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A Clinical Tool to Identify Incidental Meningioma for Early Outpatient Management
Full text linkImportance Incidental meningiomas are common. There is a need for a validated clinical tool to stratify patients into early intervention, serial monitoring, or safe discharge from outpatient care. Objective To externally validate the Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and Magnetic Resonance Imaging Tests (IMPACT) tool. Design, Setting, and Participants This retrospective cohort study included 33 centers in 15 countries. Adult patients diagnosed with an incidental meningioma from January 2009 to December 2010 were included, up to the point of intervention, death, or last clinical encounter. Patients with radiation-induced meningioma and NF2-related schwannomatosis were excluded. Data collection was completed on December 31, 2023. Statistical analysis was conducted between March 2024 and December 2024. Main Outcomes and Measures The primary outcome of the study was a composite end point comprising growth, symptom development, meningioma-related mortality, and end points related to loss of window of curability. Secondary end points included the occurrence of an intervention and nonmeningioma-related mortality. Results Overall, 1248 patients were included. The median (IQR) age was 66 (55-77) years and 999 were female individuals (80%). There were 945 patients (75.7%) who had 1010 treatment-naive meningiomas. During follow-up (median [IQR], 61 [17-108] months), 114 tumors (11.3%) in 113 patients (12%) progressed, 132 tumors (13.1%) in 126 patients (13.3%) underwent an intervention, and 383 patients (40.5%) died without progression or intervention, from a nonmeningioma-related cause. The 5- and 10-year progression-free survival rates were 88.1% (95% CI, 85.8%-90.5%) and 85.7% (95% CI, 83.2%-88.2%), respectively. A low-risk meningioma had a disease progression risk of 3.9%, compared with 24.2% in medium-risk meningioma, and 51.6% in high-risk meningioma (χ2 test, P <.001). Measures of external validity were adequate (Brier score = 0.12; C-statistic = 0.80; 10-year area under the curve, 0.83) and the addition of other variables in a Cox regression analysis did not confound the statistical significance of the IMPACT tool. Patients with an age-adjusted Charlson Comorbidity Index score of 6 or higher (eg, a patient aged 80 years with type 2 diabetes and a previous myocardial infarction) and a performance status of 2 to 4 (unable to carry out any work activities or in a chair/bed for 50% or more of the day) were more likely to die of other causes than to receive intervention following diagnosis. Conclusions and Relevance This cohort study found that the IMPACT tool accurately predicted the risk of incidental meningioma progression and can be used to stratify patients into early intervention, serial monitoring, or safe discharge from outpatient care
Ytterbium Surprise – the meeting of a rare earth element with symmetry, group theory and culture
No full textThis article uses concepts of symmetry and group theory that are familiar to the inorganic chemist to explain some of the theory of the ancient (4 centuries old) practice of change ringing on church bells. The algorithms that are used by change ringers to enable them to ring all possible permutations on n bells are known as ‘methods’, and every element in the Periodic Table gives its name to at least one method. Of all these ‘elemental methods’, the most performed is Ytterbium Surprise Major – hence providing a link between rare earth chemistry and culture
Synergistic associations of metformin and GLP-1 receptor agonist use with adiposity-related cancer incidence in people living with type 2 diabetes
No full textBackground: Metformin and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may reduce the risk of adiposity-related cancers in patients with type 2 diabetes (T2D). The potential synergistic effects of these treatments on cancer incidence remain unclear, considering their distinct biological mechanisms and their associated effects on body weight. Methods: A retrospective cohort analysis was conducted using a large global database (TriNetX) of patients with T2D. Three cohorts: single agent use with metformin or GLP-1 RAs, and dual/combination metformin/GLP-1 RA use, were compared with a reference group treated with DPP4 inhibitors (DPP4i). Propensity score matching (1:1) was applied to control for confounders. Cancer incidence and all cause mortality were assessed over 5 years of follow up. Results: After matching, metformin and GLP-1 RA treatment were both associated with a lower risk of all adiposity-related cancers and all-cause mortality; the latter was associated with greater reductions in both. Cancer rates were (hazard ratio) 0.96 [95% CI 0.92, 0.99] and 0.86 [0.82, 0.89], while mortality rates were 0.78 [0.76, 0.80] and 0.61 [0.59, 0.63] for metformin and GLP-1 RA, respectively. Dual therapy showed the strongest association with lower cancer incidence (0.61 [0.57, 0.65]) and mortality (0.33 [0.32, 0.35]). Results were more significant in younger, male patients with obesity. Conclusion: In patients with T2D, dual metformin and GLP-1 RA treatment was associated with a 39% lower incidence of adiposity-related cancers and a 67% lower mortality, with a striking impact on cancer-related outcomes
World Postpartum Haemorrhage Day: Renewing the Global Call to End Deaths From Postpartum Haemorrhage
No full textA comprehensive review of modeling techniques for double-row tapered roller bearings
No full textDouble-Row Tapered Roller Bearings (DTRBs) possess notable advantages, including large load-carrying capacity, long service life, and the ability to withstand combined radial and axial loads, as well as bending moments. DTRBs are widely used in mechanical equipment and machinery, such as precision machine tools, automotive vehicles, railway vehicles, and wind turbines. The static and dynamic modeling of DTRBs plays a pivotal role in analyzing bearing tribological behavior and mechanical system performance, as well as in design and optimization. Over the past decades, extensive research has focused on DTRBs modeling and analysis to elucidate their tribological behavior and vibration mechanisms, thereby improving design and application. However, no comprehensive review has yet summarized the research progress on this topic. To fill this gap, this paper conducts a state-of-the-art review on DTRBs modeling and analysis, including the processes and differences in static modeling using traditional, multibody, and finite element methods, the techniques and implementation of dynamic modeling, and the current research progress in this field. This review also provides recommendations for future research, aiming to facilitate further development of DTRBs modeling and analysis
Highly variable light attenuation across a gneiss rock wall in eastern Greenland
No full textExposure ages and erosion rates determined using rock surface luminescence have the potential to revolutionalise Quaternary Science. However, accurately quantifying μ (the light attenuation coefficient) is a significant challenge. Our study shows how variable light attenuation properties (i.e. μ) can be for five samples taken from a small (423 m) elevation range of a near-vertical gneiss rock wall, which we would have expected to have had a shared μ value. The light attenuation properties varied on multiple scales: (i) between samples; (ii) between replicate cores; and (iii) between slices within a core. To avoid the between sample variability, we need to either measure μ directly from the rock cores used to derive the exposure age or erosion rate, or prove that these samples and the sample used to calibrate μ have identical light attenuation properties. To avoid variability between replicate cores observed in samples, it may be more accurate to derive exposure ages or erosion rates using a single core with identical light attenuation properties to the sample used to calibrate μ. Finally, where possible, we should avoid rocks that have hetergeneous mixes of minerals with different opacities (lighter and darker). However, if it is not possible, we should routinely measure red-green-blue (RGB) values to link the presence of any low datapoints in the luminescence depth profiles to overlying lighter-coloured minerals that could have caused light ‘piping’. Our findings further emphasise the detailed consideration required for deriving μ to determine accurate exposure ages and erosion rates
Fatigue in amyotrophic lateral sclerosis/motor neuron disease: prevalence, influences and trajectories
No full textObjective: In a large cohort of people with amyotrophic lateral sclerosis/motor neuron disease (pwALS), we examined the age-sex prevalence of fatigue, its relationship to other symptoms and functioning, and trajectories over time. Methods: Data from the Trajectories of Outcome in Neurological Conditions study were analyzed by Rasch analysis, structural equation and group-based trajectory models. Results: Fatigue was reported by 97.8% on Neurological Fatigue Index-MND (NFI-MND) and 96.4% on Numeric Rating Scale Fatigue among 1058 pwALS: mean age 65 (range 20–90); mean duration 23 months (range 0–301); 60.7% male; onset 26.5% Bulbar, 71.5% Limb and 2.0% Respiratory. Mean (metric) level on NFI-MND was 12.8 (SD 5.3; range 0–24). Cut-points on the NFI-MND of 10 and 15 divided fatigue into mild (27.3%); moderate (36.1%) and severe (36.2%). Structural equation modeling showed that function, cognition, spasticity, dyspnea and pain have descending order of effect. Over average 11.6 months follow-up, 60.5% had stable fatigue, 23.8% increased fatigue level, while 15.8% showed declining fatigue. Trajectory analysis showed three groups, low, average and high fatigue. Those with low trajectories had less spasticity, worry, cognitive problems, as well as better functioning, longer duration and were less likely to be male. High fatigue trajectory was associated with worse spasticity, cognition and anxiety. Conclusions: Fatigue is extremely common among pwALS, thus more work is required on fatigue management. In addition to treating fatigue itself, the current study shows that targeting cognition, spasticity, dyspnea and pain might be fruitful
Combating Burnout Amongst Residents Through Fostering Resilience: A Systematic Review
No full textBackground: Burnout, marked by emotional exhaustion, depersonalization and depletion of professional efficacy, is rampant among residents. With deleterious effects on productivity, conduct and patient care, resident programs have increasingly emphasized resilience training to combat burnout. However, the personalized nature of burnout complicates the effective design of such programs. Premised on recent works that identify burnout as a result of shifting personhood, this study utilizes the Ring Theory of Personhood to guide the conceptualization of resilience training programs that address changes in the belief systems shaping one’s self-concept. Methods: A systematic scoping review to explore how resilience is addressed and assessed amongst medical residents was conducted. Guided by the PRISMA-compliant Systematic Evidence-Based Approach (SEBA), searches for relevant articles published between 1st January 2000 and 4th November 2024 on PubMed, Embase, Scopus, ERIC and PsycINFO were performed. The SEBA methodology facilitated the integration of the themes and categories identified using thematic and content analyses. Results: Of 15 953 abstracts screened, 666 articles were reviewed and 69 full-text articles were included. Three domains were identified: guiding theories; methods of teaching resilience; and assessment. Conclusion: The reliance on individual or societal theories has constrained the understanding, design and assessment of resilience programs. Current approaches, including mindfulness workshops, self-care initiatives and organization-led resilience training, are neither timely nor focused on the needs of each resident. To mitigate burnout, personalized, longitudinal and timely support is essential. Mentoring offers a more suitable alternative, providing culturally sensitive, resource-appropriate, sustainable and clinically relevant support to build resilience effectively
After-Sales Services Coordination Contracts in Platforms With Integration Mode Operations
Full text linkIn service operations, there is an emerging integration mode between platforms, such as Gaode-Maps DiDi-Chuxing. In this mode of operation, consumers order on an integrated platform (such as Gaode-Maps), but accept services from a professional platform (such as DiDi-Chuxing) or an offline integrator (such as a taxi company). This multiagent characteristic complicates the after-sales services of the respective integration modes. This study first established three game models in different scenarios and found that depending on the reputation effect and after-sales service cost, it could be optimal for an integrated platform to avoid providing online after-sales services. However, the failure to obtain online after-sales services directly on an integrated platform led to consumer dissatisfaction. Therefore, the deployment of coordination contracts to resolve this problem was meaningful. Second, to realize the Pareto optimality of these platforms, the performance of after-sales services cost-sharing (ASCS) contracts was analyzed. We found that, although the ASCS contract incentivized the integrated platform to provide after-sales services, it stimulated the professional platform and offline integrator to increase prices, leading to a reduction in consumer surplus. Finally, to reduce the order error probability and improve the satisfaction of consumers, we designed an innovative “after-sales services cost-sharing plus consumer subsidy” (A-CS) contract. We proved that the A-CS contract achieved an all-win situation for both platform members and consumers
Called Upon or Stumbled Upon? A Careers Perspective on Equity, Diversity, and Inclusion Work in UK Higher Education
Full text linkSocial scientists are showing increasing interest in workers engaged in social change work and related organizational roles. While the sociological literature on occupational activism as well as scholarship on organizational change agents have provided insights into this work, the career pathways employes take to these roles are rarely the explicit focus of this research, prompting the following research question: how do workers enter socially conscious jobs, and with what consequences? I address this question by drawing on qualitative interviews of professionals working in equity, diversity, and inclusion (EDI) roles across universities in the United Kingdom. My analysis finds three divergent pathways to EDI roles: the activist, the administrative, and the hybrid pathway. These different occupational pathways are further related to varied occupational rhetorics, workplace challenges, and career outlooks. My research contributes to scholarship on occupational activism, the literature on social change within organizations, and the sociology of EDI
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