C&D) of live-pig transport trucks is required by law, there is still no universally accepted protocol for C&D of trucks. This study aimed to evaluate the effectiveness of a standardized hygiene protocol under field conditions and to provide practical guidance, thereby fostering harmonized hygiene procedures. Starting from current legislation for barn C&D, and refining it through available literature, a detailed standardized protocol for truck hygiene was developed. Each vehicle was divided into three functional sections: transport unit, boot-storage compartment, and driver’s cabin. The protocol was applied to 15 trial trucks transporting live pigs and compared with 23 market trucks, which served as controls. C&D was assessed through visual inspection, adenosine triphosphate (ATP) testing, and microbiological analyses of environmental samples, including total viable count (TVC) on all trucks. Samples were collected at the three functional sections of the trucks. Trial trucks achieved significantly higher visual scores than control trucks (82.10 ± 9.72 vs. 72.20 ± 7.48; p = 0.0018). The 80% cleanliness threshold required for ATP testing was achieved by nearly half of the trial trucks (46.7%) but by only one control truck (4.3%) (p = 0.0065). Microbiological results further highlighted the protocol effectiveness: all cleaned trial trucks showed low mean TVC values (<10 CFU/cm2 or a 3 log₁₀ CFU/cm2 reduction, as acceptable threshold). In contrast, only 33.3% of driver’s cabin swabs and 50.0% of cargo-area swabs from control trucks met this threshold, while none of the boot storage samples did (p = 0.0254). Bacteriological testing revealed MRSA in 100% of trial trucks before C&D, but in 0% after cleaning (p = 0.0079). Overall, the standardized protocol markedly improved the sanitary status of pig-transport vehicles. The combined use of different assessment methods proved valuable for identifying critical control points, particularly the boot-storage area, the most contaminated site. The protocol also showed strong potential for eliminating MRSA from trucks, contributing to reduce antimicrobial resistance transmission. These findings provide a replicable and field-ready model for improving C&D compliance and biosecurity across the swine transport sector.

Malnutrition is a frequent problem in cancer patients, which leads to prolonged and repeated hospitalizations, increased treatment-related toxicity, reduced response to cancer treatment, impaired quality of life, a worse overall prognosis and the avoidable waste of health care resources. Despite being perceived as a limiting factor in oncologic treatments by both oncologists and patients, there is still a considerable gap between need and actual delivery of nutrition care, and attitudes still vary considerably among health care professionals. In the last 5 years, the Italian Intersociety Working Group for Nutritional Support in Cancer Patients (WG), has repeatedly revisited this issue and has concluded that some improvement in nutritional care in Italy has occurred, at least with regard to awareness and institutional activities. In the same period, new international guidelines for the management of malnutrition and cachexia have been released. Despite these valuable initiatives, effective structural strategies and concrete actions aimed at facing the challenging issues of nutritional care in oncology are still needed, requiring the active participation of scientific societies and health authorities. As a continuation of the WG's work, we have reviewed available data present in the literature from January 2016 to September 2021, together with the most recent guidelines issued by scientific societies and health authorities, thus providing an update of the 2016 WG practical recommendations, with suggestions for new areas/issues for possible improvement and implementation.

Cryoglobulins are immunoglobulins that precipitate at low temperature. Strict preanalytical and analytical conditions are critical for the detection of cryoglobulins. This review will focus on practical recommendations for detection and characterization of cryoglobulins and the technical problems that may be encountered. A laboratory report format is proposed for presentation of these results that includes the parameters necessary for an optimal interpretation by clinicians. The first step of detection of cryoglobulins can be performed in any laboratory that has a 37 °C incubator and temperature-controlled centrifuge. The second step is the characterization of cryoglobulins, and this often must be performed in more specialized laboratories. Characterization includes immunoglobulin typing, for the classification of cryoglobulins and potential underlying disease(s); quantification of immunoglobulins and rheumatoid factor in the cryoprecipitate to define the pathogenicity; and quantification of serum complement, which is useful for diagnosis. These practical recommendations will be useful for the accurate detection of cryoglobulins, an essential step for the diagnosis of cryoglobulinemic vasculitis, a rare but severe clinical manifestation of cryoglobulins.

The transformation of financial auditing through digitization, big data, and artificial intelligence is one of the most important challenges and opportunities for the contemporary accounting profession. The research aims to investigate how auditors and other professionals in the field of auditing and accounting in Moldova perceive the adoption of these technologies, with a focus on the level of digital skills, anticipated benefits, and barriers associated with implementation. Based on a systematic analysis of the international literature, five research hypotheses were formulated regarding the relationship between digital readiness, familiarity with artificial intelligence tools, perception of the human-technology partnership, ethical barriers, and experience in using AI solutions. The hypotheses were tested through a questionnaire applied to a sample of 63 respondents, including active auditors registered with audit entities, as well as other audit professionals (public auditors, internal auditors, audit trainees, accountants). Data analysis revealed correlations between the theoretically derived variables and the perceptions expressed, leading to the full confirmation of four hypotheses and the partial validation of one. The results showed that, although there is a clear association between digital skills and openness to the use of AI, reservations remain regarding familiarity and full confidence in its added value.

This research aims to develop and assess a mathematical model based on linear programming (LP) to optimize the distribution of COVID-19 vaccines, considering population priority groups, epidemic dynamics, and vaccine availability. We analyzed data on morbidity, mortality, and vaccine distribution in Russia using LP methods, scenario modeling, and statistical analysis. The findings of the study indicate a significant reduction in overall mortality to 5.2 per 100,000 individuals, with a vaccine effectiveness of 89% and vaccination coverage reaching 80%. The model incorporates epidemic parameters such as morbidity, mortality rates, virus spread rate, and characteristics of population groups, including age categories, healthcare and education workers, and vulnerable groups such as the elderly and those with chronic conditions. LP was applied to optimize vaccine distribution by formulating an objective function and constraints based on factors such as vaccine availability, population priorities, and epidemic dynamics, with scenario modeling used to simulate different epidemic conditions and assess the model’s stability and effectiveness. The assessment of differences using a 99.5% confidence interval and statistical significance in vaccine distribution changes yielded p < 0.001. The developed LP model effectively optimized vaccine distribution, reducing overall mortality and ensuring vaccination efficiency. The results were adapted to various epidemic scenarios and successfully correlated with real-world data obtained from official statistical reports of the Ministry of Health of the Russian Federation, regional epidemiological centers (including the Moscow Center), and vaccine manufacturers. The data covered the period from January 2021 to December 2022. To achieve a substantial impact of vaccines, it is essential to reach a population coverage of 60-70%.

Background Precise prognostication is the key to optimum and effective treatment planning for early-stage hormone receptor (HR) positive, HER2/neu negative breast cancer patients. Differences in the breast cancer incidence and tumor anatomical features at diagnosis, pharmacogenomics data between Western and Indian women along with the vast diversity in the economic status and differences in insurance policies of these regions; suggest recommendations put forward for Western women might not be applicable to Indian/Asian women. Opinions from oncologists through a voting survey on various prognostic factors/tools to be considered for planning adjuvant therapy are consolidated in this report for the benefit of oncologists of the sub-continent, SAARC and Asia’s LMIC (low and middle-income countries). Methods A three-phase DELPHI survey was conducted to collect opinions on prognostic factors considered for planning adjuvant therapy in early-stage HR+/HER2/neu negative breast cancer patients. A panel of 25 oncologists with expertise in breast cancer participated in the survey conducted in 2021. The experts provided opinions as ‘agree’ or disagree’ or ‘not sure’ in phases-1 and 2 which were conducted virtually; in the final phase-3, all the panel experts met in person and concluded the survey. Results Opinions on 41 statements related to prognostic factors/tools and their implications in planning adjuvant endocrine/chemotherapy were collected. All the statements were supported by the latest data from the clinical trials (prospective/retrospective). The statements with opinions of consensus less than 66% were disseminated in phase-2, and later in phase-3 with supporting literature. In phase-3, all the opinions from panelists were consolidated and guidelines were framed. Conclusions This consensus guideline will assist oncologists of India, SAARC and LMIC countries in informed clinical decision-making on adjuvant treatment in early HR+/HER2/neu negative breast cancer patients.

•Medical cannabis clinics are an emergent focused clinical practice globally.•Novel, multidisciplinary clinical model with significant clinical experience.•Evidence-based, peer-reviewed practice provides validity of clinical standards.•Refractory symptom management, chronic pain, cancer treatment, quality of life.•Clinical structure provides opportunity for standardized, real-world evidence. Medical cannabis access has been legalized in more than 30 countries worldwide and popularity among patients is increasing rapidly. Cannabinoid-based treatments have been shown to be beneficial for several symptoms such as chemotherapy-induced nausea and vomiting, spasticity, chronic pain, intractable seizures and insomnia, yet high-quality clinical trials are still limited. As millions of patients now have legal access to medical cannabis, little information is available about the development of best clinical practices and an effective medical cannabis clinic model. A medical cannabis clinic is an innovative and emergent practice model that may be necessary to bridge the gap between patient and healthcare provider interest and existing barriers to the prescription of medical cannabis treatments, such as limited medical education, lack of high-quality clinical research and challenging or evolving regulatory frameworks. In this paper, we describe the model of care and organization of a dedicated medical cannabis clinic operating in Quebec, Canada since 2014. We share the principles of medical cannabis practice, including the structure of its medical and support team, clinic organisation and procedure guidelines. Key clinic statistics and patient demographics are shared with year by year comparison. Operating since 2014, the clinic has endured a rapidly changing regulatory landscape in Canada, overcoming numerous challenges including medical and social stigma, limited funding, resources and institutional support combined with a high demand for services. To support medical cannabis leaders globally, an important knowledge-sharing is required. The clinic has expanded to a network of four clinic sites across Quebec and offers continuing education and preceptorships to health care providers and trainees as well as research services to both academic and industry partners. The description of the clinic offers guidance on medical cannabis treatment and care and discusses possible solutions to associated challenges. The clinic model of care can be adapted to different healthcare settings and regulatory frameworks; it may assist physicians and health care providers in the development of medical cannabis clinics or the implementation of best practices as medical cannabis access continues to evolve.

Purpose As a result of COVID-19 and associated stay-at-home orders, the number of employees working remotely reached unprecedented levels during early periods of the pandemic. Since that time, some employees have returned to the office; yet, there is a lasting impact on employees’ desires for remote work. In response, decision-makers in organizations should be equipped with knowledge regarding what makes remote work beneficial for both employees and the organization and also fair and compliant with the law. This paper aims to take a dual perspective spanning human capital and legal aspects of remote work to offer six practical recommendations to organizations. Design/methodology/approach This paper reviews the human resources (HR) scholarly literature on remote work, using principles from evidence-based management to select valid and reliable findings in which to base practical recommendations for organizations. Associated legal risks are identified through a review of the legal literature on remote work and integrated into the recommendations. Findings Building on a multilevel model of HR practices, the authors offer the following six practical recommendations to organizations: offer hybrid work and both location and schedule flexibility; ensure fair and compliant work schedules; acknowledge manager perceptions; ensure fair approval and evaluation of remote workers; acknowledge individual workers; and align remote work practices with diversity, equity and inclusion efforts. Originality/value The multilevel model of remote work practices discussed in this paper offers an organizing framework for identifying advantages and disadvantages of remote work that future research may build upon. The six recommendations help bridge the research–practice gap by providing organizations with knowledge on how to maximize the benefits of remote work while mitigating potential legal risks.

Hypercholesterolaemia is amongst the most common conditions encountered in the medical profession. It remains one of the key modifiable cardiovascular risk factors and there have been recent advances in the risk stratification methods and treatment options available. In this review, we provide a background into hypercholesterolaemia for non-specialists and consider the merits of the different risk assessment tools available. We also provide detailed considerations as to: i) when to start treatment, ii) what targets to aim for and iii) the role of low density lipoprotein cholesterol.