Background: After the invasion of Ukraine, neighbouring countries were forced to find systemic solutions to provide medical care to those fleeing the war, including children, as soon as possible. In order to do this, it is necessary to know the communication problems with refugee minors and find proposals for their solutions. Methods: A systematic review of the literature from 2016 to 2022 was conducted according to PRISMA criteria. Results: Linguistic diversity and lack of professional readiness of teachers are the main constraints hindering the assistance of refugee children in schools. Problems during hospitalization include lack of continuity of medical care and lack of retained medical records. Solutions include the use of the 3C model  and the concept of a group psychological support program. Conclusions: In order to provide effective assistance to refugee minors, it is necessary to create a multidisciplinary system of care. It is hoped that the lessons learned from previous experiences will provide a resource to help refugee host countries prepare for a situation in which they are forced to provide emergency assistance to children fleeing war. After weeks of tension and an escalation of the conflict in eastern Ukraine that began in 2014, Russian troops invaded Ukrainian territory on 24 February 2022. The escalation of the conflict has transformed the country’s already unstable situation into a full-scale state of emergency . The majThe role of communication in medicine was studied and described back in the 20th century. The results of a 1995 systematic review showed a correlation between effective doctor–patient communication and improved patient health outcomes . PractitAt the same time, studies have outlined the effects of poor communication. It has been found that poor communication can lead to a variety of negative consequences: lack of continuity of care, compromised patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary research and physician time and economic consequences . For exaWith reference to the benefits of proper communication in medicine and the negative consequences in the case of poor and uncoordinated communication, systemic solutions should be sought to simultaneously provide medical assistance to fleeing refugees while preventing a reduction in the quality of the services provided to citizens of countries receiving refugees. With the sudden influx of such a large number of people in such a short space of time, it is essential to develop a management strategy to help as many people as possible in the most effective way. Particular care should be given to fleeing children, for whom the war situation will leave long-term consequences in terms of physical and mental health . By haviIn order to achieve good communication in medical facilities during the influx of paediatric refugees into the host country, it is additionally necessary to learn about the differences in the characteristics of the psychological profile between refugee minors and their peers from a war-affected country, and to find out what challenges the health system of the host country faces and what role non-medical facilities close to the refugee can play in assisting medical facilities in their activities. We believe that the knowledge gained will allow institutions to prepare in advance to effectively assist paediatric refugees, as they will know in advance what health and psychological problems underage refugees may present with, and will allow the better coordination of healthcare activities between the institutions themselves, increasing the quality of medical services and reducing hospitalisation times.The aim of this paper is to report on the topic of communication between refugee minors and health care workers and other public actors from countries experiencing a refugee crisis. A systematic review of the scientific literature from 2016 to 2022 was conducted using PubMed and ResearchGate search engines, followed by a selection according to PRISMA-S Checklist criteria .The thematic search involved finding scientific articles in the PubMed database from the years 2016 to 2022 (a period of increased number of papers emerging on paediatric refugee patients) meeting the criteria: [health care] AND [paediatric refugee], for ResearchGate: [paediatric] AND [refugee] AND [health care] in order to find articles meeting the article’s objectives as accurately as possible. In addition, 3 articles meeting the topic of the paper from other sources (Google Scholar) were included in the review. The search was restricted to English-language articles. Duplicate articles were removed and the abstracts of the received articles were reviewed. The co-authors selected papers containing relevant data on one of the three topics addressed in the paper: issues and characteristics of the health and psychological profile of refugee minors, difficulties related to the refugee crisis in different countries of the world, and proposals for systemic solutions to prepare a country at risk of a sudden influx of refugee minors. The article proposal lists were presented to the other co-authors dealing with the relevant subsections of the thesis, who decided to include a number of articles finally selected for review of the full versions of the articles contributing relevant content to the thesis. Detailed numerical information is provided in The general health status of refugee children is worse than that of non-immigrant children. Infectious diseases such as tuberculosis, measles, malaria, hepatitis B, HIV and intestinal parasites are considered to be among the more serious health problems. An increased prevalence of syphilis and polio virus has also been reported ,15. In tA positive correlation was observed between the incidence of tuberculosis and the percentage of immigrants living in the region .Infections are the most common cause of hospitalisation of refugee minors, and among children, respiratory infections are the most common (Syrian refugees) ,19. StudThe high proportion of children with severe nutritional problems is also a significant problem. Lack of access to sufficient, safe and nutritious food results in a low intake of micronutrients, fibre, fruit and vegetables and a higher incidence of both overweight and obesity and malnutrition resulting in developmental disorders  ,22.Refugee children are at high risk of toxic stress, i.e., extreme, frequent and persistent adverse events without the presence of a supportive carer. These events include, but are not limited to, the death of a family member, a life-threatening illness, a natural or man-made disaster or a terrorist incident. There is often social isolation, discrimination and isolation from family members, which greatly affects the child’s mental health. The prevalence of mental illness among this group is high. Post-traumatic stress disorder, depression and anxiety disorders are the most common ,24; 25% Post-traumatic stress was also observed in 33% of Syrian children living in a refugee camp in Germany  . Similar disorders are observed in Bangladesh, which received Rohingya fleeing the genocide in 2017. Of the 342 children assessed, 97% were hyperactive and 85% had behavioural problems. Half of the respondents were unable to build relationships with their peers .Children may also experience acculturative stress related to the difficulties that may arise in maintaining their own traditions in a foreign environment and religious customs including, but not limited to, preparation for prayer (Afghan refugees) .In studies, refugee minors also indicated negative perceptions of mental illness, the stigma that goes with it, and fear of the social consequences of having such an illness .Among newly arrived refugees, almost 30% of patients were diagnosed with two or more conditions, demonstrating the complex diversity of conditions. The important role of family physicians in the ongoing care, as well as the comprehensive assessment of the health status of immigrants upon arrival in a new country  is highlighted . The quaInadequate oral hygiene and resulting tooth decay is also a serious problem among refugee and immigrant children. The main factors influencing its development are cultural differences and lack of knowledge of protective factors, but also financial constraints. Language and dental experience in the home country are also barriers ,34. The In addition to the aforementioned health problems, one of the reasons for the need for urgent medical care is unintentional injuries. Refugee immigrants have a 20% higher rate of unintentional injuries compared to non-refugee immigrants . SurgicaAmong paediatric refugees, there is also a group of patients suffering from rare genetic diseases including Noonan syndrome, Laron syndrome, mitochondriopathy, Turner syndrome and arthrogryposis. They constitute a small but equally important group requiring regular medical consultations  .Another aspect is skin diseases, which are common among displaced populations. There may also be few or largely limited access to dermatologists in the host country, due to the distance of specialists from the refugee camp and thus the cost of transport . Within The specialised care of refugee patients is quite challenging due to the communication and language barrier, but also the lack of previous medical records, reports of past illnesses and surgical procedures (Syrian refugees) . AnotherAlmost 85% of the world’s refugee population has been hosted in low- and middle-income developing countries. These countries, Lebanon, Jordan and Bangladesh among others, are unable to provide adequate living conditions for such a large number of admitted refugees and face a heavy burden on their health systems .Data from Lebanon indicate that Syrian refugee children are very often injured while living in refugee camps. The most common type of injury was burns, which have been proven to be clearly due to the low socio-economic status of Syrian refugee families and poor housing conditions . In addition, refugees have limited access to health care, lack insurance and the ability to cover medical costs. In Lebanon, there is a lack of systemic interventions to improve this situation, in contrast to numerous high-income countries where significant funding has been allocated for prevention, burns treatment and aftercare .Statistics show that around 83% of refugee families in Lebanon have at least one person who suffers from a chronic illness, putting a significant strain on Lebanon’s already underfunded health system. One study analysed data on Syrian refugee children with heart defects. It noted that there is an increased rate of severe CHD among refugee children due to lack of access to health care, with only children with severe symptoms being able to receive medical attention. In developing countries, fewer patients reach adulthood due to delayed diagnosis, and inability to start or complete treatment. All costs associated with this examination and treatment of Syrian children with heart defects have been covered by non-governmental organisations , and medical professionals have often waived their salaries .Another form of assistance to refugees is NGO-organised medical missions in Jordan such as the short-term SAMS medical mission in a camp for underage Syrian refugees. Infectious diseases and GDO infections were most common among the children treated. This was facilitated by the living conditions in the camp, including overcrowding, lack of access to drinking water and hygiene products. Typically, infections were severe due to delayed diagnosis and difficult treatment conditions—doctors received patients in tents without specialised equipment .One study in Bangladesh highlighted the widespread lack of palliative care for refugees in humanitarian relief, an essential component during a humanitarian crisis. Many patients are experiencing pain and suffering due to severe injuries and illnesses, yet national regulations limit access to powerful painkillers. Neither the government nor NGOs are showing action to improve this situation. Among the refugees surveyed, as many as 62% (n = 96) experienced significant pain  and in 70% (n = 58), the prescribed treatments were ineffective . A total of 39.1% reported a need for medication and only 52.5% (n = 32) among them received their medication; 52.6% reported needing medical equipment and 72.0% (n = 59) of these patients did not have access to it .In contrast to developing countries, highly developed countries face, usually, quite different problems regarding refugees. As a rule, they are provided with decent living conditions and care, but systemic solutions that are not fully effective are a problem.According to the 2016 Australian guidelines, every arriving refugee must undergo a comprehensive health assessment. A medical examination is mandatory for all refugees and asylum seekers and should be conducted within 1 month of arrival in Australia. TB and Hepatitis B screening and booster vaccinations are also part of this procedure. These comprehensive screenings are carried out within the primary health care setting and with the assistance of nurses from the Special Refugee Health Program, who are also tasked with facilitating access to health care for newly arrived refugees. Refugees with confirmed active TB are treated prior to travel, and those with early or latent TB are referred to TB centres for follow-up in separate health facilities . HoweverSome inconsistency in health care for asylum seekers has been shown in Finland. The Finnish health care system for refugees is separate from general health care and funded by the immigration service. However, asylum seekers under the age of 18 have the same access to health services as Finnish children, including school health care. Despite this, the municipal authorities managing the medical facilities in their area have not provided services to refugees, have not been involved in combating infectious disease outbreaks and have denied public health services to refugee children. As a consequence, immigration services were forced to organise and pay for medical services in private facilities, where they were often incomplete or of poor quality. Even the introduction of further guidelines by the Finnish government did not influence the decisions of municipal authorities .An important aspect concerning the lives of refugees in highly developed countries is marginalisation, discrimination and racism. In European countries, i.e., Italy, Switzerland and the Netherlands, the risk of immigrants being assaulted was much higher than in Canada or the USA .Using Spain as an example, it can be concluded that unstable living situations and frequent relocation, limit access to healthcare and prevent continuity of treatment. In the study conducted, approximately 83% of the immigrants surveyed completed the entire treatment process, while only 22% completed the hepatitis B vaccination schedule. It should be noted that the medical care and vaccination offered were free of charge, and the failure of the treatment process was most likely due to the unfavourable factors mentioned earlier .Migrants and refugees have specific health needs while facing a number of barriers to accessing the health care system. Research indicates that language and cultural barriers have a negative impact on the healthcare of people with limited knowledge of the language spoken in the country, resulting in limited access, higher hospital admissions, increased risk of permanent damage and limited health knowledge due to communication difficulties . In thisInterpreter services play a key role in the healthcare system. An interpreter is a communication specialist trained to translate everything that is said, maintain confidentiality, ensure transparency and point out cultural differences that impede communication . The useRefugees, especially children, are exposed to multiple mental health risks. Repeated trauma in turn puts the refugee child at high risk of post-traumatic stress disorder (PTSD), anxiety, somatisation disorder and depression . To addrEstimates of the prevalence of PTSD among adolescent refugees range from 11 to 75 percent, while depression ranges from 4 to 47% . In ordeIt is also beneficial to include the targeted community in the development of solutions. This was demonstrated by the example of developing, according to the community-based participatory research (CBPR) model, an innovative vaccine education technology using virtual reality. The project targeted Somali refugees. The community was involved through a series of discussions, interviews with Somali parents, workshops and the use of virtual reality techniques in teaching .Refugee children often have learning and developmental problems, but come for help too late, failing to take advantage of early intervention or school and social support available in developed countries. Risk factors for problems at school include the experience of trauma (before or after migration), interrupted learning, low teacher expectations of school achievement, financial problems in the household, while protective factors include knowledge of the language of instruction in the new country, adequate recognition of the child’s educational experience by the school team, appropriate assessments and expectations, parental support in the education process and a high level of parental education .The Turkish General Directorate of Teacher Training and Education has launched a series of national in-service training workshops on inclusive education, specifically the education of Syrian refugee children, children with disabilities and children affected by violence, immigration or natural disasters. The introduction of visuals, games or stories for Syrian children with Turkish subtitles has been shown to assist their integration into their new school environment . In ordeThe health status of children and adolescents is significantly influenced by school nurses, who are the first of the health professionals to encounter refugee children and adolescents. Therefore, they may have a particular role in supporting them during such a difficult time. A qualitative study conducted in 2019 among Swedish nurses found that they need to expand their skills in recognising the needs of people in crisis and after traumatic events, expanding their knowledge of the culture of the refugee child’s country of origin .The fluctuating situation and the increasing number of displaced persons pose humanitarian and logistical challenges to the health systems of refugee-hosting countries. For example, Ukrainian refugees may face barriers to healthcare upon arrival in both transit and destination countries.This review highlights the importance of changing the mindset between a paediatric refugee patient and a patient who has not experienced fleeing war. The authors of the study repeatedly highlighted the situation where, together with the arriving patient, the local health system had to face de facto problems of the health system of the country from which the refugee came, if only in the context of immunization ,15,16. CThe experience of countries that have had to deal with the need to take in refugees in the past decade shows that there is a large spectrum of problems in providing assistance to displaced persons depending on the wealth of the country. While elementary health care needs, i.e., prevention, burn and post-burn care, availability of doctors or palliative care, are not being met in the poorest countries ,46,47, iIn order to provide effective assistance, it is necessary both to ensure rapid communication within the ward and between hospital departments, which requires financial outlays for, among other things, hiring interpreters, and to create a system in which the patients’ records are available in other facilities in the country or region, e.g., the European Union . It is wThe important role of the school in the process of integrating students must not be forgotten. The involvement of medical professionals working there, e.g., school psychologists and nurses, should be used to break down barriers between children speaking different languages to each other ,67. In aThe problem raised calls for systemic changes that are necessary to effectively help refugees. Let us not forget that today’s young patients are a group of intelligent and valuable people who, in a few years or so, may repay the societies that receive them in an emergency situation with their work, for example, filling jobs in professions that are understaffed in the country that has duly taken them in. We believe that the effort made to improve communication in medicine will bring with it long-term positive effects in every country where minors are helped.


Damage occurs easily and is difficult to find inside fruits and vegetables during transportation or storage, which not only brings losses to fruit and vegetable distributors, but also reduces the satisfaction of consumers. Spatially resolved spectroscopy (SRS) is able to detect the quality attributes of fruits and vegetables at different depths, which is of great significance to the quality classification and defect detection of horticultural products. This paper is aimed at reviewing the applications of spatially resolved spectroscopy for measuring the quality attributes of fruits and vegetables in detail. The principle of light transfer in biological tissues, diffusion approximation theory and methodologies are introduced, and different configuration designs for spatially resolved spectroscopy are compared and analyzed. Besides, spatially resolved spectroscopy applications based on two aspects for assessing the quality of fruits and vegetables are summarized. Finally, the problems encountered in previous studies are discussed, and future development trends are presented. It can be concluded that spatially resolved spectroscopy demonstrates great application potential in the field of fruit and vegetable quality attribute evaluation. However, due to the limitation of equipment configurations and data processing speed, the application of spatially resolved spectroscopy in real-time online detection is still a challenge. Nowadays, optical imaging and spectroscopy technologies are widely used in the quality and safety assessment of fruits and vegetables. The quality of fruits and vegetables has also attracted more attention, especially under the serious circumstances of the global COVID-19 pandemic, which is forcing people to rethink their lifestyles and diets. This will undoubtedly introduce many opportunities and challenges into the quality evaluation of fruits and vegetables. From the initial focus on external detection to the current research on the internal quality evaluation of fruits and vegetables [Optical detection technology is mainly based on the principle of interaction between light and biological tissues. Absorption and scattering effects will occur when the light source illuminates the biological tissue. The absorption is mainly related to chemical composition, while the scattering is often thought to be connected with the physical structure of biological tissues. Therefore, the internal quality of biological materials changes with their physical structure and chemical composition, resulting in changes in the optical properties of biological tissues ,3,4. ThuIn order to remove this limitation, researchers have begun to study the optical absorption and scattering characteristics of biological tissues separately, and many new technologies have emerged, such as time-domain technology ,22, freqTherefore, in the following, the principle of light transmission in biological tissues and the diffusion approximation theory are explained. Then, different potential ranges, advantages, and problems of the spatially resolved spectroscopy are described in relation to different instrument configurations. The application for SRS in fruit and vegetable quality detection is also reviewed from two aspects of optical properties and spatially resolved (SR) spectra. Finally, the challenge and problems for previous studies are discussed and analyzed, and then future development trends are given.To understand the principle of spatially resolved spectroscopic technology when used in fruit and vegetable quality detection, we must first understand how light propagates in and interacts with biological tissues, and how to apply this propagation law to the actual application of fruit and vegetable quality inspection.From the microscopic point of view, biological tissue is composed of a large number of tiny cells. They are mainly composed of the nucleus, cytoplasm, and various organelles . Each ofaμ) to describe the ability of biological tissues to absorb light. The light scattering characteristics of biological tissue are mainly related to its physical structure, such as cell density, cell volume, and so on. Similarly, we will use the scattering coefficient (sμ) to describe the light scattering ability of biological tissues [The light absorption characteristics of biological tissues mainly depend on its chemical components, such as pigment, water, carbohydrate, etc. (for fruit and vegetable products). We usually use the absorption coefficient ( tissues .g) is introduced to measure this inhomogeneity. Combined with the scattering coefficient (sμ), the reduced scattering coefficient (sμ′) is obtained to reduce the variables of the transmission model (sμ′ = sμ(1 − g)) [However, light scattering is inhomogeneous, proliferating in all directions in biological tissues. The anisotropy coefficient ((1 − g)) .The propagation of light in biological tissues can be described by the radiation transfer equation (or the Boltzmann equation) ,47. Howesμ′ >> aμ), the radiation transfer equation can be simplified to a diffusion approximation equation. Two analytic solutions commonly used at present were respectively proposed by Farrell and Patterson [For biological materials dominated by scattering effects  camera, as shown in However, as it is limited by the size and shape of the probe, this configuration is only suitable for samples with a small source-detector distance and a flat surface ,65. EspeAt present, the most commonly used measurement method within spatially resolved technology is hyperspectral line-scan imaging ,71, as saμ) and reduced scattering coefficient (sμ′) values related to the optical properties of fruits and vegetables, and they are then combined with mathematical models based on the aμ and sμ′ values to realize the prediction of quality attributes of fruits and vegetables. The study of optical properties has generally been aimed at quality attribute assessment, defect detection, and layered structure analysis.In the beginning, spatially resolved spectroscopy was mostly used in the field of medical diagnosis, to carry out the inspection of diseased or abnormal tissues of the human body by analyzing the propagation characteristics of light in biological tissues. Later, it was used to evaluate the quality attributes of fruits and vegetables. The specific steps are as follows: firstly, based on diffusion theory and the reverse algorithm, the spectral data are fitted to obtain the absorption coefficient  are thought to be internal quality characteristics closely related to the maturity of garden products. Therefore, it is necessary to explore the relationship between quality attributes and optical characteristic parameters. In experimental research, standard reference values are often set by means of physical and chemical experiments. Firmness values can be measured by the Magness Taylor test, while SSC values are usually determined by the Brix meter. As mentioned above, the absorption and scattering coefficient values are obtained by fitting the spectral data, and they are then correlated with the standard value of the quality attribute to judge the accuracy of the prediction model.aμ and sμ′ were related to fruit firmness and SSC, and the same conclusion was also achieved by Qin and Lu [aμ or sμ′) for quality attribute prediction, the combination of the absorption coefficient and the reduced scattering coefficient can improve the prediction results [Qin et al.  measuredn and Lu  (tomato)n and Lu   and reduced scattering coefficient (sμ′) of normal and damaged tissues of two different varieties of apples (Golden Delicious and Red Delicious). They found that bruising would change the aμ, but the change patterns of two different varieties of apples were not consistent. In addition, the scattering coefficients (sμ) of normal apples were much higher than those of bruised apples. Therefore, an optical system for measuring enhanced scattering features will be more useful for damaging detection. Similarly, they investigated the optical absorption and scattering characteristics of normal and internally defective pickled cucumbers, and found that the influence of the total mechanical damage on the scattering properties is greater than that on the absorption properties [sμ′ and an increase in aμ. Moreover, internal damage to the peach tissue can be observed via the optical properties before the appearance of symptoms observable by the naked eye, which confirms the potential utility of fruit optical property assessment compared with manual selection.Defect detection is focused on the application of classification on damaged or diseased fruits and vegetables. Some fruits are likely to be damaged during picking or postharvest transportation, such as apples and peaches. It is necessary to analyze the optical properties of these fruits to judge the relationship between damage and fruit defect detection. Using SRS technology based on hyperspectral imaging, Lu et al.  studied operties . The resoperties  measuredsμ′ decreased with the aggravation of peach disease. Moreover, aμ and sμ′ showed the highest correlation with chlorophyll content in the first 72 h after inoculation. This means that the optical absorption and scattering properties can provide effective information useful for early disease detection in peaches.In the process of postharvest transportation and storage, fruits are prone to become diseased as a result of fungal infection, which will bring about unnecessary economic losses in the fruit industry. Sun et al.  measuredMealiness is an internal disorder without any obvious external symptoms but affects the taste of apples. Three classification models were used to sort mealy and non-mealy apples with spatially-resolved scattering images at 650 and 980 nm in Kaveh’s study . An overMost fruits and vegetables are multiple-layer structures. The depth of light penetration into fruit and vegetable tissues is much greater than the thickness of the peel, and ranges from 2 to 4 mm  for applAskoura et al.  found thGreat majority of studies have been conducted on various quality attributes of fruits and vegetables from a macroscopic perspective. Cen et al. made a preliminary exploration on the relationship between the changes of optical properties and the microstructure of fruits . The tisSpatially resolved spectroscopy is based on spectral data instead of optical property parameters, and is coupled with a selected mathematical model to directly predict the quality attributes, or to carry out a classification of fruits and vegetables. As P = 0.848–0.919. This study shows that hyperspectral scattering can be used to evaluate the bruise sensitivity of apples, which will inform the post-harvest treatment of fruit.Bruising is also a common cause of losses to orchardists during the post-harvest transportation and storage of fruits. To quantify the bruise susceptibility of fruits, Zhu et al.  extractePeng and Lu  proposedMealiness is a symptom of physiological fruit disorder, characterized by the abnormal softness and the lack of free juice in the fruit. Huang and Lu  acquiredHuang et al.  applied Currently, with the increase in human consumption levels and the changes in consumption acceptance, more attention is being paid to the issue of healthy diet habits, especially related to fruits and vegetables. In recent years, research and surveys based on spatially resolved spectroscopic technology have become prevalent, providing an effective and reliable method for the evaluation of the quality attributes of fruits and vegetables ,74.The optical fiber probe-based SRS method is simple in configuration, easy to operate, and can obtain quality information at different depths in the sample . Great rThe SRS method also has limitations in fruit and vegetable quality evaluation . Since tThe selection of different mathematical models has a significant impact on the results of prediction or classification. At present, most of the models used in fruit and vegetable quality detection are PLS and SVM models. Neural network or deep learning algorithms based on spatially resolved spectroscopy have not been reported. Therefore, appropriate mathematical models should be developed for different fruits and vegetables, rather than using the same mathematical model. In addition, compared with the average reflectance method alone, the extraction of spectral data combined with image feature analysis can significantly improve the prediction results of the quality attributes of fruits and vegetables . ExtractConsiderable progress in research on spatially resolved spectroscopy has been made in the past 20 years, and it has demonstrated the great application potential in the field of fruit and vegetable quality attribute detection. This paper reviews the applications of spatially resolved spectroscopy in the quality evaluation of fruits and vegetables in detail. Applications on the prediction and classification of fruit and vegetable quality attributes are widely developed based on optical properties. SRS shows great potential in physical and chemical property evaluation, defect detection and tissue structure analysis. There are few studies on the applications of the quality evaluation directly based on spatially resolved spectra for fruits and vegetables. However, for directly spatially resolved spectra assessment, the data process is simpler than that for extracting optical properties, which reduces the possibility of introducing errors. Overall, the internal and external quality characteristics of fruits and vegetables can be detected simultaneously via spatially resolved spectroscopy. However, there are still great challenges in improving the detection speed and accuracy. Therefore, the comprehensive utilization of various processing means, including the design of instrument configuration, data preprocessing, the selection of the specific wavelength and model, and the combination with other imaging methods, can expand the SRS applications.


African Swine Fever (ASF) is a challenge for pig health worldwide. The disease has spread to multiple countries on five continents. ASF‐free countries need to apply effective strategies to prevent the introduction of infection.Italy implemented a surveillance and prevention plan for ASF in 2020, supported by a dedicated information system. Several pillars for action have been identified: passive surveillance in both domestic pigs and wild boar populations, verification of the implementation of biosecurity measures on farms and an awareness campaign for all involved stakeholders.There were some regional differences in the management of passive surveillance. In order to identify all critical points and apply corrective measures, regional authorities were called to carry out a gap analysis exercise in July 2020. There were an adequate number of samples collected from wild boar but the number of samples collected from domestic pigs was below the target in most regions. Furthermore, sample distribution within the country was not homogeneous.During the forthcoming year, some issues must be addressed in order to establish an effective early detection system in Italian ASF‐free regions. African Swine Fever (ASF) is a challenge for pig health worldwide. Italy implemented a surveillance and prevention plan for ASF in 2020. An analysis of results of this plan for 2020 has been carried out. ASF was first detected in sub‐Saharan Africa, where it is an endemic disease maintained by a wild cycle between warthogs and Ornithodoros soft tick vectors, but it was able to spread worldwide, both by direct as well indirect contact  is a haemorrhagic disease that occurs in domestic pigs and wild boars. It is caused by a DNA virus belonging to the Moreover, the virus is very stable in the environment and in food, being able to remain in preserved meat for up to 6 months , developed a surveillance plan to be implemented in 2020, with the aim of preventing the possible introduction of virus in the rest of the country through early detection of infection .In 2020, the Italian Ministry of Health implemented a national surveillance and prevention plan to prevent and detect ASF infection in domestic pigs and wild boars. The plan included different actions, such as passive surveillance measures in wild boar populations and domestic pigs, application of biosecurity measures, and communication and training of stakeholders. The surveillance program was based on collecting and analysing samples from found dead animals and on the notification of every suspect case. National legislation, as recommended by European rules, requires that any suspect case of ASF should be notified; moreover, if a suspect case of ASF is detected, the National Contingency Plan should be applied. The measures required to prevent the spread of infection are maintained by the local veterinary service until laboratory investigations enable the occurrence of the disease  to be ruled out. In the event that an outbreak is confirmed, all the measures provided by the National Contingency Plan are confirmed and reinforced in the restricted zones (surveillance and protection zones) around the first detection of the virus . Wild boar sampling was planned in order to rule out ASF virus infection in the general wild boar population. The ASF plan includes the sampling of all wild boars found dead; in order to provide a number to be used as indicator in reporting, a minimum target of 600 samples is identified for the whole country. Each Italian region is required to collect a certain number of samples, according to the wild boar population estimate in that territory, with the aim to find at least one positive sample in case of infection presence. Each regional target represents in turn the minimum number of samples to be collected and tested. Anyway, of course, in case of reasonable suspicion of ASF based on the clinical signs, post mortem lesions, or epidemiological evidence , the National Contingency Plan should be applied.Regarding domestic pigs, any suspected case  must be notified to the competent authority, and the authority should apply the measures described in the specific contingency plan. Sampling for passive surveillance in domestic pigs was planned for all suspect cases and preferably for farms including less than 50 animals (family and backyard farms). In the absence of suspect cases, veterinary service is required to collect samples from at least two dead pigs per region and per week, in order to improve the sampling sensitivity.Moreover, in order to include the rearing systems considered at major risk for the transmission of ASF due to their lower levels of biosecurity, in every region, half of the whole amount of samples planned from domestic pigs should be collected from backyard and family farms, while the remaining ones should be collected from commercial farms.For both wild boars and domestic pigs, the collected target organs, such as the spleen, kidney, lymph nodes, or bone in the case of wild boar carcasses in an advanced state of decomposition, are delivered to the competent official laboratory for analysis. The veterinary service can choose to send organs or the whole carcass to the laboratory, according to the regional guidelines. Samples collected for surveillance are accompanied by a dedicated form reporting information about the animal , the location where it was found  or origin farm details (for domestic pigs) and the sample type (organ).All forms are registered in a national database, hosted by the national portal of the animal information system (Vetinfo), and is used for both wild boars and domestic pigs. The database contains all data regarding each sample collected for ASF passive surveillance. Specifically, the veterinary services are responsible for data entry regarding farm details (domestic pigs) and source location (wild boars), while laboratories input the results of the diagnostic tests. In fact, each form is identified by a unique numeric code that allows the sample to be traced and matches the sample identification data with the corresponding results.The collected samples are used for ASF genome investigation in line with the European Commission guidelines on rapid alert systems . Routine tests are carried out by the network of the Istituti Zooprofilattici Sperimentali regional laboratories, while confirmatory tests are examined by the NRL. In the event of any clinically or epidemiologically suspected case, samples are sent directly to the NRL. All laboratories were asked to take part in a ring test, arranged by the NRL, so that standard diagnostic procedures could be followed throughout the country. The NRL suggested the use of real‐time PCR targeting a 250 bp fragment of the reference strain BA71V. It represents an extremely conserved portion of the B646L gene, which encodes the principal structural protein of the virus (VP72) and is able to identify all known genotypes (King et al., NRL supports the Ministry of Health compiling periodic reports to verify the progress of surveillance activities for ASF and to manage any critical issues. A general activity check was conducted from June to September 2020, by engaging with regional authorities. The gap analysis approach was used to evaluate eventual gaps affecting surveillance activities and to identify corrective measures. Specifically, 20 regional working groups have been established, including regional veterinary authorities, that focused on the territory under their jurisdiction.The whole process was planned in three stages. First, a virtual meeting was held, after the first semester of plan implementation, on June 2020. Ministry of Health described the aim of this verification activity and asked each regional delegation to conduct a gap analysis based on a standardised questionnaire. Then regional working groups carried out their assignments in three months. In order to perform the required activities, components of each group met as often as needed, and they could be supported by NRL in those occurrences more difficult to solve. When completed, gap analysis results were evaluated by Ministry of Health and NRL for each region. Finally, a virtual meeting took place on September 2020 in order to give a feedback to working groups. So, based on gap analysis results, adequate measures were recommended by Ministry of Health in order to solve the identified regional gaps.‐The current situation and optimal standards to be achieved‐Identification of gaps between the current and the desired situation and of the measures to be applied‐Evaluation and identification of the resources needed to fill the gaps identified‐Identification of factors that could promote or limit performance of surveillance activitiesThe questionnaire comprised five key sections about the implementation of the ASF plan: passive surveillance in wild boars, passive surveillance in domestic pigs, wildlife management procedures, implementation of biosecurity measures, and training activities. For each topic, the regional working groups were asked to provide the following information:3The law orders were not yet ready at the beginning of 2020 and the official launch of the plan was delayed. In addition, the national database was implemented later than the official launch of the plan. For this reason, samples collected in the first months of 2020 were registered in the database retrospectively, and some data may have been lost.Veterinary services accidentally creating a record, resulting in the database having an incomplete form suggesting that samples have not been providedRegional laboratories failing to enter test results, resulting in the database having an incomplete form suggesting that tests have not been conductedTherefore, many of the records were non‐compliant, registering incomplete data, both for domestic pigs and for wild boar. In particular, a considerable number of samples were not registered correctly, lacking some data in the database, for different reasons, such as:This topic was accentuated especially in some regions, where data entry work proved to be more difficult, for insufficient skill or matter of delay in data input.Regarding domestic pigs, the target was reached in only a few regions Figure . CertainRegarding wild boars, sampling started slowly in several regions, and many records were incorrectly or incompletely registered in the national database. Despite the difficulties, at the end of the year, many regions reached or exceeded the minimum number of samples requested by the plan. Specifically, 15 regions were able to achieve their sampling targets for wild boars Figure , compareConsidering the localisation of sampled animals, wild boars were fairly homogeneously distributed throughout the country, but with fewer samples submitted in the southern regions. The under‐sampling of the southern regions was more marked for domestic pig surveillance Figure . However4The Italian veterinary services have had the opportunity to get to know ASF very well. They have had longstanding experience because of the endemic situation in the Sardinia Region, which has required significant resources, particularly in recent years, to get closer to eradicating the infection and which still necessitates restrictions on the Sardinian swine sector effectively preventing its development (Loi et al., Considering the evidence recorded over more than 40 years, the Italian and Sardinian authorities have demonstrated that they are able to effectively manage the risk of virus escape from Sardinia. There has been only one outbreak originating from Sardinia that occurred in 1983. It was notified and immediately eradicated (Danzetta et al., At present, based on different conditions in Sardinian scenario rather than the European one (Laddomada et al., Thus, all Italian regions are exposed to the risk of ASF outbreaks that would have devastating effects on local and national economies. A possible ban on the export of fresh and cured pork products is a particular concern. Italian pork products are in large demand worldwide and are of great economic importance, with potential for growth in the near future.For these reasons, the initiative of Ministry of Health to provide a dedicated surveillance plan, able to implement the actions required to prevent the spread of the disease in the wild boar population and the domestic swine population, was theoretically appreciated by stakeholders. The National Surveillance Plan applied in 2020 aims to promote greater awareness that the early detection of infection is necessary in order to reduce ASF serious health and economic consequences. In fact, the main objective of the plan is to manage the alert and pre‐emergence phases in order to increase the attention level in official veterinarians and farmers.Overall, this plan is an ambitious programme in Italian contest. For the first time, the veterinary services had to consider wildlife as a relevant target of their activity. Similarly, the surveillance of domestic pigs has been planned in detail and is directed specifically towards small farms that often have an inadequate level of biosecurity. The plan was developed as the result of a collaboration between the Ministry of Health, the NRL, wildlife experts, and representatives of the regional authorities. In addition, in the past, disease eradication plans were based on active surveillance and detection of residual infected animals on farms, in order to obtain the indemnity status. In this case, however, the program is based on prevention and the protection of territories that are currently free of infection. This approach is perfectly in compliance with the guiding principles of the European AHL.Despite these positive expectations and a spirit of active collaboration, the initial phases of the plan have revealed a number of implementation challenges, particularly in the first part of the year. General guidelines were not immediately received and implemented at local level and, in the absence of specific local procedures, an insufficient number of samples were collected, particularly in the southern regions.Regarding the wild boar surveillance, most tested samples were related to road accidents. As these data were not officially recorded in 2020, it was established to insert the flag ‘wild boar road killed’ into the national database for 2021 and 2022 years. Nevertheless, the method of sampling wild boars needs further consideration because using samples collected following road accidents is a matter of debate (Jori et al., Surveillance in domestic pigs was initially directed towards family and backyard farms, recognised as having the highest risk of exposure to the eventual introduction of the virus. However, family farms are intended for self‐consumption: mortality rate is low and farmers do not communicate data about mortality events regularly to veterinary services. For this reason, in the plan, also commercial herds were considered as feasible to be sampled for surveillance purposes.Based on this evidence, the Ministry of Health, in cooperation with NRL, after the first half year of plan measures implementation, carried out an intensive verification activity by using the gap analysis technique, as above described. The impact of this training was positive and resulted in an increase in the number of samples submitted in the second half of the year.However, some weaknesses remain unresolved. Specifically, sampling is not representative of the entire country because program administrators in some regions entered poor quality data in the surveillance system. This lack of data was partially due to a large number of incomplete records. Moreover, the COVID‐19 pandemic affected the organisation and outcome of the surveillance plan. Although ASF passive surveillance was considered a non‐deferrable activity, a number of regions requested a reduction of the targets specified in the plan.Despite the difficulties, most of the Italian regions reacted in a positive manner to the surveillance plan during its first year of implementation, and as a result of this experience, compliance with the plan is likely to improve, and to reach an adequate level of surveillance in relation to the disease risk by the end of 2021. The ASF plan for 2021/2022 intends to increase the level of alerts and improve the early detection system. New tools, such as guidelines on the management of the wild boar population and a method to perform a risk analysis for passive surveillance in domestic pigs, have been introduced in the ASF plan for 2021/2022. It also includes also new activities, such as simulation exercises and carcass research.The Italian Veterinary System hopes in this way to address the threat posed by ASF and to limit the damage of a possible future introduction of the infection in territories that are currently still ASF free.Post scriptum: under the surveillance activities above described, on January 2022, ASF virus, genotype II, was detected in a wild boar found dead in Piedmont region. In mainland Italy, ASF threat has been real ever since.The authors declare no conflict of interest.The authors confirm that the ethical policies of the journal, as noted on the journal's author guidelines page, have been adhered to. No ethical approval was required as this article reports on routine surveillance activities.Writing‐ original draft preparation: V.C. Conceptualisation and writing: C.I. and F.F. Investigation and formal analysis: C.I. Review and editing: F.F. Visualisation: O.B., F.P., L.R. Supervision: F.F.https://publons.com/publon/10.1002/vms3.824The peer review history for this article is available at


Health-related quality of life (HRQoL) is an interesting topic in health care sciences and psychology. Deeper insight into the internal mechanism of this effect through large samples is crucial to further understanding HRQoL and making targeted suggestions to improve HRQoL. The present study aims to investigate the mediating role of interpersonal trust between age and HRQoL from a developmental lens. The purpose of this study was to profile the Pediatric Quality of Life Inventory 4.0 generic scale in China and test the relationship between age and health-related quality of life, as well as the mediating role of interpersonal trust and the moderating role of gender. A sample of 6248 children completed measures of demography, health-related quality of life, and interpersonal trust. Regression analyses were performed to test the mediating role of interpersonal trust and the moderating role of gender. Age was associated with lower health-related quality of life and lower interpersonal trust. Similarly, gender differences were also noted, with boys reporting higher health-related quality of life and lower interpersonal trust than girls. Additionally, the health-related quality of life of girls declined more than that of boys with increasing age. Regression analyses revealed that age could predict decreased health-related quality of life via lower levels of interpersonal trust. What is more, the mediation effect was moderated by gender, with the observed mediation effect being stronger among boys than girls. The current study replicates age and gender differences in health-related quality of life and interpersonal trust. Moreover, this study explained how and when age affected the health-related quality of life of children, and provided a deeper understanding of the relation between age and health-related quality of life. The Program for a Healthy China 2030, approved by the Political Bureau of the CPC Central Committee, has set an action plan for the construction of a healthy China. The program aims to improve health, including health-related quality of life (HRQoL), because HRQoL is an indispensable prerequisite for national well-being as well as the foundation of economic and social development . Health-Research assessing gender differences in HRQoL in children and adolescents is much more consistent across different studies. Specifically, a study on the self-reported problems of 9 to 17-year-old youth from seven European countries revealed that a greater decrease in HRQoL was found for girls than boys . AnotherConsistent with other international studies, a few studies have replicated both age and gender differences in HRQoL in a Chinese context. For example, Dou 2007) gathered data on 1113 children from Henan province and found that children in the elementary grades reported higher HRQoL than older children, and boys reported higher HRQoL than girls . Li and 07 gatherInterpersonal trust refers to a mental state of individuals involving confident, positive expectations about the actions of another  and is aSurprisingly, only two studies, to our knowledge, focus on the links between interpersonal trust and HRQoL. Specifically, Tokuda and colleagues 2008) examined the relationship between interpersonal trust and HRQoL among a sample of adults from a Japanese population 08 examin. The worA growing body of research has indicated that interpersonal trust is pertinent to age and gender. Specifically, adults tend to have an increase in interpersonal trust as they get older ,33, wherFor these reasons, it seems more likely that interpersonal trust is a mediator between age and HRQoL. However, no published work to date has merged these variables together to examine whether interpersonal trust mediates the association between age and HRQoL. Further, given the gender differences in HRQoL ,9,10, itAlthough some studies have explored the relationship between age and HRQoL, there has been a lack of research exploring the potential mechanisms underlying the age-HRQoL pathway, especially among children . In addip = 0.12), and no significant difference in the demographics between the students who were included in the study and those who were excluded.Participants were recruited from primary and secondary schools in China. Seven thousand students took part in this study in exchange for extra course credit in their psychology class. Of the initial 7000 students, 752 (11%) were excluded because of incomplete data related to study variables. The final sample consisted of 6248 Chinese students from 9 to 15 years of age  enrolled in fourth grade to ninth grade, including 2938 girls  and 3310 boys . The distribution of age and gender among participants is presented in With appropriate permissions from the school boards, we fully communicated with parents/legal guardians through the teacher to obtain their assent. After obtaining the assent of teachers, parents, and students, students completed the survey during normal class hours. Students were allowed to participate voluntarily and anonymously and clarify questions in a unified environment. A cluster sampling method was employed to sample. Moreover, they were thanked and assured that their answers were completely confidential. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at Zhengzhou University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.HRQoL was measured using the Pediatric Quality of Life Inventory 4.0 generic scale (PedsQL), which is a well-validated measure to evaluate the HRQoL of children. The scale comprises 23 items that are scored on a 5-point scale  and provides the physical, emotional, social, and school functioning score. The score of each subscale was the sum of the scores of the contained items divided by the number of the contained items, and the score of the entire scale was the sum of the scores of the items divided by the number of the items in the whole scale. Higher scores indicate that the children have a better HRQoL. In this study, we used the Chinese version of this scale. Sample items included low energy and worry about what will happen, and the Cronbach’s α was 0.90 for the entire scale.Interpersonal trust was measured using the Kiddie Machiavellianism Scale (KMS), which is a validated measure to evaluate the children’s attitudes towards human nature and interpersonal trust in interpersonal relationships . The scaAll statistical analyses were carried out using SPSS Statistics for Windows, Version 22.0 . Boys and girls were compared on all constructs. Relationships among age, gender, interpersonal trust, and HRQoL were examined with Pearson’s correlation. Tests for the moderated mediation effect (Model 59) were conducted using the procedures outlined in Hayes . Before Significant trends were observed in both HRQoL and interpersonal trust related to age, indicating that, compared with older children, younger children have higher interpersonal trust and a higher quality of life. Specifically , the totPearson product-moment correlations are presented in We conducted a moderated mediating effect analysis to confirm whether the gender of the participant moderates the mediating effect of interpersonal trust on the relationships between age and HRQoL .p < 0.01, 95% CI ), and indirectly associated with lower HRQoL via lower interpersonal trust  . These results suggest a significant mediating effect of interpersonal trust on this relationship.For the indirect effect of interpersonal trust on the relationship between age and overall HRQoL , resultsp < 0.01, 95% CI ), gender was associated with lower HRQoL . The interaction of age and gender was negatively associated with HRQoL . Results of the simple slope test revealed that the regression slope of age on HRQoL was stronger for girls  than boys   .p < 0.01, 95% CI ), and gender was associated with higher interpersonal trust  . The interaction of age and gender was positively associated with interpersonal trust . Results of the simple slope test revealed that the regression slope of age on interpersonal trust was stronger for boys  than girls   .p < 0.01, 95% CI ), and gender was associated with higher interpersonal trust  . The interaction of gender and interpersonal trust was not significantly associated with HRQoL .For the moderating effect of gender on the relationship between interpersonal trust and HRQoL , the resThe conditional indirect effect was stronger for boys  than girls . This result meant that interpersonal trust played a mediating role in the relationship between age and HRQoL, and the mediating effect was moderated by the gender of the participants .HRQoL is an informative topic in health care sciences and psychology. Researchers have examined various objective and subjective correlates. Although age, gender, and health conditions are associated with HRQoL, there is a paucity of research examining developmental predictors ,46,47. TIn good agreement with previous research, this study found a change trend in the development of HRQoL at different ages. Results revealed that age was negatively associated with HRQoL, suggesting that younger participants scored higher on HRQoL compared to older participants. This is different from the relationship between adult age and interpersonal trust. Middle-aged people’s social relationships  seem to last longer than those formed when they are just adults. Similarly, many adults may be more deeply integrated into social groups where most members are connected . At the To our knowledge, the present study is one of the first to empirically test the mediating role of interpersonal trust on the association between age and HRQoL. Results revealed that age was directly associated with lower HRQoL, and indirectly associated with lower HRQoL via lower interpersonal trust. These results suggest that (1) with an increase in age, more participants endorsed lower interpersonal trust. This result is in line with previous research , which sAs expected, the present study also found that the observed mediation model was moderated by the gender of the participant. These findings support the health promotion model that people’s health depends on the interactions of their physical and interpersonal environments , indicatIn conclusion, this study examines age and interpersonal trust in relation to HRQoL using the data of 6248 children. We also examined the potential moderating role of gender in the relationship. Consistent with our hypotheses, the results revealed that age was associated with lower HRQoL, interpersonal trust was associated with higher HRQoL, and age was indirectly associated with lower HRQoL via lower interpersonal trust. Notably, gender did serve as a moderator, with the indirect effect being stronger for boys than for girls. Our findings explained how and when age affected children’s HRQoL and extended the current literature on the predictors of age and gender differences in HRQoL of children.Our paper has three implications for prevention and intervention for these youth. First, given that age was associated with lower HRQoL, youth can be taught useful skills  in order to achieve a satisfactory life. Second, it is important to note that the HRQoL of girls declined more than that of boys as they grew older, indicating that researchers and practitioners should pay attention to how to improve the quality of life for girls. Third, because interpersonal trust was found to be associated with higher HRQoL, we speculate that having a generally high level of interpersonal trust will bring a more adaptive and productive life to individuals, especially in the Chinese context . Here arThere are several limitations to the current study that should be considered. First, only self-reported measures were used. Future research may use multiple-source data, such as that from teachers and family members, to triangulate on the results found using self-reports. Second, the present study is of a cross-sectional design and reveals the correlativity among all variables ,58. HencThe present study adds to the growing literature on the association between age and health-related quality of life. The results reveal that the older have low interpersonal trust and HRQoL, and the gender difference is significant. Therefore, researchers should not only pay attention to the objective factors affecting HRQoL but also pay attention to the important influence of interpersonal trust.


Precision medicine has greatly aided in improving health outcomes using earlier diagnosis and better prognosis for chronic diseases. It makes use of clinical data associated with the patient as well as their multi-omics/genomic data to reach a conclusion regarding how a physician should proceed with a specific treatment. Compared to the symptom-driven approach in medicine, precision medicine considers the critical fact that all patients do not react to the same treatment or medication in the same way. When considering the intersection of traditionally distinct arenas of medicine, that is, artificial intelligence, healthcare, clinical genomics, and pharmacogenomics—what ties them together is their impact on the development of precision medicine as a field and how they each contribute to patient-specific, rather than symptom-specific patient outcomes. This study discusses the impact and integration of these different fields in the scope of precision medicine and how they can be used in preventing and predicting acute or chronic diseases. Additionally, this study also discusses the advantages as well as the current challenges associated with artificial intelligence, healthcare, clinical genomics, and pharmacogenomics. Precision medicine is the utilization of healthcare tools to create specialized treatments that consist of optimal actions for the patient, based on the data available . As clinInternational interest in precision medicine could be seen as early as 2011, with the American Association for Cancer Research’s (AARC) Project GENIE, which utilized several “big data initiatives” such as Genomics Evidence Neoplasia Information Exchange (GENIE) . The aimetc.) that can be useful when applied to healthcare  is a general term used to describe the process of using computers and technology to create stimulating software that resembles human-like critical thinking . AI is kalthcare . AI can althcare  to neuraalthcare . The phyalthcare , or AI-galthcare . In addialthcare . Classicalthcare . This realthcare .A healthcare system is the combination of institutions, people, and resources that are involved in delivering health services and care to individuals . The twoEHRs can assist healthcare providers in efficiently diagnosing specific rare medical cases that may not be encountered often . In receClaims data refers to health insurance claims, which can contain a large variety of information about a specific patient, including details about patient diagnoses, treatments required, and finances . In addiGenomics is a subfield of molecular biology concerned with mapping structure and function genomes. The differences between individual genomes are due to the unique biological DNA they are composed of . Humans The phenotypic display of humans is dependent upon the expression of genes, which is affected by numerous factors . The briNext-generation sequencing (NGS) refers to the genome sequencing technologies that began to rapidly develop in the early 2000s . Prior tNGS data can supplement other genomic sequencing methods and further develop the capabilities of DNA sequencing, which can significantly improve the effectiveness of precision medicine . In conjWGS and WES are two different types of NGS, which are more efficient and accurate methods of DNA sequencing than traditional Sanger sequencing . These tThe gene–disease relationship involves the detection of diseases associated with numerous genes with the help of sequencing techniques . ApplicaGene–disease databases are essential due to their unique display of information regarding the “exchange and reporting of actionable genetic variants and associated phenotype” . This inAs the technology for genomic analysis advances, more reports of gene–disease relationships are beginning to expand, facilitating the need for accessibility to information storage . The abiDespite the plethora of gene–disease databases available to researchers and the healthcare industry, there are quite a few shortcomings within the databases . The priPharmacogenomics is the analysis of how an individual’s genome (their unique genetic makeup) influences their reaction to certain medications prescribed to them . ProteinPharmacogenomics has a multitude of applications for both precision medicine and related fields, allowing for the improvement of drugs in all stages of the process, from production to consumption . One sucClinical genomics, AI, big data, and pharmacogenomics are essential in the future development of precision medicine . PrecisiWith the rapid development of many new approaches in precision medicine, the integration of two or more fields is currently being explored. Each type of approach offers a unique understanding and perspective of the data. The integration of multiple approaches allows for a more holistic and comprehensive approach to precision medicine, incorporating information from several different fields. In precision medicine, integration of these approaches provides researchers a comprehensive understanding of a given medical case, from the cause of the disease to the relevant mechanisms and interactions associated with the disease . This, iAlthough big data have some advantages in medical research, such as reduction of medical error and enablement of the correct treatment approach to a disease, the need to standardize the data content and clinical definition presents a significant disadvantage . DespiteThe advancements in AI, healthcare, clinical genomics, and pharmacogenomics have resulted in a substantial volume of data generated. However, this large influx of data presents an issue, as no reliable or standardized means of analysis has been developed. Such data are too large to be analyzed through common visual analysis or statistical correlation methods . The useIn this study, we hypothesize that the continued integration of pharmacogenomics, clinical genomics, AI, and healthcare will allow for increased potential in patient diagnosis and treatment. A standardized model linking and translating all these different variables needs to be implemented at the clinical level in order to further progress in the precision medicine field. The application of clinical genomics, pharmacogenomics, artificial intelligence algorithms, and big data analytics in precision medicine across different types of patient data (multi-omics) will allow for better prognosis and prediction of disease states and their mechanisms.


In the field of endometriosis, several classification, staging and reporting systems have been developed and published, but there are no data on the uptake of these systems in clinical practice.The objective of the current study was to examine whether clinicians routinely use the existing endometriosis classification systems, which system do they use and what are the clinicians’ motivations?A cross-sectional study was performed to gather data on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis. Of particular focus were three systems most commonly used: the Revised American Society for Reproductive Medicine (rASRM) classification, the Endometriosis Fertility Index (EFI), and the ENZIAN classification. Data were analysed by SPSS. A survey was designed using the online SurveyMonkey tool consisting of 11 questions concerning three domains— participants’ background, existing classification systems and intentions with regards to a new classification system for endometriosis. Replies were collected between 15 May and 1 July 2020.Uptake, feedback and future intentions.The final dataset included the replies of 1178 clinicians, including surgeons, gynaecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Overall, 75.5% of the professionals indicate that they currently use a classification system for endometriosis. The rASRM classification system was the best known and used system, the EFI system and ENZIAN system were known by a majority of the professionals but used by only a minority. The lack of clinical relevance was most often selected as a problem with using any system. The findings of the survey suggest that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardised reporting, and is clinically relevant and simple.Even with a high uptake of the existing endometriosis classification systems , most clinicians managing endometriosis would like a new simple surgical descriptive system for endometriosis.The findings therefore support future initiatives for the development of a new descriptive system for endometriosis and provide information on user expectations and conditions for universal uptake of such a system. In the field of endometriosis, several classifications, staging and descriptive systems have been developed, however, none seem to be comprehensive, or correlate sufficiently with clinically relevant outcomes for general uptake. In an attempt to provide direction for the future development of a new endometriosis classification system that is clinically relevant, three essential projects were defined: to review existing classification and staging systems for endometriosis; to develop a standard glossary to be utilised across the field of endometriosis; and to assess the current knowledge and uptake of classification systems among practitioners in the field.In the first project, 22 published classification and staging systems for endometriosis were summarised as well as the studies evaluating these with regards to feasibility, validity and reproducibility  classification , the endA cross-sectional study was conducted using an online survey, which focused on classification of endometriosis. The questions were drafted by an international group of experts in endometriosis representing four societies: the American Association of Gynecologic Laparoscopists (AAGL), European Society for Gynaecological Endoscopy (ESGE), ESHRE, and the World Endometriosis Society (WES). The survey was conducted online and afterwards distributed amongst all members of the participating societies and the members of the American Society for Reproductive Medicine (ASRM).The survey included 11 questions organised in three sections. The first section focused on the participants’ background and included questions related to their country, professional status  and expertise in managing endometriosis patients (Supplementary Data 1). The second part of the survey focused on existing classification systems, and the third part on the uptake of a potential new descriptive system for endometriosis.The survey was open between 15 May and 1 July 2020. Recruitment strategies included mass mailings by each of the participating societies and promotion on social media. A total of 1251 replies were received.The results of the survey were exported to SPSS 19  for Windows for further analysis. Analysis and comparisons were focused on respondents who treat patients with endometriosis in clinical practice. Two sub- analyses were conducted, comparing surgeons versus other physicians, and replies between different regions. Statistically significant differences (p<0.05) were assessed through Chi- square analysis.Of the 1251 respondents to the survey, the majority represented Europe (40.8%) and North-America (28.8%) . Figure The rASRM classification system was the best known and most frequently used system, with only 4.7% of the respondents indicating they did not know or use the system. The EFI system and ENZIAN system were known by 76.1% and 53.8% of respondents, respectively, but used by only a minority  .Overall, 75.5% of the respondents indicated that they currently use a classification system for endometriosis. One-third of the respondents further reported that they use more than one system . The rASRM system was most often used. A minority of respondents  indicated that they use another published classification system  or their own system .On the question of which problems responders had encountered with the existing classification systems, 22.7% replied that they do not encounter any problems. The remaining respondents indicated a variety of problems. The lack of clinical relevance (n=341) was most often selected .The vast majority of respondents (95.1%) replied positive to the question on whether they would use a simple surgical descriptive system for endometriosis, if available . They inThe responses were compared between those respondents the indicated surgeon (non-gynaecologists) or gynaecologist-surgeon as their profession, and other clinicians  . There wIn the comparison by continent, there was significant variation in the frequency of professions of the respondents and consequently in the number of surgeries they performed , but theWith regards to the primary motivation to use a descriptive system, standardisation was most often selected in all continents, apart from Asia and South-America, where prediction of response to treatment was the primary motivation. These results, specifically for Oceania and Africa, should be considered with caution considering the low number of replies from these areas.This report summarises the replies of 1178 clinicians, including surgeons, gynaecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Questions focused on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis.Overall, three-quarters of the respondents indicate that they use a classification system for endometriosis, with limited variation according to profession or location. The rASRM classification system, the oldest system, was the best known and used. The ENZIAN classification system, published in 2005, and the EFI system, published in 2010, were known by half of the respondents, but used less often, by 1 in 5 and 1 in 4 clinicians, respectively. The ENZIAN classification system was more often used by surgeons.Our results highlight some problems with the currently available classification systems. The most often reported problem, both by physicians using a classification system and those that do not, is the lack of clinical relevance. The complexity of the currently available classification systems is also considered a barrier for uptake, which is in line with previous reports . It shouIn contrast to the high uptake of the rASRM, ENZIAN and EFI systems, the vast majority of clinicians managing endometriosis intended to use a new simple surgical descriptive system for endometriosis if developed. Standardisation of reporting and prediction of response to treatment would be the main motivating factors to do so: the latter is consistent with the lack of clinical relevance of the current available systems. Standardised reporting of surgical findings is implemented in the WERF EPHect  and CORDAlthough confined to the inherent limits of the methodology, this report provides relevant information with regards to the uptake of currently available systems and suggests that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardised reporting, and is clinically relevant and simple. These considerations should be taken into account in the development of future endometriosis classifications.Classification systems for endometriosis have been developed, but there is no data as to whether clinicians actually use them in the management of their patients in clinical practice. We have organised a large survey to gather this information, and we found that indeed a large number of clinicians use the existing classification systems. The clinicians also mentioned a number of issues with the existing classification systems, including that the systems may not be very relevant for the diagnosis or treatment of the patient, or that they are not linked to the patients’ symptoms. Finally, the clinicians answering the survey made suggestions on how to improve the classification systems. The information collected is very valuable towards future updates of existing classification systems, or development of a new, simple and clinically relevant universal system.