bluuebunny/crossref_metadata_2025 huggingface dataset:
SWOG S2107: Randomized phase II trial of encorafenib and cetuximab with or without nivolumab for patients with previously treated, microsatellite stable, BRAFV600E metastatic and/or unresectable colorectal cancer.
Authors: Morris Van K. , Guthrie Katherine A. , Kopetz Scott , Breakstone Rimini , Karasic Thomas Benjamin , Hu Zishuo Ian , Colby Sarah , Fakih Marwan , Gholami Sepideh , Gold Philip Jordan , Chiorean E. Gabriela , Philip Philip A.
Published: June 2024

TPS3640

Background: Patients with microsatellite stable (MSS), BRAFV600E metastatic colorectal cancer (mCRC) experience poor survival outcomes. Second-line treatment with the BRAF inhibitor encorafenib (E) and anti-EGFR antibody cetuximab (C) is an approved treatment combination, with overall response rate (ORR) of 20% and median progression-free survival (PFS) of 4.1 months. Anti-PD-1 antibodies like nivolumab (N) are ineffective as monotherapy for patients with MSS, BRAFV600E mCRC. In preclinical models of MSS, BRAFV600E CRC, inhibition of BRAF and EGFR induces loss of expression of mismatch repairs genes and promotes a microsatellite instability-high phenotype, which may prime these tumors for response to immunotherapy. In support of these findings, a single-institution clinical trial of E + C + N for 26 patients with MSS, BRAFV600E mCRC reported an ORR of 50% and median PFS of 7.2 months. We hypothesize that the addition of N to E + C will improve median PFS for patients with MSS, BRAFV600E mCRC. Methods: In this prospective phase II clinical trial (N=84), patients with previously treated MSS, BRAFV600E mCRC are randomized 2:1 into 2 arms, respectively: experimental treatment (E + C + N) or standard treatment (E + C). No prior BRAF, EGFR, or immunotherapy agents are allowed. All patients receive E (300 mg PO daily) and C (500 mg/m2 IV every 14 days), and patients in the experimental arm receive N (480 mg IV every 28 days). The primary endpoint is PFS. Secondary endpoints include overall survival, best overall response, duration of response, and safety/tolerability. Using a one-sided α= .10 and power 80%, we target an improvement in median PFS from 4.2 to 7.3 months (hazard ratio 0.57). Additional patient specimens will be collected for exploratory correlative research. As of 2/2024, 50 of 84 planned participants have been enrolled. Clinical trial information: NCT05308446 .
Colon adjuvant chemotherapy based on evaluation of residual disease (CIRCULATE-NORTH AMERICA): NRG-GI008.
Authors: Dasari Arvind , Yu Guan , Kopetz Scott , Puhalla Shannon L. , Lucas Peter C. , Sahin Ibrahim Halil Halil , Deming Dustin A. , Philip Philip A. , Hong Theodore S. , Rojas-Khalil Yesenia , Loree Jonathan M. , Wolmark Norman , Yothers Greg , George Thomas J. , Lieu Christopher Hanyoung
Published: June 2024

TPS3641

Background: Currently, there are no biomarkers validated prospectively in randomized studies for resected colon cancer (CC) to determine need for adjuvant chemotherapy (AC). However, circulating tumor DNA (ctDNA) represents a highly specific and sensitive approach (especially with serial monitoring) for identifying minimal/molecular residual disease (MRD) post-surgery in CC patients (pts), and may outperform traditional clinical and pathological features in prognosticating risk for recurrence. CC pts who do not have detectable ctDNA (ctDNA-) are at a much lower risk of recurrence and may be spared the toxicities associated with AC. Furthermore, for CC pts with detectable ctDNA (ctDNA+) who are at a very high risk of recurrence, the optimal AC regimen has not been established. We hypothesize that for pts whose CC has been resected, ctDNA status may be used to risk-stratify for making decisions about AC. Methods: In this prospective phase II/III trial, up to 1,912 pts with resected stage IIB, IIC, and III CC will be enrolled. Based on the post-operative ctDNA status using personalized and tumor-informed assay (Signatera, bespoke assay), those who are ctDNA- (Cohort A) will be randomized to immediate AC with fluoropyrimidine (FP)+oxaliplatin (Ox) for 3-6 mos per established guidelines vserial ctDNA monitoring. Patients who are ctDNA+ post-operatively, or with serial monitoring (Cohort B), will be randomized to FP+Ox v more intensive AC with addition of irinotecan (I) for 6 mos. One cycle of chemotherapy is allowed while awaiting ctDNA testing results for cohort assignment. The primary endpoints for Cohort A are time to ctDNA+ status (phase II) and disease-free survival (DFS) (phase III) in the immediate v delayed AC arms. The primary endpoint for Cohort B is DFS in the FP+Ox v FP+Ox+I arms for both phase II and phase III portions of the trial. Secondary endpoints include prevalence of detectable ctDNA post-operatively, time-to-event outcomes (overall survival and time to recurrence) by ctDNA status, and the assessment of compliance to adjuvant therapy. Biospecimens including archival tumor tissue, as well as post-operative plus serial matched/normal blood samples, will be collected for exploratory correlative research. Active enrollment across the NCTN started in June 2022 with CCTG sites joining in August 2023. Current accrual (as of 02-02-2024) is 240/1,912. NCT05174169. Support: U10-CA-180868, -180822; UG1CA-189867; Natera, Inc. Clinical trial information: NCT05174169 .
Adjuvant chemotherapy with mFOLFOXIRI versus mFOLFOX6 in MRD-positive stage II-III colorectal cancer.
Authors: Zhang Jianwei , Hu Huabin , Cai Yue , Xie Xiaoyu , Wu Zehua , Ling Jiayu , Chen Dianke , Liu Ping , Kang Liang , Deng Yanhong
Published: June 2024

TPS3642

Background: About 25% to 30% of resectable high-risk stage II and stage III colon cancers might relapse after radical resection and adjuvant chemotherapy with FOLFOX regimen. Recent studies have underscored the significance of circulating tumor DNA (ctDNA)-based minimal residual disease (MRD), representing a residual presence of cancer cells, as a prognostic factor for postoperative recurrence in CRC. Patients exhibiting positive MRD predicted a considerable high risk of recurrence and metastasis, even after adjuvant chemotherapy. In the realm of postoperative adjuvant chemotherapy, Comparing with FOLFOX, whether the early introduction of intensified chemotherapy, mFOLFOXIRI, could further eradicate MRD and improve the long-term prognosis remains unclear. Methods: This multicenter phase III study (NCT05427669) plans to enroll 340 colorectal cancer patients with MRD positive after curative-intent R0 surgical resection, age 18 to 70 years, ECOG performance status 0-1. Patients were randomized (1:1) to receive mFOLFOXIRI (oxaliplatin 85 mg/m², leucovorin 400 mg/m², irinotecan 150 mg/m², and 5-FU 2.4 g/m²over 46 h) or mFOLFOX6 (oxaliplatin 85 mg/m², leucovorin 400 mg/m², 5-FU bolus 400 mg/m2 then 2.4 g/m² over 46 h) every two weeks for 24 weeks (12 cycles). Patients will be followed for 5 years after the end of adjuvant chemotherapy. The primary endpoint was 3-year DFS. A gain of 14% in 3-yr DFS is expected (74% in the experimental arm vs. 60% in the control arm; α, 5% [two-sided log-rank test]; 1-β, 80%). Secondary endpoints included overall survival, 3-year distant metastasis-free survival, QoL and toxicity. Clinical trial information: NCT05427669 .
The NEO-RT trial: A phase 3 randomized trial of neoadjuvant chemotherapy, excision and observation versus chemoradiotherapy for early rectal cancer, CCTG CO.32.
Authors: Kennecke Hagen Fritz , O'Callaghan Christopher J. , Tu Dongsheng , Leung Roger , Dennis Kristopher , Kachnic Lisa A. , Loree Jonathan M. , Whiteford Mark , Hall William A. , Cohen Stacey A. , Cann Christopher G , VanderWalde Noam Avraham , Nurkin Steven J. , Juul Therese , Cheung Winson Y. , Horowitz David Paul , Locke Gordon , Brown Carl J.
Published: June 2024

TPS3646

Background: There is significant interest in organ-sparing management of rectal cancer. Data from the National Cancer Database suggest that in 2020 only 20% of US patients with stage I rectal cancer are managed non-operatively. The phase II CCTG CO.28/NEO trial previously reported high rates of tumor downstaging, organ preservation and excellent rectal function among patients with T1-T3abN0 rectal adenocarcinoma treated with 3 months of FOLFOX/CAPOX followed by Transanal Endoscopic Surgery (TES). The phase III CO.32/NEO-RT trial (NCT06205485) will compare two organ sparing strategies for patients with stage I rectal cancer. Methods: Eligible patients with clinical stage T1/2 N0 adenocarcinoma with preserved mismatch repair (MMR) will be randomized 1:1 to ARM A, 3 months of FOLFOX or CAPOX versus ARM B, chemoradiation (54 Gy) followed by tumor restaging within 16 weeks of start of therapy. Patients with histological high grade, mucinous or deficient MMR and those that can be treated with tumor excision alone are excluded. The primary endpoint is tumor downstaging to clinical Complete Response (cCR) by pelvic MRI, endoscopy and digital rectal exam. Subsequent TES is recommended for all patients with tumor response and may be done within 24 weeks of treatment begin, followed by 5 years (y) of observation with serial MRI (q6m x 2y then annually) and endoscopy (q4m x 2y, then q6m during year 3, then annually). The co-primary endpoint is Quality Of Life (QOL) measured by the Low Anterior Resection Score (LARS). In a non-inferiority comparison between treatment arms, if the cCR is assumed to be 45% in ARM B and if there is no true difference between ARMS A and B, then 250 patients are required to be 80% sure that the upper limit of a one-sided 90% confidence interval will exclude a difference in favor of chemoradiation of more than 14%. Results: The approved CCTG CO.32 trial is expected to open February, 2024 at Canadian CCTG and US Alliance, ECOG-ACRIN, NRG, and SWOG NCTN sites with an estimated accrual duration of 4 years. Conclusions: The results of this study will have a major impact on the treatment of patients with stage I rectal cancer. Both arms offer the potential of organ preservation and results will inform whether induction chemotherapy is non-inferior to ChemoRT and compare patient QOL and functional outcomes. Clinical trial information: NCT06205485 .
From the Ordinary to the Everyday
Authors: Laugier Sandra , Cox Hannah
Published: June 2024

This is a new English translation of “De l’ordinaire au quotidien,” originally published in French in 2023. In paragraph 116 of Philosophical Investigations Wittgenstein seems to outline the fundamental goal of his philosophy: “What we do is to bring words back from their metaphysical to their everyday use.” The everyday use to which Wittgenstein constantly refers is far from self-evident: it is just as elusive and indeterminate as our forms of life. The project of Philosophical Investigations is not to replace disqualified logic with the study of use, finding therein a new foundation or new convictions, even purely practical ones. The study of everyday language use presents new problems, arduous in a different way from those of logical analysis, as J. L. Austin and the Oxford School later showed—the same school that, in coining the term Ordinary language philosophy, formalized the Ordinary rather than the Everyday as a central concept. The present article considers several reasons for returning to the concept of the Everyday, Wittgenstein’s point of departure, in the philosophy of language.
Waxing lyrical: ancient medical authors on wax and wax tablets
Authors: Totelin Laurence
Published: June 2024

This short survey discusses some of the uses of wax in ancient medicine: it was a key pharmacological ingredient; it served to create models of surgical tools; and it was a support for the writing of ancient recipes. Physicians distinguished between different types of wax, some of which were considered more efficacious than others. Wax could be consumed orally, but most commonly entered in the production of salves (cerates).
Film, Medicine and Freemasonry: Jenő Janovics and the Transylvanian “Hollywood”
Authors: Varga Attila
Published: June 2024

This study highlights the life and work of Jenő Janovics, a renowned Hungarian theater director in Cluj, the capital of Transylvania. Janovics was a multi-talented figure, excelling as a film director and actor, and was also a freemason. Often hailed as the creator of Transylvanian “Hollywood”, he directed a total of 66 films. One of them, “The Horror of the World” (Hu: “Világrém”, 1920), focuses on medicine and its preventive role in safeguarding societal health. Using cinematography, Janovics expressed the concerns of both the physicians and the freemasons of Cluj regarding the detrimental impact of immorality and veneral diseases on the individual and the nation. At a time of profound political, territorial and social changes, this silent movie highlights the importance of medicine in society.
Eugenics and Freemasonry in the Banat during the first half of the XX Century: The Banat-Crişana Social Institute
Authors: Varga Attila
Published: June 2024

The present study highlights the beginning of the dissemination of eugenic ideas in Banat, Caraș and the Severin counties, in two different phases: before and after the World War I. On the basis of archival documents, we have shown that Freemasonry, namely the “Dél” (South) Lodge of Lugoj, played an important role in the dissemination of eugenic ideas in the aforementioned area. After the Great Union of 1918, eugenics activism in the province was taken over by the members of the prestigious Banat-Crișana Social Institute, founded in 1932. Nevertheless, the role of Freemasonry in spreading eugenic ideas did not diminish in this new period. This is due to cultural and scientific personalities such as Cornel Grofșorean, who was a publicist, journalist, politician, director of the Institute’s journal, but also a Freemason in the Lugoj Lodge.
Ο προσδιορισμός της ‘διαφΩράς’ στην αρχιτεκτονική δομική οργάνωση
Authors: Μιχαλοπούλου Κατερίνα
Published: June 2024

Η αντίληψη της αρχιτεκτονικής αφορά πρωτίστως στην αίσθηση που αποκτούμε καθώς κινούμαστε μέσα στο χώρο και δευτερευόντως στην εικόνα που συνθέτουμε από στατικές απόψεις του χώρου. Κατ΄ αντιστοιχία λοιπόν, η σύνθεση της αρχιτεκτονικής αφορά πρωτίστως στην οργάνωση των αρχιτεκτονικών στοιχείων με βάση τη διαδοχή τους. Μιας διαδοχής που ανακαλύπτεται μέσω της σχεδιασμένης κίνησης εντός του χώρου. Η παρούσα διδακτορική διατριβή αφορά λοιπόν την αντίληψη και σχεδιασμό της αρχιτεκτονικής εκ των έσω. Αντικείμενο της διατριβής είναι η διερεύνηση τρόπων αντίληψης και σχεδιασμού της χρονικής εμπειρίας, θεωρώντας την καταγραφή του χρόνου ως ρυθμική διαδοχή αντιθετικών «σχημάτων» που αποτελούν μεταλλασσόμενες δομές. Έτσι εξετάζεται η χρονικότητα και η ένταξή της στην αρχιτεκτονική σύνθεση, συσχετισμένη με την γενικότερη αντίληψη, που θέλει την οργάνωση της έκφρασης και της εν-νόησης του κόσμου να γεννιέται με τη διαρκή κίνηση των σημασιών. Μέσα από μια σειρά θεωριών και παραδειγμάτων διαφαίνεται ξεκάθαρα πως οποιαδήποτε ανάλυση ή σύνθεση στην αρχιτεκτονική, όταν δεν συμπεριλαμβάνει την έννοια της χρονικότητας, είναι ελλιπής και αναχρονιστική. Έτσι το ζήτημα της ένταξης την χρονικότητας στον αρχιτεκτονικό σχεδιασμό είναι θεμελιώδες, αφού ουσιαστικά αφορά στο ίδιο το αντικείμενο της αρχιτεκτονικής και όχι σε μια πτυχή του. Κατ’ επέκταση, η παρούσα εργασία δεν στοχεύει μόνο στο να δημιουργήσει τις βάσεις για μια γόνιμη ένταξη του σχεδιασμού του χρόνου στην αρχιτεκτονική με σύγχρονους για την εποχή της όρους. Μέσα από αυτή την αναθεώρηση στοχεύει κυρίως στον επαναπροσδιορισμό και την επανένταξη της Αρχιτεκτονικής στο πεδίο των Τεχνών, σε νέα βάση, ως καλλιτεχνικό δημιούργημα. Η διατριβή βασίζεται στην κατάργηση τριών βασικών παρεξηγήσεων που αφορούν: στην κατάταξη της Αρχιτεκτονικής στις Τέχνες του χώρου και όχι του χρόνου, στη γραμμική θεώρηση του χρόνου και στη σύγχυση του ρυθμού με το μέτρο. Η επίλυση των παραπάνω παρεξηγήσεων δεν αφορά στη θεώρηση «σωστού ή λάθους», αλλά στην επανερμηνεία τους με νέα δεδομένα. Η προτεινόμενη από την διατριβή θεωρία ένταξης της χρονικότητας στην αρχιτεκτονική δομείται σταδιακά σε κάθε κεφαλαίο μέσω θεωριών παραδειγμάτων και συμπερασμάτων. Η ανάπτυξη των προβληματισμών βασίζεται αρχικά σε μια σειρά από θεωρητικές τοποθετήσεις που αφορούν στη Φιλοσοφία και την Επιστήμη και αναπτύσσεται μέσω μιας διαρκούς σύγκρισης ανάμεσα στην αρχιτεκτονική και τέχνες που κατεξοχήν χειρίζονται το σχεδιασμό του χρόνου. Έτσι, η αρχιτεκτονική συγκρίνεται με την μουσική, την ποίηση, τη λογοτεχνία, το χορό και τον κινηματογράφο, χωρίς εντούτοις να απαξιώνονται συναφείς προσπάθειες των συμβατικών εικαστικών τεχνών. Όλη η έρευνα βασίζεται στην πεποίθηση ότι εκτός από την Επιστήμη, οι Τέχνες είναι ικανές να μας αποκαλύψουν νέους κόσμους ή να ερμηνεύσουν διαφορετικά ό,τι νοούμε ως παγιωμένο.
Υδροκίνηση και ανεμοκίνηση στην προβιομηχανική Αττική
Authors: Λεκού Όλγα
Published: June 2024

Η ραγδαία ανάπτυξη και οικοδόμηση που έχει υποστεί η Αττική κατά τις προηγούμενες δεκαετίες, έχει δημιουργήσει την εσφαλμένη αντίληψη ότι στην περιοχή δεν υπήρχαν παρά ελάχιστες υδροκίνητες και ανεμοκίνητες εγκαταστάσεις. Στόχος της έρευνας ήταν ο εντοπισμός, η συστηματική καταγραφή και τεκμηρίωση τους, συμβάλλοντας στην γνώση της ιστορίας της τεχνολογίας της περιοχής και κατ’ επέκταση της πολιτιστικής κληρονομιάς του τόπου. Προκειμένου να διαπιστωθεί η ύπαρξη ή μη υδροκίνητων και ανεμοκίνητων εγκαταστάσεων στην περιοχή μελέτης, έγινε έρευνα στις κάθε είδους πηγές (χάρτες, γραπτές πηγές, απεικονίσεις και προφορικές μαρτυρίες). Οι χάρτες του 18ου-19ου αι., μολονότι συντάχθηκαν για διαφορετικούς σκοπούς ο καθένας (υδρογραφικοί, στρατιωτικοί, αρχαιολογικοί, τοπογραφικοί κ.ά.), παρέχουν πολλά στοιχεία για τις εγκαταστάσεις, με αυτούς της Αττικής του Kaupert να ξεχωρίζουν, λόγω της ακρίβειας σχεδίασής τους. Στις γραπτές πηγές ανήκουν οι απογραφές, τα φορολογικά κατάστιχα, τα δικαιοπρακτικά έγγραφα, τα περιηγητικά κείμενα, οι ταξιδιωτικοί οδηγοί, οι εφημερίδες, τα περιοδικά και τα βιβλία, από τα οποία αντλήθηκαν πολυάριθμες πληροφορίες για μύλους. Πολύτιμο υλικό για την έρευνα υπήρξαν και οι κάθε είδους απεικονίσεις, χαρακτικά, υδατογραφίες, σχέδια, φωτογραφίες και καρτ ποστάλ, όπου αποτυπώνονται μύλοι, έστω και συμπτωματικά, επειδή είναι κυρίως πανοραμικές απόψεις πόλεων, τοπίων ή αρχαίων μνημείων. Η έρευνα εμπλουτίστηκε με προφορικές μαρτυρίες ανθρώπων που γνώριζαν καλά την περιοχή, είτε επειδή ζούσαν εκεί για πολλά χρόνια είτε επειδή κατάγονταν από αυτήν. Τα στοιχεία που συγκεντρώθηκαν μετατράπηκαν σε γεωγραφικά δεδομένα και οδήγησαν στην χαρτογράφηση όλων των εγκαταστάσεων. Στη συνέχεια ακολουθήθηκε η μεθοδολογία της τεκμηρίωσης, με επιτόπια έρευνα, καταγραφή, αποτύπωση και σχεδίαση, καθώς και φωτογραφική τεκμηρίωση. Έγινε ανάλυση, σύγκριση και ερμηνεία όλων των δεδομένων που συγκεντρώθηκαν, η οποία οδήγησε σε συμπεράσματα γενικά (ποσοτικά, χρήσεων, στατιστικά κ.ά.), ανά χωρική ενότητα και ανά είδος εγκατάστασης (υδροκίνητες – ανεμοκίνητες). Επιπλέον, καταγράφηκαν όλα τα σχετικά με τους μύλους τοπωνύμια και τοπόσημα και εξάχθηκαν συμπεράσματα αναφορικά με αυτά. Τέλος, έγιναν προτάσεις για την αξιοποίηση και ανάδειξη της προβιομηχανικής τεχνολογίας της Αττικής.
Aktywność antyoksydacyjna naparów z suszonych owoców bzu czarnego Sambucus nigra L.
Authors: Bienia Bernadetta , Mroczka Małgorzata , Uram-Dudek Angelika
Published: June 2024

Owoce czarnego bzu (Sambucus nigra L.) dostępne na polskim rynku charakteryzują się zmienną zawartością związków bioaktywnych. Celem pracy była ocena potencjału antyoksydacyjnego naparów sześciu preparatów suszonych owoców czarnegobzu dostępnych na polskim rynku w 2023 r. Oznaczono zawartość antocyjanów i polifenoli ogółem oraz zdolność antyoksydacyjną z użyciem rodnika DPPH za pomocą spektrofotometru UV-Vis. Najwyższe zawartości analizowanych składników i największą aktywność antyutleniającą stwierdzono w naparach w saszetce – T-2. Napary z owoców w całości (S-1–S-4) wykazały zbliżone wartości badanych parametrów. Stwierdzono, że za aktywność antyoksydacyjną naparów z owoców czarnego bzu niemal w całości odpowiedzialne są polifenole oraz że większy wpływ na zawartość tozwiązków i zdolność antyoksydacyjną ma forma technologiczna produktu niż miejsce jego pozyskania.
El acto fotográfico como experiencia de creación de conocimiento. El acto frente al extracto.
Authors: Ramon Ricard
Published: June 2024

El artículo aborda el desarrollo del acto fotográfico, desde una perspectiva artística, estética y simbólica, como un medio esencialmente tecnológico que articula una forma contemporánea de creación de nuevos conocimientos sensibles. De esta forma, se plantea un recorrido por las características que definirían al acto fotográfico, a partir de estas premisas conceptuales. Frente al acto, se contrapone la idea del extracto, como un proceso necrológico y enfermizo que atraviesa las prácticas fotográficas del presente. Finalmente, se define el acto fotográfico, trascendiendo los precedentes teóricos al respecto, como una forma compleja de construcción de conocimientos y de creación de mundos sensibles, que permite abrir nuevas vías de conocimiento y ampliar la visión y mirada sobre el mundo y sobre nosotros con relación a cómo miramos ese mundo y los construimos con nuestra mirada.
Fisic-Arte: una propuesta interdisciplinar de creación de material en Educación Artística y Educación Física.
Authors: Borrueco Sánchez Mario
Published: June 2024

Este artículo analiza y evalúa una serie de dinámicas pedagógicas utilizadas en el Taller de Proyectos (Design Studio), en las Enseñanzas Artísticas Superiores de Diseño de Interior. Las dinámicas son inspiradoras hasta tal punto que pueden ser trasladables a cualquier disciplina. No obstante, el artículo incluye un soporte teórico específico: una discusión y un contraste comparativo con diferentes modelos del método pedagógico del Taller de Proyectos (Design Studio). Cada dinámica se diseña artísticamente, casi como si fuera una acción, para crear un ‘evento pedagógico’ que enseña a diseñar a través de la experiencia, lo cual hace que el contenido de este artículo no sea tanto conceptual, sino sobre todo vivencial. De hecho, las dinámicas diseñadas apelan, desde la afectación y la sensibilidad, a estratos profundos inconscientes activos en la realidad del aula. Así, este método recrea situaciones que operan en el trasfondo del sentimiento afectado durante el proceso de aprendizaje. Por ello, estas dinámicas ya en su misma concepción son ‘acciones diseñadas’ o ‘diseño en acción’, constituyendo lo que podríamos denominar ‘performances educativas’ dentro del aula (hooks, 2021, p. 32). De este modo, aplicando herramientas puramente artísticas y creativas a la ‘docencia de la creatividad’, practicamos lo que podría considerarse el ‘diseño de la pedagogía del diseño’.
«No soy lo que digo o hago; soy algo más que eso»: trastorno neurocognitivo mayor y bioética a través del cine
Authors: Pinto Bustamante Boris Julián , Carrillo Pedrosa Daniela María , Sandoval Cardozo Juan Manuel , Rey Sánchez Daniela Alejandra , Chaves Gualteros Brenda Katherin , Ramírez Parra Lina María
Published: June 2024

La inversión de la pirámide poblacional y el incremento global de la expectativa de vida son fenómenos demográficos con importantes repercusiones sociales, económicas y de salud pública. Una de tales consecuencias es el aumento en la prevalencia de enfermedades crónicas no transmisibles, como son las diferentes formas de trastorno neurocognitivo mayor (TNM). El presente capítulo examina algunos de los problemas bioéticos que suscitan estas condiciones, como son: el reconocimiento de la agencia moral de las personas que viven con estas condiciones, la solicitud de pruebas genéticas, la participación de las personas con TNM en los procesos de toma de decisiones, la revelación de la verdad y la importancia de los cuidados paliativos en el tratamiento de estas condiciones en el final de la vida. Las representaciones sociales y los imaginarios reflejados en productos culturales como el cine y la literatura permiten identificar elementos relevantes en torno a la atención en salud de los pacientes con tnm y la reivindicación de sus derechos. En este capítulo se abordan estos elementos a partir de películas como Iris, Siempre Alice, Amour y Nebraska.
Los desafíos y oportunidades de la agenda climática de cara al futuro
Authors: Barrera Ximena , Varón Daniela
Published: June 2024

El propósito de este capítulo es ofrecer un panorama sobre el estado actual de la lucha global frente al cambio climático, sus desafíos y oportunidades para aumentar los esfuerzos, haciendo énfasis en lo que sucede en la región de ALC. El texto se divide en tres partes principales, en la primera se hace una síntesis de los avances en la implementación del Acuerdo de París; en la segunda, se analizan los desafíos actuales para lograr los objetivos planteados en el Acuerdo, y en la tercera se exponen las oportunidades para abordar los desafíos en el contexto de América Latina, en especial a corto plazo.
Assessment of pain management among nurses using the knowledge and attitude survey regarding pain tool
Authors: Chia Gerk Sin , Wong Yat Yen , Yow Fionna , Ong Wendy YM
Published: June 2024

Background:

The prevalence of pain among cancer patients vary in the cancer trajectory and nurses will encounter patients with cancers who may experience pain. Nurses routinely need to assess and manage pain to deliver quality care.

Aim and method:

The study aims to understand the knowledge and attitudes of nurses towards pain management using the self-administered questionnaire—the Knowledge and Attitude Survey Regarding Pain (KASRP).

Findings:

Some 80 nurses participated in the study with an average overall KASRP score of 56%. Areas that were poorly answered are related to the knowledge about opioids, assessment of pain and management of pain in different scenarios. Factors like nurse-patient relationships and being unfamiliar with opioids may affect the knowledge and attitude of nurses towards pain management.

Conclusion:

Curriculum on pain management needs to consider strategies to help nurses translate knowledge to bedside clinical teaching. It needs to include facts of pain management, and topics regarding self-awareness and clarifying misconceptions.
Considerations around Gillick competence in healthcare
Authors: Davies Kate
Published: June 2024

This article explains the principles of Gillick competence, including how to involve young people and those with parental responsibility in decisions about medical treatment
İKİ DÜNYA ARASINDA: ÖTEBAY TURMANJANOV VE FOLKLOR
Authors: Duman Gül Banu
Published: June 2024

ÖZ: 19. yüzyılın ortalarından itibaren yazılı edebiyatı gelişmeye başlayan Kazak edebiyatı, zengin bir sözlü edebiyat geleneğini miras almıştır. Yirminci yüzyıl Kazak edebiyatının ilk yazar ve şairlerinde sözlü kültürün izleri görülür. Sovyet Kazak Edebiyatının kurucuları arasında ismi anılan Ötebay Turmanjanov, Kazak kültürünün ve anonim edebiyatının canlı olduğu bir Kazak köyünde dünyaya gelmiştir. İlk edebi zevkini bu köyde alan şairin şiirlerinde halk kültürü ve edebiyatının etkileri vardır. Onun şiirlerinde Sovyet folklor anlayışının etkileri görülmesine rağmen kuru kuruya bir propaganda yoktur. Halkın anlayabileceği sade bir üslupla, halk söyleyişini benimseyen şairin şiirlerinde zamanın şairlerinde az rastlanan lirizm vardır. “Milliyetçilik, Mağcancılık, Abaycılık” ile suçlanan şair 1938 yılında 20 yıl sürecek sürgün cezasına gönderilir. Sürgünden döndükten sonra daha çok çocuk edebiyatı alanında eserler veren şair, eski eserleri dikkate alınmadığından ismini ancak çocuk edebiyatı içerisinde duyurabilmiştir. Şair şiirlerinde folklorik unsurlar kullanmayı bir üslup olarak benimsemiştir. Bu çalışmada şairin şiirlerindeki folklorik unsurlar incelenerek şiirlerindeki folklor etkisi örneklerle açıklanmaya çalışılmıştır.
MINIMALLY INVASIVE SURGERY VERSUS CONSERVATIVE TREATMENT FOR DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURES: A PROSPECTIVE PROPENSITY SCORE-MATCHED COHORT STUDY WITH TWO-YEAR FOLLOW-UP
Authors: Ahluwalia R. , Lewis T. , Musbahi O. , Reichert I.
Published: June 2024

Background

Optimal management of displaced intra-articular calcaneal fractures remains controversial. The aim of this prospective cohort study was to compare the clinical and radiological outcomes of minimally invasive surgery (MIS) versus non-operative treatment in displaced intra-articular calcaneal fracture up to 2-years.

Methods

All displaced intra-articular calcaneal fractures between August 2014 and January 2019 that presented to a level 1 trauma centre were considered for inclusion. The decision to treat was made by a multidisciplinary meeting. Operative treatment protocol involved sinus tarsi approach or percutaneous reduction & internal fixation. Non-operative protocol involved symptomatic management with no attempt at closed reduction. All fractures were classified, and the MOXFQ/EQ-5D-5L scores were used to assess foot and ankle and general health-related quality of life outcomes respectively.

Results

101 patients were recruited at a level 1 major trauma centre, between August 2014 and January 2019. Our propensity score matched 44 patients in the surgical cohort to 44 patients in the non-surgical cohort. At 24 months, there was no significant difference in the MOXFQ Index score (p<0.05) however the patients in the surgical cohort had a significantly higher EQ-5D-5L Index score (p<0.05). There was also a higher return to work (91% vs 72%, p<0.05) and physical activity rate (46 vs. 35%, p<0.05) in the surgical cohort despite a higher proportion of more complex fractures in the surgical cohort. The wound complication rate following surgery was 16%. 14% of patients in the non-operative cohort subsequently underwent arthrodesis compared to none of the patients in the surgical cohort.

Conclusion

In this study, we found operative treatments were associated with low rates of surgical complication at 2-years and long term pain improvement, facilitating earlier and better functional outcomes for complex injury patterns compared to nonoperative treatment.
MEDIAL MALLEOLUS: OPERATIVE OR NONOPERATIVE (MOON). A RANDOMIZED CLINICAL TRIAL OF OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF ASSOCIATED MEDIAL MALLEOLUS FRACTURES IN UNSTABLE ANKLE FRACTURE DISLOCATIONS
Authors: Carter T. , Oliver W. , Bell K. , Graham C. , Duckworth A.D. , White T. , Heinz N.
Published: June 2024

Introduction

Unstable ankle fractures are routinely managed operatively. Due to soft-tissue and implant related complications, there has been recent literature reporting on the non-operative management of well-reduced medial malleolus fractures following fibular stabilisation, but with limited evidence supporting routine application. This trial assessed the superiority of internal fixation of well-reduced (displacement ≤2mm) medial malleolus fractures compared with non-fixation following fibular stabilisation.

Methods and participants

Superiority, pragmatic, parallel, prospective randomised clinical trial conducted over a four year period. A total of 154 adult patients with a bi- or trimalleolar fractures were recruited from a single centre. Open injuries and vertical medial malleolar fractures were excluded. Following fibular stabilisation, patients were randomised intra-operatively on a 1:1 basis to fixation or non-fixation after satisfactory fluoroscopic fracture reduction was confirmed. The primary outcome was the Olerud Molander Ankle Score (OMAS) at one-year post-randomisation. Complications and radiographic outcomes were documented over the follow-up period.

Results

Among 154 participants (mean age, 56.5 years; 119 women [77%]), 144 [94%] completed the trial. At one-year the median OMAS was 80 (IQR, 60–90) in the fixation group compared with 72.5 (IQR, 55–90) in the non-fixation group (p=0.17). Complication rates were comparable. Significantly more patients in the non-fixation group developed a radiographic non-union (20% vs 0%; p<0.001), with the majority (n=8/13) clinically asymptomatic and one patient required surgical re-intervention for this. Fracture type and reduction quality appeared to influence fracture union and patient outcome.

Conclusions

In this randomised clinical trial comparing internal fixation of well-reduced medial malleolus fractures with non-fixation, following fibular stabilisation, fixation was not superior according to the primary outcome. However, 1 in 5 patients following non-fixation developed a radiographic non-union and whilst the re-intervention rate to manage this was low, the future implications require surveillance. These results may support selective non-fixation of anatomically reduced medial malleolus fractures.
ATTACHMENT WITH SUTURE VIA BONE TUNNELS IS COMPARABLE BIOMECHANICALLY TO SINGLE-ROW ANCHOR SUTURE FOR REATTACHMENT OF ACHILLES TENDON TO BONE
Authors: Aizah N. , Haseeb A. , Draman M.R.
Published: June 2024

Insertional Achilles tendinitis with considerable degeneration that failed non-operative treatment typically requires tendon debridement and reattachment to bone. It is common practice for tendons to be reattached back with anchor sutures, but this poses a challenge to patients who are not able to afford them. Bony anchorage of tendons may be performed by passing sutures through tunnels, but the strength of repair compared to by using anchors is not known. We investigated the load at clinical and catastrophic failure of these two methods of reattachment. Sixteen paired Achilles tendons along with the calcaneus were harvested from eight fresh frozen cadavers. Paired randomization was done. For the anchor suture group, two 5’0 anchors with polyethylene #2 sutures were used for reattachment whereas for the suture only group, tendons were reattached to bone using braided polyester #2 sutures via two bony tunnels. All samples were mounted on a materials testing system and preloaded at 50N for 60sec before load to failure at a rate of 1mm/sec. With the assumption that preloading has removed tendon crimp and any subsequent extension is a result of gapping at the repair site, loads at 5mm, 10mm, 15mm, and 20mm of extension were noted as well as the maximal load at failure. We found higher loads were needed to cause an extension of 5 to 20mm in the suture only group compared to the anchor suture group but these data were not significant. On the other hand, the anchor suture group required higher loads before catastrophic failure occurred compared to the suture only group, but this again is not significant. We conclude that suture only reattachment of the Achilles tendon is comparable in strength with anchor suture reattachment, and this method of reattachment can be considered for patients who do not have access to anchor sutures.
A TWO-STAGE APPROACH IN MANAGING DIABETIC FOREFOOT ULCERS
Authors: Sayani J. , Tiruveedhula M.
Published: June 2024

Aim

Forefoot ulcers in patients with diabetic neuropathy are a result of factors that result in increased forefoot plantar pressures. Progressive hindfoot equinus from contraction of gastrocnemius-soleus-tendo-Achilles complex and progressive plantar flexed metatarsal heads secondary to claw toe deformity results callus at the metatarsal heads which break down to ulceration. The aim is to describe 2-stage treatment pathway for managing these ulcers.

Methods

Consecutive patients, who presented with forefoot ulcers since February 2019 were treated with a 2-stage treatment pathway. The first stage of this is an out-patient tendo-Achilles lengthening (TAL). The second stage is surgical proximal dorsal closing wedge metatarsal osteotomy for patients with persistent or recurrent ulcers. Patients were followed for a minimum of 12 months.

Results

112 patients (146 feet) underwent TAL by 3 consultants. Of these, 96 patients were followed for a minimum of 12 months (range 12–36 months). None had infection or wound related problems at the tenotomy sites; complete transection of the tendon was noted in 4 patients (4%) and one-patient developed heel callosity suggestive of over-lengthening.

In 92 patients (96%), the ulcers healed within 10 weeks (± 4 weeks). Additional z-lengthening of peroneal longus and tibialis posterior tendons helped in patients with 1st metatarsal and 5th metatarsal head ulcers respectively. In 12 patients (10%), the ulcer failed to heal or recurred. MRI scan in these patients showed plantar flexed metatarsals from progressive claw toe deformity. The ulcer in this group healed after surgical offloading with proximal dorsal closing wedge osteotomy of the metatarsal/s, with no recurrence at a minimum 12months of follow-up.

Conclusion

The described 2-stage treatment pathway results in long-term healing of neuropathic forefoot ulcers, and in 96% of patients, the ulcer healed after the first stage out-patient percutaneous TAL.
CLINICAL, RADIOLOGICAL, AND PATIENT-REPORTED OUTCOMES OF CHARCOT FOOT RECONSTRUCTIVE SURGERY IN A SINGLE CENTRE OVER A FOLLOW-UP PERIOD OF ONE TO SEVEN YEARS
Authors: Martin R. , Sylvester H. , Ramaskandhan J. , Chambers S. , Qasim S.
Published: June 2024

Introduction

Surgical reconstruction of Charcot joint deformity is increasingly being offered to patients. In our centre a hybrid type fixation technique is utilised: internal and external fixation. This combined fixation has better wound management and earlier mobilisation in this deconditioned patient group. The aim of this study was to assess clinical, radiological and patient reported outcomes for all patients who underwent this hybrid technique.

Methods

This is a prospective observational case series of all patients who underwent surgical reconstruction of Charcot foot deformity in a single centre between June 2017 and June 2023. Patient demographics, smoking status, diabetic control and BMI were recorded. Outcomes were determined from case notes and included clinical outcomes (complications, return to theatre, amputation and mortality) radiological outcomes and patient reported outcomes. The follow up period was 1–7 years post operatively.

Results

42 reconstructions were included. At the time of surgery the mean age was 59.1 years (29 – 91 years), average HbA1c was 65.2 (33–103); this did not correlate with return to theatre rate. 4 procedures were internal fixation alone (9.5%), 3 external fixation alone (7.1%) and 35 were combined fixation (83.3%). At most recent follow up 7 patients were deceased (16.7%), 2 patients had ipsilateral amputations, 2 had contralateral amputations. 11 patients had issues with recurrent ulcerations. Excluding refreshing of frames and operations on the contralateral side, 17 patients (40%) returned to theatre. We aim to present a detailed analysis of the rate of post-operative complications, return to theatre, radiographic outcomes and patient reported outcomes.

Conclusion

This is the largest UK based case series of hybrid type Charcot joint reconstructions and shows that hybrid fixation is a viable option for patients undergoing Charcot joint reconstruction. To best confirm findings and determine which patients have the best post-operative prognosis a larger multi-centre study is required.
SINGLE-STAGE, COMBINED, ORTHO-PLASTICS TREATMENT OF SEVERE CALCANEAL OSTEOMYELITIS WITH LARGE SOFT-TISSUE DEFECTS: LONG-TERM FOLLOW-UP
Authors: Down B. , Tsang S.-T. Jerry , Hotchen A. , Ferguson J. , Stubbs D. , Loizou C. , Ramsden A. , McNally M. , Kendal A.
Published: June 2024

Background

Calcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence and below knee amputation; particularly in cases of severe soft tissue destruction.

Aim

Assess the outcomes of combined ortho-plastics treatment of complex calcaneal osteomyelitis.

Method

A retrospective review was performed of all patients who underwent combined single stage ortho-plastics treatment of calcaneal osteomyelitis (2008–2022). Primary outcome measures were osteomyelitis recurrence and BKA. Secondary outcome measures included flap failure, operative time, complications, length of stay.

Results

33 patients (16 female, 17 male, mean age = 54.4 years) underwent combined ortho-plastics surgical treatment for BACH “complex” calcaneal osteomyelitis with a median follow-up of 31 months (s.d. 24.3). 20 received a local flap, 13 received a free flap. Fracture-related infection (39%) and diabetic ulceration (33%) were the commonest causes. 54% of patients had already undergone at least one operation elsewhere. There were seven cases of recurrent osteomyelitis (21%); all in the local flap group. One patient required a BKA (3%). Recurrence was associated with increased mortality risk (OR 18.8 (95% CI 1.5–227.8), p=0.004) and reduced likelihood of walking independently (OR 0.14 (95% CI 0.02–0.86), p=0.042).

Local flap reconstruction (OR 15 (95% CI 0.8–289.6), p=0.027) and peripheral vascular disease (OR 39.7 (95% CI 1.7–905.6), p=0.006) were associated with increased recurrence risk.

Free flap reconstruction took significantly longer intra-operatively than local flaps (443 vs 174 minutes, p<0.001), but without significant differences in length of stay or frequency of out-patient appointments.

Conclusions

Single stage ortho-plastic management was associated with 79% eradication of infection and 3% amputation in this complex and co-morbid patient group. Risk factors for failure were peripheral vascular disease and local flap reconstruction. Whilst good outcomes can be achieved, this treatment requires high levels of in-patient and out-patient care.
WHAT HAPPENS AFTER FAILED TOTAL ANKLE ARTHROPLASTY?
Authors: Jagani N. , Harrison W. , Davenport J. , Karski M. , Ring J. , Smith R. , Clough T.
Published: June 2024

Aims

Retrospective review of a consecutive series of 1,168 total ankle replacements (TAR) performed at Wrightington, to analyse modes of failure and clinical outcomes following TAR failure.

Methods

All patients undergoing TAR between November 1993 – June 2019 were collated (4–25 year follow-up; mean 13.7 years). 6 implants were used (300 STAR, 100 Buechal Pappas, 509 Mobility, 118 Zenith, 41 Salto and 100 Infinity). 5 surgeons, all trained in TAR, performed the surgery. Modes of failure were collated and clinical and radiological outcomes recorded for the revisional surgery following failure of the TAR.

Results

156 (13.4%) TARs failed (47STAR 15.6%, 16BP 16%, 77Mobility 15.1%, 6Salto 14.6%, 10Zenith 8.5% and 0Infinity 0%). Mean time to failure 5.8 years (0.1- 21.4 years). The 4 most common modes of failure were 44.9% aseptic loosening, 11.5% gutter pain, 10.9% infection and 10.3% recurrent edge loading. 50 underwent conversion to tibiotalocalcaneal (TTC) fusion with nail with 9 (18%) failing to fuse. 31 underwent revision TAR with 2 (6.5%) subsequently failed. 22 underwent ankle fusion with 10 (45%) failing to fuse. 21 underwent polyethylene exchange of which 8 (38%) had further poly failure. 20 (12.8%) were managed conservatively, 2 (1.3%) required below knee amputation and 6 were listed but lost to follow-up. 81 of the 1168 (7%) consecutive cohort were lost to follow-up.

Conclusions

13.4% of the TAR cohort have failed at average follow-up 13.7 years. There was no difference in failure modes across the implant designs. Whilst the fixed bearing has the shortest follow-up, it may be performing better as there have been no failures so far. Prior to October 2016, most revisions were to fusion (TTC 18% failure rate, ankle 45% failure rate), whereas post 2016, 57% patients elected for revision TAR (6.5% failure).
ARE TOTAL ANKLE ARTHROPLASTIES MORE PROTECTIVE OF THE HINDFOOT JOINTS THAN ANKLE ARTHRODESIS? A 13-YEAR AVERAGE RETROSPECTIVE REVIEW OF 516 CASES
Authors: Trew C. , Chambers S. , Siddique M. , Qasim S.
Published: June 2024

One assumed function of Total Ankle Replacement (TAR) is that by maintaining ankle joint motion we can protect the other hind foot joints from further degredation1. However, there is no work to our knowledge that compares hindfoot outcomes between TAR and arthrodesis. Sokolowski et al. found that 68% of TAR patients had no radiological progression of subtalar arthritis after TAR, and 4% went on to fusion2. However, no evaluation of the other hindfoot joints was made and no comparison made to other treatment. We performed a retrospective review of all patients at our centre who had had a TAR or ankle arthrodesis since 2002. Case notes and imaging were reviewed and all instances of hindfoot treatment (injections or surgical procedures) noted. Patients were excluded who had no documentation, were followed up at other hospitals, had prior hindfoot fusion, or were having staged surgeries at the time of index treatment. Chi squared analysis was used to compare the cohorts. 214 arthrodesis cases and 302 TAR were eligible. The average age was 57. Average time to follow up was 13 years (4–21). At the time of abstract submission 107 sets of notes had been reviewed fully. Full analysis will be performed by conference. 14% of TAR patients went on to have further procedures to the hindfoot joints while 35% of arthrodesis patients had further procedures (p=0.014). There was also a significant difference in the number of patients progressing to fusion of a further hindfoot joint between groups (TAR- 4%, arthrodesis- 20%, p=0.01). These data suggest that TAR are protective of symptomatic change of hindfoot joints. Patients with TAR had fewer hindfoot fusions than those with arthrodesis and also fewer procedures of any form, including injections.
Intrusion Detection in Wireless Sensor Networks Based on IPSO-SVM Algorithm
Authors: Lv Zhimin , Wan Jun
Published: June 2024

To optimize node energy consumption and improve its security, this paper uses the DEEC algorithm to layer WSN and reduce the probability of channel information collision and uses the weighted probability of cluster head election to optimize node energy expenditure, so that WSN can obtain a longer lifecycle. Improved Particle Swarm Optimization-based Support Vector Machine (IPSO-SVM) algorithm is used for intrusion detection and experimental testing in WSN. The results showed that the IPSO-SVM algorithm exhibited good convergence, with a convergence step size of 5 steps, which converged earlier than the Support Vector Machine Algorithm based on Particle Swarm Optimization (PSO-SVM), which had a convergence step size of 10 steps. The IPSO-SVM algorithm performed best in WSN intrusion detection, with the highest detection rate of 96.20% in Probe attack data detection, which was 0.80% higher than the Support Vector Machine Algorithm based on Genetic Algorithm (GA-SVM). The PSO-SVM algorithm had the lowest detection rate of 95.20%. The IPSO-SVM algorithm had a minimum false positive rate of 1.54% in Dos attack data detection. In terms of average training time, the IPSO-SVM algorithm had a minimum average training time of 323.45 seconds. Compared to the Low Energy Adaptive Clustering Hierarchy (LEACH) algorithm, the Distributed Energy Efficient Clustering (DEEC) algorithm performs better, has less energy consumption, and retains more nodes. The method adopted in this study can make WSN have a longer life cycle and ensure its security.