bluuebunny/crossref_metadata_2025 huggingface dataset:
Playing the game of selectivity: The normalisation of merit and invisibilisation of advantage in students’ admission into competitive schools
Authors: Tham Melissa , Walsh Lucas
Published: October 2024

Students’ beliefs in schooling to achieve opportunity have been well documented in the school choice literature. How students make sense of successful entry into competitive and high-demand schools via high-stakes entrance exams is less researched. High-demand schools, including both public and private schools, can utilise entrance exams to enrol their students. This paper aims to contribute empirical and conceptual insights into school selectivity by tracing the experiences of students as they navigate exams into selective and high-fee private schools, to broaden understandings of how competitive school admissions processes can impact students. Interviews reveal that many students are motivated to achieve occupational opportunities through admission into competitive schools. Influenced by their families, all participants undergo private tutoring and exam coaching to prepare for entrance exams, from a few months to 8 years. Long-term tutoring, repetitive test-taking and applying for multiple high-demand schools both simultaneously and consecutively constitute ‘playing the game of selectivity’, an experience from which students develop conceptions of merit that normalises these processes. Such conceptions of merit include individualistic strategies that render invisible their own sense of economic advantage relative to others.
Most Common Pathogens Causing Rhinosinusitis in Patients Who Underwent Endoscopic Sinus Surgery Before, During, and After the COVID-19 Pandemic
Authors: Almhanedi Hamad , Aldajani Ahmad , Steinberg Emily , Tewfik Marc
Published: October 2024

Importance

Chronic rhinosinusitis (CRS) significantly impacts patients’ quality of life and incurs substantial healthcare costs. Understanding pathogen trends before, during, and after the COVID-19 pandemic can inform better management and treatment strategies.

Objective

To identify the common pathogens associated with CRS and compare them across pre-pandemic, during-pandemic, and post-pandemic periods.

Design

Retrospective chart review.

Setting

McGill University Health Centre, Montreal, Canada.

Participants

Around 147 patients were 18 years and older, diagnosed with CRS, underwent endoscopic sinus surgery within the specified timeframe (January 2017 to September 2023), and whose charts contained relevant microbiology information. Patients were categorized into 3 groups based on surgery dates: pre- (January 2018 to November 2019), during- (January 2020 to December 2021), and post-pandemic (February 2022 to September 2023).

Main Outcome Measures

Distribution and prevalence of pathogens associated with CRS across the 3 time periods. Microbiology results from nasal cultures were analyzed to identify predominant pathogens.

Results

Among the 147 patients, 46 distinct organisms were identified. Staphylococcus aureus was the most prevalent pathogen, increasing during the COVID-19 period (24.7%) compared to pre-pandemic (17.9%) and post-pandemic (21.5%) periods. Significant increases during the COVID-19 period were noted for Aspergillus fumigatus (6.8%, P < .001), Enterobacter cloacae (6.8%, P = .01), and Cutibacterium acnes (6.8%, P = .03). Post-pandemic, significant rises were observed in Serratia marcescens ( P < .001) and Achromobacter denitrificans ( P = .03).

Conclusions and Relevance

Significant shifts in CRS-associated pathogens occurred during the COVID-19 pandemic. Notable changes in the prevalence of S. aureus, A. fumigatus, E. cloacae, and C. acnes were observed during the pandemic, with increases in S. marcescens and A. denitrificans post-pandemic. These findings suggest that the pandemic’s impact on healthcare practices and environmental factors influenced the microbial etiologies of CRS. Future research may explore the mechanisms driving these changes and their long-term implications for CRS management.
Soluble Guanylate Cyclase Dysfunction and Nitric Oxide Pathway in Chronic Rhinosinusitis With Nasal Polyps: Predictive Markers for Postoperative Recurrence
Authors: Jiang, MD Sijie , Zhang, MD Caixia , Tong, MD Zongjing , Xie, PhD Shaobing , Xie, MD Zhihai , Zhang, MD Hua , Jiang, MD Weihong
Published: October 2024

Background

Elevated nitric oxide (NO) levels have been linked to a heightened risk of recurrence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, the precise influence of NO on CRSwNP recurrence remains unclear.

Objective

This study seeks to elucidate the relationship between NO levels and the risk of CRSwNP recurrence.

Methods

A protein chip array analysis was conducted to identify differentially expressed inflammatory mediators in the nasal tissues between patients with CRSwNP and healthy controls (HC). Differentially expressed proteins were analyzed, and bioinformatics analysis was used to predict the potential functions and pathways of these proteins. Western blotting (WB) and immunohistochemistry were employed to validate the candidate proteins in 2 independent cohorts. Receiver-operating characteristic (ROC) curves were employed to assess the abilities of target proteins for predicting the postoperative recurrence of CRSwNP.

Results

Twelve differentially expressed proteins were identified between the CRSwNP and HC groups. Notably, differentially expressed proteins exhibited high expression of the biological process term “positive regulation of nitric oxide-mediated signal transduction” ( P < .05). WB and immunohistochemistry results demonstrated that guanylate cyclase 1 soluble subunit alpha 1 (GUCY1A1), GUCY1A2, nitric oxide synthase 1 adaptor protein, epidermal growth factor receptor, and insulin were found to be upregulated in the CRSwNP group compared to the HC group ( P < .05). Moreover, elevated levels of GUCY1A2 and GUCY1A1 were observed to be associated with an increased risk of CRSwNP recurrence ( P < .05), and ROC curve analysis confirmed their effectiveness as predictors for postoperative recurrence ( P < .05).

Conclusion

Our findings revealed that CRSwNP exhibited a distinct tissue protein profile, with soluble guanylate cyclase dysfunction and the nitric oxide pathway implicated in the underlying pathological mechanisms. The discovery-validation results suggested that GUCY1A1 and GUCY1A2 were promising predictors for postoperative recurrence in patients with CRSwNP.
Implementation of an Optimized Preoperative Checklist for Endoscopic Sinus Surgery Within a Multiinstitutional Resident Education Curriculum
Authors: Leong Stephen , Scharfenberger Thomas , Yang Nathan , Ray Amrita , Akbar Nadeem , Colley Patrick M. , Signore Anthony Del , Eloy Jean Anderson , Govindaraj Satish , Gudis David , Helman Samuel , Hsueh Wayne , Iloreta Alfred-Marc , Kacker Ashutosh , Lieberman Seth M. , Pearlman Aaron N. , Schaberg Madeleine R. , Tabaee Abtin A. , Overdevest Jonathan B.
Published: October 2024

Background

Preoperative review of computed tomography (CT) imaging assists with endoscopic sinus surgery (ESS) planning, where trainees may benefit from a systematic approach. We have previously developed an optimized preoperative checklist for sinus CT imaging using an iterative modified Delphi method.

Objective

In this study, we assess the utility of an optimized preoperative checklist for residents performing ESS.

Methods

Resident sinus CT scan education consisted of a preintervention questionnaire, an 18-min video outlining the optimized preoperative checklist, and a delayed postintervention questionnaire; these were distributed via Qualtrics to otolaryngology residents across 5 training programs in the NY metro area. The preintervention questionnaire contained 25 survey questions and a 225-point quiz on sinus CT anatomy; the delayed postintervention questionnaire contained the same 25 survey questions and a second, distinct 225-point quiz.

Results

In total, 74 residents completed the preintervention questionnaire, 47 completed the postintervention questionnaire, and 36 completed both. Among residents completing both questionnaires, the average preintervention quiz score was 136.8 ± 24.0 and the average postintervention quiz score was 156.0 ± 23.5 ( P < .001). Resident habitual utilization of a systematic preoperative CT imaging checklist increased significantly from 21.6% to 72.9% as a result of the curriculum intervention.

Conclusion

We find that an educational program centered on an iteratively optimized preoperative checklist for ESS improves the ability of trainees to identify critical sinus CT structures. Further integration of checklists and educational curricula may enhance rhinology education efforts and improve surgical anatomy competency.
Dark patterns: Can criminal law remedy the shortcomings of antitrust law?
Authors: Ziermann Fabian
Published: October 2024

Antitrust laws' remedies to address Big Tech's anticompetitive business models have often been questionable. Since the fundamental design choices of business models pose significant challenges, due to dark patterns, Austrian criminal law may compensate for antitrust laws' enforcement limits. It is argued that Amazon's Prime and BuyBox, Google's Search and its AI Bard, Activision Blizzard's lootboxes, and Engagement Optimised Matchmaking (EOMM) algorithms contain dark patterns that may constitute (commercial) fraud within the meaning of §§ 146, 148 StGB. This is because these business models are designed to deceive consumers to unlawfully enrich Big Tech and video game publishers.
Shared leadership – vertical leadership dynamics in teams
Authors: van Knippenberg Daan , Pearce Craig L. , van Ginkel Wendy P.
Published: October 2024

Shared leadership, team members collectively leading the team, has developed from a new perspective on team leadership to an established area of research. As the evidence of the effectiveness of shared leadership accumulates, it comes increasingly into focus that we lack theory about the dynamic interplay of shared leadership and vertical leadership – the leadership by the individual formally assigned to lead the team. The absence of such theory is problematic because vertical leadership is a continuing presence in the shared leadership process and, to be effective, vertical leadership should arguably both influence and be influenced by shared leadership. Linear models in which vertical leadership is treated as a predictor of shared leadership without taking this dynamic into account fall short of capturing how vertical and shared leadership work in conjunction. We propose theory to address this, outlining how vertical leadership can develop, maintain, and complement shared leadership in a process in which shared and vertical leadership coevolve as they influence each other. We identify an internal role for vertical leadership in stimulating the development and maintenance of team cognition for shared leadership, guiding the team in shared leadership, and engendering team reflexivity to learn from the experience with shared leadership, and an external role in complementing shared leadership through boundary spanning to connect the team to its external environment. As shared leadership develops over time, it influences these vertical leadership behaviors, such that vertical leadership evolves as shared leadership evolves.

Plain Language Summary Title

Shared leadership in teams: the role of the formal team leader.
Patient-centric decision-making in supplements intake and disclosure in clinical practice: a novel SIDP-12 tool to prevent drug–supplement interaction
Authors: Ait Gacem Sabrina , Huri Hasniza Zaman , Wahab Izyan A. , Abduelkarem Abduelmula R.
Published: October 2024

Background:

Self-treatment of dietary supplements may contribute to interactions and severe side effects. Limited studies have constructed a scale that can measure the disclosure practice of supplements to healthcare providers and the influencing factors.

Objective:

The study aims to investigate the supplement disclosure practice among the public in the UAE using a developed and validated supplement disclosure assessment scale tool.

Design:

A cross-sectional survey study that targeted those residing in the United Arab Emirates (UAE) aged 18 years and above from both genders through an online survey.

Methods:

A novel scale tool was developed and examined for its validity and reliability through three pilot studies.

Results:

The study included three validity and reliability pilot studies before the main study evaluation: pilot 1 ( n = 104), pilot 2 ( n = 101), pilot 3 ( n = 37), and study data ( n = 407). A total of 407 respondents provided feedback from which 137 stated that they consumed supplements. A significant indirect effect of healthcare provider initiation of enquiry (HPE) on patient-informing practice (PI) was observed through two mediating variables, patient’s beliefs (PB) and pharmacist counseling regarding supplements interactions (PC) ( B = 0.106, t = 2.120, p = 0.03 and B = 0.077, t = 2.011, p = 0.04, respectively). Most respondents were not asked about their supplement consumption by the hospital and community pharmacists (52.94 and 50.74, respectively). Most respondents (54.89%) stated that pharmacists did not counsel them about any possible interaction of supplements with laboratory tests. The mean construct scores were 1.096 for PI, 2.618 for PC, 1.552 for HPE, and 1.412 for PB.

Conclusion:

The instrument demonstrates desirable validity and reliability. The study results revealed a direct effect of PB and PC on the supplement disclosure practice. HPE indirectly affected PI through two mediating variables: PB and PC. The results showed a moderate HPE and PC and an excellent PB and PI construct.
Impact of an antibiotic stewardship program on adherence to antibiotic prescription in children admitted with urinary tract infection
Authors: Brigadoi Giulia , Liberati Cecilia , Gres Emelyne , Barbieri Elisa , Boreggio Elena , Rossin Sara , Tirelli Francesca , Tesser Francesca , Chiusaroli Lorenzo , Demarin Giulia Camilla , Maestri Linda , Giaquinto Carlo , Da Dalt Liviana , Bressan Silvia , Donà Daniele
Published: October 2024

Background:

Urinary tract infections (UTIs) are the most common bacterial infections in children. The high variability in pathogen susceptibility rates leads to the lack of clear guidelines for empiric and targeted therapies. In this view, local microbiological surveillance and locally adapted stewardship interventions need to be implemented.

Objective:

The study aims to describe the results of a pediatric antimicrobial stewardship program on antibiotic prescriptions for UTIs over 8 years in a pediatric general ward of a tertiary center.

Design:

This quasi-experimental study was conducted between 2015 and 2022, with two different implementations, one in 2018 and one in 2021.

Methods:

Demographic, clinical, microbiological, and therapeutic data were retrieved from the electronic clinical records of included patients. The primary outcomes were adherence to local guidelines for empiric therapies and the adequacy of targeted therapy. Secondary outcomes were evaluating antibiotic prescription patterns stratified by antibiotics during hospital stay and at discharge, and assessing the microbiological characteristics of UTI episodes.

Results:

During the study period, 7038 patients were admitted to the pediatric acute care unit (PACU), and 264 (3.7%) were included in this study. Adherence to local guidelines was highest immediately after the interventions, and it slightly decreased thereafter. Use of cephalosporins remained high throughout the 8 years but the changing microbiological scenario observed led to changing recommendations within the study period. An increase in E. coli strains resistant to co-amoxiclav was observed in the last years. Oral second-line agent consumption remained high but was adequate considering the prevalence of resistant bacteria.

Conclusion:

The variability of antimicrobial consumption reflects the changing resistance patterns for UTIs pathogens, underlying the importance of locally adapted, persevering antimicrobial stewardship interventions.
Exploring the characteristics of conversational agents in chronic disease management interventions: A scoping review
Authors: Uetova Ekaterina , Hederman Lucy , Ross Robert , O’Sullivan Dympna
Published: October 2024

Objective

With the increasing global burden of chronic diseases, there is the potential for conversational agents (CAs) to assist people in actively managing their conditions. This paper reviews different types of CAs used for chronic condition management, delving into their characteristics and the chosen study designs. This paper also discusses the potential of these CAs to enhance the health and well-being of people with chronic conditions.

Methods

A search was performed in February 2023 on PubMed, ACM Digital Library, Scopus, and IEEE Xplore. Studies were included if they focused on chronic disease management or prevention and if systems were evaluated on target user groups.

Results

The 42 selected studies explored diverse types of CAs across 11 health conditions. Personalization varied, with 25 CAs not adapting message content, while others incorporated user characteristics and real-time context. Only 12 studies used medical records in conjunction with CAs for conditions like diabetes, mental health, cardiovascular issues, and cancer. Despite measurement method variations, the studies predominantly emphasized improved health outcomes and positive user attitudes toward CAs.

Conclusions

The results underscore the need for CAs to adapt to evolving patient needs, customize interventions, and incorporate human support and medical records for more effective care. It also highlights the potential of CAs to play a more active role in helping individuals manage their conditions and notes the value of linguistic data generated during user interactions. The analysis acknowledges its limitations and encourages further research into the use and potential of CAs in disease-specific contexts.
How Migrants Experience Information Uncertainty and Vulnerability: Lessons for (Dis)information Studies
Authors: Siles Ignacio , Salas María Fernanda , Waisbord Silvio
Published: October 2024

This article develops a phenomenological approach to examine the intersection of global migration and rising concerns about disinformation. Drawing on interviews with Venezuelans en route to the United States-Mexico border through Central America, the article analyzes how undocumented migrants live amid information precarity, how they relate to disinformation, and how disinformation affects their decisions. We demonstrate the centrality of information and communication practices in managing (dis)information during the migration experience. This includes distrusting traditional media, using various platforms like social media and messaging apps, and exchanging both information and disinformation with others. By adopting a phenomenological approach, the article demonstrates that migrants’ relationship with (dis)information is shaped by their conviction that each person has unique life experiences and a profoundly religious view of life and destiny. The article thus advocates for a deeper exploration of migrants’ sociocultural beliefs rather than focusing solely on issues such as information accuracy, accessibility, flows, and platforms when accounting for disinformation. In addition to valuable lessons for (dis)information studies, this approach could enrich communication interventions tailored to migrant communities in vulnerable conditions.
Exploring the Role of Nurses in Travel Medicine to Improve Service Performance in Travelers: A Systematic Review
Authors: Gandari Komang Matalia , Seri Ani Luh , Wirawan I Made Adi
Published: October 2024

Nurses play an important role in travel medicine. However, information about the role of nurses in travel medicine is still limited. This systematic literature review is aimed to exploring the role of nurses in travel medicine to improve service performance in travelers. This study was systematically compiled this review based on a literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The inclusion criteria are articles about travel health nursing, complete original articles, articles written in English and non-review articles. The quality of the studies was also assessed based on the Newcastle Ottawa Scale for observational studies. About 5 out of 257 articles were selected from 3 electronic databases, namely PubMed, Ebsco Host, and Scopus. Analysis of the 5 articles found that the role of travel health caregivers differs from country to country. The primary role of nurses in travel health in the U.S. is to conduct are-travel counseling. Nurses in the Netherlands have the authority to prescribe medicines needed for tourists. In Iris nurses play a role in providing support to the mental health of individual tourists, while in Spain, nurses play a role in emergency care for tourists. Nurses play an important role in the health of travel, including health services for travelers before and during the trip. The results of this review add to the understanding of the role of nurses in travel medicine that contributes to improving nurse performance and tourist welfare.
BREAK FREE and Fly: A CBT School Counseling Group Curriculum for Anxiety
Authors: Mitchell Deedre , Martin Laura , Ebersole Denise , Sperlich Elizabeth
Published: October 2024

A junior/senior high school counselor used an innovative psychoeducational group counseling curriculum based on cognitive behavioral therapy to meet the social/emotional needs of identified students. This article provides a summary and evaluation of the small group plan conducted via practitioner research. Results indicated that, although participants’ overall feelings of anxiety did not significantly improve, the curriculum enabled study participants to meet defined learning objectives. We discuss implications for school counselors.
Distinguishing Transcreation From Translation: Exploring Strategies to Render Gender Stereotypes
Authors: Zhu Li , Ang Lay Hoon , Sun Yanna
Published: October 2024

Academics have long debated the similarities and differences between translation and transcreation. Despite extensive discussion, few studies have examined these distinctions through the lens of the strategies adopted. In response, this study explores how strategies of translation and transcreation are utilized to render gender stereotypes within a specific text type. The theoretical framework is grounded in Karoubi’s categorization of translating gender and Ketola’s types of transcreation strategies, which focus on how gender is interpreted and represented across languages and cultures. Utilizing a qualitative approach, this research analyzes English fragrance product descriptions and their Chinese versions across 12 brands, comprising 224 pairs of descriptions. The findings reveal significant differences in the use of target culture-oriented strategies, with transcreation employing these strategies in approximately 90% of cases, compared to only about 50% in translation. The results suggest that the primary distinction between translation and transcreation lies in the extent to which practitioners alter the source text when creating new content. Moreover, identifying strategies of translation and transcreation based on the established framework could also help distinguish transcreation from translation. These findings contribute new empirical insights to the ongoing debates about the distinctions between translation and transcreation.
Local Government Monitoring System’s Design and Implementation in Ghana from the Lens of the Project Life Cycle
Authors: Akanbang Bernard Afiik Akanpabadai
Published: October 2024

Monitoring at the subnational level has connotations for the effectiveness of local governance in the developing world. Using a cross-sectional survey underpinned by the project life cycle model, the paper contributes to understanding essential considerations in developing and implementing subnational monitoring in Africa. About 74 of the targeted 275 District Development Officers responded to the online Google form questionnaire. The study employed descriptive statistics to analyze data. Results demonstrate that the monitoring system is excellent in design, but its implementation and reflection stages are weak. It highlights planning for subnational monitoring systems encompassing setting clear objectives, utilizing robust indicators, involving stakeholders, and an elaborate plan for data collection, analysis, communication, and reporting as vital ingredients of a monitoring system. Sufficient resources and capacity-building initiatives, including providing on-the-job training, hiring experienced staff, committing financial resources and logistics, and backstopping support, are necessary to implement monitoring activities effectively. An appropriate policy environment, including manuals and legislation, is critical to anchoring and sustaining subnational monitoring systems. Local government’s monitoring systems should prioritize learning, knowledge sharing, and documentation of lessons learned to facilitate programmatic improvements and replication and devote at least 2.5% of the District Assembly Common Fund to finance monitoring and evaluation actions.
Association Between Patient-Reported Enablement and Customer Satisfaction in 140 055 Primary Care Patients After Doctor Appointment
Authors: Ämmälä Antti-Jussi , Taimela Simo
Published: October 2024

Customer satisfaction and enablement are key facets of healthcare quality. We examined their interplay within a large sample of predominantly working-age primary care patients. Our dataset encompasses 140 055 customer satisfaction reports, with concurrently gathered measures of patient enablement, delivered after doctor appointments. We used the customer satisfaction (CSAT) score and the patient enablement instrument (PEI). Additionally, we assessed 3 dimensions of customer satisfaction in conjunction with the CSAT score and calculated a sum score. Age and gender were included as covariates. Our findings from linear regression analyses are twofold: (1) customer satisfaction and enablement are interconnected, yet they maintain a degree of distinctiveness, as indicated by a beta coefficient of 0.45 on a 5-point scale, and (2) within the customer experience on a dichotomous scale, negative experiences exert a more substantial impact (betas between −0.77 and −0.97) on enablement than positive experiences (betas between 0.24 and 0.40). In addition, a dose–response relationship was observed between the sum of customer experiences and PEI. Ensuring that patients’ voices are acknowledged, their queries are addressed, and they have comprehensible guidance regarding the progression of their treatment, are fundamental aspects of interactions with patients.
The Five-Dimension Patient Experience Model and Its Applications in Healthcare Using the Example of Spinal Cord Injury and COPD
Authors: Daleske Carlos Bezos
Published: October 2024

The need for a comprehensive patient experience model across healthcare sectors is crucial. This study introduces IEXP's five-dimension model: physical, emotional, social, cultural, and healthcare. Unlike hospital-centric frameworks, this model acknowledges holistic experiences, vital for chronic conditions. Applied to chronic obstructive pulmonary disease (COPD) and spinal cord injury (SCI), it showcases its adaptability. This model benefits healthcare, patient groups, pharmaceuticals, and medical tech, optimizing care, policy support, adherence, and patient-focused tech. Despite limitations and a chronic condition focus, the model adds value in shaping patient experience cross-sector.
Endovascular therapy in patients with acute intracranial non-terminal internal carotid artery occlusion (ICA-I)
Authors: Riegler Christoph , von Rennenberg Regina , Bollweg Kerstin , Siebert Eberhard , de Marchis Gian Marco , Kägi Georg , Mordasini Pasquale , Heldner Mirjam R , Magoni Mauro , Pezzini Alessandro , Salerno Alexander , Michel Patrik , Globas Christoph , Wegener Susanne , Martinez-Majander Nicolas , Curtze Sami , Dell’Acqua Maria Luisa , Bigliardi Guido , Wali Nabila , Nederkoorn Paul J , Jovanovic Dejana R , Padjen Visnja , Metanis Issa , Leker Ronen R. , Bianco Giovanni , Cereda Carlo W , Pascarella Rosario , Zedde Marialuisa , Viola Maria Maddalena , Zini Andrea , Ramos João Nuno , Marto João Pedro , Audebert Heinrich J , Trüssel Simon , Gensicke Henrik , Engelter Stefan T , Nolte Christian H
Published: October 2024

Background:

Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions.

Methods:

A large international multicentre cohort was searched for patients with intracranial ICA occlusion treated with EVT between 2014 and 2023. Patients were stratified by ICA occlusion pattern, differentiating ICA-I and ICA-L/-T occlusions. Baseline factors, technical (modified thrombolysis in cerebral infarction (mTICI) scale) and functional outcomes (modified Rankin scale [mRS] at 3 months) as well as rates of (symptomatic) intracranial hemorrhage ([s]ICH) were analyzed.

Results:

Of 13,453 patients, 1825 (13.6%) had isolated ICA occlusion. ICA-occlusion pattern was ICA-I in 559 (4.2%) and ICA-L/-T in 1266 (9.4%) patients. Age (years: 74 vs 73), sex (female: 45.8% vs 49.0%) and pre-stroke functional independency (pre-mRS ⩽ 2: 89.9% vs 92.2%) did not differ between the groups. Stroke severity was lower in ICA-I patients (NIHSS at admission: 14 [7–19] vs 17 [13–21] points). EVT was similarly successful with respect to technical (mTICI2b/3: 76.1% (ICA-I) vs 76.6% (ICA-L/-T); aOR 1.01 [0.76–1.35]) and functional outcome (mRS ordinal shift cOR 1.01 [0.83–1.23] in adjusted analyses. Rates of ICH (18.9% vs 34.5%; aOR 0.47 [0.36–0.62] and sICH (4.7% vs 7.3%; aOR 0.58 [0.35–0.97] were lower in ICA-I patients.

Conclusion:

EVT might be performed safely and similarly successful in patients with ICA-I occlusions as in patients with ICA-L/-T occlusions.
Outcomes of different anesthesia techniques in nonagenarians treated with mechanical thrombectomy for anterior circulation large vessel occlusion: An inverse probability weighting analysis
Authors: Levee Viva , Valente Mariarosaria , Bax Francesco , Zhang Liqun , Sacco Simona , Foschi Matteo , Ornello Raffaele , Chulack Katherine , Marchong Emma , Sheikh Fahad , Fayez Feras , Del Regno Caterina , Aggour Mohammed , Sponza Massimo , Toraldo Francesco , Algazlan Razan , Lobotesis Kyriakos , Bagatto Daniele , Mansoor Nina , Kalladka Dheeraj , Gavrilovic Vladimir , Deana Cristian , Bassi Flavio , Stewart Berry , Gigli Gian Luigi , Banerjee Soma , Merlino Giovanni , D’Anna Lucio
Published: October 2024

Introduction:

There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT.

Patients and methods:

Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3.

Results

We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77–7.77, p = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00–28.09; p = 0.003).

Conclusion:

Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. Further studies in larger cohorts are warranted to evaluate the optimal type of anesthesia in this patient population.
Comparing the properties of traditional and novel approaches to the modified Rankin scale: Systematic review and meta-analysis
Authors: Tvrda Lucie , Mavromati Kalliopi , Taylor-Rowan Martin , Quinn Terence J
Published: October 2024

Introduction:

The Modified Rankin Scale (mRS) is the most commonly used functional measure in stroke research but is limited by inter-rater reliability (IRR). Various interventions to improve mRS application have been described. We aimed to compare properties of differing approaches to mRS assessment.

Patients and methods:

Multidisciplinary databases (MEDLINE, EMBASE, Health and Psychosocial Instruments [OVID], CINAHL, PsycINFO [EBSCO]) were searched for adult human stroke studies describing psychometric properties of mRS. Two researchers independently screened 20% titles and abstracts, reviewed all full studies, extracted data, and conducted risk of bias (ROB) analysis. Primary outcomes for random-effects meta-analysis were IRR measured by kappa (K) and weighted kappa (KW). Validity and inter-modality reliability measures (Spearman’s rho, KW) were also summarised.

Results:

From 897 titles, 46 studies were eligible, including twelve differing approaches to mRS, 8608 participants. There was high ROB in 14 (30.4%) studies. Overall, reliability was substantial ( n = 29 studies, K = 0.65, 95% CI: 0.58–0.71) but IRR was higher for novel approaches to mRS, for example, the Rankin Focussed Assessment ( n = 2 studies, K = 0.94, 95% CI: 0.90–0.98) than standard mRS ( n = 13 studies, K = 0.55, 95%CI:0.46–0.64). Reliability improved following the introduction of mRS training ( K = 0.56, 95% CI: 0.44–0.67; vs K = 0.69, 95% CI: 0.62–0.77). Validity ranged from poor to excellent, with an excellent overall concurrent validity of novel scales ( n = 6 studies, KW = 0.86, 95% CI: 0.75–0.97). The agreement between face-to-face and telephone administration was substantial ( n = 5 studies, KW = 0.80, 95% CI: 0.74–0.87).

Discussion:

The mRS is a valid measure of function but IRR remains an issue. The present findings are limited by a high ROB and possible publication bias.

Conclusion:

Interventions to improve mRS reliability (training, structured interview, adjudication) seem to be beneficial, but single interventions do not completely remove reliability concerns.
Reliability of ABC/2 volumetric estimation in spontaneous intracerebral hemorrhage for hematoma expansion prediction scores
Authors: Tanioka Satoru , Aydin Orhun Utku , Hilbert Adam , Kitano Yotaro , Ishida Fujimaro , Tsuda Kazuhiko , Araki Tomohiro , Nakatsuka Yoshinari , Yago Tetsushi , Kishimoto Tomoyuki , Ikezawa Munenari , Suzuki Hidenori , Frey Dietmar
Published: October 2024

Introduction:

Prediction scores for hematoma expansion in spontaneous intracerebral hemorrhage (ICH), such as the 9-point and BRAIN scores, were developed predominantly using planimetry to measure hematoma volume. In this study, we aim to investigate whether the ABC/2 formula, which is known to overestimate hematoma volume, can be reliably used as a substitute for planimetry in these prediction scores.

Patients and methods:

A total of 429 patients from four hospitals were retrospectively enrolled. CT scan and clinical data at admission and follow-up CT scan were collected. The 9-point and BRAIN scores were calculated using hematoma volume from ABC/2 and planimetry. Hematoma expansion was assessed using hematoma volume from planimetry.

Results:

The median hematoma volume measured by ABC/2 was 11.97 ml (interquartile range [IQR], 4.8–30.0), whereas the volume measured by planimetry was 11.70 ml (IQR, 4.9–26.6). The median measurement error between ABC/2 and planimetry was 0.30 ml (IQR, −0.72–2.87). ABC/2 overestimated hematoma volume in 244 patients (56.9%) compared to planimetry. In the 9-point score, the area under the curves (AUCs) for predicting hematoma expansion were 0.735 (95% confidence interval [CI], 0.675–0.796) with ABC/2 and 0.732 (95% CI, 0.672–0.793) with planimetry. In the BRAIN score, the AUCs were 0.753 (95% CI, 0.693–0.813) with ABC/2 and 0.745 (95% CI, 0.688–0.803) with planimetry.

Discussion and conclusion:

The 9-point and BRAIN scores using hematoma volume measured by ABC/2 and planimetry showed good performance in predicting hematoma expansion in ICH. ABC/2 volumetric estimation proved to be reliable for these scores.
Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database
Authors: Ishiguchi Hironori , Huang Bi , El-Bouri Wahbi K. , Dawson Jesse , Lip Gregory Y. H. , Abdul-Rahim Azmil H. , Lees (Chair) K.R. , Alexandrov A. , Bath P.M. , Bluhmki E. , Bornstein N. , Chen C. , Claesson L. , Curram J. , Davis S.M. , Diener H-C. , Donnan G. , Fisher M. , Ginsberg M. , Gregson B. , Grotta J. , Hacke W. , Hennerici M.G. , Hommel M. , Kaste M. , Lyden P. , Marler J. , Muir K. , Roffe C. , Sacco R. , Shuaib A . , Teal P. , Venketasubramanian N. , Wahlgren N.G. , Warach S.
Published: October 2024

Background:

Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS.

Methods:

We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30 days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/flutter, other arrhythmia/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure.

Results:

From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21–1.63]; p < 0.001, 1.71 [1.39–2.10]; p < 0.001, respectively, compared to referential blood pressure range). Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16–4.73]; p = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds.

Conclusions:

There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.
Multimodal Imaging of a Unique Transitory Finding in Ocular Syphilis
Authors: Winebrake James P. , Chirko Dawn , Papakostas Thanos , Kovacs Kyle D.
Published: October 2024

Purpose: To describe a unique finding in ocular syphilis using multimodal imaging. Methods: A single case was analyzed. Results: A 52-year-old man presented with chronic syphilitic posterior uveitis and was treated with intravenous and intramuscular penicillin for systemic manifestations, topical steroids, and unilateral bevacizumab for secondary macular neovascularization. Bilateral transitory outer retinal microcysts were subsequently seen on optical coherence tomography, with an appearance distinct from outer retinal lesions found in other degenerative retinal diseases. Conclusions: Longstanding smoldering inflammation in this patient resulted in retinal pigment epithelial disruption and subsequent overlying photoreceptor rearrangement with microcyst formation. The spontaneous resolution and reappearance of these lesions elsewhere, despite previous treatment, may offer further insight into localized retinal tissue response from treponemal disease.
Combined Surgical Approach for Repair of Refractory Macular Hole in Myopic Traction Maculopathy
Authors: Parolini Barbara , Matello Veronika , Rosales-Padrón Jaime Francisco
Published: October 2024

Purpose: To present a combined surgical approach for repair of a persistent full-thickness macular hole (MH) in patients with myopic traction maculopathy. Methods: Two cases were evaluated. Results: Combining a macular buckle and pars plana vitrectomy with a controlled subretinal injection of a balanced salt solution resulted in MH closure and vision improvement in both cases. Case 1 also had significant recovery of macular sensitivity on microperimetry evaluation. Conclusions: Retinal redetachment was avoided by using the buckle indentation to provide external support of the posterior pole, resulting in successful closure of the MH and improvement in functional outcomes.
Mycophenolate Mofetil–Induced Lymphoproliferative Disorder in a Young Adult With Chronic Posterior Uveitis
Authors: Habib Nabiha B. , Boss Joseph
Published: October 2024

Purpose: To present a case of a young adult with bilateral chronic posterior uveitis resulting from Vogt-Koyanagi-Harada (VKH) disease treated with mycophenolate mofetil who subsequently developed vitreoretinal lymphoma in the right eye. Methods: A case and its findings were analyzed. Results: A 34-year-old Hispanic woman presented with an 8-year history of chronic recurrent posterior uveitis in both eyes secondary to VKH disease. A vitreous infiltrate that was treatment resistant occurred in the right eye. Subsequently, a diagnostic vitrectomy was performed, and it was determined that the patient had developed unilateral vitreoretinal lymphoma. Conclusions: Masquerade syndromes should remain in the differential in patients with well-established uveitis who are on immunomodulatory treatment. A diagnostic vitrectomy should be considered when the treatment response is uncharacteristic. Furthermore, guidelines are lacking for central nervous system prophylaxis for isolated unilateral ocular intraocular lymphoma in young adults.
Challenging SpaceX on the US–Mexico border: Value struggles against racial authoritarian neoliberalism
Authors: Clua-Losada Mònica
Published: October 2024

SpaceX’s launch site on the US–Mexico border, in the Rio Grande Valley, is an ideal example of the interconnected relationship between racial capitalism and authoritarian neoliberalism, the neoliberal expropriation of spaces and communities, and the tapestries of resistance weaved against these processes. The privatisation of space exploration is an illustration of the development of authoritarian modes of governance that are designed to facilitate such expropriation of spaces and communities. In the case considered in this article, these processes are directly related to the development of racial capitalism on the US–Mexico border. This article places the focus on how racial authoritarian neoliberalism is a response to capitalism’s inability to successfully impose a hegemonic project.
Creating the conditions for inclusion: Investigating optimal physical spaces for supporting neurodivergent staff and postgraduate students
Authors: Riordan Jessica , Timperley Sarah , O’Brien Courtney , Edwards Chris , Murrihy Cheree , Harrison Matthew , McKay-Brown Lisa , Mendus Alys
Published: October 2024

One commonly reported area of difference reported by neurodivergent individuals are sensory differences (e.g. hyper- or hypo-sensitivities and sensory processing difficulties). The objective of this pilot project was to investigate the lived experiences of current postgraduate students and staff within a university faculty who have self-identified as having sensory differences. Neurodivergent researchers interviewed 11 participants about their experiences working within the faculty's physical environments and the various enablers and barriers for inclusion. We used a combination of reflexive thematic analysis and content analysis to code the data and identified three overarching themes: (a) there are many sensory and spatial challenges to navigate within the faculty, (b) it takes a lot of time and energy to navigate the complex terrain of accommodations, and (c) neurodivergent people have many aspirations for inclusive university spaces. We also identified a series of subthemes. Overall, participants shared a series of barriers to inclusion within the faculty's existing physical spaces, including sensory challenges and difficulties working in open-plan spaces. Additionally, many participants did not have formal accommodations as they were viewed as too difficult to access and required “outing” themselves as neurodivergent. Building from participants’ suggestions, we offer several recommendations for reducing barriers to inclusion, including universal design for accommodations, the development of more sensory-friendly workspaces, and neurodiversity-affirming professional development for all staff.
Supplementary Private Health Insurance and Household Debt, Health Care Utilization, and Medical Spending Following A Health Shock
Authors: Park Sooyeol , Kim Kanghee , Callison Kevin
Published: October 2024

This article aims to evaluate the effect of enrolling in supplementary private health insurance on household debt, medical spending, and medical service use among South Koreans experiencing a health shock. Using data from the Korean Welfare Panel Study from 2009 through 2017, we compared household debt and health service use for those with and without private supplemental health insurance after experiencing a health shock. We found no significant differences in household debt or the financial burden of a health shock between those with and without supplemental health insurance coverage following a shock. Households with supplemental coverage used more medical services compared to households without supplementary coverage and incurred additional medical expenses.
Probability Updating in the Classical and the Quantum Model
Authors: Gallus Christoph , Pothos Emmanuel M. , Ebelt Zo , Skouteris Dimitris , Blasiak Pawel
Published: October 2024

Imagine a Bayesian decision agent who is keen to invest only in technologies or businesses that are conductive to achieving a sustainable economic future. Being initially keen to invest in a certain technology, subsequently two pieces of new information are received that both individually reduce the agent’s inclination to make that investment. In such a situation, it would be natural to assume that the simultaneous consideration of both pieces of information should further reduce the agent’s initial enthusiasm; after all the Bayesian method has been called “ nothing but common sense reduced to calculation.” Somewhat surprisingly, making general statements like this about the double conditional probability requires substantial additional assumptions in classical Bayesian probability theory. We investigate four schemes of assumptions that allow ‘reasonable’ conclusions about the double conditional probability. We compare this with two schemes for the quantum probability model where the double conditional results from sequential updating through projections.