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A User-Driven Framework for Dose Selection in Pregnancy:Proof of Concept for Sertraline
No full textDespite growing knowledge of pregnancy-induced changes in physiology that may alter maternal and fetal pharmacokinetics, evidence-based antenatal doses are lacking for most drugs. Pharmacokinetic modeling and expanding clinical data in pregnancy may support antenatal doses. We aimed to develop and pilot a comprehensive and user-driven Framework for Dose Selection in Pregnancy to support the clinical implementation of a best-evidence antenatal dose for sertraline. After initial development and evaluation by experts, the framework prototype was piloted to formulate an antenatal dosing strategy for sertraline in depression and anxiety disorders. Next, the framework was reviewed and assessed for usability by a multidisciplinary working committee of end-users comprising healthcare practitioners, experts from other disciplines including pharmacometrics, reproductive toxicology and medical ethics, alongside pregnant women and a partner. The resulting framework encompasses the following: rationale for drug selection, a comprehensive analysis of pharmacokinetic and dose-related efficacy and safety data, and implementation aspects including feasibility and desirability of the recommended antenatal dose based on a structured maternal and fetal benefit-risk assessment. An antenatal dose recommendation for sertraline, as a case study, was formulated using this approach and endorsed for clinical use by the working committee. Future applications of the framework for other drugs can further demonstrate its suitability for developing best evidence, acceptable and clinically feasible antenatal doses
Examining the Effect of Research Engagement on the Interest in Integrating Research into Future Career Paths Among Medical Graduates in China:An Instrumental Variable Analysis
No full textBackground: While the importance of physician research has been underscored, a shortage of qualified physicians engaged in research persists. Early exposure to research could potentially ignite medical students’ interest in research, thereby motivating them to pursue research-related careers. Objective: The study aims to examine early research engagement and medical graduates’ interest in incorporating research into their future career paths. Methods: This was a national cross-sectional survey administered in 2020, with 152,624 medical students from 119 medical schools in China completing it. We selected and resampled the graduates’ data, and the final sample included 17,451 respondents graduating from 101 medical schools. Results: For graduates engaged in research, 63.4% (3054) had the interest in integrating research into their future careers. Such interest in research did differ between medical graduates with and without research engagement by linear probability regression (β, 0.50; 95%CI, 0.48 to 0.52), but did not differ in instrumental variable regression analysis (β, 0.31; 95%CI, − 0.18 to 0.80). Furthermore, engaging in research significantly increased the top 50% of academically ranked graduates’ research interest in instrumental variable regression analysis (β, 0.44; 95%CI, 0.01 to 0.86). Conclusions: Contrary to expectations, research engagement does not necessarily enhance medical graduates’ interest in integrating research into their future careers. However, graduates with strong academic performance are more inclined to develop this research interest. In light of these findings, we propose recommendations for nurturing research interest within medical education.</p
User Experience of a (Semi-) Automated Cognitive Phone-Based Assessment Within a Memory Clinic Population
No full textObjective We examined the user experience in different modalities (face-to-face, semi-automated phone-based, and fully automated phone-based) of cognitive testing in people with subjective cognitive decline and mild cognitive impairment.Method A total of 67 participants from the memory clinic of the Maastricht University Medical Center+ participated in the study. The study consisted of cognitive tests in different modalities, namely, face-to-face, semi-automated phone-based guided by a researcher, and fully automated phone-based without the involvement of a researcher. After each assessment, a user experience questionnaire was administered, including questions about, for example, satisfaction, simplicity, and missing personal contact, on a seven-point Likert scale. Non-parametric tests were used to compare user experiences across different modalities.Results In all modalities, user experiences were rated above average. The face-to-face ratings were comparable to the ratings of the semi-automated phone-based assessment, except for the satisfaction and recommendation items, which were rated higher for the face-to-face assessment. The face-to-face assessment was preferred above the fully automated phone-based assessment on all items. In general, the semi- and fully automated phone-based assessments were comparable (simplicity, conceivability, quality of sound, visiting the hospital, and missing personal contact), while on all the other items, the semi-automated phone-based assessment was preferred.Conclusions User experience was rated high within all modalities. Simplicity, conceivability, comfortability, and participation scores were comparable in the semi-automated phone-based and face-to-face assessment. Based on these findings and earlier research on validation of the semi-automated phone-based assessment, the semi-automated assessment could be useful for screening for clinical trials, and after more research, in clinical practice
The Party’s Court or the Court for the Parties: An Empirical Assessment of the Fifth Judicial Reform in China
No full textThis article empirically assesses the effectiveness of China’s Fifth Judicial Reform, which was implemented from 2019 to 2023. The Reform endeavored to balance upholding the absolute leadership of the Party and ensuring the independent exercise of judicial power by the courts, as well as to realize the people’s expectations for fairness and justice. To date, empirical research on China’s Fifth Judicial Reform has been relatively limited. This article examines in detail the practical effects of the Reform through the perspective of frontline judges. The findings suggest that the courts have made some progress toward realizing the aims of the Reform. The courts have reinforced the absolute leadership of the Party. Moreover, the Reform has provided litigants with more convenient litigation services and established a remuneration system closely linked to the performance of judges. Thirty-eight per cent of the judges considered the Judicial Reform to be very effective. However, the analysis also reveals some underlying problems with the Reform. Despite the Reform’s aims of strengthening judicial independence, the symbiosis between the Party and the judiciary has become more pronounced. Local government interference in the judiciary still exists. Judicial openness has regressed, with fewer judgments being published. Judges also face pressure from litigants for false accusations. The construction of smart courts remains inadequate in terms of technological updates, data security, and privacy protection. Chinese courts still need further reforms to strengthen the role of the court in the administration of justice
Efficacy of eHealth monitoring in pediatric asthma:Efficacy of eHealth monitoring in pediatric asthma
No full textClarifying and expanding equity in assessment by considering three orientations:Fairness, inclusion and justice
No full textContext:Despite increasing discussion and scholarship, equity in assessment is rarelydefined and distinguished in a way that allows for shared understanding in medicaleducation. This paper seeks to clarify and expand the conversation about equity inassessment by critically reviewing three distinct and evolving orientations towardequity in assessment. Orientations refers to the positions, attitudes, interests or pri-orities individuals can hold toward equity in assessment. The three orientationsinclude fairness-oriented assessment, assessment for inclusion and justice-orientedassessment. While fairness-oriented assessment is a prevailing orientation in medicaleducation, assessment for inclusion and justice-oriented assessment, originally devel-oped in other fields of education, deserve careful consideration. Methods:In this paper, the authors explore unique underpinning assumptions ofeach orientation by critically examining the foundational literature of each orienta-tion. They reflect on the unique perspectives each orientation provides, including theactions one might take and what advantages and disadvantages might result fromlooking at equity in assessment from any one orientation. Conclusions:Informed by this reflection, the authors propose that to more effec-tively advance equity in assessment in medical education, those working in the fieldshould clearly identify their respective orientations, intentionally choose methods,tools and measures aligned with their orientations and expand their work by explor-ing alternative orientations
The Future of Marketing and Marketing Education
No full textEmployers expect university graduates seeking entry-level marketing jobs to be well-versed in contemporary topics, such as sustainable development, digital marketing, big data, analytics, and the role of artificial intelligence (AI) in both traditional and contemporary marketing domains. Because many of today's cutting-edge technological advances are deeply relevant to marketing, marketing educators must reconsider how they prepare marketing students to enter the technology-enabled world and workforce. The authors propose that marketing educators adapt their teaching of foundational marketing concepts to reflect the technology-augmented marketing era. Such reconsiderations span multiple arenas, including how classes are conducted, which topics are covered, how assignments are crafted, and how technology-and AI and generative artificial intelligence (gen AI) in particular-will transform future marketing roles. The authors also suggest ways educators can modify and reimagine existing marketing courses to prepare students for a successful entry into technology-enabled marketing jobs, as exemplified with some sample class assignments
The role of tissue oxygenation in obesity-related cardiometabolic complications
No full textObesity is a complex, multifactorial, chronic disease that acts as a gateway to a range of other diseases. Evidence from recent studies suggests that changes in oxygen availability in the microenvironment of metabolic organs may exert an important role in the development of obesity-related cardiometabolic complications. In this review, we will first discuss results from observational and controlled laboratory studies that examined the relationship between reduced oxygen availability and obesity-related metabolic derangements. Next, the effects of alterations in oxygen partial pressure (pO2) in the adipose tissue, skeletal muscle and the liver microenvironment on physiological processes in these key metabolic organs will be addressed, and how this might relate to cardiometabolic complications. Since many obesity-related chronic diseases, including type 2 diabetes mellitus, cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease and obstructive sleep apnea, are characterized by changes in pO2 in the tissue microenvironment, a better understanding of the metabolic impact of altered tissue oxygenation can provide valuable insights into the complex interplay between environmental and biological factors involved in the pathophysiology of metabolic impairments. This may ultimately contribute to the development of novel strategies to prevent and treat obesity-related cardiometabolic diseases
The EU's longer arm abroad:the role of EU Delegations in crisis management
No full textSince the establishment of the EEAS as the EU's diplomatic service and the transformation of the EU's representation abroad into EU Delegations, the EU has been a pioneer in multilateral diplomacy and contributed to development in its wider neighbourhood. These bodies made a significant contribution to widening the EU's diplomatic network and strengthening its position in foreign policy and external relations. However, EU Delegations play a minimal role in the EU's crisis management efforts despite their presence on the ground and their useful recourses, which could, in fact, provide crucial assets to EU-led missions. While the EU has shown successes in diplomacy, its Delegations face the problems of multiple principals and non-exclusive delegation which risk undermining the EU's overall capacities as a global actor. This article applies the PA model to illustrate these dual problems in the cases of the CSDP missions conducted in Mali and Ukraine
Large language models to facilitate pregnancy prediction after in vitro fertilization
No full textWe evaluated the efficacy of large language models (LLMs), specifically, generative pre-trained transformer-4 (GPT-4), in predicting pregnancy following in vitro fertilization (IVF) treatment and compared its accuracy with results from an original published study. Our findings revealed that GPT-4 can autonomously develop and refine advanced machine learning models for pregnancy prediction with minimal human intervention. The prediction accuracy was 0.79, and the area under the receiver operating characteristic curve (AUROC) was 0.89, exceeding or being at least equivalent to the metrics reported in the original study, that is, 0.78 for accuracy and 0.87 for AUROC. The results suggest that LLMs can facilitate data processing, optimize machine learning models in predicting IVF success rates, and provide data interpretation methods. This capacity can help bridge the knowledge gap between data scientists and medical personnel to solve the most pressing clinical challenges. However, more experiments on diverse and larger datasets are needed to validate and promote broader applications of LLMs in assisted reproduction.</p