bluuebunny/crossref_metadata_2025 huggingface dataset:
Sense and nonsense
Authors: Brown Gillian R. , Lala Kevin N.
Published: December 2024

This chapter describes the rationale for the book, which is to describe and evaluate how evolutionary theory has been, and is currently being, applied to the study of human behaviour. The application of evolutionary theory to our own species is often controversial, as demonstrated by historical abuses of evolutionary theory. Despite such controversies, a number of schools of thought have arisen within this contemporary field of research, with sometimes conflicting positions. This chapter explains that the goal of the book is to provide a balanced and impartial ‘guide for the bewildered’ when describing and evaluating these contemporary sub-fields. It introduces the concept of ‘genetic determinism’ and discusses the role of culture and learning in human evolution, which are themes that recur in later chapters.
Comparing and integrating approaches
Authors: Brown Gillian R. , Lala Kevin N.
Published: December 2024

This chapter starts with a short summary of what has been covered in the preceding chapters and reminds the reader about the contemporary sub-fields that were described and evaluated. The chapter then discusses how comparisons of humans with other species can also shed light on human behaviour and cognition. The next section attempts to integrate the contemporary sub-fields, focusing specifically on the levels of explanation and the methods of hypothesis generation and hypothesis testing, using infanticide and social learning of foraging skills as examples of integrative research. The following section discusses points of contention, focusing on how the different sub-fields view human culture, whether the concept of ‘human nature’ is useful, and how the ‘extended evolutionary synthesis’ is relevant for the future of this research field. The concluding section offers some reflections on what has been learnt through comparing and contrasting evolutionary perspectives on human behaviour.
Languages of Minority
Authors: Dechamma CC Sowmya
Published: December 2024

This work seeks to understand how the languages of minorities in India have been constructed and understood throughout colonialism and nationalist periods up to the present day. By using certain examples, the work also attempts to chart how concepts and practices of orality and writing, the concept of the vernacular, and the thought and act of translation are crucial in our understanding of languages. More importantly, the work points to different axes of power that (un)make language communities. The work also presents how the role of English within India is complex and perhaps the desire for English needs to be understood differently for minoritized people.
The Political Returns to Cultural Revival
Authors: Robinson Amanda Lea
Published: December 2024

This chapter presents the theoretical argument for how a cultural revival can be used to increase ethnic party support. It argues that ethnic visibility is not inherent to ethnic identities, and, in fact, that it varies significantly across cleavages, groups, and individuals. It then explains the two mechanisms that lead more ethnically visible individuals to express more support for coethnic politicians and political parties: expectations of targeted patronage and fear of collective persecution. Finally, the chapter posits that elite-led cultural revivals serve as a powerful tool for reifying distinctive group characteristics and incentivizing the adoption of ethnic markers by (1) engendering demand for cultural distinctiveness by stoking group-based pride and (2) supplying the means to achieve it through explicit cultural instruction.
Conclusion
Authors: Robinson Amanda Lea
Published: December 2024

This chapter provides an integrated summary of the main findings of the book and lays out an agenda for future research. After enumerating the broad takeaways of the book, the chapter first offers speculation about how the Lhomwe cultural revival is likely to evolve given changes in the Malawian electoral system, how interpersonal dynamics may shape further cultural change, and how the Lhomwe revival may impact the cultural and political behavior of other Malawian ethnic groups. It next looks beyond Malawi and provides a brief overview of three other contemporary cultural revivals: the Oromo in Ethiopia, the Arameans in Israel, and the Limbu in Nepal. These brief case studies are leveraged to situate the scope of the book’s argument and the extent of its generalizability, as well as to identity promising avenues for future research through the comparative study of cultural revivals.
Create Layers of Reading
Authors: Bhargava Rahul
Published: December 2024

Data stories that offer layers of reading can more effectively lead diverse audiences into narratives that are complex and nuanced. The modern efficiency-focused visual forms of data offer us a very limited toolbox, one that doesn’t appeal to broad sets of audiences encountered in community settings. The narrow set of norms that govern data visualization right now don’t offer enough opportunities to construct slowly unfurling narratives. A data fashion show in Tanzania offers an alternative example, showing how culturally resonant materials can be used to effectively engage broader sets of people around data that impacts their lives and communities. The radical methods of participatory theatre offer inspiration for data theatre, an approach that uses performance to build from simple to complex stories. Data theatre leverages theories of embodied learning and somatic memory, bringing data in appropriate ways to new settings, and demonstrating layers of reading in action.
Conclusion
Authors: Bhargava Rahul
Published: December 2024

Popular data is a framework that offers a larger toolbox for bringing people together around data, specifically designed for pro-social settings in communities. This book catalogs the motivation and practice, building on inspirations from libraries, newspapers, museums, CSOs, and other civic contexts. A set of projects from housing activists in Los Angeles shows how the five key tenets can be applied effectively in a data mini-golf course, a satirical play, and an interactive physical museum exhibit. Popular data helps those working with data in community settings take creative approaches to empowering people with information in effective and more appropriate ways.
Stewardship and ESG in Europe
Authors: Ferrarini Guido , Siri Michele
Published: December 2024

Globally, three main legal strategies are used to pursue ESG stewardship: stewardship codes; disclosure regulation; and fiduciary duties. In this chapter, we compare these strategies, focusing on the EU’s approach to ESG stewardship, which is mainly based on regulation. First, we introduce the three strategies from a comparative perspective. We then analyse the extent to which institutional investors are incentivized by EU disclosure regulation to consider ESG issues when investing in corporate securities. We also consider how institutional investors classify their investments in practice according to the importance they attach to ESG considerations, and summarize the criteria they and their asset managers use to select investments from an ESG perspective. Finally, we examine EU legislation on fiduciary duties and sustainability and draw some conclusions on the incentives for institutional investors to analyse and make investment decisions based on ESG data and preferences.
The French ‘Duty of Vigilance’ and the European Proposal on Companies’ Due Diligence Duties
Authors: Pietrancosta Alain
Published: December 2024

This chapter deals with recent French and European developments regarding integration of environmental and social due diligence requirements into company law. The reference to French law is justified by the pioneering nature of the duty of ‘vigilance’ introduced in 2017, which served as a model for the European Commission. The proposed European directive is, however, more ambitious in terms of scope, prescriptive content, and enforcement. Normatively, these regulatory developments reflect the incorporation into substantive law of standards that until now have come under soft law or transparency requirements. More specifically, they mark a use and exploitation of company law for environmental and social (E/S) purposes, a consequent politicization of the role of companies, a ‘mix of genres’ between public interest and private interest goals, which can be a source of confusion.
Unconditional Basic Income
Authors: Lister Andrew
Published: December 2024

Unconditional Basic Income (UBI) defends the reciprocity objection to UBI against the inherited assets argument, while also presenting a Rawlsian case for UBI. Defenders of UBI can claim that taxpayers are not being asked to do more than their conditional duties require, by supporting non-contributors, because recipients are contributing their rightful share of inherited assets. This inheritance is not entirely unconditional, however, but must be limited by prior duties of justice. We also need to think about inheritance prospectively. A social system that is overly competitive will undermine the social conditions in which conditional duties are binding. Justice requires a guarantee of a minimum access to income at all points in time, not just that we maximize the lifetime expectation of the least advantaged. Given uncertainty, the benefits of unconditionality may outweigh its costs, depending on the level at which the UBI is set and what it replaces.
Perception and cognition in music listening
Authors: McAdams Stephen
Published: December 2024

Perception and cognition organize incoming sensory information into events, objects, and messages, and interpret their meaning in the current context based on knowledge previously acquired through experience within a culture. They also orient attention to relevant events, and store relevant information in memory. An integrative framework for music perception and cognition is proposed through which sound is encoded in the brain and analysed through grouping processes from which auditory attributes of events and event streams are extracted. Sequences of attributes activate knowledge structures in memory, allowing for recognition of sound sources and patterns, building up a mental representation of what is happening in the music, which in turn generates expectations for what follows that then affect further processing of the sensory information.
The perception of musical timbre
Authors: McAdams Stephen
Published: December 2024

Timbre is a multidimensional perceptual quality, the dimensions of which can be characterized acoustically and semantically. Timbre space models derived from perceptual dissimilarity data can be used to predict aspects of instrumental blends, the perception of timbre intervals, and the integration or segregation of auditory streams based on timbre. Timbral properties play a strong role in the identification of sounding objects and the actions that set them into vibration. Timbre, through orchestration, can be used to structure music into auditory streams, musical surface textures, and orchestral layers and can create timbral contrasts that segment the music perceptually. Timbral properties play an important role along with other musical parameters in the creation of movement between tension and relaxation in music, and timbral patterns can be learned implicitly, opening the door to the creation of timbral grammars in music.
Achieving Better Decisions
Authors: Mayer Benoit
Published: December 2024

This chapter considers how climate assessment procedures can help society reach better decisions. First, it explores the roles of the public, decision-makers, and courts in making these decisions. While an extended role for political bodies is justified by climate assessment decisions’ extensive reliance on value-based judgements, it is argued that this should not exclude a role for courts. Second, the chapter reviews the different substantive decisions to which climate assessments can lead. Climate assessment rarely result in the rejection of proposed activities, but the activities that are approved are often subjected to conditions that aim at reducing climate impacts. Third, the chapter assesses the real-world effects of these decisions. Counterintuitively, it is argued that the rejection of a proposed greenhouse gas emitting activity may not achieve as much as a decision to approve the activity with conditions aimed at reducing its climate impact.
Conclusion
Authors: Mayer Benoit
Published: December 2024

This chapter concludes the book by formulating 10 policy recommendations for the application of environmental assessment procedures as a tool for climate change mitigation. These recommendations highlight the need to conduct climate assessments in spite of potential policy redundancies, to consider climate impacts both at the screening and scoping stages, to clarify methods for the assessment of significance relevant at different stages of the procedure, to deal with uncertainty in particular with regard to indirect climate impacts, to assess extraterritorial sources of greenhouse gas emissions, to consider public participation as a relevant tool in spite of the absence of directly affected populations, to define relevant and effective mitigation conditions, and to review and improve climate assessment frameworks on a continuous basis.
Indirect effects of the COVID-19 pandemic: A cause-of-death analysis of life expectancy changes in 24 countries, 2015 to 2022
Authors: Polizzi Antonino , Zhang Luyin , Timonin Sergey , Gupta Aashish , Dowd Jennifer Beam , Leon David A , Aburto José Manuel
Published: December 2024

Worldwide, mortality was strongly affected by the COVID-19 pandemic, both directly through COVID-19 deaths and indirectly through changes in other causes of death. Here, we examine the impact of the pandemic on COVID-19 and non-COVID-19 mortality in 24 countries: Australia, Austria, Brazil, Bulgaria, Canada, Chile, Croatia, Czechia, Denmark, England and Wales, Hungary, Japan, Latvia, Lithuania, The Netherlands, Northern Ireland, Poland, Russia, Scotland, South Korea, Spain, Sweden, Switzerland, and the United States. Using demographic decomposition methods, we compare age- and cause-specific contributions to changes in female and male life expectancy at birth in 2019–2020, 2020–2021, and 2021–2022 with those before the COVID-19 pandemic (2015–2019). We observe large life expectancy losses due to COVID-19 in most countries, usually followed by partial recoveries. Life expectancy losses due to cardiovascular disease (CVD) mortality were widespread during the pandemic, including in countries with substantial (Russia, Central and Eastern Europe, and the Baltic countries) and more modest (United States) improvements in CVD mortality before the pandemic. Many Anglo-Saxon countries, including Canada, Scotland, and the United States, continued their prepandemic trajectories of rising drug-related mortality. Most countries saw small changes in suicide mortality during the pandemic, while alcohol mortality increased and cancer mortality continued to decline. Patterns for other causes were more variable. By 2022, life expectancy had still not returned to prepandemic levels in several countries. Our results suggest important indirect effects of the pandemic on non-COVID-19 mortality through the consequences of COVID-19 infection, nonpharmaceutical interventions, and underreporting of COVID-19-related deaths.
Inferring structure of cortical neuronal networks from activity data: A statistical physics approach
Authors: Po Ho Fai , Houben Akke Mats , Haeb Anna-Christina , Jenkins David Rhys , Hill Eric J , Parri H Rheinallt , Soriano Jordi , Saad David
Published: December 2024

Understanding the relation between cortical neuronal network structure and neuronal activity is a fundamental unresolved question in neuroscience, with implications to our understanding of the mechanism by which neuronal networks evolve over time, spontaneously or under stimulation. It requires a method for inferring the structure and composition of a network from neuronal activities. Tracking the evolution of networks and their changing functionality will provide invaluable insight into the occurrence of plasticity and the underlying learning process. We devise a probabilistic method for inferring the effective network structure by integrating techniques from Bayesian statistics, statistical physics, and principled machine learning. The method and resulting algorithm allow one to infer the effective network structure, identify the excitatory and inhibitory type of its constituents, and predict neuronal spiking activity by employing the inferred structure. We validate the method and algorithm’s performance using synthetic data, spontaneous activity of an in silico emulator, and realistic in vitro neuronal networks of modular and homogeneous connectivity, demonstrating excellent structure inference and activity prediction. We also show that our method outperforms commonly used existing methods for inferring neuronal network structure. Inferring the evolving effective structure of neuronal networks will provide new insight into the learning process due to stimulation in general and will facilitate the development of neuron-based circuits with computing capabilities.
P001 The patient journey to diagnosis for axial Spondyloarthritis - The challenges in primary care and the positive impact of specialist axial SpA services
Authors: Eddison Joe , Bamford Sian , Chan Antoni , Chan Marian , Das Dhivya , Freeston Jane , Gregory William J , Gudu Tania , Hutton Kristi , Moorthy Arumugan , Sengupta Raj , Tahir Hasan , Webb Dale
Published: December 2024

Background and aims

The mean average time to diagnosis (TTD) in the UK for axial SpA is currently 8.29 yearsi. However, it should be possible to ensure diagnosis within 12 months of symptom onset to optimise clinical outcomesii. Current evidence suggests significant variability in the patient journey, particularly within primary care, where patients have repeat consultations for axial SpA related symptoms before being referred onward to rheumatologyiii. The National Axial Spondyloarthritis Society (NASS) TTD patient survey assesses where in the pathway patients experience most delays and the factors that may be driving these pinch points.

Methods

We developed a patient self-administered post-diagnosis axial SpA online survey form, and analysed the results along the pathway. Data were collected from 534 patients diagnosed since January 2021.

Results

The average time from first GP appointment to rheumatology referral was the longest wait, at 4.33 years (53% of the total delay). Other elements of the pathway were (mean):

• 2.49 years (31%) from experiencing symptoms to seeking help from a GP,

• 0.39 years (5%) waiting for a first rheumatology appointment following referral,

• 0.88 years (11%) for the time from first appointment in rheumatology to formal diagnosis.

Patients also reported seeing healthcare practitioners multiple times pre diagnosis. Physiotherapists (66%, n = 353) and GPs (63%, n = 337) were seen most frequently, with chiropractors (19%, n = 103) and osteopaths (17%, n = 93) seeing around a fifth of patients repeatedly. P001 Figure 1.Proportional split of average (mean) time to diagnosis by pathway.  P001 Figure 2.Number of visits to other Health Care Professionals (HCPs) before receiving a formal diagnosis.

Whilst specialist clinics are not possible everywhere, patients in these settings get a swifter diagnosis due to increased expertise, greater access to co-located MSK radiology services and expedited triage out of general rheumatology pools.

References

1. Eddison J, et al. www.actonaxialspa.com; Webb D, et al. Act on axial SpA: A Gold Standard time for the diagnosis of axial SpA (2021); Al-Attar M, et al. Ann Rheum Dis 2021;80(Suppl 1):757.
P004 Difficult to Treat axial Spondyloarthritis- insights from a tertiary rheumatology service
Authors: Weddell Jake , Duckett Millie , Harrison Stephanie R , Barr Andrew , Vandevelde Claire , McGonagle Dennis , Freeston Jane E , Marzo-Ortega Helena
Published: December 2024

Background

Therapy non-response (NR) can be seen in 30% of axial spondyloarthritis (axSpA) with some patients requiring multiple therapies. We wanted to assess in our axSpA population those with difficult to treat (D2T) disease as defined in two ways: (ever) failure of any 2 b/ts-DMARDs which we called “standard definition” or (ever) failure ≥2 b/ts-DMARDs with differing mechanisms of action (MoA), “strict definition”.

Aims

To describe the clinical, laboratory and imaging characteristics of axSpA patients meeting varying definitions of D2T disease and to compare differences between those responding to their current b/tsDMARD (BASDAI <4) and those who are not (BASDAI ≥4).

Methods

A cross-sectional analysis of b/ts-DMARD prescribing in the Leeds Specialist Spondyloarthritis Service identified patients with axSpA treated with a b/ts-DMARD between October 2023 and May 2024. Demographics and clinical characteristics including BASDAI, CRP and imaging were assessed. Patients were classified as NR at the time of assessment based if BASDAI ≥4, as a marker of ongoing disease activity.

Results

Overall, 680 patients on b/ts-DMARDs were identified, of which 109 (16.0%) had (ever) failed any 2 b/ts-DMARDs and 58 (8.5%) ≥2 b/ts-DMARDs with differing MoA. The demographics were similar between groups with mean age (49.2 [SD12.4] vs 49.5 [SD12.3]), predominant male sex (62% vs 65%), HLA-B27 (77% vs 81%), and prevalence of radiographic disease (59% vs 56%) in those meeting standard and strict definitions respectively. At last clinical review, 99 (91%) patients meeting standard definition and 51 (88%) meeting strict definition remained on a b/ts-DMARD. Of the patients reviewed during 2023/2024, 40/55 (73%) meeting the standard definition and 18/25 (72%) meeting the strict definition had NR. In patients experiencing NR, 17/35 (49%) had CRP >5 mg/L in the standard definition compared to 7/15 (47%) in the strict definition. Active inflammation on MRI was found on 1/4 patients meeting the standard criteria and 0/2 patients meeting the strict criteria. All patients had non-axSpA related pathology on MRI.

Conclusions

In this cross-sectional assessment a small proportion of axSpA patients appear to have D2T disease according to above definitions. Objective evidence of inflammation was seen in less than 50% either by CRP, MRI or both, suggesting a mix of non-inflammatory and true refractory disease. Further characterization of these populations in this and larger cohorts may identify predictors of non-response to b/tsDMARD therapy in axSpA.
Protective effect of Auraptene, a novel acetylcholinesterase inhibitor, on hydrogen peroxide-induced cell toxicity in PC12 cells
Authors: Hadipour Elham , Khodadadi Mahdi , Emami Seyed Ahmad , Haghighi Samaneh Rahamouz , Ramazani Elham , Tayarani-Najaran Zahra
Published: December 2024

Objective: Alzheimer's disease (ad) is a progressive and degenerative disorder of the central nervous system that is associated with cognitive and memory impairment. The main factors which have been implicated in neurodegeneration of ad are oxidative stress and cholinergic neurons dysfunction. Here, we examined the effects of auraptene, a novel acetylcholinesterase (AChE) inhibitor, on hydrogen peroxide (H2O2)-induced cell death in PC12 cells. Methods: Thereby, we measured cell viability, intracellular reactive oxygen species (ROS) production, AChE inhibitory activity, cell damage and apoptosis with AlmarBlue, 2′, 7′-dichlorodihydrofluorescein diacetate (DCFH-DA), Ellman method, lactate dehydrogenase (LDH) release, propidium iodide (PI) staining and western blot analysis, respectively. Results: H2O2 (150 μM) resulted in the cell death and apoptosis while, pretreatment with auraptene (10, 20 and 50 μM) significantly increased the viability (P < 0.01), and at 5–50 μM decreased ROS amount (P < 0.05 and P < 0.001). Pretreatment with auraptene (10, 20 and 50 μM) lessened AChE activity (P < 0.001), and at 20 and 50 μM reduced the release of LDH (P < 0.001), and at (10, 20 and 50 μM) diminished the percentage of apoptotic cells (P < 0.001). Also, pretreatment with auraptene at 10,20 and 50 μM prevented from poly (ADP-ribose) polymerase (PARP) cleavage (P < 0.001), and cytochrome c release (P < 0.01 and P < 0.001). The amount of caspase 3 activity (P < 0.001) and survivin (P < 0.001) were elevated after pretreatment of cells with auraptene at 10–50 μM and 10 and 50 μM. Conclusion: It seems that auraptene has the ability to slow down or stop H2O2-induced nerve cells death by reducing the activity of AChE and suppression of internal pathway of apoptosis.
Transcriptomic and lipidomic profiling reveals distinct bioactive lipid signatures in slow and fast muscles and highlights the role of resolvin‐D2 in fiber type determination during myogenesis
Authors: Rieger Lupann , Molina Thomas , Fabre Paul , Greffard Karine , Pellerito Ornella , Dort Junio , Bilodeau Jean‐François , Dumont Nicolas A.
Published: December 2024

Skeletal muscles are predominantly composed of long, multinucleated muscle fibers, classified according to their metabolic and contractile phenotype. The determination of fiber types is influenced by various factors (e.g., innervation, hormones, physical demand). Our laboratory and others showed that resolvins, lipid mediators derived from omega‐3 fatty acids, promote muscle regeneration and function after an injury or in models of muscular dystrophies; however, the effect of resolvins on the determination of muscle phenotype remains unknown. Here, we investigated the impact of lipid mediators on muscle phenotype during myogenesis. Transcriptomics analysis of single‐nuclei RNAseq data sets revealed that the enzymes responsible for bioactive lipids biosynthesis are differentially expressed in slow fibers versus fast fibers. Lipidomics analysis of slow‐twitch muscle (soleus) versus fast‐twitch muscle (tibialis anterior) showed that the levels of lipids derived from arachidonic acid are similar between muscle groups, but lipids derived from alpha‐linolenic acid, linoleic acid, eicosapentaenoic acid, and docosahexaenoic acid are enriched in slow‐twitch muscle. Screening for different lipids in vitro showed that resolvin‐D2 enhances the formation of myotubes expressing the slow myosin heavy chain isoform. In vivo, the administration of resolvin‐D2 enhances muscle strength, increases myofiber size, and affects fiber typing in injured muscles but not in uninjured muscles. Resolvin‐D2 promoted the transition toward the dominant fiber types in regenerating muscle (i.e., type I in the slow‐twitch soleus and type IIB in the fast‐twitch tibialis anterior muscle), suggesting its participation in fiber typing in conjunction with other factors. Overall, these findings identified new roles of bioactive lipids in the regulation of fiber typing, which could have therapeutic applicability in muscle injuries or dystrophies.
Platelets as key cells in endometriosis patients: Insights from small extracellular vesicles in peritoneal fluid and endometriotic lesions analysis
Authors: Bortot Barbara , Di Florio Roberta , Merighi Simona , Peacock Ben , Lees Rebecca , Valle Francesco , Brucale Marco , Mangogna Alessandro , Di Lorenzo Giovanni , Romano Federico , Zito Gabriella , Zanconati Fabrizio , Ricci Giuseppe , Cancila Valeria , Belmonte Beatrice , Biffi Stefania
Published: December 2024

Endometriosis is a chronic inflammatory condition characterized by the presence of endometrium‐like tissue outside the uterus, primarily affecting pelvic organs and tissues. In this study, we explored platelet activation in endometriosis. We utilized the STRING database to analyze the functional interactions among proteins previously identified in small extracellular vesicles (EVs) isolated from the peritoneal fluid of endometriosis patients and controls. The bioinformatic analysis indicated enriched signaling pathways related to platelet activation, hemostasis, and neutrophil degranulation. Double immunohistochemistry analysis for CD61 and MPO revealed a significant presence of neutrophils and platelets in close contact infiltrating endometriotic lesions, suggesting potential cell–cell interactions. Subsequently, we isolated small EVs from the peritoneal fluid of women diagnosed with endometriosis and from women without endometriosis who underwent surgery for non‐inflammatory benign diseases. We performed single‐particle phenotyping analysis based on platelet biomarkers GPIIb/IIIa and PF4 using nanoflow cytometry, as well as single‐particle morphological and nanomechanical characterization through atomic force microscopy. The study demonstrated that patients with endometriosis had a notably higher proportion of particles testing positive for platelet biomarkers compared to the total number of EVs. This finding implies a potential role for platelets in the pathogenesis of endometriosis. Further research is necessary to delve into the mechanisms underlying this phenomenon and its implications for disease progression.
Demystifying AI: Current State and Future Role in Medical Education Assessment
Authors: Turner Laurah , Hashimoto Daniel A. , Vasisht Shubha , Schaye Verity
Published: December 2024

Medical education assessment faces multifaceted challenges, including data complexity, resource constraints, bias, feedback translation, and educational continuity. Traditional approaches often fail to adequately address these issues, creating stressful and inequitable learning environments. This article introduces the concept of precision education, a data-driven paradigm aimed at personalizing the educational experience for each learner. It explores how artificial intelligence (AI), including its subsets machine learning (ML) and deep learning (DL), can augment this model to tackle the inherent limitations of traditional assessment methods.

AI can enable proactive data collection, offering consistent and objective assessments while reducing resource burdens. It has the potential to revolutionize not only competency assessment but also participatory interventions, such as personalized coaching and predictive analytics for at-risk trainees. The article also discusses key challenges and ethical considerations in integrating AI into medical education, such as algorithmic transparency, data privacy, and the potential for bias propagation.

AI’s capacity to process large datasets and identify patterns allows for a more nuanced, individualized approach to medical education. It offers promising avenues not only to improve the efficiency of educational assessments but also to make them more equitable. However, the ethical and technical challenges must be diligently addressed. The article concludes that embracing AI in medical education assessment is a strategic move toward creating a more personalized, effective, and fair educational landscape. This necessitates collaborative, multidisciplinary research and ethical vigilance to ensure that the technology serves educational goals while upholding social justice and ethical integrity.
Haptics: The Science of Touch As a Foundational Pathway to Precision Education and Assessment
Authors: Perrone Kenneth. H. , Abdelaal Alaa Eldin , Pugh Carla M. , Okamura Allison M.
Published: December 2024

Clinical touch is the cornerstone of the doctor-patient relationship and can impact patient experience and outcomes. In the current era, driven by an ever-increasing infusion of point-of-care technologies, physical exam skills have become undervalued. Moreover, touch and hands-on skills have been difficult to teach due to inaccurate assessments and difficulty with learning transfer through observation. In this article, the authors argue that haptics, the science of touch, provides a unique opportunity to explore new pathways to facilitate touch training. Furthermore, haptics can dramatically increase the density of touch-based assessments without increasing human rater burden—essential for realizing precision assessment. The science of haptics is reviewed, including the benefits of using haptics-informed language for objective structured clinical examinations. The authors describe how haptic devices and haptic language have and can be used to facilitate learning, communication, documentation and a much-needed reinvigoration of physical examination, and touch excellence at the point of care. The synergy of haptic devices, artificial intelligence, and virtual reality environments are discussed. The authors conclude with challenges of scaling haptic technology in medical education, such as cost and translational needs, and opportunities to achieve wider adoption of this transformative approach to precision education.
Covert Perioperative Strokes in Older Patients Having Noncardiac Surgery (PRECISION): A Prospective Cohort Analysis
Authors: Cui Qianyu , Zhao Weixing , Chen Hongyan , Ren Yue , Yin Xueke , Zheng Maoyao , Li Muhan , Wang Jie , Wang Juan , Zeng Min , Li Shu , Zhang Kai , Wu Xiaodong , Zhou Liye , Jiao Youyou , Sessler Daniel I. , Mi Weidong , Peng Yuming
Published: December 2024

Background:

Perioperative strokes may promote postoperative neurocognitive dysfunction. This study thus evaluated the incidence of postoperative strokes and the association between strokes and postoperative neurocognitive outcomes in older patients recovering from noncardiac surgery.

Methods:

The Postoperative Covert Stroke and Cognitive Dysfunction among Elderly Patients Undergoing Noncardiac Surgery study (PRECISION) was a two-center prospective cohort study evaluating patients aged 60 yr or older who had elective, noncardiac inpatient surgery at two Chinese academic centers. Postoperative strokes were evaluated by scheduled magnetic resonance brain imaging within 7 days. The primary outcome was the cumulative incidence of postoperative stroke. Secondary outcomes included postoperative delirium within the first 5 days after surgery, neurocognitive decline at 12 months, and the association between stroke and neurocognitive dysfunction.

Results:

Among 934 patients (mean age, 67 yr; 45% male) included in the analyses, two thirds had neurosurgical craniotomies. There were 111 (11.9%; 95% CI, 9.8 to 14.0%) covert strokes within 7 days after surgery and no overt strokes. Postoperative delirium was observed in 117 patients (12.5%; 95% CI, 10.4 to 14.7%) within 5 days, and neurocognitive decline was observed in 147 patients (18.8%; 95% CI, 16.0 to 21.5%) at 1 yr after surgery. Postoperative covert strokes were significantly associated with delirium (adjusted odds ratio, 2.18; 95% CI, 1.31 to 3.62; P = 0.003) and 1-yr neurocognitive decline (adjusted odds ratio, 2.33; 95% CI, 1.31 to 4.13; P = 0.004) in overall participants.

Conclusions:

Among patients aged 60 yr and older who had major noncardiac surgery, mainly intracranial, one in nine patients experienced a perioperative covert stroke. Covert strokes more than doubled the risk of postoperative delirium and long-term neurocognitive decline. Covert perioperative strokes are common and clinically meaningful.
Oncologic Outcomes of Laparoscopic Radical Hysterectomy Incorporating Modified Tumor-Free Techniques
Authors: Li Yuan , Zhao Jiayuan , Ding Xuesong , Liang Chao , Wang Weidi , Ren Tong , Jiang Fang , Yang Junjun , Xiang Yang
Published: December 2024

OBJECTIVE:

It remains unclear whether modifying laparoscopic radical hysterectomy to adopt tumor-free principles can improve oncologic outcomes in patients with early-stage cervical cancer.

METHODS:

We performed a single-center retrospective cohort study of 276 patients with early-stage cervical cancer who were treated between January 2017 and January 2023, including 151 patients who underwent laparoscopic radical hysterectomy that incorporated modified tumor-free techniques (MTF group) and 125 patients who underwent conventional laparoscopic radical hysterectomy with a uterine manipulator and unprotected intracorporeal colpotomy (non-MTF group). Oncologic outcomes and perioperative results were analyzed using inverse probability treatment weighting (IPTW).

RESULTS:

Patients in the MTF group had shorter length of hospital stay than those in the non-MTF group. However, there were no significant differences in operative time, decrease in hemoglobin, or complications. After a median follow-up of 36.0 months (range 15.3–62.0 months) for the MTF group and 66.8 months (range 3.0–82.5 months) for the non-MTF group, recurrence was observed in two (1.3%) and 16 (12.8%) of the patients, respectively. The 2-year disease-free survival (DFS) rates in the MTF group and non-MTF group were 99.3% and 91.9%, respectively. In the primary analysis limited to 2-year survival, the adjusted multivariate analysis showed that use of modified tumor-free techniques was an independent predictor of longer DFS (hazard ratio 0.10 95% CI, 0.01–0.77, P=.027). After IPTW, patients in the MTF group had a more favorable DFS than those in the non-MTF group (log-rank P=.031).

CONCLUSION:

Laparoscopic radical hysterectomy that incorporates modified tumor-free techniques is a feasible treatment for patients with early-stage cervical cancer. Oncologic outcomes of individuals who underwent this procedure were more favorable than those of conventional laparoscopic radical hysterectomy.
Evaluating the Impact of Eosinophil Count on the Long-term Clinical Outcomes of Patients With an Acute ST-segment Elevation Myocardial Infarction Who Require Emergency Percutaneous Coronary Intervention: Results of a Multicenter Cohort Study
Authors: Guo Lei , Liu Hao , Dong Zhichao , Zhou Xuchen , Zhu Hao , Gu Xia , Zhang Bo
Published: December 2024

Objective:

Eosinophils (EOS) are inflammatory innate immune cells that play an important role in arterial thrombogenesis. There is a paucity of data on whether EOS levels have an impact on long-term outcomes following ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate the impact of EOS count on the clinical outcomes of STEMI patients who underwent emergency percutaneous coronary intervention (PCI).

Methods:

This is a retrospective multicenter cohort study. A total of 754 patients with STEMI who required emergency PCI at 5 centers were screened between October 2015 and November 2016. Patients were divided into 2 groups based on EOS count: EOS count <0.02 × 109/L group (n = 264) and EOS count ≥0.02 × 109/L group (n = 490). Baseline demographic characteristics, clinical information, and medical test data were collected at study entry. The primary endpoint was all-cause death. The secondary endpoint was a major adverse cardiac event. Multivariablete Cox regression analysis was performed to identify the independent predictors of all-cause death, with a follow-up period of 5 years.

Results:

The incidence of all-cause death (14.8% vs. 7.6%, P = 0.002) and major adverse cardiac event (20.1% vs. 13.1%, P = 0.011) were significantly higher in EOS count <0.02 × 109/L group compared with ≥0.02 × 109/L group. Multivariablete Cox regression analysis showed that an EOS count <0.02 × 109/L, age ≥65 years, previous heart failure, previous stroke, and left ventricular ejection fraction ≤ 40% were independent predictors of all-cause death in patients with STEMI who underwent an emergency PCI.

Conclusions:

Low EOS counts were associated with all-cause mortality in STEMI patients who underwent emergency PCI.
International trends in biliary tract cancer–related mortality, 2000–2022: An observational study of the World Health Organization Mortality Database
Authors: Vu Quynh Thi , Nishimura Yoshito , Harada Ko , Ito Hiroki , Higashionna Tsukasa , Maruo Akinari , Harada Keisaku , Takeda Tatsuaki , Hamano Hirofumi , Zamami Yoshito , Hagiya Hideharu , Koyama Toshihiro
Published: December 2024

Background and Aims:

Biliary tract cancers (BTCs), including intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma, gallbladder cancer, and ampullary cancer, exhibit poor prognosis. This study examined temporal trends in mortality due to BTCs and their major subtypes at international, regional, and national levels.

Approach and Results:

This observational study used the World Health Organization mortality database. Locally weighted regression (LOESS) was used to produce a smoothed curve of long-term international and regional BTC and major subtype-related mortality rates in 2000–2022 based on available data from countries. Trends in age-standardized mortality rates (ASRs) during 2013–2022 for individual countries were examined using joinpoint regression analysis. Internationally, LOESS-smoothed ASRs per 100,000 population due to BTCs were 2.8 (95% CI: 2.5–3.1) in 2000, and 2.7 (2.3–3.1) in 2022. LOESS-smoothed BTC-related ASRs were the highest in the Western Pacific region at 4.2 (1.8–6.6) in 2022, compared with those in the European and American regions at 2.6 (2.3–2.9) and 2.2 (1.8–2.6), respectively. Among major subtypes, LOESS-smoothed ASRs due to iCCA increased by 120.0%, those due to gallbladder cancer decreased by 45.5%, and those due to extrahepatic cholangiocarcinoma remained stable between 2000 and 2022. Disparities in BTC and major subtype-related ASR trends were observed between countries during 2013–2022, with iCCA-associated ASRs showing increasing trends in many countries.

Conclusions:

Although internationally estimated BTC-associated ASRs showed a stable trend over the last 2 decades, a large increase in estimated iCCA-associated ASRs necessitates developing effective screening for high-risk individuals and disease management strategies.
Bleb Reformation After Lateral Cantholysis in a Case of Prostaglandin-associated Periorbitopathy
Authors: Sugano Akira , Mito Hidenori , Ide Tomoko , Nakakura Shunsuke , Ambat Jose Miguel , Takahashi Yasuhiro
Published: December 2024

An 84-year-old male with uncontrolled intraocular pressure (IOP), despite maximum topical medications including prostaglandin F2α analog, had bilateral prostaglandin-associated periorbitopathy-related tight upper eyelids. One day after trabeculectomy of the left eyelid, IOP was 24 mm Hg, with a flat bleb. Daily ocular massage failed to maintain bleb filtration. IOP was reduced to 4 mm Hg after lifting the left upper eyelid; hence, ocular compression from a tight upper eyelid was the suspected cause preventing flow from the scleral flap. A lateral cantholysis was performed to release the eyelid pressure. On the first postoperative day, the bleb was documented to be large and diffuse, with subsequent IOP reduction to 10 mm Hg. At the third month of follow-up, the IOP was 8 mm Hg in the left eyelid, with a well-formed bleb.
Sports Medicine Physician Confidence in Concussion Assessments for Postconcussion Return-to-Play Decisions
Authors: Miller Jacob J. , Hansen Kelsey , Dorman Jason , Jensen Katie , Gurumoorthy Aarabhi , Combs Josefine
Published: December 2024

Objective:

To identify sport-related concussion (SRC) assessments sports medicine physicians perform and in which they place confidence when making return-to-play (RTP) decisions.

Design:

Cross-sectional study.

Setting:

Online survey.

Participants:

Active members of the American Medical Society for Sports Medicine (AMSSM) at the fellowship level or higher making RTP decisions following concussion within the last year.

Interventions:

An electronic REDCap survey gathering demographic and practice information and responses to clinical scenarios was sent to AMSSM members.

Main Outcome Measures:

The primary outcome was the SRC assessment(s) in which physicians expressed the most confidence for RTP decisions.

Results:

Four hundred thirty AMSSM members responded to the survey, 392 of which met inclusion criteria. The graded symptom checklist was rated the most useful test for making return-to-play decisions, and respondents felt most confident starting the RTP process if the graded symptom checklist was normal. An assessment was considered most useful if it closely reflected resolution of SRC's pathological processes. Computerized neurocognitive testing was most likely to be ignored if abnormal. An abnormal neurological examination made physicians feel least confident SRC had resolved.

Conclusions:

Sports medicine physicians view the graded symptom checklist as a useful tool for making RTP decisions. Physicians expressed less confidence in computerized neurocognitive testing to determine RTP readiness. This study uncovered reliance on symptom reporting by sports medicine physicians and an opportunity for the creation of concussion clinical decision tools.
Cozen's phenomenon
Authors: Sepúlveda Matias , Ulloa Macarena , Birrer Estefanía
Published: December 2024

Purpose of review

The purpose of this review is to describe the current trends in the treatment of Cozen's phenomenon and evaluate if there are changes in the treatment paradigm due to the advent of implant-mediated guided growth.

Recent findings

Current literature emphasizes the need for early recognition of Cozen's phenomenon (tibia valgus), with a high incidence associated with proximal tibia fractures. There are cases with late onset progression of the valgus deformity, which can be easily treated with implant-mediated guided growth.

Clinical observation continues to be the current standard of treatment for this phenomenon. An average surveillance time of 2 years postfracture is recommended to observe for valgus deformity of the tibia. During this period, implant-mediated guided growth may be utilized to correct tibial deformity, which is an easier and safer solution than tibial osteotomy.
What's up with patella alta?
Authors: Jones Ruth H. , Lijesen Emilie , Green Daniel W.
Published: December 2024

Purpose of review

Patella alta, which describes an abnormally proximally positioned patella, has become of particular interest as it has been identified as a potential factor in patellofemoral instability (PFI) and other common pediatric orthopedic conditions. The purpose of this review is to describe the condition, measuring techniques, and its association with pediatric orthopedic conditions, and to evaluate methods of correction of patella alta.

Recent findings

Recent literature has explored the etiology of patella alta by investigating patellar height as age increases, with inconclusive findings as to whether the condition is congenital or acquired over time. Additionally, patella alta has been identified to be associated with several pediatric orthopedic conditions, including PFI, anterior knee pain, and cerebral palsy. As such, methods of correction for patella alta, including medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle distalization, and patella tendon imbrication, have been studied.

Patella alta, defined by an abnormally high patellar height, is associated with patellofemoral instability, anterior knee pain, and cerebral palsy. Various indices have been developed to measure and define patellar height, including the Caton-Deschamps Index and Koshino-Sugimoto Index which are applicable to a pediatric population. Treatments include isolated or concomitant MPFLR, distalizing tibial tubercle osteotomy, and patella tendon imbrication, which have shown success in reducing patellar height and improving patella alta, though risks for complications do exist.