Under which conditions do extreme events support a paradigm shift? Studying focusing events during two centuries of Swiss flood risk management.

Extreme weather events affect many areas around the world. How a country or region reacts to it can take many forms. In this article, we concentrate on policy responses, as typically found in laws, acts, or strategies. Recent research in climate change adaptation or environmental governance concluded that the degree of severity of extreme events is a crucial indicator that policy action should be taken. The event alone is a necessary, but insufficient condition for policies to be introduced. In this context, we ask: Which conditions must be at stake so that an extreme event is able to deploy its focal power and induce policy introduction or change? To answer this question, we studied more than two centuries of flood risk management in Switzerland. We relied on qualitative and quantitative data, as well as process tracing techniques, to relate event characteristics, media, political, and policy contexts to policy change in flood risk management. Results indicate that two conditions made floods turn into focusing events and support paradigm shift: high economic damage and a policy subsystem's actor constellation favorable to change. We are convinced that our results are also replicable for other natural disasters and other countries than only Switzerland. Supplementary Information: The online version contains supplementary material available at 10.1007/s10113-024-02316-2.

The Beauty Revolution of Nanotechnology: Unveiling the Impact of Cosmetic Nano Wonders.

The infusion of nanotechnology into cosmetic formulations marks a transformative shift in beauty science. Although Raymond Reed originally used the word "cosmeceutical," Dr. Albert Kligman popularised the idea in the late 1970s. Cosmetic Nano Wonders are redefining skincare by leveraging nanomaterials to enhance the stability, delivery, and efficacy of active ingredients. The paradigm shift holds promise for overcoming longstanding challenges in traditional cosmetic formulations. This article aims to explore and showcase the revolutionary impact of nanotechnology on the cosmetic industry. Focusing on key nanocarriers, such as liposomes and nanoparticles, our objective is to illuminate how nanotechnology elevates the performance of beauty products, providing advanced solutions for skincare concerns. This revolution promotes sustainability through green synthesis techniques and enables more accurate and effective therapies for a variety of skin issues, including acne and ageing that raises the bar for safety and innovation in the cosmetics business by enhancing product performance and environmental impact. Conducting a thorough literature review, we analyze recent scientific studies and industry reports to unveil the mechanisms and applications of nanotechnology in cosmetics. Special attention is given to the role of nanocarriers in stability enhancement, targeted delivery, and controlled release, unraveling the methods that drive the transformative potential of Cosmetic Nano Wonders. The database sources are Scopus, PubMed, Google Scholar, and Google Patents. The examination of recent research underscores the tangible benefits of nanotechnology in cosmetics. Cosmetic Nano Wonders demonstrate superior stability, enhanced penetration into skin layers, and controlled release mechanisms, showcasing their potential to revolutionize beauty science and address longstanding challenges in skincare. Cosmetic Nano Wonders represent a groundbreaking shift in beauty science, offering unprecedented possibilities for formulators and consumers. As nanotechnology continues to reshape cosmetic formulations, the future holds the promise of safer, more effective, and personalized skincare solutions, ushering in a new era in beauty science.

Tourism promotion during emergency response to Omicron subvariant outbreak.

This study aimed to explore optimal ways to promote all kinds of tourism during the phase of emergency response to the current outbreak of Omicron subvariants. A framework-based systematic literature review was conducted as the primary methodology, supported by the preferred reporting items for systematic reviews and meta-analyses checklist. Four analytical units were allocated to include United Nations agencies, governments, tour businesses, and local communities. Economic interest-based tourism promotion was examined to develop local temperature-based tourism promotion via the same four variables. The study found that the pursuit of economic interests was not a productive solution for tourism promotion any longer due to the matter of local weather. It concluded that the four stakeholders should work to replace economic interest-based tourism promotion with local temperature-based tourism promotion. Results of this study can guide the positive effects of warm temperatures, brand image, psychological impacts, digital marketing, and others.

An electrochemical point-of-care testing device for specific diagnosis of the albinism biomarker based on paradigm shift designs.

L-tyrosine is a recognized biomarker of albinism, whose endogenous level in human bodies is directly linked to melanin synthesis while no attention has been paid to its specific diagnosis. To this end, we have developed an electrochemical point-of-care testing device based on a molecularly imprinted gel prepared by a universal paradigm shift design to achieve the enhanced specific recognition of the L-tyrosine. Interestingly, this theoretically optimized molecularly imprinted gel validates the recognition pattern of L-tyrosine and optimizes the structure of the polymer itself with the aid of computational chemistry. Besides, modified extended-layer MXene and Au nanoclusters have significantly improved the sensing activity. As a result, the linear diagnostic range of this electrochemical point-of-care testing device for L-tyrosine is 0.1-100 µM in actual human fluids, which fully covers the L-tyrosine levels of healthy individuals and people with albinism. The diagnosis is completed in 90 s and then the results are transmitted by Bluetooth low energy to the smart mobile terminal. Therefore, we are convinced that this electrochemical point-of-care testing device is a promising tool in the future smart medical system.

Depathologization of trans* experience in ICD-11: Suggestions for context-sensitive psychotherapeutic work.

The current changes to the treatment recommendations and the diagnostic categorization of trans* identities in the ICD-11 require a new consideration of past therapeutic methods and approaches. The depathologization of trans* lives in the ICD-11 finally enables trans* people to access psychotherapeutic services more freely, as the compulsory therapy that has thus far been required for access to transition-related treatments, as well as the so-called "diagnosis" and "treatment" of "transsexuality", have been removed. Trans* people will nevertheless be interested in qualified psychotherapeutic treatment options. Due to the decades-long discrimination and treatment in the health system that has disregarded the human rights of trans* people, a trans*-affirmative approach is necessary, one that takes into account the context of the treatment and critically reflects upon one's own position as a health professional. This affirmative and self-reflective approach provides the basis upon which therapeutic concerns and topics related to a life lived in accordance with a self-determined (gender) identity, related needs, and the fulfillment of those needs, can be discussed. The consequences of experiences of discrimination, violence and exclusion are, moreover, important elements of therapy that require a structural and social contextualization in order to address internalized trans*-negativity and to empower trans* people in their self-assertion.

Structured Routine Use of Styletubation for Oro-Tracheal Intubation in Obese Patients Undergoing Bariatric Surgeries-A Case Series Report.

The aim of this case series report is to provide a new topical view of styletubation (video intubating stylet technique) in obese patients undergoing bariatric surgeries. In contrast to various conventional direct laryngoscopes (DLs), videolaryngoscopes (VLs) have been applied in such obese populations with potentially difficult airway complications. The safety and effectiveness of VLs have been repeatedly studied, and the superiority of VLs has then been observed in and advocated for routine use. In this article, among our vast use experiences with styletubation (more than 54,998 patients since 2016) for first-line routine tracheal intubation, we present the unique experience to apply the styletubation technique in obese patients undergoing bariatric surgery. Consistent with the experiences applied in other patient populations, we found the styletubation technique itself to be swift (the time to intubate from 5 s to 24 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction). The learning curve is steep, but competency can be enhanced if technical pitfalls can be avoided. We, therefore, propose that the styletubation technique can be feasibly and routinely applied as a first-line airway modality in obese patients undergoing bariatric surgery.

Advancing Evidence-based Palliative Care Research: Navigating Challenges and Proposing Solutions.

Amid the increasing demand for palliative care, driven by demographic shifts and medical progress, evidence-based practices face obstacles due to limited research. Complex patient conditions and ethical considerations challenge traditional methodologies, while the absence of comprehensive clinical trials hinders innovative interventions. Empowering practitioners with research skills and establishing a palliative care research network are efforts aimed at bridging these gaps. It is important to emphasise that these initiatives collectively aspire to enhance evidence-based practices, ensuring quality care for individuals facing severe illnesses.

From field to table: Ensuring food safety by reducing pesticide residues in food.

The present review addresses the significance of lowering pesticide residue levels in food items because of their harmful impacts on human health, wildlife populations, and the environment. It draws attention to the possible health risks-acute and chronic poisoning, cancer, unfavorable effects on reproduction, and harm to the brain or immunological systems-that come with pesticide exposure. Numerous traditional and cutting-edge methods, such as washing, blanching, peeling, thermal treatments, alkaline electrolyzed water washing, cold plasma, ultrasonic cleaning, ozone treatment, and enzymatic treatment, have been proposed to reduce pesticide residues in food products. It highlights the necessity of a paradigm change in crop protection and agri-food production on a global scale. It offers opportunities to guarantee food safety through the mitigation of pesticide residues in food. The review concludes that the first step in reducing worries about the negative effects of pesticides is to implement regulatory measures to regulate their use. In order to lower the exposure to dietary pesticides, the present review also emphasizes the significance of precision agricultural practices and integrated pest management techniques. The advanced approaches covered in this review present viable options along with traditional methods and possess the potential to lower pesticide residues in food items without sacrificing quality. It can be concluded from the present review that a paradigm shift towards sustainable agriculture and food production is essential to minimize pesticide residues in food, safeguarding human health, wildlife populations, and the environment. Furthermore, there is a need to refine the conventional methods of pesticide removal from food items along with the development of modern techniques.

Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute's perspective.

INTRODUCTION: Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. METHODS: This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. RESULTS: In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. CONCLUSION: Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.

Living Synthelectronics: A New Era for Bioelectronics Powered by Synthetic Biology.

Bioelectronics, which converges biology and electronics, has attracted great attention due to their vital applications in human-machine interfaces. While traditional bioelectronic devices utilize nonliving organic and/or inorganic materials to achieve flexibility and stretchability, a biological mismatch is often encountered because human tissues are characterized not only by softness and stretchability but also by biodynamic and adaptive properties. Recently, a notable paradigm shift has emerged in bioelectronics, where living cells, and even viruses, modified via gene editing within synthetic biology, are used as core components in a new hybrid electronics paradigm. These devices are defined as "living synthelectronics," and they offer enhanced potential for interfacing with human tissues at informational and substance exchange levels. In this Perspective, the recent advances in living synthelectronics are summarized. First, opportunities brought to electronics by synthetic biology are briefly introduced. Then, strategic approaches to designing and making electronic devices using living cells/viruses as the building blocks, sensing components, or power sources are reviewed. Finally, the challenges faced by living synthelectronics are raised. It is believed that this paradigm shift will significantly contribute to the real integration of bioelectronics with human tissues.

Stakeholder analysis for effective implementation of water management system: Case of groundwater charge in South Korea.

Groundwater Charge was introduced in 2005 as one of the sustainable resource management measures in South Korea. The implementation rate, however, stagnated around 37 %, indicating that most local governments chose not to adopt this 'optional' regulation. While previous Stakeholder Analysis studies mainly blamed exclusion - or limited involvement - of stakeholders in the designing and structuring stage of policy-making process for policy failures, this study focused on the interest conflicts and dynamics hindered implementation process. This is because the issue with the subject policy, i.e., Groundwater Charge in South Korea, is low 'implementation rate' not the 'collection rate' or 'tax deficit.' If it was simply design or structural issue, the Charge should suffer from tax deficit problem due to lower tax income than operational costs. Thus, in order to investigate the reasons of low Charge adoption rate at the local government level, the Stakeholder Analysis Theory was applied to examine each stakeholder of the Charge to distinguish the interaction among supportive and opposing groups. The analysis revealed that there are only strong opponents of the policy without clearly identifiable supporters. Having agricultural & fishery industry and small independent businesses in spas, hotels, and swimming pool as strong Players, the Context setters (local governments) are not motivated to enforce Groundwater charge. Furthermore, today's social norm governed by economic efficiency is preventing the environmentalists and other Subjects to counteract Players. Under these circumstances, this study recommends the Subject to transform the Crowds (general public) into policy supporters through education. Environmental education is the only viable means to encourage necessary paradigm shift to enable effective implementation of environmental policies like Groundwater charge.

Time for a paradigm shift? Small carnivores' sensitivity highlights the importance of monitoring mid-rank predators in future global change studies.

Research Highlight: Jachowski, D. S., Marneweck, C. J., Olfenbuttel, C., & Harris, S. N. (2024). Support for the size-mediated sensitivity hypothesis within a diverse carnivore community. Journal of Animal Ecology, https://doi.org/10.1111/1365-2656.13916. A current paradigm in ecological research suggests that top predators are suitable sentinel species to identify ecosystem dysfunctions and monitor the effects of climate change. However, the adequacy of top predators to systematically take this function may be mistakenly inferred or unintentionally conflated from the fact that these species are regarded as biodiversity indicators or keystone, umbrella and flagship species in most ecosystems. Regarding terrestrial mammalian carnivores (order Carnivora), some researchers recently suggested that the smaller species likely possess a higher sensitivity to environmental changes than large carnivores because of their biological attributes and their intermediate position in food webs. To test this hypothesis, Jachowski et al. (2024) used camera trapping followed by occupancy and structural equation modelling to explore the dynamics of a diverse carnivore community and the factors that influence them. Their results confirmed that small carnivores are more sensitive to habitat changes and are interconnected by a greater number of significant pathways compared with larger carnivores. This support for the size-mediated sensitivity hypothesis strengthens the proposition that small carnivores (and other mid-rank predators) are ideal sentinel species for monitoring the effects of the wide range of contemporary and future environmental changes. Time will tell whether this new 'middle-out ecology' paradigm will be considered in future global change studies.

First-line Management of Metastatic Urothelial Cancer: Current and Future Perspectives After the EV-302 and CheckMate-901 Studies.

The standard of care for the first-line management of metastatic urothelial carcinoma has been recently challenged, with the combination of pembrolizumab and enfortumab vedotin (P-EV) strongly arising as a practice-changing option from classical platinum-based chemotherapies. With this paradigm shift on the horizon new questions, including the most suitable second line of treatment for these patients, and the role that the molecular characterization of these tumours will have when selecting these therapies will inevitably arise. Furthermore, after the negative results of the Keynote 361 and IMvigor 130 trials, the combination of nivolumab with platinum-based chemotherapy followed by nivolumab maintenance (Nivo GC-Nivo) has also shown positive results when compared with chemotherapy alone. Translational studies at a molecular, cellular, and functional level will be key to better explain these discordant results. In this Current Perspective, we discuss the potential impact of these results in clinical practice and propose specific guidance for prospective translational research.

Evidentiary Significance of Routine EEG in Refractory Cases: A Paradigm Shift in Psychiatry.

Over the past decade, the Diagnostic and Statistical Manual's method of prescribing medications based on presenting symptoms has been challenged. The shift toward precision medicine began with the National Institute of Mental Health and culminated with the World Psychiatric Association's posit that a paradigm shift is needed. This study supports that shift by providing evidence explaining the high rate of psychiatric medication failure and suggests a possible first step toward precision medicine. A large psychiatric practice began collecting electroencephalograms (EEGs) for this study in 2012. The EEGs were analyzed by the same neurophysiologist (board certified in electroencephalography) on 1,233 patients. This study identified 4 EEG biomarkers accounting for medication failure in refractory patients: focal slowing, spindling excessive beta, encephalopathy, and isolated epileptiform discharges. Each EEG biomarker suggests underlying brain dysregulation, which may explain why prior medication attempts have failed. The EEG biomarkers cannot be identified based on current psychiatric assessment methods, and depending upon the localization, intensity, and duration, can all present as complex behavioral or psychiatric issues. The study highlights that the EEG biomarker identification approach can be a positive step toward personalized medicine in psychiatry, furthering the clinical thinking of "testing the organ we are trying to treat."

Invited review: Ketone biology-The shifting paradigm of ketones and ketosis in the dairy cow.

Ketosis is currently regarded as a major metabolic disorder of dairy cows, reflective of the animal's efforts to adapt to energy deficit while transitioning into lactation. Currently viewed as a pathology by some, ketosis is associatively implicated in milk production losses and peripartal health complications that increase the risk of early removal of cows from the herd, thus carrying economic losses for dairy farmers and jeopardizing the sustainability of the dairy industry. Despite decades of intense research in the mitigation of ketosis and its sequelae, our ability to lessen its purported effects remains limited. Moreover, the association of ketosis to reduced milk production and peripartal disease is often erratic and likely mired by concurrent potential confounders. In this review, we discuss the potential reasons for these apparent paradoxes in the light of currently available evidence, with a focus on the limitations of observational research and the necessary steps to unambiguously identify the effects of ketosis on cow health and performance via controlled randomized experimentation. A nuanced perspective is proposed that considers the dissociation of ketosis-as a disease-from healthy hyperketonemia. Furthermore, in consideration of a growing body of evidence that highlights positive roles of ketones in the mitigation of metabolic dysfunction and chronic diseases, we consider the hypothetical functions of ketones as health-promoting metabolites and ponder on their potential usefulness to enhance dairy cow health and productivity.

Adaptive Care Planning: A paradigm shift.

A key challenge of implementing advance care planning lies in the fact that decisions made in advance require patients and their family members to imagine what their clinical picture will look like rather than knowing or experiencing the clinical circumstances as they unfold. Even more important is the acknowledgment of the unpredictability of a given clinical course. This type of situation requires adaptiveness and flexibility in decision-making that frequently occurs in the moment(s) triggered by changes in health state(s). We describe an alternative frameshifting approach called "Adaptive Care Planning (AdaptCP)," which features an evolving communication between physicians and patients/families with ongoing incorporation of the patient's/family's perspective. This process continues iteratively until each decision can be reached in a way that is both harmonious with the patient's/family's perspective and is consistent with medical treatment options that are actionable for the healthcare team. We include a table of tools drawn from the literature that can help clinicians when implementing AdaptCP.

A new paradigm for regulatory sciences.

Regulatory science, rooted in legal requirements, provides a mechanism for identifying, assessing, and managing harm to humans and the environment from exposure to hazardous substances. A challenge for regulatory authorities is that many governing laws reflect the scientific paradigm of the mid-20th century. By the nature of legislative processes, most laws are not able to readily adapt to incorporate scientific advances that are inherent in an ever-evolving paradigm. Consequently, the issue of rigid legal frameworks has become prominent in global discussions related to the incorporation of reliable and relevant modern technology to fulfill regulatory needs. To explore this issue, we apply Thomas Kuhn's The Structure of Scientific Revolutions as a conceptual framework to help understand the natural progression of scientific paradigms (from normal science, to anomaly, to crisis, to revolution, and finally to a new normal), identify where we are now in the paradigm cycle, and to explore a path towards a revolution that enables timely implementation of the best available science to fulfil legal requirements.

The scientific reinvention of forensic science.

Forensic science is undergoing an evolution in which a long-standing "trust the examiner" focus is being replaced by a "trust the scientific method" focus. This shift, which is in progress and still partial, is critical to ensure that the legal system uses forensic information in an accurate and valid way. In this Perspective, we discuss the ways in which the move to a more empirically grounded scientific culture for the forensic sciences impacts testing, error rate analyses, procedural safeguards, and the reporting of forensic results. However, we caution that the ultimate success of this scientific reinvention likely depends on whether the courts begin to engage with forensic science claims in a more rigorous way.