EngenderHealth

У статті представлено ґрунтовний аналіз кореляції між культурою рецензування коду та рівнем надійності у великих міжнародних інженерних командах. Застосовуючи міждисциплінарний підхід, що проводить широкі паралелі між програмною інженерією та науковим методом, аргументовано, що такі ключові інженерні практики, як code review, є прямими аналогами академічного рецензування (peer review), які забезпечують колективну верифікацію та підвищення достовірності програмного коду. Цей підхід дає змогу переосмислити процес розробки як постійний цикл висування гіпотез, експериментальної перевірки та колективного аналізу, що веде до системного поліпшення якості. Проведене дослідження показало, що code review має не лише очевидний технічний вплив, пов’язаний зі зниженням кількості дефектів, виявленням архітектурної ерозії та підвищенням читабельності коду, але й глибоке культурне значення, що сприяє формуванню довіри, покращенню комунікації та створенню колективної відповідальності за якість програмного продукту, що є особливо важливим в умовах роботи розподілених команд. На основі окреслених складних взаємозв’язків розроблено модель, яка візуалізує причинно-наслідкові зв’язки, демонструючи, як зріла культура рецензування безпосередньо діє на ключові метрики надійності, зокрема на частоту відкатів та кількість критичних інцидентів, що виникають після релізу. Результати дослідження мають вагоме практичне значення для менеджерів та інженерних команд, оскільки підкреслюють, що інвестування в організаційну культуру, яка підтримує відкрите та конструктивне рецензування, є переломним фактором для гарантування довгострокової стабільності та якості програмного продукту, перетворюючи його з технічного процесу на фундаментальний атрибут успішної інженерної практики. Отже, зазначена модель втілює універсальний інструмент для оцінювання та покращення ефективності роботи команд, орієнтуючись на культуру як на основний драйвер надійності.

Purpose:Adolescent and young adult (AYA) cancer patients frequently receive intensive measures at the end of life; many also express care goals that align with a palliative approach. We sought to understand the extent to which AYAs are referred to palliative care before death, the timing of referrals, and associations between referral timing and end-of-life care outcomes.Patients and Methods:Review of electronic health data and medical records for 1,918 AYAs aged 12–39 years who died after receiving care at one of 3 sites between 2003–2019. Patients who received palliative care but lacked documentation of referral timing were excluded.Results:Most included AYAs were White (61%); 12% were Asian, 8% Black, and 27% Hispanic. Nearly three-quarters (73%) were referred to palliative care before death. Thirty-six percent of palliative care referrals took place before the last 90 days of life; 30% were in the last month of life. Palliative care referrals and their timing were associated with care received at the end of life, with earlier referrals associated with fewer intensive measures near death, including chemotherapy in the last 14 days of life (P=0.001) as well as intensive care unit admissions, emergency room visits, and hospitalizations in the last month of life (P<0.001 for all.) Patients who were referred to palliative care were more likely to have symptoms assessed in the last 90 days of life, including pain, dyspnea, nausea, diarrhea, constipation, depression, and anxiety (P<.001 for all.)Conclusions:While many AYAs receive intensive measures at the end of life, most are also referred to palliative care. Earlier referrals have potential to reduce care intensity and enhance attention to symptoms and quality of life near death.

Lower birth rates and higher pregnancy loss are observed after childhood cancer. Studies specific to adolescent and young adult (AYA) cancer rarely have information on pregnancies that do not end in live birth, fertility preservation strategies, or detailed cancer treatment information to assess these risks. To address this gap, we examined pregnancy outcomes after cancer in a cohort of 30,020 AYAs with detailed clinical records. We identified 6021 survivors of AYA cancer matched to 23,999 AYAs without cancer enrolled in the Kaiser Permanente California health systems during 2004-2016. Of these, 950 survivors had ≥1 pregnancy during follow-up through 2018. Hazard ratios (HR) and 95% confidence intervals (CI) for pregnancy were estimated using multivariable subdistribution hazard models accounting for competing risks. Relative risks (RR) and 95% CIs for pregnancy loss were calculated with multivariable Poisson regression with generalized estimating equations. Pregnancy was less common after AYA breast (HR = 0.57; 95% CI: 0.50, 0.66) or gynecologic cancer (HR = 0.55; 95% CI: 0.42, 0.73) compared to AYAs without cancer. Among AYAs with cancer, some alkylating and platinum chemotherapy agents, but not gonadotoxic radiation, were associated with a lower likelihood of pregnancy. Use of assisted reproductive technologies was not common, and 69% of pregnancies after AYA cancer resulted in live birth. Pregnancy loss was not statistically significantly elevated for any cancer type. Among survivors, pregnancy loss was more common at older ages, with smoking during pregnancy, and among those who received cyclophosphamide. Our findings inform reproductive counseling and prenatal care for reproductive age cancer survivors.

Health risks associated with short interpregnancy intervals, coupled with women's desires to avoid pregnancy following childbirth, underscore the need for effective postpartum family planning programs. The antenatal period provides an opportunity to intervene; however, evidence is limited on the effectiveness of interventions aimed at reaching women in the antenatal period to increase voluntary postpartum family planning in low- and middle-income countries (LMICs). This systematic review aimed to identify and describe interventions in LMICs that attempted to increase postpartum contraceptive use via contacts with pregnant women in the antenatal period. Studies published from January 2012 to July 2022 were considered if they were conducted in LMICs, evaluated an intervention delivered during the antenatal period, were designed to affect postpartum contraceptive use, were experimental or quasi-experimental, and were published in French or English. The main outcome of interest was postpartum contraceptive use within 1 year after birth, defined as the use of any method of contraception at the time of data collection. We searched EMBASE, Global Health, and Medline and manually searched the reference lists from studies included in the full-text screening. We double-screened 771 records and included 34 reports on 31 unique interventions in the review. Twenty-three studies were published from 2018 on, with 21 studies conducted in sub-Saharan Africa. Approximately half of the study designs (n=16) were randomized controlled trials, and half (n=15) were quasi-experimental. Interventions were heterogeneous. Among the 24 studies that reported on the main outcome of interest, 18 reported a positive intervention effect, with intervention recipients having greater contraceptive use in the first year postpartum. While the studies in this systematic review were heterogeneous, the findings suggest that interventions that included a multifaceted package of initiatives appeared to be most likely to have a positive effect.

O texto apresenta os estudos e a proposta de um planejamento permacultural para uma praça típica de cidades que tiveram intenções de acolher a comunidade com atrativos, mas que não conseguiram devido ao modelo usual negligente de planejamento das cidades. Foram realizados estudos de fundamentação, levantamentos documentais, imagéticos e de demandas da Praça Cadige Bacri Costa para entender as condicionantes a serem trabalhadas em um planejamento permacultural que considere os processos naturais e antrópicos locais ao mesmo tempo que traga benefícios sociais, ambientais e econômico aos usuários e à cidade. A proposta elaborada deverá trazer ao lugar, uma vivacidade maior e mais resiliência da cidade em temos de respostas às adversidades em tempos de mudanças climáticas. Assim, foi possível concluir que o planejamento permacultural pode ser um modelo a ser seguido pelos gestores urbanos.