bluuebunny/crossref_metadata_2025 huggingface dataset:
Constructing the space of transition within the early childhood education and care pedagogical environment: A child's resources and positions
Authors: Raittila Raija , Vuorisalo Mari , Rutanen Niina
Published: April 2024

This article examines how the space of transition is constructed within and linked to the early childhood education and care (ECEC) pedagogical environment during a child's first transition to ECEC. In many studies, this transition has been characterised as a stressful situation in which to cope successfully with the demands of the new environment. In this study, the focus is on the construction of the space of transition and, particularly, on children's active involvement in this process. The data include video recordings from children's first days in ECEC. We focus on children's resources and discuss how the pedagogical environment enabled newcomers’ active positions, which they used to reshape daily practices in ECEC. The emerging space of transition was constructed on the basis of the relations that the newcomers enabled in the situation. The results shed new light on the strengths of the newcomers as co-constructors of daily practices of the ECEC pedagogical environment, even on the first day of the transition. In addition, the space of transition as a new conceptual way to explore educational transitions is discussed.
Severe bradycardia at acute medical take – Think about myxoedema coma
Authors: Maung Aye Chan , Brain Henrietta , Ballav Chitrabhanu , Sihota Sarbpreet
Published: April 2024

We report two cases of myxoedema coma that presented to the acute medical take with severe bradycardia. These patients were initially misdiagnosed as bradyarrhythmia of primary cardiac origin. They were then diverted to the cardiology service at another district general hospital (DGH) for admissions. Both cases were subsequently diagnosed with myxoedema coma having screened thyroid function tests on arrival at the cardiology unit. Despite being treated for myxoedema coma, both patients unfortunately succumbed to the disease and later died in the hospital. These cases highlight that clinical suspicion and recognition of myxoedema coma remain significant challenges in a developed world despite readily available and highly sensitive thyroid hormone assays.
Predicting Language Function Post-Stroke: A Model-Based Structural Connectivity Approach
Authors: Hildesheim Franziska E. , Ophey Anja , Zumbansen Anna , Funck Thomas , Schuster Tibor , Jamison Keith W. , Kuceyeski Amy , Thiel Alexander
Published: April 2024

Background

The prediction of post-stroke language function is essential for the development of individualized treatment plans based on the personal recovery potential of aphasic stroke patients.

Objective

To establish a framework for integrating information on connectivity disruption of the language network based on routinely collected clinical magnetic resonance (MR) images into Random Forest modeling to predict post-stroke language function.

Methods

Language function was assessed in 76 stroke patients from the Non-Invasive Repeated Therapeutic Stimulation for Aphasia Recovery trial, using the Token Test (TT), Boston Naming Test (BNT), and Semantic Verbal Fluency (sVF) Test as primary outcome measures. Individual infarct masks were superimposed onto a diffusion tensor imaging tractogram reference set to calculate Change in Connectivity scores of language-relevant gray matter regions as estimates of structural connectivity disruption. Multivariable Random Forest models were derived to predict language function.

Results

Random Forest models explained moderate to high amount of variance at baseline and follow-up for the TT (62.7% and 76.2%), BNT (47.0% and 84.3%), and sVF (52.2% and 61.1%). Initial language function and non-verbal cognitive ability were the most important variables to predict language function. Connectivity disruption explained additional variance, resulting in a prediction error increase of up to 12.8% with variable omission. Left middle temporal gyrus (12.8%) and supramarginal gyrus (9.8%) were identified as among the most important network nodes.

Conclusion

Connectivity disruption of the language network adds predictive value beyond lesion volume, initial language function, and non-verbal cognitive ability. Obtaining information on connectivity disruption based on routine clinical MR images constitutes a significant advancement toward practical clinical application.
Institutionalized Aesthetics: Video Games and the Contemporary Art Gallery
Authors: Atkinson Paul , Parsayi Farzad
Published: April 2024

The art museum or gallery is not a neutral space for housing works. As much as it accepts new types of media, they have to adapt to suit the context of viewing and the conventions of an art-historical discourse. This type of institutionalized aesthetic underpins the evaluation of art objects and even imposes a definition on what art is. Working critically through this discourse, this article examines the limitations of art museums and galleries in presenting, evaluating, or addressing the ludological and temporal aspects of video games. First, it outlines how assumptions pertaining to the visual arts carry over into the selection of games as well as their placement within exhibitions. Second, it examines how this discourse, which is invested in the architecture and structure of the art museum, also privileges a particular regime of spectatorship based on shared viewing, the autonomy of art, and aesthetic contemplation.
Skateboard crime and the pirating of urban space
Authors: Glenney Brian
Published: April 2024

This paper seeks to analyze “skate crime:” what skateboarders do, why they do it, and why it is criminalized even in public spaces. I begin with a case example of the Dolores Street Hill Bomb in San Francisco, a seemingly over-criminalized annual event that treats skaters as enemies of the city, a logic of enmity. This same logic was used to criminalize 17th–18th century “Golden Age” maritime piracy, a heuristic that helps assess the role that stigmatization by dominant orders of authority plays in skate crime. I deepen this narrative of skate crime by discussing four diverse facets that distinguish whether they are caused by political motivations or not and whether they have effects of social harm or not. I argue further that Golden Age piracy also fits this four-fold narrative, leading to my conclusion that skateboarding might be considered a kind of piracy, a “street piracy.”
Comparison of nebulisation 0.75% ropivacaine with 2% lignocaine for attenuation of haemodynamic response due to intubation: A prospective randomised study
Authors: Geetha Singam , Prashanth Naramoni VSSK , Durga Padmaja , Jayaram Kavitha , Farooq Mohamad , Chandra Sharath , Sushma
Published: April 2024

Introduction:

Laryngoscopy and intubation are associated with the reflex response of hypertension, tachycardia and other intraoperative complications. Nebulised route drug administration and entropy-guided induction enable optimal intubating conditions.

Aims:

To compare pre-induction nebulisation between 0.75% ropivacaine and 2% lignocaine in blunting the nasotracheal intubation response.

Materials and Methods:

A total of 100 patients undergoing elective faciomaxillary surgeries were prospectively randomised to receive pre-induction nebulisation: 5mL of 2% lignocaine (100mg) (Group L) or 5mL of 0.75% ropivacaine (37.5mg) (Group R). Patients were induced and intubated (nasotracheal) with entropy monitoring. Observed parameters included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, entropy at baseline, induction, intubation, post-intubation one, three and five minutes, propofol induction dose, electrocardiogram changes and peri-intubation cough reflex.

Results:

Ropivacaine aerosol proved significantly better than lignocaine aerosol on haemodynamics (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) and cough reflex ( p < 0.05). Both groups experienced similar entropy changes and propofol induction dose requirements and no fresh electrocardiogram changes (compared with the baseline).

Conclusion:

Pre-induction nebulised ropivacaine offers superior intubating conditions than lignocaine regarding haemodynamic response and cough reflex for faciomaxillary surgeries.
Current perspectives on peripheral nerve repair and management of the nerve gap
Authors: McMorrow Liam A. , Czarnecki Piotr , Reid Adam J. , Tos Pierluigi
Published: April 2024

From the first surgical repair of a nerve in the 6th century, progress in the field of peripheral nerve surgery has marched on; at first slowly but today at great pace. Whether performing primary neurorrhaphy or managing multiple large nerve defects, the modern nerve surgeon has an extensive range of tools, techniques and choices available to them. Continuous innovation in surgical equipment and technique has enabled the maturation of autografting as a gold standard for reconstruction and welcomed the era of nerve transfer techniques all while bioengineers have continued to add to our armamentarium with implantable devices, such as conduits and acellular allografts. We provide the reader a concise and up-to-date summary of the techniques available to them, and the evidence base for their use when managing nerve transection including current use and applicability of nerve transfer procedures.
A phase III, single-arm, 6-month trial of a wide-dose range oral testosterone undecanoate product
Authors: Bernstein James S. , Dhingra Om P.
Published: April 2024

Background:

Oral testosterone undecanoate (TU) formulations may provide effective, safe, and easily titratable testosterone replacement therapy.

Objective:

Demonstrate efficacy and safety of a novel oral TU formulation.

Design:

An open-label, single-arm, multi-center trial treated 155 hypogonadal men for 180 days. Treatment began at 200 mg TU twice daily with meals; doses were titrated over two 28-day cycles to between 100 and 800 mg TU daily, measuring average testosterone (T Cavg) after 90 days. Ambulatory blood pressure monitoring (ABPM) occurred at baseline, 120, and 180 days.

Methods:

Titrations used a randomized blood sample taken 3-, 4-, or 5-h post-morning dose. Outcomes used sodium fluoride/ethylenediaminetetraacetate plasma testosterone (T) values; serum results were also reported. Blood pressure (ABPM and in-clinic) was evaluated for change from baseline.

Results:

After titration, 87.8% of KYZATREX™ treated participants (worse-case scenario) and 96.1% of 90-day completers achieved eugonadal mean plasma T values. Serum T Cavg was 452 ng/dL and maximum T concentrations (T Cmax) met all FDA criteria. Participant eugonadal percentages were comparable across subgroups for age, weight, and body mass index. Diet had no effect on participant eugonadal percentages. KYZATREX was well tolerated, with no drug-related serious adverse events (SAE) and one adverse drug reaction (hypertension) observed in 2% or more of participants. Systolic ambulatory blood pressure increased 1.7 mmHg (95% confidence interval: 0.3–3.1). At baseline, 36% of 155 participants were receiving anti-hypertensive medication and 22% were diabetic. No dose increases occurred in existing anti-hypertensive medication; five participants (3.2%) started anti-hypertensive medication.

Conclusion:

KYZATREX provided safe and effective testosterone levels within the normal range in hypogonadal male study participants.

Clinical trial registration:

URL: https://clinicaltrials.gov/ unique identifier NCT04467697, conducted under NCT03198728. Post-completion, clinicaltrials.gov requested creation of the separate NCT04467697 identifier. All subjects were recruited under NCT03198728.
Unraveling the tumor immune microenvironment of lung adenocarcinoma using single-cell RNA sequencing
Authors: Song Lele , Gong Yuan , Wang Erpeng , Huang Jianchun , Li Yuemin
Published: April 2024

Tumor immune microenvironment (TIME) and its indications for lung cancer patient prognosis and therapeutic response have become new hotspots in cancer research in recent years. Tumor cells, immune cells, various regulatory factors, and their interactions in the TIME have been suggested to commonly influence lung cancer development and therapeutic outcome. The heterogeneity of TIME is composed of dynamic immune-related components, including various cancer cells, immune cells, cytokine/chemokine environments, cytotoxic activity, or immunosuppressive factors. The specific composition of cell subtypes may facilitate or hamper the response to immunotherapy and influence patient prognosis. Various markers have been found to stratify the patient prognosis or predict the therapeutic outcome. In this article, we systematically reviewed the recent advancement of TIME studies in lung adenocarcinoma (LUAD) using single-cell RNA sequencing (scRNA-seq) techniques, with specific focuses on the roles of TIME in LUAD development, TIME heterogeneity, indications of TIME in patient prognosis and therapeutic response during immunotherapy and drug resistance. The main findings in TIME heterogeneity and relevant markers or models for prognosis stratification and response prediction have been summarized. We hope that this review provides an overview of TIME status in LUAD and an inspiration for future development of strategies and biomarkers in LUAD treatment.
HR-positive/HER2-negative breast cancer arising in patients with or without BRCA2 mutation: different biological phenotype and similar prognosis
Authors: Li Pu-Chun , Zhu Yi-Fan , Pan Jia-Ni , Zhu Qiao-Yan , Liao Yu-Yang , Ding Xiao-Wen , Zheng Lin-Feng , Cao Wen-Ming
Published: April 2024

Background:

BRCA2 plays a key role in homologous recombination. However, information regarding its mutations in Chinese patients with breast cancer remains limited.

Objectives:

This study aimed to assess the clinicopathological characteristics of BRCA2 mutation breast cancer and explore the mutation’s effect on hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer survival in China.

Design:

This hospital-based cohort study prospectively included 629 women with breast cancer diagnosed from 2008 to 2023 at Zhejiang Cancer Hospital in China.

Methods:

We compared the clinicopathological characteristics and metastatic patterns and analysed the invasive disease-free survival (iDFS), distant relapse-free survival (DRFS) and first-line progression-free survival (PFS1) of patients with HR-positive/HER2-negative breast cancer according to BRCA2 mutations.

Results:

Among the 629 patients, 78 had BRCA2 mutations (12.4%) and 551 did not (87.6%). The mean age at diagnosis was lower in the BRCA2 mutation breast cancer group than in the non-mutation breast cancer group (38.91 versus 41.94 years, p = 0.016). BRCA2 mutation breast cancers were more likely to be lymph node-positive than non-mutation breast cancers (73.0% versus 56.6%, p = 0.037). The pathological grade was higher in 47.1% of BRCA2 mutation breast cancers than in 29.6% of non-mutation breast cancers ( p = 0.014). The proportions of patients with BRCA2 mutations who developed contralateral breast cancer (19.2% versus 8.8%, p = 0.004), breast cancer in the family (53.8% versus 38.3%, p = 0.009) and ovarian cancer in the family (7.6% versus 2.4%, p = 0.022) were higher than those of patients without the mutation. The median follow-up time was 92.78 months. Multivariate analysis showed that BRCA2 mutation was not associated with poorer iDFS [hazard ratio = 0.9, 95% confidence interval (CI) = 0.64–1.27, p = 0.56] and poorer distant relapse-free survival (DRFS) (hazard ratio = 1.09, 95% CI = 0.61–1.93, p = 0.76). There was no significant difference between the two groups with regard to metastatic patterns in the advanced disease setting. In the first-line metastatic breast cancer setting, PFS1 expression was broadly similar between the two groups irrespective of chemotherapy or endocrine therapy.

Conclusion:

HR-positive/HER2-negative breast cancer with BRCA2 mutations differs from those without mutations in clinical behaviour and reflects more aggressive tumour behaviour. Our results indicate that BRCA2 mutations have no significant effect on the survival of Chinese women with HR-positive/HER2-negative breast cancer.
From Jamestown to Bethlehem: Local connections of geopolitical violence
Authors: Devadoss Christabel
Published: April 2024

In this visual intervention, I demonstrate connections between Israel’s military occupation of the West Bank and rural Jamestown, Pennsylvania, USA, through 14 photos of surrounding landscapes. This intervention demonstrates how local geopolitical landscapes between two settler colonial nations perpetuate violence in the occupied Palestinian Territory (oPT), specifically through photos of “less-lethal munitions” in the West Bank and the site near the Pennsylvania manufacturer. While many scholars have demonstrated how US media and broader geopolitical discourses shape violence in everyday, intimate ways on bodies and people, this photo essay demonstrates how geopolitical violence and rhetoric manifest in everyday, local landscapes. Photos in this essay come from Aida Camp in the occupied West Bank outside of Bethlehem and rural Ohio and Pennsylvania, USA, on the route to where Combined Systems, Inc. manufactures rubber bullets, tear gas canisters, and other “less-lethal munitions and launching systems” deployed by the Israeli Security Force (ISF) in Aida.
A surgical case report on primary umbilical endometriosis (Villar’s nodule)
Authors: Benlghazi Abdelhamid , Benali Saad , Belouad Moad , Bouhtouri Yassine , Rachid Ait Bouhou , El Mangoub Fatima , Elhassani Moulay Mehdi , Kouach Jaouad
Published: April 2024

Endometriosis is a disease characterized by the implantation of endometrial-like tissue outside the uterine cavity. Common symptoms include cyclical pain, dysmenorrhea, dyspareunia, and infertility. Although endometriosis can spread to various extrauterine locations including the ovaries, fallopian tubes, and peritoneal surfaces, umbilical endometriosis is a rare manifestation of the disease. We report an intriguing clinical case of primary umbilical endometriosis in a 36-year-old female patient admitted to our department due to the notable manifestation of a painful swelling at the umbilicus, accompanied by cyclic episodes of bleeding. Subsequent investigations, incorporating ultrasound and computed tomography, indicated the presence of umbilical endometriosis, a finding that was subsequently confirmed by pathological examination of a mass biopsy. Surgical resection of the umbilical mass was performed, and histopathological analysis definitively confirmed the diagnosis of endometriosis. This case report aims to discuss in depth the diagnosis and management of umbilical endometriosis.
Effect of a Legal Clinic Program Within an Urban Primary Health Care Center on Social Determinants of Health: A Program Evaluation
Authors: Agarwal Gina , Pirrie Melissa , Edwards Dan , Delleman Bethany , Crowe Sharon , Tye Hugh , Mallin Jayne
Published: April 2024

Background:

Individuals living in poverty often visit primary healthcare clinics for health problems stemming from unmet legal needs. We examined the impact of a medical-legal partnership on improving the social determinants of health (SDoH), health-related quality of life, and perceived health status of attendees of a Legal Clinic Program (LCP).

Methods:

This was a pre-post program evaluation of a weekly LCP established within an urban primary healthcare clinic to provide free legal consultation. Patients aged 18 years or older were either approached or referred to complete a screening tool to identify potential legal needs. Those identified with potential legal needs were offered an appointment with LCP lawyers who provided legal counsel, referrals, and services. For those who attended the LCP, changes in SDoH and health indicators were collected via a self-reported survey 6 months after they attended the LCP and compared to their baseline scores using paired t-tests, McNemar’s test for paired proportions, and the Wilcoxon Signed Rank Test for related samples.

Results:

During the 6-month evaluation period, 31 participants attended the LCP and completed both the baseline and 6-month surveys; 67.8% were female, 64.5% were white, 90.3% were not working full-time, and 61.3% had a household income of $700 to 1800 per month. At follow-up, 25.8% were receiving at least 1 new benefit and there was a statistically significant reduction in food insecurity (35.5% vs 9.7%, P < .05). Also, perceived health status using the visual analog scale (ranges from 0 to 100) significantly improved from 42.5 points (SD = 25.3) at baseline to 56.6 points (SD = 19.6) after 6 months ( P < .05).

Conclusions:

The LCP has the potential to improve the health and wellbeing of patients in primary healthcare clinics by addressing unmet legal needs and SDoH.
A Bibliometric Literature Review of Digital Supply Chain: Trends, Insights, and Future Directions
Authors: Benatiya Andaloussi Manal
Published: April 2024

This paper presents a comprehensive bibliometric literature review that aims to analyze and synthesize the existing research on the digital supply chain. By employing a bibliometric approach, this study provides insights into the trends, key research themes, influential authors, and relevant journals in the field of DSC. Furthermore, it explores the geographical distribution of publications, collaboration networks among researchers, and the evolution of research topics. The comprehensive bibliometric analysis of literature in DSC is performed through data visualization and content analysis. Data visualization enables the analysis of publication performance and science mapping by examining prolific journals, authors, countries, influential papers, and conducting citation, co-citation, and bibliographic coupling analyses. Content analysis is carried out by examining the occurrence and clustering of textual data. The bibliometric literature review and content analysis were carried out on 114 documents indexed in the Scopus database, which were selected using the Prisma protocol. The data visualization analysis of the literature review through VOSviewer draws the landscape of scholarly research in the digital supply chain. Based on the research landscape, the content analysis demonstrates the significant effects that the incorporation of digital technology into supply chain management has had on several important research topics. The main research trends in digital supply chain according to the content analysis are: intelligent supply chain management, technologies to drive supply chains performance, circular supply chains, information reliability in supply chains, and sustainable supply chains. The findings of this review highlight the transformative potential of digital technologies in supply chain management and its performance optimization.
Asset Based Community Development: Co-Designing an Asset-Based Evaluation Study for Community Research
Authors: South Jane , Coan Susan , Woodward Jenny , Bagnall Anne-Marie , Rippon Simon
Published: April 2024

This paper responds to challenges around how to generate robust evidence in keeping with the principles of an asset-based approach based on mobilization of community strengths. The design of a collaborative evaluation of a multi-site Asset Based Community Development program is described and emergent learning discussed. A qualitative mixed method design was used to capture changes at community and program level drawing on diverse sources of evidence. Shared principles on the conduct of the evaluation were developed with program leads and community practitioners and opportunities for shared learning were built in. The paper distils learning on evaluation into six design features including the asset-based model as a framework, understandings of evidence and outcomes, ethical conduct, and the centrality of a collaborative and developmental approach. The paper concludes that these features form a coherent approach to asset-based evaluation which can link the theory and practice of Asset Based Community Development.
Revisiting Transnational Activities: Korean Immigrant Mothers’ Home Visit for Families
Authors: Jeong Yu-Jin , You Hyun-Kyung , Yang Sungeun
Published: April 2024

Immigrant mothers engage in numerous transnational activities. In this qualitative study, we explored one distinct type of transnational activity, a return trip to the home country for visit, as experienced by Korean immigrant mothers. Through purposeful sampling, 11 married middle-class Korean immigrant women with children were recruited to be interviewed during their visit to South Korea. By exploring the transcripts through the thematic analysis, we paid attention to how these women negotiated and constructed the meaning of their return trip. These mothers carefully planned and coordinated these return trips so that their children could find their Korean roots by being immersed in the culture and build close intergenerational relationships. The mothers also perceived the trip as an opportunity to see their relatives face-to-face and spend quality time with their aging parents. Similar to other transnational activities, the meanings of return trip to home country might reflect social and cultural climates of Korea and the United States.
Understanding English Language Teachers’ (De)motivation Toward Continuing Professional Development Through Psychological Contract and Work Attitude
Authors: Ezel Acar Sonay , Erozan Fatoş
Published: April 2024

Motivation as the driving force for achieving success, pursuing goals and fulfilling objectives, is shaped and affected by intrinsic and extrinsic factors, psychological contract and work attitude. Like other professionals, English language teachers also need to be motivated for continuous professional improvement in order to achieve organizational goals and ultimately reach high educational quality. Thus, it is of high importance to investigate teachers’ (de)motivation toward CPD. This paper focuses on the (de)motivational reasons as to why English language teachers at a university do not take part in professional development despite their awareness of its significance for their career, institution’s development and their students’ learning. The data from EFL teachers were collected through an online questionnaire consisting of three open-ended questions. The majority of the teachers were found to feel that the continuing professional development events were organized without considering their current workload, needs and contextual factors. It was also found out that the general organizational atmosphere and work attitudes of their colleagues led to decreased motivation and psychological contract. These results offer certain implications for the administrators of educational institutions regarding the importance of considering motivational factors, psychological contract and work attitude in planning continuing professional development for English language teachers.
Utility of Adult-Based Discoid Lateral Meniscus Diagnostic Criteria in a Pediatric Population
Authors: Beck Jennifer J. , Wahle Charlotte F. , Wood Anna , Bennett Abbie , Jackson Nicholas
Published: April 2024

Background:

Commonly cited discoid lateral meniscus (DLM) imaging definitions are based on adult magnetic resonance imaging (MRI) measurements. This pathology commonly presents in pediatric populations; however, whether accepted adult measurements reliably apply to children and adolescents is unknown.

Purpose/Hypothesis:

This purposes of the study were to determine (1) the utility of applying adult-accepted MRI definitions of DLM to pediatric patients, (2) whether sex differences affect the applicability of the criteria, and (3) whether MRI magnet strength and/or tear presence affect MRI measurements for diagnosing DLM in pediatric patients. It was hypothesized that MRI criteria for DLM would be similar in adults and pediatric patients.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 100 consecutive MRIs from pediatric patients with DLM were evaluated, with 91 scans included. Two study authors independently reviewed the MRIs, evaluating meniscal height and width on sagittal and coronal images, “bow tie signs” on sagittal images, tibial sagittal and coronal width, and tear presence. For analysis, MRI magnet strength was dichotomized into high (>1.5 T) and low (<1.5 T) groups.

Results:

The mean age of the patients at MRI evaluation was 12.3 ± 3.4 years; 51% of the patients were male, and 56% of the scans were of left knees. Included patients with DLM showed a mean of 3.68 bow tie signs, a sagittal total anterior to posterior meniscal width/tibial width ratio of 73%, a coronal meniscal width/tibial width ratio of 30%, and a coronal, transverse width of the lateral meniscus at the midportion of the meniscal body of 20.6 ± 7.7 mm. The MRI tesla strength of the images included in this study ranged from 0.3 to 3. It was determined that high- versus low-resolution MRI scans did not affect the inter- or intraobserver reliability of the MRI measurments ( P > .05). However, several measurements showed improved intraclass correlation coefficients with increased tesla strength.

Conclusion:

This study confirms that pediatric patients with DLM, diagnosed by board-certified pediatric sports medicine orthopaedic surgeons, have measurements on MRI consistent with adult DLM diagnostic criteria. This finding held true regardless of sex or MRI tesla strength. Pediatric patients with DLM had >3 bow tie signs, >70% sagittal tibial plateau coverage, >14 mm coronal width, and >20% coronal tibial plateau coverage on MRI.
In Search of a Middle East and North Africa Peace System
Authors: Ahram Ariel I.
Published: April 2024

This article examines the strengths and weaknesses of the peace system in the Middle East and North Africa (MENA). It views peace not merely as the absence of direct violence but as the result of institutions and systems that mitigate, defuse, and diminish conflict. The peace system of MENA operates at multiple scales and deals with multiple kinds of violent conflict. Different system components produce different forms of positive and negative peace through both formal and informal institutional channels. Consequently, peace in MENA is often uneven and unstable, with progress in one dimension coming at the expense of another. Understanding the gaps and inconsistencies within the MENA peace system can help devise a more realistic and feasible approach to conflict resolution rather than abstract and ultimately impractical ideals. The article identifies shortcomings in the current explanations for the frequency of war, explores the idea of a regional peace system that operates in regional and domestic arenas both formally and informally, and examines policy measures that might bolster or undercut the MENA peace system.
Development of a Patient-Reported Experience Measure Tool for Ambulatory Patients With Acute Unexpected Needs: The APEX Questionnaire
Authors: Nadeau Myriam , Chabot Dominique , Breton Mylaine , Guertin Jason R. , Harvey Labbé Laurie , Roberge Danièle , Lefebvre Gabrielle , Mallet Myriam , Beaulieu Sandrine , Kavanagh Éric , Cloutier Nathalie , Garant Philippe , Bélanger Lynda , Vaillancourt Samuel , Boumenna Tarek , Bareil Kathryn , Savard Joanie , Simonyan David , Ulrich Singbo Mahukpe Narcisse , Berthelot Simon
Published: April 2024

Background: The aim of this study was to develop a patient-reported experience measure (PREM) for comparing the experience of care received by ambulatory patients with acute unexpected needs presenting in emergency departments (EDs), walk-in clinics, and primary care practices. Methods: The Ambulatory Patient EXperience (APEX) questionnaire was developed using a 5-phase mixed-methods approach. The questionnaire was pretested by asking potential users to rate its clarity, usefulness, redundancy, content and face validities, and discrimination on a 9-point scale (1 = strongly disagree to 9 = strongly agree). The pre-final version was then tested in a pilot study. Results: The final questionnaire is composed of 61 questions divided into 7 sections. In the pretest (n = 25), median responses were 8 and above for all dimensions assessed. In the pilot study, 63 participants were enrolled. Adjusted results show that access, cleanliness, and feeling treated with respect and dignity by nurses and physicians were significantly better in the clinics than in the ED. Conclusion: We developed a questionnaire to assess and compare experience of ambulatory care in different clinical settings.
The Patient's Perspective on the Functioning of the Primary Healthcare Centres in Bangalore, India: An Illustrated Guide
Authors: Bangalore Sathyananda R , Krumeich A , Manjunath U , de Rijk A , van Schayck CP
Published: April 2024

India's healthcare system is, for a large part, organized around a vast network of Primary Healthcare Centres (PHCs) that form the pillar on which the public healthcare sector functions. The World Health Organization (WHO) has emphasized the important role that PHCs play in strengthening community health and the provision of healthcare. Although a few studies have assessed specific elements of services offered by PHCs, only a few have studied the patients’ perspectives on the functioning and performance of PHCs in the Indian context. A qualitative research methodology was employed to explore the opinions of 188 patients attending one of three PHCs in Bengaluru (India), using in-depth interviews and thematic analysis. Results showed that patients assessed PHC based on the nine themes that broadly can be classified into components of the center, and that of the personnel. The patients valued the behavioural aspects of the personnel during service delivery and should be configured into the PHC performance.
Urban-rural inequalities in IV thrombolysis for acute ischemic stroke: A nationwide study
Authors: Buus Sine Mette Øgendahl , Behrndtz Anne Brink , Schmitz Marie Louise , Hedegaard Jakob Nebeling , Cordsen Pia , Johnsen Søren Paaske , Phan Thanh , Andersen Grethe , Simonsen Claus Ziegler
Published: April 2024

Introduction:

Rural residency has been associated with lower reperfusion treatment rates for acute ischemic stroke in many countries. We aimed to explore urban-rural differences in IV thrombolysis rates in a small country with universal health care, and short transport times to stroke units.

Patients and methods:

In this nationwide cohort study, adult ischemic stroke patients registered in the Danish Stroke Registry (DSR) between 2015 and 2020 were included. The exposure was defined by residence rurality. Data from the DSR, Statistics Denmark, and the Danish Health Data Authority, were linked on the individual level using the Civil Registration Number. Adjusted treatment rates were calculated by balancing baseline characteristics using inverse probability of treatment weights.

Results:

Among the included 56,175 patients, prehospital delays were shortest for patients residing in capital municipalities (median 4.7 h), and longest for large town residents (median 7.1 h). Large town residents were predominantly admitted directly to a comprehensive stroke center (98.5%), whereas 30.9% of capital residents were admitted to a hospital with no reperfusion therapy available (non-RT unit). Treatment rates were similar among all non-rural residents (18.5%–18.7%), but slightly lower among rural residents (17.2% [95% CI 16.5–17.8]). After adjusting for age, sex, immigrant status, and educational attainment, rural residents reached treatment rates comparable to capital and large town residents at 18.5% (95% CI 17.7–19.4).

Discussion and conclusion:

While treatment rates varied minimally by urban-rural residency, substantial differences in median prehospital delay and admission to non-RT units underscored marked urban-rural differences in potential obstacles to reperfusion therapies.
Plasma fibrinogen and risk of vascular recurrence after ischaemic stroke: An individual participant and summary-level data meta-analysis of 11 prospective studies
Authors: McCabe John J , Walsh Cathal , Gorey Sarah , Harris Katie , Hervella Pablo , Iglesias-Rey Ramon , Jern Christina , Li Linxin , Miyamoto Nobukazu , Montaner Joan , Pedersen Annie , Purroy Francisco , Rothwell Peter M , Sudlow Catherine , Ueno Yuji , Vicente-Pascual Mikel , Whiteley William , Woodward Mark , Kelly Peter J
Published: April 2024

Introduction:

Inflammation is an emerging target for secondary prevention after stroke and randomised trials of anti-inflammatory therapies are ongoing. Fibrinogen, a putative pro-inflammatory marker, is associated with first stroke, but its association with major adverse cardiovascular events (MACE) after stroke is unclear.

Materials and Methods:

We did a systematic review investigating the association between fibrinogen and post-stroke vascular recurrence. Authors were invited to provide individual-participant data (IPD) and where available we did within-study multivariable analyses with adjustment for cardiovascular risk factors and medications. Adjusted summary-level data was extracted from published reports from studies that did not provide IPD. We pooled risk ratios (RR) by random-effects meta-analysis by comparing supra-median with sub-median fibrinogen levels and performed pre-specified subgroup analysis according to timing of phlebotomy after the index event.

Results:

Eleven studies were included (14,002 patients, 42,800 follow-up years), of which seven provided IPD. Fibrinogen was associated with recurrent MACE on unadjusted (RR 1.35, 95% CI 1.17–1.57, supra-median vs sub-median) and adjusted models (RR 1.21, 95% CI 1.06–1.38). Fibrinogen was associated with recurrent stroke on univariate analysis (RR 1.19, 95% CI 1.03–1.39), but not after adjustment (RR 1.11, 95% CI 0.94–1.31). The association with recurrent MACE was consistently observed in patients with post-acute (⩾14 days) fibrinogen measures (RR 1.29, 95% CI 1.16–1.45), but not in those with early phlebotomy (<14 days) (RR 0.98, 95% CI 0.82–1.18) ( Pinteraction = 0.01). Similar associations were observed for recurrent stroke.

Discussion and Conclusion:

Fibrinogen was independently associated with recurrence after stroke, but the association was modified by timing of phlebotomy. Fibrinogen measurements might be useful to identify patients who are more likely to derive benefit from anti-inflammatory therapies after stroke.
Offenders’ perspectives on acquisitive crime targets and stolen goods disposal methods
Authors: Clare Joseph , Quinn Liam , Gately Natalie , Rock Suzanne
Published: April 2024

This paper examines offenders’ perspectives about acquisitive crime targets and stolen goods markets in Australia that have not been comprehensively reviewed since 2005. Over the last 18 years there have been significant changes in the rates of property crime, reductions in cash usage, and rapid movements to online markets as a disposal outlet, that motivate this updated analysis. In late 2022, n = 107 detainees in a Western Australian police watchhouse were interviewed about their property offending frequency, offence preferences, target selection, disposal methods, and estimated financial return for targeted goods. Results demonstrated (a) meaningful shifts towards shoplifting and away from the other stealing offences, (b) increases in stealing for personal consumption rather than selling on, (c) declines in preferences for small electronic items, (d) ongoing dependence on drug dealers as a preferred outlet for off-loading stolen goods, (e) disposal of stolen goods is still quick, easy, and typically offenders receive about one-third of the original purchase price for items, and (f) growth in the use of online markets to dispose of stolen goods. The theoretical and applied implications of these findings are discussed, emphasising the importance of opportunity-focused interventions to prevent crime.
Responsiveness in context: Unpacking the causal model of the wisdom-responsiveness link
Authors: Kachhiyapatel Niyati , Grossmann Igor
Published: April 2024

By exploring the nuances of responsive phenomenology, Streib extends the science of wisdom beyond person-centric phenomena to include the social, interpersonal, and intersubjective dimensions. We applaud Streib’s efforts to enrich wisdom models and highlight several areas requiring further clarity, particularly regarding the causal relationship between responsive phenomenology and wisdom, and the role of broader cultural-historical factors for understanding the wisdom of responsiveness. Our commentary highlights the need for greater conceptual precision to differentiate responsiveness from related constructs in social psychology and calls for future research to delineate when responsiveness contributes to wisdom in varied contexts. Through this critical examination, we aim to advance the science of wisdom by emphasizing the significance of responsiveness within a comprehensive social-ecological framework, thereby fostering a deeper understanding of interpersonal and intergroup relations.
Longitudinal Assessment of Emergency Responders’ Attitudes Toward People Who Overdose and Naloxone Following an Overdose Education Training
Authors: Phillips Sarah , Budesa Zach , Smith Ryan , Wood Claire , Winograd Rachel
Published: April 2024

Background:

In addition to teaching overdose recognition and response, overdose education and naloxone distribution (OEND) trainings for emergency responders aim to improve trainee attitudes toward people who use drugs and toward naloxone. This study examines the training effectiveness long term, as well as the extent to which improvements are dependent on profession type or recent experience administering naloxone.

Methods:

A total of 774 emergency responders, consisting of law enforcement officers (LEOs) (n = 624, 81%) and emergency medical service (EMS) personnel (n = 150, 19%), attended OEND trainings and completed surveys immediately prior to (“pre”) and following (“post”) the training, as well as 6 months later (“follow-up”). Survey items assessed attitudes toward people who have overdosed, naloxone-related risk compensation (ie, “enabling”) beliefs, and whether participants had administered naloxone since attending the training. Multiple regression and estimated marginal means were used to evaluate changes in scores.

Results:

Emergency responders showed improved attitudes (pre = 2.60, follow-up = 2.45, P < .001) and risk compensation beliefs (pre = 2.97, follow-up = 2.67, P < .001) 6 months following the training. Follow-up scores differed by profession, with LEOs endorsing worse attitudes (difference = 0.55, P = .013) and more risk compensation beliefs (difference = 0.67, P = .014) than EMS. In addition, having recently administered naloxone predicted more negative attitudes (EMS: difference = 0.55, P = .01; LEO: difference = 0.54, P = .004) and risk compensation beliefs (EMS = 0.73, P = .006; LEO = 0.69, P = .002) at follow-up.

Conclusion:

Six months after an OEND training, emergency responders’ attitudes toward people who overdose, and their risk compensation beliefs remained improved. However, LEOs had more negative follow-up attitudes and beliefs compared to EMS. Emergency responders who had administered naloxone had worse attitudes and beliefs at follow-up than those who had not. Of note, our sample evidenced sizable attrition between pre and follow-up assessments, leaving room for selection bias. Future studies should investigate how to mitigate negative effects of administering naloxone on attitudes toward those who overdose, and belief that naloxone is “enabling.”
What clinicians should know about surrogate end points in hematologic malignancies
Authors: Bommier Côme , Maurer Matthew John , Lambert Jerome
Published: April 2024

Use of surrogates as primary end points is commonplace in hematology/oncology clinical trials. As opposed to prognostic markers, surrogates are end points that can be measured early and yet can still capture the full effect of treatment, because it would be captured by the true outcome (eg, overall survival). We discuss the level of evidence of the most commonly used end points in hematology and share recommendations on how to apply and evaluate surrogate end points in research and clinical practice. Based on the statistical literature, this clinician-friendly review intends to build a bridge between clinicians and surrogacy specialists.
Dual role of signaling pathways in myeloma requires cell type–specific targeting of ligand-receptor interactions
Authors: Hernandez-Lopez Pablo , Vijaykumar Tushara , Anand Praveen , Auclair Daniel , Frede Julia , Knoechel Birgit , Lohr Jens G.
Published: April 2024

Although most patients with multiple myeloma respond to treatment initially, therapy resistance develops almost invariably, and only a subset of patients show durable responses to immunomodulatory therapies. Although the immune microenvironment has been extensively studied in patients with myeloma, its composition is currently not used as prognostic markers in clinical routine. We hypothesized that the outcome of immune signaling pathway engagement can be highly variable, depending on which 2 cellular populations participate in this interaction. This would have important prognostic and therapeutic implications, suggesting that it is crucial for immune pathways to be targeted in a specific cellular context. To test this hypothesis, we investigated a cohort of 25 patients with newly diagnosed multiple myeloma. We examined the complex regulatory networks within the immune compartment and their impact on disease progression. Analysis of immune cell composition and expression profiles revealed significant differences in the B-cell compartment associated with treatment response. Transcriptional states in patients with short time to progression demonstrated an enrichment of pathways promoting B-cell differentiation and inflammatory responses, which may indicate immune dysfunction. Importantly, the analysis of molecular interactions within the immune microenvironment highlights the dual role of signaling pathways, which can either be associated with good or poor prognosis depending on the cell types involved. Our findings therefore argue that therapeutic strategies targeting ligand-receptor interactions should take into consideration the composition of the microenvironment and the specific cell types involved in molecular interactions.
Organ involvement in adults with BPDCN is associated with sun exposure history, TET2 and RAS mutations, and survival
Authors: Shimony Shai , Keating Julia , Fay Christopher J. , Luskin Marlise R. , Neuberg Donna S. , LeBoeuf Nicole R. , Lane Andrew A.
Published: April 2024

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) can involve skin, bone marrow (BM), central nervous system (CNS), and non-CNS extramedullary sites. Preclinical models demonstrated clonal advantage of TET2-mutated plasmacytoid dendritic cells exposed to UV radiation. However, whether sun exposure, disease characteristics, and patient survival are clinically related is unclear. We classified organ involvement in 66 patients at diagnosis as skin only (n = 19), systemic plus skin (n = 33), or systemic only (n = 14). BM involvement was absent, microscopic (<5%), or overt (≥5%). UV exposure was based on clinical and demographic data. Patients with skin only BPDCN were more frequently aged ≥75 years (47% vs 19%; P = .032) and had lower rates of complex karyotype (0 vs 32%, P = .022) and mutated NRAS (0 vs 29%, P = .044). Conversely, those without skin involvement had lower UV exposure (23% vs 59%, P = .03) and fewer TET2 mutations (33% vs 72%, P = .051). The median overall survival (OS) was 23.5, 20.4, and 17.5 months for skin only, systemic plus skin, and systemic only, respectively. Patients with no BM involvement had better OS vs overt involvement (median OS, 27.3 vs 15.0 months; P = .033) and comparable with microscopic involvement (27.3 vs 23.5 months; P = .6). Overt BM involvement remained significant for OS when adjusted for baseline characteristics and treatment received. In summary, BPDCN clinical characteristics are associated with disease genetics and survival, which together may impact prognosis and indicate informative disease subtypes for future research.