Search Results (4,328)

Aims: International diabetes guidelines recommend inpatient glycaemic management protocols for bolus enteral feeding in people with diabetes to improve clinical outcomes. This study aims to evaluate before and after hospital-wide implementation of an inpatient bolus enteral feeding protocol: (1) the incidence of hyperglycaemia (>13.9 mmol/L) and hypoglycaemia (<4.0 mmol/L), (2) medication prescribing practices and capillary blood glucose monitoring and (3) health care professionals’ knowledge and confidence levels. Methods: We implemented an inpatient glycaemic management protocol for bolus enteral feeding developed by a multidisciplinary team of diabetes nurse educators and endocrinologists and approved by the institutional medical board in July 2024. This before-and-after quality improvement study was conducted over 3 months across eight inpatient wards. Adult inpatients were consecutively enrolled if they met the inclusion criteria: (1) a documented diagnosis of diabetes mellitus, (2) receiving bolus enteral feeding and (3) treatment with glucose-lowering medication. Patients listed as critically ill were excluded. Nurses working in the pilot wards were also recruited. Before implementing the protocol, diabetes nurse educators trained inpatient nurses on understanding and executing the protocol for administering capillary blood glucose monitoring and medications for patients with diabetes on enteral feeding. Nurses’ pre- and post-knowledge levels and perceived confidence were assessed using a structured questionnaire. Electronic medical records were reviewed to evaluate the incidence rates of hypoglycaemia and hyperglycaemia before and during the 3 months following protocol implementation. We also assessed adherence to protocol-recommended capillary blood glucose monitoring frequencies based on the diabetes medication regimen. Results: A total of 31 patients were observed during the 6-week baseline period and 28 patients following protocol implementation. A total of 192 clinical care episodes were audited, comprising 78 in the pre-intervention phase and 114 in the post-intervention phase. The incidence of hyperglycaemia decreased from 43.6% to 10.5%, while hypoglycaemia decreased from 3.8% to 2.6%. After adjusting for protocol adoption rates, protocol implementation was associated with significantly lower odds of hyperglycaemia (odds ratio [OR] 0.22, 95% CI [0.07, 0.65], p = 0.006). A significant increase in appropriate nursing practices was observed post-intervention (p < 0.001). Adoption of the protocol by nurses decreased the odds of hyperglycaemia by 70% (p = 0.014). Nurses’ knowledge scores improved significantly from baseline to 3 months post-implementation (p < 0.001). Conclusions: Implementation of a standardised inpatient glycaemic management protocol for PWD receiving bolus enteral feeding was associated with reduced rates of hyperglycaemia and hypoglycaemia. Larger-scale studies are warranted to evaluate the effectiveness and sustainability of wider implementation in improving clinical outcomes. Full article

Geopolitical fragmentation, intensifying geoeconomic competition, and the securitisation of economic relations are reshaping the international environment and changing the conditions under which the European Union (EU) conducts its external economic policy. As economic interdependence has become a source of both prosperity and vulnerability, the EU has begun to redefine the relationship between openness, resilience, and economic security. This article examines how these developments are reshaping the EU’s geoeconomic model and its role within an evolving global order. The study develops an analytical framework that links geopolitical pressures, external dependencies, and institutional responses to the Union’s geoeconomic adaptation. The research employs a concept-driven qualitative design combining qualitative content analysis, analytically focused comparison, and process-oriented interpretation of key EU strategic documents and the relevant academic literature. The study shows that the EU is developing a hybrid geoeconomic model that combines openness with resilience, market integration with economic security, and international cooperation with a stronger capacity to manage critical vulnerabilities. This process reflects a longer-term adjustment of the Union’s external economic strategy and its international role. The article advances current debates on geoeconomics, European integration, and global governance by explaining how geopolitical fragmentation is reshaping the EU’s external action in a more contested international environment. Full article

Background/Objectives: Veterinary vaccine manufacturing is essential for controlling transboundary animal diseases, strengthening animal health systems, and supporting livestock development, particularly in Southeast Asia where livestock production continues to expand. However, modernization toward Pharmaceutical Inspection Co-operation Scheme (PIC/S) Good Manufacturing Practice (GMP) compliance remains challenging because it requires coordinated development across regulatory, technical, organizational, financial, and governance domains. This study aimed to develop an evidence-informed strategic framework for veterinary vaccine manufacturing modernization through a structured and systematically documented framework development methodology integrating multidisciplinary evidence and practice-informed implementation experience. Methods: An evidence-informed framework development study was conducted through the multidisciplinary integration of multiple evidence sources, including international regulatory guidance, peer-reviewed scientific literature, multidisciplinary feasibility assessment, and practice-informed implementation experience derived from a government-commissioned consultancy project. Framework development followed a structured methodology comprising evidence collection, evidence categorization, multidisciplinary evidence synthesis, framework development, iterative refinement, and expert-informed validation. Only generalized methodological principles and potentially transferable implementation knowledge were incorporated to ensure confidentiality of project-specific information. Results: Multidisciplinary evidence synthesis identified ten evidence domains encompassing regulatory, technical, organizational, economic, legal, environmental, governance, workforce, infrastructure, and implementation considerations. These domains were translated through a structured process into an evidence-informed strategic framework organized around four sequential modernization phases—Design, Construction, Validation, and Continuous Improvement—supported by cross-cutting strategic enablers. Iterative refinement through expert review, technical consultation, and implementation verification strengthened the framework’s scientific consistency, regulatory alignment, and practical applicability. Conclusions: Veterinary vaccine manufacturing modernization should be regarded as a multidisciplinary organizational transformation rather than solely as an infrastructure or engineering project. Beyond proposing a strategic framework, this study provides a transparent, systematically documented and traceable methodology for translating multidisciplinary evidence into strategic decision-support tools. The proposed framework may assist governments, regulatory authorities, vaccine manufacturers, and researchers in developing evidence-informed modernization strategies for veterinary biological manufacturing systems, particularly in low- and middle-income countries, subject to adaptation to specific regulatory, technical, institutional, and resource contexts. Full article

Background: Assessment of lymph node involvement was incorporated into the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system as a critical determinant of patient management and prognostication. This study aims to validate the prognostic significance of metastatic lymph node characteristics and their correlation with molecular classification. Methods: We conducted a retrospective analysis of 131 patients with stage IIIC endometrial carcinoma who underwent surgical intervention at the Tianjin Medical University Cancer Institute and Hospital from 2010 to 2025. The patients were stratified based on various characteristics of metastatic lymph nodes. Progression-free survival (PFS) was estimated using Kaplan–Meier curves, and group comparisons were performed using the log-rank test. Univariate Cox proportional hazards regression was conducted to identify independent prognostic factors for PFS. Results: In accordance with the 2023 FIGO staging system, within the stage IIIC cohort, patients with concurrent pelvic and para-aortic lymph node metastases and those in the stage IIIC1 cohort with macrometastasis demonstrated decreased PFS (HR = 2.748; 95% CI = 1.227–6.151; p = 0.011, and HR = 4.039; 95% CI = 1.232–13.240; p = 0.021, respectively). Furthermore, patients with lymph nodes showing extracapsular extension had significantly reduced PFS in the stage IIIC, stage IIIC1, and stage IIIC1ii cohorts (HR = 10.12; 95% CI = 2.38–42.99; p < 0.001; HR = 3.58; 95% CI = 1.242–10.31; p = 0.011; and HR = 2.32; 95% CI = 0.83–6.71; p = 0.037, respectively). The number of involved lymph nodes, the largest diameter of metastatic foci in lymph nodes, and the presence or absence of extracapsular extension of metastatic lymph nodes were significantly different among the NSMP, MMRd, and p53abn molecular classifications (p = 0.033, p < 0.001, and p = 0.002, respectively). Patients with extracapsular extension of metastatic lymph nodes had worse PFS than those without in the MMRd group (p = 0.018). Conclusions: Extracapsular extension (ECE) of metastatic lymph nodes is the strongest predictor of worse progression-free survival in stage IIIC endometrial carcinoma, especially in the IIIC1 and MMRd subgroups, supporting its value for risk stratification and prognostic assessment. Full article

China has emerged as one of the most influential actors in South–South scientific cooperation, progressively integrating agricultural innovation, technology transfer, and sustainable development into its international engagement strategy, with tropical agriculture positioned as a strategic domain in its relations with Latin America. However, despite China’s growing role as a driver of agricultural research collaboration, the specific mechanisms through which its institutions transfer knowledge and strengthen local scientific capacities in the Latin American region remain insufficiently studied, particularly in the case of Ecuador. This study adopted a qualitative scoping review methodology following PRISMA-ScR guidelines, screening 9199 records across Scopus, Web of Science, and SciELO, of which 61 documents were retained for thematic analysis. Results show that Chinese cooperation has evolved through three distinct phases: an initial phase centered on agricultural investment and resource-oriented cooperation (2000–2010); a second phase (2010–2018) characterized by the initial institutionalization of scientific and technological cooperation through bilateral agreements, joint action plans, researcher training, and institutional exchanges; and a third phase (2018–present), marked by the deliberate integration of science, technology, and innovation as central pillars of China’s engagement with Latin America, including long-term collaborative research, joint laboratories, scientific networks, and initiatives led by institutions such as the Chinese Academy of Tropical Agricultural Sciences (CATAS). In Ecuador, CATAS’s partnership with the National Institute of Agricultural Research (INIAP) illustrates China’s capacity to build joint research platforms, though sustained impact depends on long-term institutionalization, continuous financing, and transparent governance over genetic resources. The findings underscore China’s expanding support in shaping South–South agricultural cooperation and innovation, and the conditions required to translate this support force into durable, mutually beneficial scientific outcomes. From a public policy perspective, China and Ecuador could strengthen their international agricultural cooperation framework through long-term mechanisms supporting strategic scientific partnerships between the two countries, including multi-year joint research programs, dedicated funding instruments, researcher mobility, and institutional mechanisms for transparent governance of genetic resources and jointly generated intellectual property. Full article

The digital divide in developing economies persists as a multidimensional challenge encompassing infrastructure access, digital skills, usage patterns, and social inequality. This paper presents a structured literature review of 63 peer-reviewed articles (2018–2025) examining how intelligent connectivity, the convergence of fifth-generation (5G) mobile networks, artificial intelligence (AI), and the Internet of Things (IoT), can contribute to bridging this divide. The findings reveal that intelligent connectivity offers transformative potential across agriculture, healthcare, education, and financial services. However, its impact is contingent upon enabling governance, institutional capacity, and digital skills. Three contributions emerge: (1) a conceptual framework specifying directional pathways from enabling conditions to intelligent connectivity deployment and inclusive outcomes; (2) a comparative regional analysis (Sub-Saharan Africa, Southeast Asia, and Latin America) identifying context-specific barriers and opportunities; and (3) a socio-technical model positioning intelligent connectivity as an integrated system rather than a purely technological solution. A key limitation is acknowledged: only 16% of the reviewed corpus addresses developing economies, necessitating triangulation with institutional reports from the International Telecommunication Union (ITU), Organization for Economic Co-operation and Development (OECD), and Global System for Mobile Communications Association (GSMA). The paper concludes with open research challenges and policy recommendations for inclusive digital transformation. Full article

This article reviews CFO gender as a role-specific executive diversity issue and addresses the fragmented literature in which gender effects are often interpreted without separating appointment selection from the authority and organizational context of the CFO position. Using a hybrid design, we combine bibliometric analysis with a systematic literature review. A Web of Science title-and-abstract search reported through PRISMA 2020 and manual eligibility assessment identifies 68 peer-reviewed journal papers published from 2010 through 2026 across 46 outlets. The bibliometric stage maps publication growth, outlet distribution, recurring vocabulary, a ten-topic Latent Dirichlet Allocation (LDA) topic model, and term co-occurrence. The evidence shows a recent and dispersed field: more than four-fifths of the sample appear from 2019 onward, and the papers span governance, management, finance, accounting, ethics, and sustainability journals. The systematic stage compares evidence on the internal and external determinants and consequences associated with CFO gender across financial policy, earnings management, executive governance, capital markets, compensation and labor-market signals, and adjacent business fields. The findings do not support a universal gender effect. Observed associations depend on CFO authority, CEO power, board composition, incentives, task domain, institutional setting, and research design. Relative to broad reviews of executive characteristics, this article provides a current CFO gender-specific cross-outcome synthesis. The review concludes by identifying selection and endogeneity, direct measurement of CFO influence, review scope limitations, and underdeveloped applications as future directions, and developing implications for boards, executive recruitment, governance practice, professional development, and policy. Full article

The integration of Artificial Intelligence (AI) in higher education is reshaping institutional decision-making, governance, policy development, and educational innovation. Effective leadership in AI-enabled environments requires more than technical competence, extending to strategic awareness, ethical judgement, and the ability to critically evaluate the broader implications of AI technologies. Drawing on survey and interview data from 52 academic leaders across UK higher education institutions, this study examines current levels of AI literacy and explores how AI capability relates to institutional readiness and leadership practice. The findings reveal variation in participants’ self-reported AI literacy and engagement, identify technical, strategic, ethical, and organisational capability gaps, and highlight structural barriers including limited time, fragmented professional development, and insufficient institutional support for institution-wide AI adoption. In response, the paper presents the AI Literacy Leadership Framework (AILLF), which conceptualises AI literacy as a multidimensional leadership capability comprising technical, strategic, ethical, and applied dimensions that support four interconnected leadership domains: innovation, decision-making, ethical governance, and policy development. Informed by leadership theory, international AI governance frameworks, and the study’s exploratory empirical findings, the AILLF is accompanied by a proposed capability progression model and role-differentiated leadership competency guide to provide implementation guidance for higher education institutions. The study contributes an empirically informed conceptual framework that integrates AI literacy, leadership theory, and AI governance, providing a foundation for future research and institutional approaches to AI leadership within higher education. Full article

Background/Objectives: Borderline ovarian tumours (BOTs) are distinct epithelial neoplasms with excellent survival but variable recurrence, including late relapse and occasional malignant transformation. Follow-up strategies remain inconsistent internationally, with no standardised, risk-adapted framework. We aimed to synthesise the evidence on BOT recurrence patterns, risk factors and surveillance strategies, and to propose a structured, risk-adapted surveillance framework. Methods: This is a narrative expert synthesis rather than a systematic review. Three evidence sources were combined: our previously published comprehensive review of BOTs, our recent meta-analysis of recurrence and malignant transformation, and an appraisal of contemporary international guidelines. Clinicopathological and surgical determinants of recurrence were then mapped onto the available follow-up tools through a three-step approach, and the resulting risk strata, surveillance intervals and total follow-up duration were agreed on by consensus within a single tertiary gynaecological oncology centre (the “Barts Framework”). Results: Recurrence occurs in 3–10% of patients, with up to one-third arising beyond five years. Key predictors include fertility-sparing surgery (particularly cystectomy), incomplete staging, advanced stage, residual disease, and adverse histological features such as micropapillary/cribriform architecture and invasive implants. Three targets for surveillance were identified: early detection of recurrence, detection of malignant transformation, and optimisation of fertility. Transvaginal ultrasound emerged as the cornerstone modality, with cross-sectional imaging and tumour markers applied selectively. Four risk strata were derived, each specifying follow-up intensity, modality, total duration and care setting. Low-risk patients can be managed in decentralised settings (gynaecological units), whereas high-risk groups warrant specialist oversight (gynaecological oncology centres). Patient-initiated follow-up is incorporated to minimise unnecessary interventions. Conclusions: This risk-adapted approach provides a scalable framework to standardise BOT surveillance whilst reducing overuse and maintaining oncological safety. The framework is consensus-based and single-institution in origin, and prospective external validation with long-term outcome data is required before wider adoption. Integration of molecular stratification and artificial-intelligence-assisted imaging represents a key future direction. Full article

The international policy framework for “Reducing Emissions from Deforestation and Forest Degradation, plus the conservation, sustainable management of forests, and enhancement of forest carbon stocks” (REDD+) is a vital United Nations Framework Convention on Climate Change (UNFCCC) mechanism designed to assist Global South nations in reaching their climate goals under the Paris Agreement. Implementable at the project, subnational, and national levels, REDD+ has placed an increasing emphasis on subnational program implementation in recent years, exemplified by a growing focus on jurisdictional and integrated landscape strategies. These comprehensive approaches balance diverse land uses and address the complex causes of deforestation through economic incentives and multi-level, cross-sector planning at the state, provincial, or district levels. Ultimately, successful implementation depends on collaboration, active stakeholder engagement, resources, mutual trust, and adequate institutional capacity to manage conflicting local interests. However, weak forestland-use governance in many countries of the Global South often results in inefficient collaborative dynamics that hinder stakeholder cooperation. Despite this, the specific collaborative challenges hindering stakeholder collaboration in subnational REDD+ implementation remain insufficiently understood. To address this gap, this study conducts a literature review to systematically synthesize evidence on subnational REDD+ implementation, using the Integrative Framework for Collaborative Governance (IFCG) to identify key knowledge gaps and challenges. Following established methodological guidance, six databases were searched, Scopus (824), Web of Science (1347), PubMed (84), ResearchGate (557), Google Scholar (571), and Research Rabbit (191), yielding 43 articles on subnational REDD+ implementation for inclusion in the synthesis. The findings identify four main challenges: (i) system context-related challenges, (ii) burdensome global requirements, (iii) resource constraints, and (iv) challenges inherent in the institutional design of collaborative arrangements. While the IFCG proves analytically useful, the complexity and evolving nature of subnational REDD+ programs complicate its application, revealing areas for theoretical refinement. By critically examining the IFCG’s utility, this study advances collaborative governance theory and offers empirical insights into the conditions necessary for effective stakeholder collaboration in subnational REDD+ implementation across the Global South. Full article

Against the backdrop of rapid development in marine engineering, the construction industry faces practical challenges, such as water scarcity, limited availability of natural river sand, and high raw material transportation costs. This has led to an increasing demand for resource-efficient concrete production technologies and improved construction economic efficiency. Seawater–sea-sand concrete (SWSSC) offers a locally sourced solution that effectively reduces the construction sector’s overreliance on freshwater and river sand, lowers material transportation costs for coastal infrastructure projects, and supports marine engineering and infrastructure development along the Belt and Road Initiative. However, existing research lacks systematic organization and visualized quantitative analysis. Utilizing the CiteSpace 7.0.R0 knowledge graph analysis software, this study selects 982 relevant papers published in the Web of Science (WOS) Core Collection between 2016 and 2025 as the sample. By employing analytical methods—including annual publication volume statistics, collaboration networks among researchers, keyword co-occurrence patterns, and temporal evolution charts—we systematically delineate the overall research landscape, distribution of key research institutions, trends in research hotspots, and future frontier directions in this field. The analysis results indicate that: (1) The total number of publications in the global seawater–sand concrete field has been increasing year by year. From 2016 to 2018, it was the basic exploration period, with an average annual publication volume of less than 10. From 2019 to 2021, it was the deepening and expansion period, with research expanding from the performance of a single material to material modification and structural application. From 2022 to 2025, it was the rapid prosperity period, with the publication volume reaching its peak in 2024–2025 (208 articles and 203 articles), and the publication volume continued to rise. (2) China ranks first globally with 798 publications, but its centrality in international cooperation networks is only 0.24, reflecting low overall collaboration density and loose partnerships between institutions and authors, without the formation of cross-institutional core research teams with global leadership. (3) Research hotspots in this field primarily focus on material properties, durability characteristics, and mechanical strength, among which FRP reinforcement systems serve as a bridge for interdisciplinary research bridging material fundamentals and engineering applications, representing a key research branch. (4) From the perspective of evolutionary trends, the field exhibits three major developmental shifts from macroscopic mechanical performance characterization to in-depth investigation of microscopic damage mechanisms, from single-material studies to composite structural systems, and from short-term laboratory accelerated testing to full life-cycle performance evaluation, with the low-carbon potential of seawater–sand concrete increasingly becoming a prominent research focus. Therefore, this paper advocates strengthening international and inter-institutional academic collaboration, fostering multidisciplinary innovation, and prioritizing breakthroughs in key areas, such as large-scale intelligent performance prediction, long-term performance database development, and digital-twin-based operation and maintenance management, to facilitate the transition of seawater–sand concrete technology toward efficient, low-carbon, safe, and intelligent engineering applications. Full article

Background: Dietary behaviors are important modifiable factors related to health and well-being. Sports volunteers represent a population involved in sport-related environments, yet limited evidence is available regarding their specific dietary behaviors and their associations with sociodemographic characteristics. Materials and Methods: A cross-sectional survey was conducted among 297 sports volunteers (184 women, 113 men) at international sporting events in Poznan, Poland. Twenty specific dietary behaviors, including meal frequency, consumption of fruits, vegetables, cereal products, meat, dairy products, fish, sweets, sugar-sweetened beverages, salty snacks, ready-made meals, legumes, water, and selected eating behaviors, were assessed using a 20-item dietary habits questionnaire developed in accordance with dietary recommendations of the National Institute of Public Health and the National Center for Nutrition Education in Poland. Gender, age, educational attainment, and BMI were recorded. Chi-square tests were used to examine bivariate associations between each dietary behavior and sociodemographic characteristics. Multivariable logistic regression models were subsequently applied to dietary behaviors showing statistically significant bivariate associations. Results: Of the 20 dietary behaviors assessed, only a small number varied significantly according to sociodemographic characteristics. Women reported higher adherence to daily fruit consumption (46.8% vs. 28.1%; p = 0.002) and daily consumption of at least three portions of vegetables (44.1% vs. 28.9%; p = 0.013) than men. Participants aged 18 years differed from older age groups in daily fruit consumption and limiting meat consumption to no more than once per day (p < 0.05). Educational attainment was associated with daily fruit consumption, with participants with primary education reporting higher adherence than those with higher education (48.8% vs. 25.3%; p = 0.011). BMI was associated with several dietary behaviors, including fruit consumption, avoiding snacking between meals, and portion control (p < 0.05). In multivariable analyses, female gender remained independently associated with fruit and vegetable consumption, while younger age was independently associated with daily fruit consumption and lower meat consumption. BMI remained independently associated with daily fruit consumption, whereas educational attainment was no longer significantly associated with dietary behaviors after adjustment. Conclusions: Most of the 20 dietary behaviors assessed did not differ significantly according to the examined sociodemographic characteristics. The observed associations were limited to selected behaviors and varied by gender, age, educational attainment, and BMI. Further research should examine additional factors, including physical activity, volunteering characteristics, and socioeconomic conditions, that may contribute to dietary behaviors among sports volunteers. Full article

The Post Office Horizon scandal represents one of the most severe miscarriages of justice in modern British legal history, rooted in the deployment of a defective IT system and the institutional suppression of evidence that exposed its unreliability. This paper provides a systematic analysis of the scandal through the combined lenses of cyber security, digital forensics, and IT governance, drawing directly on the Post Office Horizon Public Inquiry dataset—including witness testimony, technical documentation, audit records, and internal communications spanning more than two decades. While many of the technical and procedural failures discussed have been documented in prior scholarship, the paper’s principal contribution is the systematic mapping of those failures against recognised governance frameworks and the Legally Accountable Digital Systems (LADS) proposal this mapping motivates. We identify and analyse five interconnected failure categories: software defects and poor system design; deficient patch governance; inadequate audit logging and compromised evidence integrity; investigative failures and prosecutorial conflict of interest; and a systemic absence of technical expertise and independent oversight. Each category is mapped against nine governance framework documents, including ISO/IEC 27001, NIST SP 800-53 Rev. 5, NIST SP 800-218 (SSDF), COBIT 2019, ISO/IEC 27035, NIST SP 800-61, and ISO/IEC 27036, with ISO/IEC 27037 applied additionally to evidential handling failures and NIST SP 800-92 to log management failures. A counterfactual analysis indicates that compliance with these frameworks could plausibly have detected, exposed, or substantially reduced most of the documented failures, though this claim is necessarily inferential and conditional on good-faith implementation. The scandal was therefore not caused primarily by the absence of adequate frameworks but by their wholesale non-application and by institutional incentives, examined later in the paper, that can undermine even fully compliant controls. However, the analysis also surfaces a governance gap that no existing framework addresses: the institutional failure mode in which the organisation responsible for system integrity holds active incentives to suppress evidence of failure rather than remediate it. To address this gap, we propose the concept of Legally Accountable Digital Systems (LADS)—a governance category for systems whose outputs are used as evidence in legal proceedings—and outline three supplementary pillars: technical independence, institutional independence, and forensic admissibility governance. We draw a parallel with the Sarbanes–Oxley Act of 2002, arguing that the Horizon Inquiry dataset provides an equivalent empirical foundation for the statutory reform of digital evidence governance. Finally, we outline the substantial research opportunities the Inquiry dataset presents across IT systems analysis, cyber security, forensic accounting, social network analysis, and legal informatics—a resource comparable in significance to the Enron materials that shaped a generation of corporate governance reform. Full article

Clinical decision making in Acute Myeloid Leukemia (AML) critically relies on rapid genomic characterization. To better understand the AML diagnostic landscape in Canada, the Canadian Leukemia Study Group (CLSG) conducted a survey of laboratory hematology leadership (n = 18) at 16 laboratories across 10 provinces, administered using Google Forms in September 2024. Nearly all surveyed sites were equipped to deliver a full suite of testing platforms through existing on-site infrastructure or laboratory partnerships. Reporting practices varied in terms of genomic integration into bone marrow results and the use of AML classification systems. Turn-around-time (TAT) targets were predominantly determined through internal institutional consensus (62%) or recommendations by provincial cancer agencies/international groups (44%). TAT reduction was a top priority for 56% of laboratories, suggesting timely biomarker results to be an active area for improvement. Various treatment-determining biomarkers were frequently assessed as rapid-tests (defined as a 5-day TAT), including FLT3-ITD (69%), FLT3-TKD (56%), and NPM1 (56%), while others such as IDH1 and TP53 were rapid at a limited number of laboratories. Respondents demonstrated a strong shared interest in joint projects such as the validation of AML measurable residual disease (MRD) assays (56%). There was also unanimous support for establishing CLSG AML laboratory consensus guidelines. This survey documents the current state of Canadian AML laboratories and provides a foundation for future shared development projects. Full article

We report early toxicity outcomes after institutional implementation of prostate SBRT using 42.7 Gy in seven fractions delivered with either MR-guided adaptive SBRT (MRgSBRT) or CT-guided non-adaptive SBRT (CTgSBRT). Between July 2019 and May 2023, 216 patients received this regimen. Genitourinary (GU) and gastrointestinal (GI) toxicities were retrospectively assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Most patients had intermediate-risk disease (86%), and 14% had high-risk disease. Median prostate volume was 40 mL, and median baseline International Prostate Symptom Score (IPSS) was 8 among patients with available data. MRgSBRT and CTgSBRT were used in 100 (46%) and 116 (54%) patients, respectively. At a median follow-up of 19 months, 12- and 24-month grade ≥ 2 GU toxicity rates were 20.0% and 18.2%, while grade ≥ 2 GI toxicity rates were 3.5% and 3.6%, respectively. No statistically significant platform-related differences were detected; however, these comparisons were exploratory and potentially confounded by nonrandomized platform selection, treatment era, rectal-spacer use, adaptive workflow and differing PTV margins. On univariable analysis, baseline GU symptoms were associated with higher 12-month grade ≥ 2 GU toxicity (OR, 3.68; 95% CI, 1.52–10.37; p = 0.007), while prostate-volume category was not significantly associated with this endpoint. Full article