bluuebunny/crossref_metadata_2025 huggingface dataset:
Decision rules for personalized statin treatment prescriptions over multi-objectives
Authors: Yew Pui Ying , Liang Yue , Adam Terrence J , Wolfson Julian , Tonellato Peter J , Chi Chih-Lin
Published: March 2024

In our previous study, we demonstrated the feasibility of producing a proactive statin prescription strategy – a personalized statin treatment plan (PSTP) – using neural networks with big data. However, its non-transparency limited result interpretations and clinical usability. To improve the transparency of our previous approach with minimal compromise to the maximal statin treatment benefit-to-risk ratio, this study proposed a five-step pipeline approach called the decision rules for statin treatment (DRST). Steps 1–3 of our proposed pipeline improved our previous PSTP model in optimizing individual benefit-to-risk ratio; Step 4 used a decision tree model (DRST) to provide straightforward rules in the initial statin treatment plan; Step 5 aimed to evaluate the efficacy of these decision rules by conducting a clinical trial simulation. We included 107,739 de-identified patient data from Optum Labs Database Warehouse in this study. The final decision rules were compact and efficient, resulting from a decision tree with only a maximum depth of 3 and 11 nodes. The DRST identified three factors that are easily obtainable at the point of care: age, low-density lipoprotein cholesterol (LDL-C) level, and age-adjusted Charlson score. Moreover, it also identified six subpopulations that can benefit most from these decision rules. In our clinical trial simulations, DRST was found to improve statin benefit in LDL-C reduction by 4.15 percentage points (pp) and reduce risks of statin-associated symptoms (SAS) and statin discontinuation by 11.71 and 3.96 pp, respectively, when compared to the standard of care. Moreover, these DRST results were only less than 0.6 pp suboptimal to PSTP, demonstrating that building DRST that provide transparency with minimal compromise to the maximal benefit-to-risk ratio of statin treatments is feasible.
A Collaborative Approach to Hazardous & Contaminated Collections Conundrums
Authors: Cusack-McVeigh Holly , Wilson Mark , Halter Sarah M.
Published: March 2024

A wide range of inherent vices and acquired hazards can be found in museum collections worldwide. Inherent hazards include items decorated with lead paint, objects containing dyes and pigments, archaeological and geological collections containing silica dust, poisonous herbarium specimens, geological collections that naturally contain heavy metals or are radioactive, objects created from uranium glass and even historic medicinal collections containing old medications and other dangerous substances. Acquired hazards include historic chemical pesticide treatments including toxic metal-based poisons such as arsenic and mercuric salts and, later in time, organic compounds such as DDT were also employed. How can museums identify and manage these complex issues? This case study addresses these concerns and highlights a multi-year collaboration between the Indiana University Indianapolis Museum Studies Program, Purdue University’s School of Health Sciences and the Indiana Medical History Museum (IMHM) that can serve as a replicable model for other museums grappling with these same conundrums.
Influence and improvement of stamping process parameters on V-shaped clamp forming quality
Authors: Hu Yingzhou , Qiu Yayu , Mei Mei , Chen Shichen , Zhao Yan
Published: March 2024

Aiming at the problems that a V-shaped clamp is easy to crack, wrinkle, and springback in the stamping process, a method to improve forming quality by setting the best stamping process parameters is put forward in this paper. The stamping process of the V-shaped clamp was simulated by using the software of ABAQUS, which showed that the stamping process parameters, such as friction coefficient, stamping speed, and mold gap, can affect the forming quality. The optimal combination of stamping process parameters was obtained through an orthogonal experiment. Simulation, profile dimensional measurement, and Fuji paper test were conducted to evaluate and examine the quality of V-shaped clamps before and after optimization. According to the findings of the study, the stamping speed is the main factor affecting the simulation results. The comprehensive effect of the maximum thinning rate, maximum thickening rate, and maximum springback is the best with the stamping speed of 10.00 mm·s−1. The ideal specifications for the stamping process are a 0.16 friction coefficient, a 10.00mm·s−1 stamping speed, and a 2.20 mm mold gap. Process parameter modification can greatly increase the dimensional accuracy and mechanical properties of molded parts.
Advancing the democratization of work: A new intellectual history of transformational leadership theory
Authors: Eaton Lauren , Bridgman Todd , Cummings Stephen
Published: March 2024

Amidst growing demands for more democratic forms of organizing, we argue that better understanding the origins of transformational leadership theory offers a way forward. Transformational leadership theory, originally developed by American political scientist James MacGregor Burns in the late 1970s, is the best-known and most influential leadership theory in management studies. Transformational leaders are visionaries who engage with followers’ higher-level needs and inspire them to deliver extraordinary outcomes for their organizations. Democracy was at the core of Burns’ conception of transformational leadership: voters selected their leaders and voted them out if they failed to deliver on their visions. However, this was overlooked by those who introduced the theory to management studies. Using intellectual history, we contrast the conventional representation of transformational leadership theory in business with Burns’ original conception. We explore how and why the democratic foundation of the theory was lost, why this matters, and what can be done to recover it.
Artificial Intelligence in nursing: trustworthy or reliable?
Authors: Higgins Oliver , Chalup Stephan K , Wilson Rhonda L
Published: March 2024

Background:

Trustworthiness in Artificial Intelligence (AI) innovation is a priority for governments, researchers and clinicians; however, clinicians have highlighted trust and confidence as barriers to their acceptance of AI within a clinical application. While there is a call to design and develop AI that is considered trustworthy, AI still lacks the emotional capability to facilitate the reciprocal nature of trust.

Aim:

This paper aims to highlight and discuss the enigma of seeking or expecting trust attributes from a machine and, secondly, reframe the interpretation of trustworthiness for AI through evaluating its reliability and validity as consistent with the use of other clinical instruments.

Results:

AI interventions should be described in terms of competence, reliability and validity as expected of other clinical tools where quality and safety are a priority. Nurses should be presented with treatment recommendations that describe the validity and confidence of prediction with the final decision for care made by nurses. Future research should be framed to better understand how AI is used to deliver care. Finally, there is a responsibility for developers and researchers to influence the conversation about AI and its power towards improving outcomes.

Conclusion:

The sole focus on demonstrating trust rather than the business-as-usual requirement for reliability and validity attributes during implementation phases may result in negative experiences for nurses and clinical users.

Implications for practice:

This research will have significant implications for the way in which future nursing is practised. As AI-based systems become a part of routine practice, nurses will be faced with an increasing number of interventions that require complex trust systems to operate. For any AI researchers and developers, understanding the complexity of trust and creditability in the use of AI in nursing will be crucial for successful implementation. This research will contribute and assist in understanding nurses’ role in this change.
Lack of effects of acute exercise intensity on mnemonic discrimination
Authors: Loprinzi Paul D , Caplan Jeremy B
Published: March 2024

The hippocampus is thought to support episodic memory by pattern separation, thereby supporting the ability to discriminate high similarity items. Past research evaluating whether acute exercise can improve mnemonic discrimination of high similarity items is mixed. The present experiment attempts to extend these prior mixed findings by evaluating the effects of multiple exercise intensities on hippocampal-dependent, mnemonic discrimination and memory performance. Fifty-seven young adults completed a three-condition (control, moderate-intensity, and vigorous-intensity), within-subjects crossover pretest–posttest comparison. We observed no effects of acute exercise on recognition memory or mnemonic discrimination. We discuss the implications of these null findings with the broader literature by discussing the complexity of this potential exercise–mnemonic discrimination relationship, including the unique role of exercise intensity, differences in the level of processing (e.g., conceptual vs. perceptual), and unique brain regions involved in mnemonic discrimination.
Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment
Authors: Gallucci Laura , Sperber Christoph , Guggisberg Adrian G , Kaller Christoph P , Heldner Mirjam R , Monsch Andreas U , Hakim Arsany , Silimon Norbert , Fischer Urs , Arnold Marcel , Umarova Roza M
Published: March 2024

Background:

State-of-the-art stroke treatment significantly reduces lesion size and stroke severity, but it remains unclear whether these therapeutic advances have diminished the burden of post-stroke cognitive impairment (PSCI).

Aims:

In a cohort of patients receiving modern state-of-the-art stroke care including endovascular therapy, we assessed the frequency of PSCI and the pattern of domain-specific cognitive deficits, identified risk factors for PSCI, and determined the impact of acute PSCI on stroke outcome.

Methods:

In this prospective monocentric cohort study, we examined patients with first-ever anterior circulation ischemic stroke without pre-stroke cognitive decline, using a comprehensive neuropsychological assessment ⩽10 days after symptom onset. Normative data were stratified by demographic variables. We defined PSCI as at least moderate (<1.5 standard deviation) deficits in ⩾2 cognitive domains. Multivariable regression analysis was applied to define risk factors for PSCI.

Results:

We analyzed 329 non-aphasic patients admitted from December 2020 to July 2023 (67.2 ± 14.4 years old, 41.3% female, 13.1 ± 2.7 years of education). Although most patients had mild stroke (median National Institutes of Health Stroke Scale (NIHSS) 24 h = 1.00 (0.00; 3.00); 87.5% with NIHSS ⩽ 5), 69.3% of them presented with PSCI 2.7 ± 2.0 days post-stroke. The most severely and often affected cognitive domains were verbal learning, episodic memory, executive functions, selective attention, and constructive abilities (39.1%–51.2% of patients), whereas spatial neglect was less frequent (18.5%). The risk of PSCI was reduced with more years of education (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.23–0.99) and right hemisphere lesions (OR = 0.47, 95% CI = 0.26-0.84), and increased with stroke severity (NIHSS 24 h, OR = 4.19, 95% CI = 2.72-6.45), presence of hyperlipidemia (OR = 1.93, 95% CI = 1.01–3.68), but was not influenced by age. After adjusting for stroke severity and depressive symptoms, acute PSCI was associated with poor functional outcome (modified Rankin Scale > 2, F = 13.695, p < 0.001) and worse global cognition (Montreal Cognitive Assessment (MoCA) score, F = 20.069, p < 0.001) at 3 months post-stroke.

Conclusion:

Despite modern stroke therapy and many strokes having mild severity, PSCI in the acute stroke phase remains frequent and associated with worse outcome. The most prevalent were learning and memory deficits. Cognitive reserve operationalized as years of education independently protects post-stroke cognition.
Association between critical care admission and chronic medication discontinuation post-hospital discharge: A retrospective cohort study
Authors: Kanodia Charvi , Bourne Richard S , Mansi Elizabeth T , Lone Nazir I
Published: March 2024

Background: Discontinuation of important chronic medication after hospitalisation is common. This study aimed to investigate the association between critical care (vs non-critical care) admission and discontinuation of chronic medications post-hospital discharge, along with factors associated with discontinuation among critical care survivors. Methods: This was a retrospective cohort study in Lothian, Scotland of adults who were admitted to hospital between 01/01/2012 and 31/12/2019 and survived to hospital discharge. Medication classes investigated were statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), beta-blockers, oral anticoagulants, and thyroid hormones. The risk of medication discontinuation for each class was estimated by odds ratios (OR), with 95% confidence intervals (95%CI), using multivariable logistic regression adjusted for patient demographics, main clinical condition, and index comorbidity. A secondary analysis assessed factors associated with discontinuation in critical care survivors. Results: There were 22,340 critical care and 367,185 non-critical care survivors included. Critical care admission had the highest association with ACEi/ARBs discontinuation (adjusted OR 2.41, 95%CI: 2.26–2.58), followed by oral anticoagulants (adjusted OR 1.33, 95%CI: 1.15–1.53), and beta blockers (adjusted OR 1.18, 95%CI: 1.07–1.29). There was no significant association with thyroid hormones or statin discontinuation. Among critical care survivors, hospital length of stay of 14 days or more was associated with increased discontinuation across all medication classes. Conclusion: Critical care admission was associated with discontinuation of three out of five medication classes studied (ACEi/ARBs, beta-blockers, and oral anticoagulants). Further research is needed to understand the reason for increased medication discontinuation in critical care survivors and how these risks can be mitigated to improve patient outcomes.
Adjuvant and neoadjuvant chemotherapy for MSI early gastric cancer: a systematic review and meta-analysis
Authors: Petrelli Fausto , Antista Maria , Marra Francesca , Cribiu’ Fulvia Milena , Rampulla Valentina , Pietrantonio Filippo , Dottorini Lorenzo , Ghidini Michele , Luciani Andrea , Zaniboni Alberto , Tomasello Gianluca
Published: March 2024

Background:

Perioperative chemotherapy (CT) is an established therapeutic approach for patients diagnosed with stage IB–III gastric cancer (GC).

Objectives:

This study aimed to investigate the efficacy of this approach in individuals with GC exhibiting high microsatellite instability (MSI-H).

Design:

A systematic review was conducted, including studies that provided data on (neo)adjuvant CT outcomes in patients with MSI-H GC.

Methods:

Systematic searches were conducted in PubMed, Cochrane Central of Controlled Trials, and Embase databases. Data were aggregated using hazard ratios (HRs) to compare overall survival between CT and surgery.

Results:

Data analysis from 23 studies, including 22,011 patients, revealed that the prevalence of MSI-H is 9.8%. Administration of adjuvant or perioperative CT did not significantly reduce the risk of death or relapse in patients with MSI-H GC (HR = 0.8, 95% CI 0.54–1.16; p = 0.24 and HR = 0.84, 95% CI 0.59–1.18; p = 0.31, respectively).

Conclusion:

Chemotherapy did not benefit patients diagnosed with MSI-H nonmetastatic GC but rather will be integrated with immune checkpoint inhibitors in the near future.
Diagnostic biomarkers in ovarian cancer: advances beyond CA125 and HE4
Authors: Ghose Aruni , McCann Lucy , Makker Shania , Mukherjee Uma , Gullapalli Sri Vidya Niharika , Erekkath Jayaraj , Shih Stephanie , Mahajan Ishika , Sanchez Elisabet , Uccello Mario , Moschetta Michele , Adeleke Sola , Boussios Stergios
Published: March 2024

Ovarian cancer (OC) is the most lethal gynaecologic malignancy, attributed to its insidious growth, non-specific symptoms and late presentation. Unfortunately, current screening modalities are inadequate at detecting OC and many lack the appropriate specificity and sensitivity that is desired from a screening test. Nearly 70% of cases are diagnosed at stage III or IV with poor 5-year overall survival. Therefore, the development of a sensitive and specific biomarker for early diagnosis and screening for OC is of utmost importance. Currently, diagnosis is guided by CA125, the patient’s menopausal status and imaging features on ultrasound scan. However, emerging evidence suggests that a combination of CA125 and HE4 (another serum biomarker) and patient characteristics in a multivariate index assay may provide a higher specificity and sensitivity than either CA125 and HE4 alone in the early detection of OC. Other attempts at combining various serum biomarkers into one multivariate index assay such as OVA1, ROMA and Overa have all shown promise. However, significant barriers exist before these biomarkers can be implemented in clinical practice. This article aims to provide an up-to-date review of potential biomarkers for screening and early diagnosis of OC which may have the potential to transform its diagnostic landscape.
Performance of ChatGPT on the National Korean Occupational Therapy Licensing Examination
Authors: Lee Si-An , Heo Seoyoon , Park Jin-Hyuck
Published: March 2024

Background

ChatGPT is an artificial intelligence-based large language model (LLM). ChatGPT has been widely applied in medicine, but its application in occupational therapy has been lacking.

Objective

This study examined the accuracy of ChatGPT on the National Korean Occupational Therapy Licensing Examination (NKOTLE) and investigated its potential for application in the field of occupational therapy.

Methods

ChatGPT 3.5 was used during the five years of the NKOTLE with Korean prompts. Multiple choice questions were entered manually by three dependent encoders, and scored according to the number of correct answers.

Results

During the most recent five years, ChatGPT did not achieve a passing score of 60% accuracy and exhibited interrater agreement of 0.6 or higher.

Conclusion

ChatGPT could not pass the NKOTLE but demonstrated a high level of agreement between raters. Even though the potential of ChatGPT to pass the NKOTLE is currently inadequate, it performed very close to the passing level even with only Korean prompts.
Efficacy of dalfampridine in neuromyelitis optica spectrum disorder: A pilot study
Authors: de Seze Jérôme , Clerc Christine , Béreau Matthieu , Bourre Bertrand , Zephir Hélène , Collongues Nicolas , Kremer Laurent , Vermersch Patrick , Bigaut Kevin
Published: March 2024

Objective

To assess the efficacy of dalfampridine in patients with neuromyelitis optica spectrum disorder.

Methods

We included 15 consecutive patients, who were started on a treatment of dalfampridine 10 mg twice daily for 2 weeks. Efficacy assessment was based on walking ability improvement using Timed-25-Foot Walk and 12-item Multiple Sclerosis Walking Scale tests.

Results

The mean Timed-25-Foot Walk score was reduced from 14.8 (±2.4) to 11.3 (±1.9) seconds ( p = 0.01). The mean score on the 12-item Multiple Sclerosis Walking Scale was reduced from 41.2 (±3.5) to 31.4 (±3.2) ( p = 0.004).

Conclusion

Dalfampridine seems to be useful for symptomatic treatment of walking impairment in neuromyelitis optica spectrum disorder.
Digital Equity and School Leadership in a Post-Digital World
Authors: Liu (刘艳) Katrina , Tschinkel Rebecca , Miller Richard
Published: March 2024

Purpose

This study analyzes digital equity realities in U.S. K-12 schools and the role that school leadership plays in digital equity.

Design/Approach/Methods

Based on Selwyn’s conception of technology as three interlocking elements (access, educational practices, and social context), we applied the ideals of equity and social justice to each of the three elements to conceptualize a framework of digital equity, situating school practice in the larger social, cultural, and political context of the United States. Guided by this framework, we conducted a systematic literature review of the current state of digital equity and school leadership in K-12 schools.

Findings

The findings demonstrate that U.S. K-12 schools face digital inequity issues, including inequitable access to technology, exclusionary and punitive educational practices using technology, and an unjust social context for technology in schools. These findings indicate that school leadership plays an important role in digital inequity.

Originality/Value

Based on these findings, we present a framework to assist K-12 leaders in enhancing digital equity, including addressing educational inequities and creating an inclusive social context for the school, ensuring equitable accessibility to technology in schools, and supporting teachers in developing meaningful and equitable practices using technology to address the opportunity gaps encountered by marginalized learners.
The fascinating theory of fetal programming of adult diseases: A review of the fundamentals of the Barker hypothesis
Authors: Faa Gavino , Fanos Vassilios , Manchia Mirko , Van Eyken Peter , Suri Jasjit S. , Saba Luca
Published: March 2024

The theory of fetal programming of adult diseases was first proposed by David J.P. Barker in the eighties of the previous century, to explain the higher susceptibility of some people toward the development of ischemic heart disease. According to his hypothesis, poor maternal living conditions during gestation represent an important risk factor for the onset of atherosclerotic heart disease later in life. The analysis of the early phases of fetal development is a fundamental tool for the risk stratification of children and adults, allowing the identification of susceptible or resistant subjects to multiple diseases later in life. Here, we provide a narrative summary of the most relevant evidence supporting the Barker hypothesis in multiple fields of medicine, including neuropsychiatric disorders, such as Parkinson disease and Alzheimer disease, kidney failure, atherosclerosis, coronary heart disease, stroke, diabetes, cancer onset and progression, metabolic syndrome, and infectious diseases including COVID-19. Given the consensus on the role of body weight at birth as a practical indicator of the fetal nutritional status during gestation, every subject with a low birth weight should be considered an “at risk” subject for the development of multiple diseases later in life. The hypothesis of the “physiological regenerative medicine,” able to improve fetal organs’ development in the perinatal period is discussed, in the light of recent experimental data indicating Thymosin Beta-4 as a powerful growth promoter when administered to pregnant mothers before birth.
Toward Sound Localization Testing in Virtual Reality to Aid in the Screening of Auditory Processing Disorders
Authors: Ramírez Melissa , Arend Johannes M. , von Gablenz Petra , Liesefeld Heinrich R. , Pörschmann Christoph
Published: March 2024

Sound localization testing is key for comprehensive hearing evaluations, particularly in cases of suspected auditory processing disorders. However, sound localization is not commonly assessed in clinical practice, likely due to the complexity and size of conventional measurement systems, which require semicircular loudspeaker arrays in large and acoustically treated rooms. To address this issue, we investigated the feasibility of testing sound localization in virtual reality (VR). Previous research has shown that virtualization can lead to an increase in localization blur. To measure these effects, we conducted a study with a group of normal-hearing adults, comparing sound localization performance in different augmented reality and VR scenarios. We started with a conventional loudspeaker-based measurement setup and gradually moved to a virtual audiovisual environment, testing sound localization in each scenario using a within-participant design. The loudspeaker-based experiment yielded results comparable to those reported in the literature, and the results of the virtual localization test provided new insights into localization performance in state-of-the-art VR environments. By comparing localization performance between the loudspeaker-based and virtual conditions, we were able to estimate the increase in localization blur induced by virtualization relative to a conventional test setup. Notably, our study provides the first proxy normative cutoff values for sound localization testing in VR. As an outlook, we discuss the potential of a VR-based sound localization test as a suitable, accessible, and portable alternative to conventional setups and how it could serve as a time- and resource-saving prescreening tool to avoid unnecessarily extensive and complex laboratory testing.
Lottery-Based Evaluations of Early Education Programs: Opportunities and Challenges for Building the Next Generation of Evidence
Authors: Weiland Christina , Unterman Rebecca , Dynarski Susan , Abenavoli Rachel , Bloom Howard , Braga Breno , Faria Anne-Marie , Greenberg Erica , Jacob Brian A. , Lincove Jane Arnold , Manship Karen , McCormick Meghan , Miratrix Luke , Monarrez Tomás E. , Morris-Perez Pamela , Shapiro Anna , Valant Jon , Weixler Lindsay
Published: March 2024

Lottery-based identification strategies offer potential for generating the next generation of evidence on U.S. early education programs. The authors’ collaborative network of five research teams applying this design in early education settings and methods experts has identified six challenges that need to be carefully considered in this next context: (a) available baseline covariates that may not be very rich; (b) limited data on the counterfactual; (c) limited and inconsistent outcome data; (d) weakened internal validity due to attrition; (e) constrained external validity due to who competes for oversubscribed programs; and (f) difficulties answering site-level questions with child-level randomization. The authors offer potential solutions to these six challenges and concrete recommendations for the design of future lottery-based early education studies.
Posthumous resilience and active withdrawal: Byronic contemplation of violence and vulnerabilities in the Anthropocene embodied in the sculpture of the Dying Gaul
Authors: Hathout Shahira , Chandler David
Published: March 2024

This paper focuses upon the famous sculpture of the Dying Gaul, situated in the Capitoline Museum in Rome, in order to read and to rethink discourses of resilience in the Anthropocene. The Anthropocene poses fundamental questions to understandings of ‘bouncing back’ or imaginaries of ‘sustainable futures’. There can be no affirmative futural imaginaries if saving the world requires the destruction and sacrifice of innumerable others. Thinking with Byron’s reflections upon the Dying Gaul enables us to approach resilience from a radically different perspective, one that (read in conjunction with the work of Claire Colebrook, Karen Barad, Christina Sharpe, Dionne Brand and Saidiya Hartman amongst other contemporary theorists) we call a ‘posthumous’ approach. ‘Posthumous resilience’ refuses the lure of affirmation, of imaginaries of salvage and salvation, and instead seeks to generate an ethic of ‘active withdrawal’ that points beyond the temporal and spatial constraints of the colonial, imperial, imagination. We conclude with a reflection on how posthumous discourses of ‘active withdrawal’ can be the basis of generative politics of refusal which hold open conceptions of justice and seek to break from cycles of violence.
Book review: Michael Cox (ed.), Afghanistan: Long War, Forgotten Peace
Authors: Hussain Ejaz
Published: March 2024

Michael Cox (ed.), Afghanistan: Long War, Forgotten Peace. LSE Press, 2022, 299 pp., ₹3.92 (paperback). ISBN: 978-1-909890-98-5.
Book review: Swaran Singh and Reena Marwah (Eds.), Multilateralism in the Indo-Pacific: Conceptual and Operational Challenges
Authors: Mukhia Anmol
Published: March 2024

Swaran Singh and Reena Marwah (Eds.), Multilateralism in the Indo-Pacific: Conceptual and Operational Challenges, New York: Routledge, 2023, 192 pp., £29.96 (eBook). ISBN: 9781032244693.
Combinative Hedging: Japan and Russia in the East Asian Contested Hierarchical Order
Authors: Suhito Yohanes Putra , Wicaksana I Gede Wahyu
Published: March 2024

The recent developments in world politics have demonstrated that East Asia has emerged as a critical locus for great power politics, characterised by the pluralisation of power centres resulting from the competing strategic interests of the United States and China. Indeed, the regional order’s power constellation is moving towards a contested hierarchical model. The first-tier United States seeks to maintain its ‘plural hegemony’ through social compacts, while China fits within the hierarchy as a second-tier state, gradually emerging as an influential actor on the regional and global stage. Third-tier states, such as Japan, the world’s third-largest economy, and Russia, with its abundant energy resources and military prowess, have become potential swing players of influence within the evolving orders— appropriate to their respective capabilities. Observing this dynamic geopolitical environment, our article discusses the relationship between Japan and Russia as they attempt to protect their interests within a pluralising region. We argue that Japan and Russia take a combinative hedge, focusing on flexible collaboration, enabling risk mitigation and maximising short or long-term benefits.
The Interaction between Global Privilege and the Discursive Construction of the ‘China Threat’ in the ‘New Cold War’
Authors: Ruiz Casado Juan Alberto
Published: March 2024

This article examines the relationship between privilege understood within a global frame and the discursive construction of the ‘China threat’ in the context of the ‘New Cold War’. Drawing on discourse theory and privilege studies, it investigates how the hegemonic discursive construction of China as a threat interacts with the material conditions of ‘global privilege’ in a diversity of spheres (political, military, economic, technological, cultural and academic). The article contends that the ‘China threat’ narrative is markedly informed by the global privilege, coupled with the fear of losing it, enjoyed by the countries of the ‘Global North’, particularly the United States. These findings have significant implications for our comprehension of how discursive practices impact our understanding of global affairs. They underscore the necessity for self-reflection on privilege, a critical examination of unequal international relations and the importance of empathising with those perceived as the ‘enemy’ to foster peaceful coexistence.
Higher Vocational Nursing Students’ Clinical Core Competence in China: A Cross-Sectional Study
Authors: Wang Siping , Huang Shanshan , Yan Lulu
Published: March 2024

Introduction

Understanding the clinical core competence of nursing students in higher vocational colleges is crucial for adjusting the nursing core curriculum and training of nursing professionals. However, little is known about the level of clinical core competence of higher vocational nursing students in China.

Objective

To investigate nursing students’ clinical core competence in the school of nursing and health at a vocational and technical college in Guangdong, China.

Methods

The Core Competency Scale for Registered Nurses in China was used to evaluate the clinical core competence of higher vocational nursing students from February to March 2022. Data were analyzed by descriptive statistics, Mann-Whitney U test and Kruskal–Wallis test.

Results

A total of 1,120 nursing students were investigated, 1,069 were valid questionnaires, and the response rate was 95.4%. The total score of core competence score of higher vocational nursing students was 176.55 ± 43.95, only 43.3% of students obtained an overall score more than 178, and 47.7% of students scored between 116 and 178 scores. The lowest score was on critical thinking and scientific research (2.72 ± 0.77) following by clinical nursing (2.85 ± 0.80), which had differences in gender, category of students, and years of study. There were differences in the total average score of core competence in terms of gender and category of students. Leadership and interpersonal relationships differ significantly by gender, while professional development, teaching, and coaching differ significantly by category of student.

Conclusions

The findings revealed the core competence of higher vocational nursing students is at a medium level. Moreover, critical thinking and scientific research, and clinical nursing ability are significantly insufficient.
Online Mindset Training for Prelicensure Nursing Students: A Randomized Longitudinal Study
Authors: Lewis Lisa S. , Williams Cheryl A. , Dawson Stephanie
Published: March 2024

Introduction

Research suggests students with a growth mindset are more successful. Utilizing Dweck's growth mindset model, the study explored the benefits of mindset training within nursing education.

Objective

To determine the impact of an online mindset training intervention on first-semester prelicensure nursing students’ mindset beliefs and learning and studying strategies.

Methods

This study employed a randomized longitudinal design, conducted entirely online. Sixty-eight participants completed all phases of the study. Data were collected using the Williams Inventory of Learning Strategies tool before and after participants viewed an online training.

Results

Findings indicate that online mindset training positively influenced student learning, reducing fear of failure and increasing willingness to remediate.

Conclusion

These results highlight the promising impact of an online learning approach in fostering a growth mindset among nursing students; suggesting the potential for integrating mindset training into the nursing curriculum to enhance student success, with recommendations for further research in larger-scale studies.
Concomitant Anatomic PCL and FCL Reconstructions With Partial Lateral Meniscectomy
Authors: Banovetz Mark T. , Braaten Jacob A. , Homan Morgan D. , Kennedy Nicholas I. , LaPrade Robert F.
Published: March 2024

Background:

Fibular collateral ligament (FCL) injuries commonly present in a multiligament knee injury pattern. These injuries are associated with significant instability leading to altered tibiofemoral biomechanics and therefore require surgical intervention. Similarly, grade 3 posterior cruciate ligament (PCL) injuries may disrupt normal tibiofemoral and patellofemoral biomechanics and increase the risk of secondary osteoarthritis. Therefore, concomitant reconstruction of the FCL and PCL should be performed to decrease knee laxity and optimize functional outcomes.

Indications:

Early operative treatment is indicated for patients with combined grade 3 FCL injuries and complete PCL tears. Contraindications to this procedure include patients who have significant osteoarthritis, open knee dislocations, or medical comorbidities making them unfit for surgery.

Technique Description:

The fundamental idea behind this technique is a stepwise treatment starting with open aspects of the procedure and followed by arthroscopic work. The technique is initiated with a lateral approach, common peroneal neurolysis, fibular and femoral FCL reconstruction tunnel preparation, and a gracilis or semitendinosus tendon autograft harvest. After that, focus shifts to intra-articular work such as associated meniscal assessment and treatment, PCL femoral and tibial tunnel preparation, graft passage, and PCL femoral tunnel fixation. Final graft fixation order is as follows: anterolateral bundle of PCL, posteromedial bundle of PCL, and finally FCL.

Results:

Multiple studies have reported that an anatomic FCL reconstruction in the setting of multiligament injury results in improved patient outcomes. In a prospective study of 20 patients, LaPrade et al reported −0.4 mm difference in side-to-side lateral compartment gapping and significant postoperative improvement of symptom and functional scores at a minimum 2 year postoperative follow-up after anatomic reconstruction of the FCL. Similarly, Moulton et al reported significant improvement in the average Western Ontario and Lysholm scores at 2.7 years follow-up. LaPrade et al also reported significant improvement in function and objective outcome scores at 3 years’ follow-up from anatomic double-bundle PCL reconstruction.

Discussion:

Anatomic FCL and PCL reconstructions successfully restore near native knee objective stability and provide superior clinical outcomes when compared to nonanatomic-based FCL reconstructions that continue to be performed.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Fetal Anterior Abdominal Wall Thickness as an Indicator of Gestational Diabetes: A Sonographic Study
Authors: Fatima Saadia , Hassan Zain ul , Farooq Syed Muhammad Yousaf , Khan Ayesha , Gilani Syed Amir
Published: March 2024

Objective:

During pregnancy, sonographic measurements of subcutaneous adipose tissue may be a reliable diagnostic predictor of gestational diabetes mellitus (GDM) and fetal metabolism. A sonographic view of the fetal abdominal circumference can be used to measure the fetal anterior abdominal wall thickness (AAWT), which is straightforward and simple. Consequently, in this study, the aim was to evaluate whether the fetal AAWT value could be used as a diagnostic indicator of GDM, thus preventing the adverse neonatal and maternal outcomes thereof, including shoulder dystocia, neonatal hypoxia, and injury to the birth canal, secondary to fetal macrosomia.

Materials and Methods:

This prospective cross-sectional study was conducted at a hospital in Lahore, Pakistan, over a 9-month period. A total of 176 female participants in their third trimester of pregnancy were included in this study. The participants were assigned to two cohorts: a cohort of 88 participants diagnosed with GDM and a control cohort of 88 participants without GDM. An independent sample t test, analysis of variance, and chi-square test were used to compare the characteristics between the two cohorts of participants. A final analysis was performed to determine the strength of the correlations between the estimated fetal weight (EFW) and AAWT values.

Results:

The GDM and control cohorts had mean fetal AAWT values of 12.65 ± 1.276 and 6.389 ± 1.503, respectively. Thus, a statistically significant difference in the fetal AAWT values was observed between the GDM and control cohorts. Furthermore, a statistically significant positive correlation between the EFW and AAWT values was observed ( P = .01).

Conclusion:

This study highlighted that women with GDM have a considerably higher fetal AAWT values than those without GDM. In addition, the findings revealed that the AAWT value was correlated with the EFW value. Consequently, an increased fetal AAWT value can potentially be utilized as a predictive indicator for those pregnant women at risk of developing GDM, thus preventing adverse maternal and fetal outcomes.
ctDNA improves prognostic prediction for patients with relapsed/refractory MM receiving ixazomib, lenalidomide, and dexamethasone
Authors: Kogure Yasunori , Handa Hiroshi , Ito Yuta , Ri Masaki , Horigome Yuichi , Iino Masaki , Harazaki Yoriko , Kobayashi Takahiro , Abe Masahiro , Ishida Tadao , Ito Shigeki , Iwasaki Hiromi , Kuroda Junya , Shibayama Hirohiko , Sunami Kazutaka , Takamatsu Hiroyuki , Tamura Hideto , Hayashi Toshiaki , Akagi Kiwamu , Shinozaki Tomohiro , Yoshida Takahiro , Mori Ikuo , Iida Shinsuke , Maeda Takahiro , Kataoka Keisuke
Published: March 2024

It remains elusive how driver mutations, including those detected in circulating tumor DNA (ctDNA), affect prognosis in relapsed/refractory multiple myeloma (RRMM). Here, we performed targeted-capture sequencing using bone marrow plasma cells (BMPCs) and ctDNA of 261 RRMM cases uniformly treated with ixazomib, lenalidomide, and dexamethasone in a multicenter, prospective, observational study. We detected 24 and 47 recurrently mutated genes in BMPC and ctDNA, respectively. In addition to clonal hematopoiesis–associated mutations, varying proportion of driver mutations, particularly TP53 mutations (59.2% of mutated cases), were present in only ctDNA, suggesting their subclonal origin. In univariable analyses, ctDNA mutations of KRAS, TP53, DIS3, BRAF, NRAS, and ATM were associated with worse progression-free survival (PFS). BMPC mutations of TP53 and KRAS were associated with inferior PFS, whereas KRAS mutations were prognostically relevant only when detected in both BMPC and ctDNA. A total number of ctDNA mutations in the 6 relevant genes was a strong prognostic predictor (2-year PFS rates: 57.3%, 22.7%, and 0% for 0, 1, and ≥2 mutations, respectively) and independent of clinical factors and plasma DNA concentration. Using the number of ctDNA mutations, plasma DNA concentration, and clinical factors, we developed a prognostic index, classifying patients into 3 categories with 2-year PFS rates of 57.9%, 28.6%, and 0%. Serial analysis of ctDNA mutations in 94 cases revealed that TP53 and KRAS mutations frequently emerge after therapy. Thus, we clarify the genetic characteristics and clonal architecture of ctDNA mutations and demonstrate their superiority over BMPC mutations for prognostic prediction in RRMM. This study is a part of the C16042 study, which is registered at www.clinicaltrials.gov as #NCT03433001.
Stability-Considered Lane Keeping Control of Commercial Vehicles Based on Improved APF Algorithm
Authors: Tang Bin , Yang Zhengyi , Jiang Haobin , Lin Ziyan , Xu Zhanxiang , Hu Zitian
Published: March 2024

Regarding the lane keeping system, path tracking accuracy and lateral stability at high speeds need to be taken into account especially for commercial vehicles due to the characteristics of larger mass, longer wheelbase and higher mass center. To improve the performance mentioned above comprehensively, the control strategy based on improved artificial potential field (APF) algorithm is proposed. In the paper, time to lane crossing (TLC) is introduced into the potential field function to enhance the accuracy of path tracking, meanwhile the vehicle dynamics parameters including yaw rate and lateral acceleration are chosen as the repulsive force field source. The lane keeping controller based on improved APF algorithm is designed and the stability of the control system is proved based on Lyapunov theory. In addition, adaptive inertial weight particle swarm optimization algorithm (AIWPSO) is applied to optimize the gain of each potential field function. The co-simulation results indicate that the comprehensive evaluation index respecting lane tracking accuracy and lateral stability is reduced remarkably. Finally, the proposed control strategy is verified by the HiL test. It provides a beneficial reference for dynamics control of commercial vehicles and enriches the theoretical development and practical application of artificial potential field method in the field of intelligent driving.
Outcome measures in Angelman syndrome
Authors: Hagenaar Doesjka A. , Bindels-de Heus Karen G. C. B. , van Gils Maud M. , van den Berg Louise , ten Hoopen Leontine W. , Affourtit Philine , Pel Johan J. M. , Joosten Koen F. M. , Hillegers Manon H. J. , Moll Henriëtte A. , de Wit Marie-Claire Y. , Dieleman Gwen C. , Mous Sabine E.
Published: March 2024

Background

Angelman syndrome (AS) is a rare neurodevelopmental disorder characterized by severe intellectual disability, little to no expressive speech, visual and motor problems, emotional/behavioral challenges, and a tendency towards hyperphagia and weight gain. The characteristics of AS make it difficult to measure these children’s functioning with standard clinical tests. Feasible outcome measures are needed to measure current functioning and change over time, in clinical practice and clinical trials.

Aim

Our first aim is to assess the feasibility of several functional tests. We target domains of neurocognitive functioning and physical growth using the following measurement methods: eye-tracking, functional Near-Infrared Spectroscopy (fNIRS), indirect calorimetry, bio-impedance analysis (BIA), and BOD POD (air-displacement plethysmography). Our second aim is to explore the results of the above measures, in order to better understand the AS phenotype.

Methods

The study sample consisted of 28 children with AS aged 2–18 years. We defined an outcome measure as feasible when (1) at least 70% of participants successfully finished the measurement and (2) at least 60% of those participants had acceptable data quality. Adaptations to the test procedure and reasons for early termination were noted. Parents rated acceptability and importance and were invited to make recommendations to increase feasibility. The results of the measures were explored.

Results

Outcome measures obtained with eye-tracking and BOD POD met the definition of feasibility, while fNIRS, indirect calorimetry, and BIA did not. The most important reasons for early termination of measurements were showing signs of protest, inability to sit still and poor/no calibration (eye-tracking specific). Post-calibration was often applied to obtain valid eye-tracking results. Parents rated the BOD POD als most acceptable and fNIRS as least acceptable for their child. All outcome measures were rated to be important. Exploratory results indicated longer reaction times to high salient visual stimuli (eye-tracking) as well as high body fat percentage (BOD POD).

Conclusions

Eye-tracking and BOD POD are feasible measurement methods for children with AS. Eye-tracking was successfully used to assess visual orienting functions in the current study and (with some practical adaptations) can potentially be used to assess other outcomes as well. BOD POD was successfully used to examine body composition.

Trial registration

Registered d.d. 23-04-2020 under number ‘NL8550’ in the Dutch Trial Register: https://onderzoekmetmensen.nl/en/trial/23075