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In this reflective article, I focus on the meanings and implications of conducting feminist ethnographic research during the COVID-19 pandemic with women participants of an educational project supported by the non-governmental sector in India. This research aimed to provide the space for women to organically present and provide insight into the multiplicity of factors that influence their decision-making authority and ability, illuminating the connections between education, agency, and empowerment during the COVID-19 pandemic. I discuss the nuances as well as on-the-ground limitations of developing collaborative and relational research in contexts with significant material and structural constraints. In this article, I seek to underscore the need to examine closely what collective belonging, duty, and responsibility looks like for researchers in the development and implementation of transnational feminist projects during crisis. [ABSTRACT FROM AUTHOR]

Melanoma's rare capacity to undergo heterologous differentiation can create significant diagnostic challenges. The molecular mechanisms underlying this phenomenon are not well understood. We present an unusual case of subungual melanoma exhibiting extensive cartilaginous differentiation and provide insights into its molecular and cytogenomic features. Histopathologically, the tumor was predominantly composed of nodules of malignant cartilage in association with a smaller population of nested epithelioid to rhabdoid cells. Immunohistochemically, the tumor cells in both components were positive for S100, SOX10, and PRAME, and were negative for Melan‐A and HMB‐45. Molecular analysis by whole exome DNA sequence did not detect any pathogenic variants in genes commonly implicated in melanoma. Additional analysis by SNP chromosomal microarray revealed a complex genome characterized by numerous chromosomal losses and gains, including a homozygous deletion of the CDKN2A locus and a heterozygous deletion of the locus containing EXT2, a tumor suppressor implicated in hereditary multiple osteochondromas and secondary chondrosarcomas. This case underscores the importance of recognizing cartilaginous differentiation as a rare manifestation of melanoma, particularly at subungual sites, and suggests that at least some of these melanomas may be driven by non‐canonical molecular pathways. [ABSTRACT FROM AUTHOR]

Abstract\nPoints of interestSelf-determination, or the freedom to act as the primary causal agent in one’s life, is a well-documented component of enhanced quality of life. Yet young adults with disabilities are often less self-determined than their nondisabled peers. Furthermore, there is an absence of the voices of young adults with disabilities in the literature related to self-determination. While research investigating populations positioned as marginalized has historically been defined by a marked power differential, separating the researcher from the participant, this study utilizes photovoice, a participatory method, to understand how U.S. college students with intellectual disabilities understand self-determination. We seek to trouble the dominant narrative that marginalizes students with intellectual disabilities and instead positions these emerging adults as experts in their own lives. From this study we illuminate how self-determination is enhanced through equality of opportunity and how sense of belonging is related to self-determination.Because the voices of groups of people marginalized by society (such as young adults with disabilities) are often left out of the research related to their lives, it is important to use methods of research that attempt to change this fact; some of these methods can be called participatory research.For young adults with intellectual and developmental disability, the barriers to self-determination are many; this project’s main aim was to centre their voices and position them as active participants and experts in their own lives.One particular type of participatory research called photovoice is a partnership between researchers and participants, where participants take photos of specific parts of their lives and then explain them.Using a photovoice project we carried out within a course within an inclusive postsecondary education programme on a U.S. college campus, we aimed to better understand participants’ conceptualization of self-determination in their everyday lives. [ABSTRACT FROM AUTHOR]

Purpose: To assess and analyze the visual outcomes of patients with retinal vein occlusions in a real-world setting with a long-term follow-up of more than 5 years.Methods: Retrospective analysis of 56 patients having retinal vein occlusions from a tertiary eye center, with a mean follow-up of 7 years was performed. Primary outcome measures were mean change in best-corrected visual acuity (BCVA) from baseline at 6 months, 1 year, 2 years, 3 years, and final visit (≥5 years), proportion of patients having BCVA better than 20/40 and worse than 20/200, and mean number of injections. Secondary outcome measures were change in central macular thickness (CMT), development of subsequent retinal vein occlusion (RVO) in same eye or the other eye, and development of neovascular complications.Results: The mean change in letter score was + 11.84 in branch RVO (BRVO), +7.14 in non-ischemic central RVO (CRVO), and -9.5 in ischemic CRVO at 1 year, which changed to + 8.57, -5 and - 24, respectively, at the end of follow-up. CMT had improved from 506 ± 98.8 μm, 576.44 ± 149 μm, and 618 ± 178.27 μm, respectively, at baseline to 267 ± 94 μm, 345.20 ± 122.61 μm, and 265.50 ± 107.75 μm, respectively, in BRVO, non-ischemic, and ischemic hemi RVO (HRVO)/CRVO groups. The total mean number of injections given in BRVO, non-ischemic CRVO, and ischemic CRVO groups were 4.6, 6.6, and 4.1, respectively. None of the patients with BRVO developed neovascular glaucoma (NVG). Non-ischemic to ischemic HRVO/CRVO conversion was noted in 4/11 eyes at a mean duration of 12.6 months. NVG was noted in 7/9 eyes (77.8%) in initial ischemic CRVO/HRVO group and 3/4 (75%) converted eyes.Conclusion: Patients with BRVO have good visual outcomes with anti-VEGF, while in CRVO results may vary considerably owing to patient compliance and treatment burden on long-term follow-up in a real-world setting. [ABSTRACT FROM AUTHOR]

In April 2023, the World Health Organization (WHO) issued new estimates affirming that one in six individuals experience infertility globally. Yet, many states are unclear on their responsibility to prevent infertility, ensure access to treatment, and to end the harm suffered by individuals who are considered infertile. Responding to this uncertainty, in June 2023, the United Nations Office of the High Commissioner on Human Rights (OHCHR) issued a new research paper explaining states' legal obligations regarding infertility. Importantly, OHCHR underscores that states must take steps to prevent infertility by addressing its root causes and ensure access to treatment. Further, states must address the negative consequences of infertility, including stigma and violence, as well as the discriminatory stereotypes that lead to certain groups facing disproportionate harm from infertility. This article provides an overview of the OHCHR report and explains what this means for healthcare providers, who have a critical role to play in providing care and advocating for legal and policy reform necessary to prevent, diagnose, and treat infertility. Synopsis: This article provides an overview of OHCHR's new 2023 research paper on human rights obligations to address the preventable causes and consequences of infertility, and highlights healthcare providers' role in advancing human rights and preventing harm to patients through infertility prevention, diagnosis and treatment. [ABSTRACT FROM AUTHOR]

(E-H) Pancreatic sections were analysed for (E) -cell mass (F) apoptosis by double staining for TUNEL and insulin (10,000 -cells/mouse, n = 6 mice/group) and (G) islet vessel area quantified by CD31/ Insulin co-staining (100 islets/mouse, n = 6 mice/group). Graph: Fig 3 Ang-2 over-expression impairs islet function but protects from cytokine treatmentin isolated islets. The Fig 4D results are consistent when comparing results of the t-test to the Wilcoxon test, except for comparing Ang2-rtTA HFD to Ant2-rtTA ND for which the Wilcoxon test indicated nonsignificant differences (p = 0.20). [Extracted from the article]

Purpose: Coats' disease is associated with poor outcomes, and there are limited studies on long-term outcomes of Coats' disease. The purpose of our study is to identify various predictive factors to help in prognosticating the treatment outcomes in advanced Coats' disease in children.Methods: This is a retrospective case series from a single tertiary eye care center of children (<18 years) diagnosed with coat's disease. Sixty-seven patients with Coat's disease were identified from the medical records from 2009 to 2020. Patients' demographic data, clinical presentation, stage, extent of involvement, detailed treatment history, clinical sequelae post-treatment (including complications and anatomical and functional outcomes) were noted. Binary logistic regression was performed to correlate the predictive factors for anatomical and functional improvement.Results: Of the 67 patients, 51 eyes of 51 patients were included in the study. The male to female proportion was 2.2. Mean age at presentation was 4.98 ± 3.55 years (range: 2 months-15 years). Mean duration of follow-up was 31.53 ± 26.38 months. Overall, our globe salvage rate was 92.2%. We found that vitreoretinal fibrosis (P < 0.001), subretinal gliosis (P < 0.001), vitreous hemorrhage (P = 0.02), tractional or combined retinal detachment (P < 0.001), foveal scar (P < 0.006), and cataract (P < 0.001) to be important factors to affect the outcome.Conclusion: Advanced stage of presentation (stage 3B and above), diffuse involvement, cataract, vitreoretinal fibrosis (preretinal and subretinal), vitreous hemorrhage, tractional or combined retinal detachment, and anterior hyaloid proliferation are poor prognostic factors for globe salvage in advanced disease. Subretinal gliotic nodule or scar and lack of visual rehabilitation suggest poor functional outcomes. [ABSTRACT FROM AUTHOR]

Methotrexate is historically recognized as an effective treatment of pemphigus but its utility as a single or alternate steroid‐sparing agent was not recognized in recent consensus recommendations in pemphigus management. We aimed to evaluate the efficacy and safety of a treatment course for pemphigus that involves methotrexate as a single or steroid‐sparing agent. In a retrospective cohort study, we examined patients with pemphigus vulgaris or pemphigus foliaceus who were on ≥3 months of methotrexate therapy. Efficacy and safety were evaluated by established pemphigus disease endpoints. Of the 34 patients who met inclusion criteria, 25 (73.5%) were on glucocorticoids at time of methotrexate initiation (median follow‐up: 5.4 years; median time on methotrexate: 3.7 years). An appreciable proportion achieved disease control (91.2%), with some achieving clinical remission off all systemic therapies (23.5%). For patients on glucocorticoids, median time to control was 42 days, median time to minimal steroid dose tapering (5 mg prednisone) was 161 days, and median time to complete steroid tapering was 308 days. For patients on methotrexate as a single agent, median time to control was 119 days. Among all patients, relapse commonly occurred (88.2%). At last follow‐up, 26.5% were managed on topical therapies alone and 11.8% required systemic steroid therapy. Methotrexate was largely tolerated with a low incidence of adverse events leading to treatment discontinuation (2.9%). Methotrexate has the potential to be an effective and well‐tolerated option for patients and may be considered for use as an alternate single or steroid‐sparing agent for pemphigus. [ABSTRACT FROM AUTHOR]

This study situates transnégritude within discussions that consider the ways in which young people in Senegal, with a shared transcolonial narrative, bound through an 'imagined community,' negotiate their space, their identities, and their ways of knowing through a Hip-Hop pedagogy. Our analysis is informed by Mignolo's epistemic disobedience and the geo- and body-politics that challenge neo-colonial epistemologies. The global scope of Hip-Hop culture and its manifestations in West Africa nuances the ways in which young people view education and its impact on their social identity. A transnégritude perspective aptly 'straddles' black identity, agency, and deconstructionism and allows for a fluid navigation of Hip-Hop pedagogy. Through a Hip-Hop pedagogy, young people in Senegal work towards social transformation vis-a-vis informal education as a response to imperialism. In so doing, this study intends to contribute to qualitative inquiries on the connections between Hip-Hop, identity formation, and the 'fluidity and location of engagement' in Hip-Hop culture. The goal is to challenge the formal schooling context and interrogate youth identity and engagement vis-a-vis social transformation. [ABSTRACT FROM AUTHOR]

Of note, chlamydia and gonorrhea are now some of the most common STIs, even though dermatologists less frequently screen for these infections.[4] Of the 81 providers, 54% report always or sometimes taking a sexual history, while 46% rarely or never take a sexual history. Dear Editor, The field of dermatology has historical roots in the diagnosis and treatment of sexually transmitted infections (STIs). The results of dermatologist demographics, STIs observed in practice, and STI clinical practice patterns are shown in Tables 1 and 2. [Extracted from the article]

Few medical devices are designed and marketed specifically for children. Instead, adult devices are often repurposed and used off-label in pediatrics. The innovation gap between pediatric and adult devices is complex and multifactorial. This review aims to summarize the medical device landscape, describe barriers to pediatric device development, and provide an update on current strategies to help overcome these limitations. Medical devices are regulated by the Food and Drug Administration. They are registered, cleared, or approved on the basis of a 3-tier risk classification system and a differentiated set of regulatory pathways. This includes some for products that receive special designations on the basis of specific aspects that warrant more rapid review and approval. Pediatric devices number only one-quarter of those developed for adults for multiple reasons. Clinically, innovators must adjust their products to address the smaller sizes, growth, and longer duration of use in children. Smaller sample sizes and population heterogeneity also challenge the ability to obtain sufficient safety data for regulatory submissions. Financial concerns stem from lower pediatric reimbursement rates coupled with a lack of nationally standardized coverage. There are a number of promising initiatives, including the Pediatric Device Consortia Program, Early Feasibility Studies, and the new System of Hospitals for Innovation in Pediatrics -- Medical Devices. However, the gap will likely not be narrowed without broad cooperation across stakeholders from industry, academia, patient advocacy groups, health care providers, investors, payors, regulators, and Congress. [ABSTRACT FROM AUTHOR]

Purpose: A deep learning system (DLS) using artificial intelligence (AI) is emerging as a very promising technology in the future of healthcare diagnostics. While the concept of telehealth is emerging in every field of medicine, AI assistance in diagnosis can become a great tool for successful screening in telemedicine and teleophthalmology. The aim of our study was to assess the acceptability of AI-based retina screening.Methods: This was a prospective non-randomized study performed in the outpatient department of a tertiary eye care hospital. Patients older than 18 years who came for a regular eye check-up or a routine retina screening were recruited in the study. Fundus images of the posterior pole were captured on fundus on a phone camera (REMIDIOTM, India) with a built-in AI software (Netra.AI) that can identify normal versus abnormal retina. The patients were then given an 8-point questionnaire to assess their acceptance and willingness toward AI-based screening. We recruited 104 participants.Results: We found that 90.4% were willing for an AI-based fundus screening; 96.2% were satisfied with AI-based screening. Patients with diabetes (P = 0.03) and the male population (P = 0.029) were more satisfied with the AI-based screening. The majority (i.e., 97.1%) felt that AI-based screening gave them a better understanding of their eye condition and 37.5% felt that AI-based retina screening prior to a doctor's visit can help in routine screening.Conclusion: Considering the current COVID-19 pandemic situation across the globe, this study highlights the importance of AI-based telescreening and positive patient approach toward this technology. [ABSTRACT FROM AUTHOR]

We aim to describe ocular infection epidemiology for a public tertiary care hospital in New York City (NYC). We retrospectively reviewed 558 patients with ocular isolates from conjunctival, corneal, and intraocular culture from 2009 to 2017 for microbial growth and antimicrobial sensitivities. In total, 185 ocular cultures (33%) had growth and the most commonly isolated microbes overall were Staphylococcus aureus (S. aureus) (23%), coagulase-negative Staphylococcus (CoNS) (23%), Pseudomonas aeruginosa (P. aeruginosa) (16%), and Streptococcus viridans (S. viridans) group (11%). The most common microbes within corneal (n = 61), conjunctival (n = 34), and intraocular isolates (n = 9) were P. aeruginosa (37.7%), S. aureus (35.3%), and S. viridans group (33.3%), respectively. Proportion of isolates exhibiting multi-drug resistance decreased over time (P =.006). The microbial epidemiology of ocular infection of a public NYC hospital was distinct from other geographic locations, underscoring the importance of examining local profiles to more precisely inform empiric therapy. [ABSTRACT FROM AUTHOR]

Platinum-resistant, high-grade serous ovarian cancer (HGSOC) has limited treatment options. Preclinical data suggest that poly(ADP-ribose) polymerase inhibitors (PARPi) and ataxia telangiectasia and Rad3-related kinase inhibitors (ATRi) are synergistic. CAPRI (NCT03462342) is an investigator-initiated study of olaparib plus ceralasertib in recurrent HGSOC. Herein, we present results from the platinum-resistant cohort. A Simon 2-stage design was utilized. Platinum-resistant HGSOC patients received ceralasertib 160 mg orally daily, days 1–7 and olaparib 300 mg orally twice daily, days 1–28 of a 28-day cycle until toxicity or progression. Primary endpoints were toxicity and efficacy including objective response rate (ORR) by RECIST. Secondary endpoint was progression-free survival (PFS). The null hypothesis (≤5% ORR) would be rejected if there were ≥ 1 responses in 12 patients. Fourteen PARPi-naïve patients were evaluable for toxicity; 12 were evaluable for response. Three had BRCA1 mutations (1 germline, 2 somatic). Adverse events possibly related to treatment were primarily grade (G) 1/2. G3 toxicities included nausea (14.3%), fatigue (7.1%), anorexia (7.1%), and anemia (7.1%). No objective responses occurred. Best response was stable disease in 9 patients and progressive disease in three. Five patients had a ≥ 20% to <30% reduction in disease burden, including 3 with BRCA1 mutations. Three of 11 patients (27%; 2 with BRCA1 mutations) evaluable by Gynecologic Cancer Intergroup criteria had >50% CA-125 decline, including 2 with CA-125 normalization. Median PFS was 4.2 months overall (90% CI:3.5–8.2) and 8.2 months (3.6 months–not determined) for patients with BRCA1 mutations. Olaparib plus ceralasertib is well-tolerated. No objective responses occurred, though a signal of activity was seen particularly in disease associated with BRCA1. Further evaluation of this combination should include alternate dosing strategies in genomically-selected populations. • Combination olaparib and ceralasertib is tolerable at the current RP2D. • No RECIST radiological responses occurred and PFS was 4.2 months. • PFS was 8.2 months in 3 subjects with BRCA1 mutations. • CA-125 responses by GCIG criteria were seen in 3 of 11 evaluable subjects. • A signal of activity was seen in DNA repair deficient platinum resistant HGSOC. [ABSTRACT FROM AUTHOR]

Purpose: Intravitreal anti-vascular endothelial growth factor (VEGF) injection therapy has emerged as the mainstay of treatment in the management of diabetic macular edema (DME) today. Various systemic risk factors have to be considered before initiating anti-VEGF therapy. The aim of our study was to form a consensus on various systemic factors to consider before starting anti-VEGF therapy for DME. Methods: A questionnaire was created and sent across to various retina specialists across India. A GoogleTM form with various questions pertaining to what systemic parameters would one consider before giving anti-VEGF therapy for DME was sent to each of them by email/WhatsAppTM/direct telephonic interview. Results: Of the 650 retina specialists contacted, 322 responded to the questionnaire. There was no difference in responses between private and institutional practitioners. The majority would consider RBS (85%), HbA1c (61%), blood pressure (63%), and renal function (57%) as a routine before administering the anti-VEGF injection, while the majority would not consider hemoglobin (63%) or lipid profile (55%) of the patient as a routine practice prior to administering the injection. Conclusion: In our study, most VR specialists prefer to consider RBS, HbA1c, BP, and renal profile (creatinine) routinely prior to anti-VEGF injection. We suggest that it is important to consider blood pressure control, glycemic control, HbA1c, Hb, lipid profile, and renal profile (UACR, eGFR, and creatinine) prior to anti-VEGF therapy in all diabetic patients and to discuss the need for statins in patients with dyslipidemias with the physician. [ABSTRACT FROM AUTHOR]

Smartphone-based fundus imaging (SBFI) is a low-cost approach for screening of various ophthalmic diseases and particularly suited to resource limited settings. Thus, we assessed how best to upskill alternative healthcare cadres in SBFI and whether quality of obtained images is comparable to ophthalmologists. Ophthalmic assistants and ophthalmologists received a standardized training to SBFI (Heine iC2 combined with an iPhone 6) and 10 training examinations for capturing central retinal images. Examination time, total number of images, image alignment, usable field-of-view, and image quality (sharpness/focus, reflex artifacts, contrast/illumination) were analyzed. Thirty examiners (14 ophthalmic assistants and 16 ophthalmologists) and 14 volunteer test subjects were included. Mean examination time (1st and 10th training, respectively: 2.17 ± 1.54 and 0.56 ± 0.51 min, p <.0001), usable field-of-view (92 ± 16% and 98 ± 6.0%, p =.003) and image quality in terms of sharpness/focus (p =.002) improved by the training. Examination time was significantly shorter for ophthalmologists compared to ophthalmic assistants (10th training: 0.35 ± 0.21 and 0.79 ± 0.65 min, p =.011), but there was no significant difference in usable field-of-view and image quality. This study demonstrates the high learnability of SBFI with a relatively short training and mostly comparable results across healthcare cadres. The results will aid implementing and planning further SBFI field studies. [ABSTRACT FROM AUTHOR]

BACKGROUND Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions. OBJECTIVE The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck. PATIENTS, METHODS AND MATERIALS PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations. RESULTS These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency. CONCLUSION The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes. [ABSTRACT FROM AUTHOR]

Background: Continuous glucose monitoring (CGM) systems are widely and increasingly used in diabetes self-management and in the context of clinic visits. However, access to CGM data during visits can be challenging. Clinic inefficiencies can restrict the time available for patient education, and the inability to integrate CGM data into electronic health record (EHR) systems can result in data being lost. In this study, we describe our institution's approach to integrating CGM data directly into the EHR through a partnership with a CGM device manufacturer and without a third-party data aggregation/data visualization platform. Methods: We interviewed key stakeholders with the hospital Information Technology Department, the Division of Pediatric Endocrinology, and a CGM device manufacturer. A collaborative, human-centered design approach was used to define the workflow. Health Level 7 (HL7) standards were used to build all data exchanges. Results: In collaboration with all parties, we created a simple network architecture design for both account linkage and data acquisition. The system uses the standard, computerized, physician order entry interface available in the EHR for both processes. Data acquisition occurs in real time, and customized reports are displayed within the results section of the EHR. The entire process is Health Insurance Portability and Accountability Act (HIPAA) compliant and meets all security requirements. Conclusions: Building scalable data integration using HL7 standards is possible and allows real-time access to CGM data within the diabetes provider's existing workflow and can occur with or without the patient present. This may lead to improved clinical outcomes, increased efficiency, and new revenue opportunities by documenting CGM data capture and review. [ABSTRACT FROM AUTHOR]

The landscape of genetic testing for breast cancer susceptibility has transformed dramatically over the last decade and a half. Traditionally, the process of genetic testing resided fully within a medical infrastructure, from identification of appropriate testing candidates to gene selection to risk mitigation recommendations. More recently, decreasing costs, advancing technology, and a growing understanding of therapeutic implications of certain genetic test results have led to more widespread uptake of testing that increasingly involves broad multigene panels. Germline genetic testing for breast cancer susceptibility can now be obtained through one of three approaches: through clinical care; a direct‐to‐consumer (DTC) approach that is entirely consumer‐driven; or a hybrid, patient‐initiated, provider‐mediated model. Increased access to testing has led to extensive dialogue about the best way to conduct testing and act on results. Points of discussion include: selection of appropriate candidates for genetic testing; optimal composition of genes on panels; informed consent; safe return of results; privacy; and legal protections for those found to have relevant pathogenic or likely pathogenic variants. As more individuals undergo genetic testing, a growing population of individuals with inherited breast cancer predisposition informs optimal management of cancer risk and also highlights unanswered questions. This article aims to review the current state of genetic testing for inherited breast cancer susceptibility including testing approaches, the legal, ethical and social landscape, and selected contemporary management issues. [ABSTRACT FROM AUTHOR]

Purpose: Deep learning is a newer and advanced subfield in artificial intelligence (AI). The aim of our study is to validate a machine-based algorithm developed based on deep convolutional neural networks as a tool for screening to detect referable diabetic retinopathy (DR).Methods: An AI algorithm to detect DR was validated at our hospital using an internal dataset consisting of 1,533 macula-centered fundus images collected retrospectively and an external validation set using Methods to Evaluate Segmentation and Indexing Techniques in the field of Retinal Ophthalmology (MESSIDOR) dataset. Images were graded by two retina specialists as any DR, prompt referral (moderate nonproliferative diabetic retinopathy (NPDR) or above or presence of macular edema) and sight-threatening DR/STDR (severe NPDR or above) and compared with AI results. Sensitivity, specificity, and area under curve (AUC) for both internal and external validation sets for any DR detection, prompt referral, and STDR were calculated. Interobserver agreement using kappa value was calculated for both the sets and two out of three agreements for DR grading was considered as ground truth to compare with AI results.Results: In the internal validation set, the overall sensitivity and specificity was 99.7% and 98.5% for Any DR detection and 98.9% and 94.84%for Prompt referral respectively. The AUC was 0.991 and 0.969 for any DR detection and prompt referral respectively. The agreement between two observers was 99.5% and 99.2% for any DR detection and prompt referral with a kappa value of 0.94 and 0.96, respectively. In the external validation set (MESSIDOR 1), the overall sensitivity and specificity was 90.4% and 91.0% for any DR detection and 94.7% and 97.4% for prompt referral, respectively. The AUC was. 907 and. 960 for any DR detection and prompt referral, respectively. The agreement between two observers was 98.5% and 97.8% for any DR detection and prompt referral with a kappa value of 0.971 and 0.980, respectively.Conclusion: With increasing diabetic population and growing demand supply gap in trained resources, AI is the future for early identification of DR and reducing blindness. This can revolutionize telescreening in ophthalmology, especially where people do not have access to specialized health care. [ABSTRACT FROM AUTHOR]

In this paper, asynchronous receptive circuit of retinal pathway is proposed for cone cells. Cone cells respond differently to different wavelengths of light and they are responsible for color vision. The cells present in retinal pathway namely cone photoreceptor, bipolar cell, amacrine cell and ganglion cell are mimicked using 180 nm Complementary Metal Oxide Semiconductor (CMOS) technology in strong inversion region. The proposed circuit is event based and hence asynchronous in nature. Additionally, amacrine stage is mimicked such that analog multiplexing occurs which is matching with its biological behavior. Both these features give output near to response of actual biological retinal pathway. The circuit detects wavelengths in visible spectrum of light with temporal contrast. At amacrine stage, selectivity is achieved without any external control signal which shows intelligent behavior at analog circuit level. The concept of color sensitivity of cone is considered to generate input stimulus of the circuit using Commission on Illumination (CIE) standard. The power consumed by the entire pathway circuit is 183 mW. • Asynchronous receptive circuit of retinal pathway is proposed for cone cells responsible for color detection. • Amacrine stage is mimicked such that analog multiplexing occurs, matching with its biological behavior. • Waveforms of photoreceptor current and membrane potential are reconstructed and verified using defined mathematical model. • The input stimulus to the photoreceptor is generated using CIE standards. • Proposed circuit is able to generate and change spiking rate based on input light stimulus with 183mW power consumption. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including the Muslim women, feminism and African American women.

In contemporary times, the status of Muslim women has become a lens to approach and engage with Muslim societies. Embedded in these narratives is an image of Muslim women as oppressed victims of their patriarchal families and societies. In this article, we focus on the lived experiences of educated Muslim women from Pakistan and India to examine what empowerment means for them. We are particularly interested in examining how these participants, being some of the first and only educated women in their rural and low-income communities, employ their distinct educated status to construct what it means to be empowered Muslim women in their contexts. This focus on the lived experiences is a departure from frameworks that offer universalistic and homogeneous understandings of Islam, education, and empowerment. Instead, it provides insights into the complex, and at times even contradictory, meanings and performances of gendered identities shaped by historical and social conditions. [ABSTRACT FROM AUTHOR]

There is a growing impetus to increase marine protected areas coverage globally from 6% to 30% in 2030. Successfully establishing and maintaining marine protected areas require incorporating public preferences into their establishment and management. We investigate the role of alternate management regimes (top-down and bottom-up) on preferences for marine protected areas and the marginal rate of substitution between natural and man-made capital using a case study in the Asia-Pacific region of Okinawa, Japan. We implemented a choice experiment survey to infer which attributes of marine protected areas are most important for the respondents. We use our survey results to calculate respondents’ willingness to support marine protected areas in Okinawa. This study contributes to the policy debate on management of marine protected areas with empirical data that characterizes the perception of Okinawan residents with respect to the role of local coastal communities (bottom-up) compared to central government based agencies (top-down) management. We extend the analysis and estimate the trade-offs to residents in Okinawa between natural capital (i.e. coral coverage and marine biodiversity attribute) and man-made capital (i.e. restrictions on coastal development). We find that the underlying management regime affects the local residents’ valuation of the marine protected area with residents showing a higher willingness to support bottom-up management regimes. There is also substantial differences in the willingness to support different characteristics of marine protected areas by management type. Finally, we find that the marginal rate of substitution between natural capital and man-made capital varies by management type such that residents would need to be compensated relatively less in terms of man-made capital in the presence of a policy scenario that proposes an increase in natural capital under a bottom-up management regime. [ABSTRACT FROM AUTHOR]

Through focusing on forms of clothing, this article reveals how educated women from marginalized communities in Pakistan and India made differential claims to being modern. Our analysis of two ethnographic studies shows how the participants mobilized their subjectivities as modern and educated women through a distinction between 'local modern' and 'local traditional'. In this article, our goal is not to define modernity, but instead to illuminate what it meant to be modern in both contexts. We integrate the narratives of young, rural Muslim women in Pakistan with those of young, rural Hindu women in India to disrupt the linear telling of the production of universal and homogenous modernity through education. [ABSTRACT FROM AUTHOR]

The article describes the case of a 57-year-old man with a history of hypertension and who presented with 10 days of blue skin discoloration on the bilateral arms and trunk, without any associated pain or itch. Drugs being taken by the patient include hydrochlorothiazide, olmesartan, and amlodipine. The patient was diagnosed of having infectious pseudochromhidrosis from Bacillus cereus. Other differential diagnosis for blue skin discoloration include hypoxenia and sweat pigmentation.

Background: Despite a growing interest in nonsurgical cosmetic procedures in men, the utilization of aesthetic treatments remains comparatively low, suggesting the presence of barriers to care. Objective: To describe barriers to cosmetic intervention for male patients from the perspective of dermatologists. Materials and methods: An anonymous, online survey was distributed through a listserv made available by the American Academy of Dermatology. Results: Dermatologist respondents perceived a low utilization of cosmetic services in male patients (5%) and a lack of opportunity (72.3%) to provide such services. Respondents also perceived a lack of sufficient education/training (40.9%), experience (20.5%), and a lack of evidence in the field (20.5%) for dermatologists as potential barriers to cosmetic care for male patients. Presence of targeted messaging and in-office educational materials for male patients was found to be associated with increased utilization of cosmetic treatments by male patients (p = .012, p = .012, respectively). Dermatologists reported strong confidence in delivering various noninvasive cosmetic treatments to male patients. Conclusion: Despite dermatologists' reported confidence in performing cosmetic procedures in men, many perceive insufficient education/training and experience with this population which may create barriers to cosmetic care for male patients. Increasing educational materials and targeted messaging to male patients may decrease barriers for patients to receive desired cosmetic care. [ABSTRACT FROM AUTHOR]

In this article, we analyze our experiences engaging in a collaborative ethnographic project. This project brings together two ethnographic studies undertaken independently from the other in Gujarat, India and Punjab, Pakistan. We integrate the narratives of young, rural Hindu women in India with those of young, rural Muslim women in Pakistan to depict globalization as a simultaneously interconnected and disjointed project. Our effort is to disrupt the linear telling of the production of global and universal modernity through education, which is often seen through rejecting local culture. We take a critical, feminist, postcolonial approach to challenge traditional hierarchies of knowledge and incorporate the scholarship and perspectives of non-Western scholars, problematizing the traditional self–other distinction. This article outlines the methodological process and journey that we undertook to create a dialog between our independent ethnographic work focusing on India and Pakistan. [ABSTRACT FROM PUBLISHER]

Next-generation or massively parallel sequencing has transformed the landscape of genetic testing for cancer susceptibility. Panel-based genetic tests evaluate multiple genes simultaneously and rapidly. Because these tests are frequently offered in clinical settings, understanding their clinical validity and utility is critical. When evaluating the inherited risk of breast and ovarian cancers, panel-based tests provide incremental benefit compared with BRCA1/ 2 genetic testing. For inherited risk of other cancers, such as colon cancer and pheochromocytoma-paraganglioma, the clinical utility and yield of panel-based testing are higher; in fact, simultaneous evaluation of multiple genes has been the historical standard for these diseases. Evaluating inherited risk with panel-based testing has recently entered clinical practice for prostate and pancreatic cancers, with potential therapeutic implications. The resulting variants of uncertain significance and mutations with unclear actionability pose challenges to service providers and patients, underscoring the importance of genetic counseling and data-sharing initiatives. This review explores the evolving merits, challenges, and nuances of panel-based testing for cancer susceptibility. [ABSTRACT FROM AUTHOR]

Climate-change induced uncertainties in future spatial patterns of conservation-related outcomes make it difficult to implement standard conservation-planning paradigms. A recent study translates Markowitz's risk-diversification strategy from finance to conservation settings, enabling conservation agents to use this diversification strategy for allocating conservation and restoration investments across space to minimize the risk associated with such uncertainty. However, this method is information intensive and requires a large number of forecasts of ecological outcomes associated with possible climate-change scenarios for carrying out fine-resolution conservation planning. We developed a technique for iterative, spatial portfolio analysis that can be used to allocate scarce conservation resources across a desired level of subregions in a planning landscape in the absence of a sufficient number of ecological forecasts. We applied our technique to the Prairie Pothole Region in central North America. A lack of sufficient future climate information prevented attainment of the most efficient risk-return conservation outcomes in the Prairie Pothole Region. The difference in expected conservation returns between conservation planning with limited climate-change information and full climate-change information was as large as 30% for the Prairie Pothole Region even when the most efficient iterative approach was used. However, our iterative approach allowed finer resolution portfolio allocation with limited climate-change forecasts such that the best possible risk-return combinations were obtained. With our most efficient iterative approach, the expected loss in conservation outcomes owing to limited climate-change information could be reduced by 17% relative to other iterative approaches. [ABSTRACT FROM AUTHOR]

Aims: Changes in the islet vasculature have been implicated in the regulation of β-cell survival and function during the progression to type 2 diabetes (T2D). Failure of the β-cell to compensate for the increased insulin demand in obesity eventually leads to diabetes; as a result of the complex interplay of genetic and environmental factors (e.g. ongoing inflammation within the islets) and impaired vascular function. The Angiopoietin/Tie (Ang/Tie) angiogenic system maintains vasculature and is closely related to organ inflammation and angiogenesis. In this study we aimed to identify whether the vessel area within the islets changes in diabetes and whether such changes would be triggered by the Tie-antagonist Ang-2. Methods: Immunohistochemical and qPCR analyses to follow islet vascularization and Ang/Tie levels were performed in human pancreatic autopsies and isolated human and mouse islets. The effect of Ang-2 was assessed in β-cell-specific Ang-2 overexpressing mice during high fat diet (HFD) feeding. Results: Islet vessel area was increased in autopsy pancreases from patients with T2D. The vessel markers Tie-1, Tie-2 and CD31 were upregulated in mouse islets upon HFD feeding from 8 to 24 weeks. Ang-2 was transiently upregulated in mouse islets at 8 weeks of HFD and under glucolipotoxic conditions (22.2 mM glucose/ 0.5 mM palmitate) in vitro in human and mouse islets, in contrast to its downregulation by cytokines (IL-1β, IFN-ɣ and TNF-α). Ang-1 on the other hand was oppositely regulated, with a significant loss under glucolipotoxic condition, a trend to reduce in islets from patients with T2D and an upregulation by cytokines. Modulation of such changes in Ang-2 by its overexpression or the inhibition of its receptor Tie-2 impaired β-cell function at basal conditions but protected islets from cytokine induced apoptosis. In vivo, β-cell-specific Ang-2 overexpression in mice induced hypervascularization under normal diet but contrastingly led to hypovascularized islets in response to HFD together with increased apoptosis and reduced β-cell mass. Conclusions: Islet hypervascularization occurs in T2D. A balanced expression of the Ang1/Ang2 system is important for islet physiology. Ang-2 prevents β-cell mass and islet vascular adaptation in response to HFD feeding with no major influence on glucose homeostasis. [ABSTRACT FROM AUTHOR]

This article seeks to illustrate how various actors involved in a state-NGO partnership to provide marginalized girls educational opportunities appropriate discourses related to schooling and empowerment in India. It traces the multiple discourses of empowerment underlying the implementation of the Kasturba Gandhi Balika Vidyala (KGBV) program in the Western state of Gujarat to gain a more nuanced understanding of the influences on educational programs' ability to support social transformation. I show how these multiple, and often competing, discourses might be appropriated to take into account the systems, structures, and practices that act as barriers to implement reform-oriented practices that perpetuate girls' marginalization. To do so, I also posit that programs and partnerships must specifically and systematically address the cultural and institutional forces that work to reinforce inequality and marginalization, but that these perspectives need large scale popular and political buy-in in order to realize their dual goals of service provision and long-term social transformation. [ABSTRACT FROM AUTHOR]

Background: Biological differences between BRCA-associated breast cancer and sporadic breast cancer may warrant different adjuvant chemotherapy (ACRx) recommendations despite similar phenotypic features. A 21-gene expression profile (Oncotype DX) generates a prognostic recurrence score (RS) that predicts the ACRx benefit in patients with hormone receptor-positive breast cancer. No reports describe assay results for BRCA-associated breast cancer.Methods: A review of Memorial Sloan Kettering Cancer Center databases identified 4908 patients with hormone receptor-positive, node-negative breast cancer who underwent Oncotype DX testing between July 2006 and March 2014. BRCA1/BRCA2 carriers (cases) were identified and matched (1:2) by age at diagnosis and tumor size to noncarrier controls. Two-sample nonparametric tests were used to compare the baseline characteristics, RSs, and risk stratification between BRCA1 and BRCA2 patients. Conditional logistic regression was used to assess these differences by mutational status.Results: Fifty mutation-associated cases (19 BRCA1 cases and 31 BRCA2 cases) and 100 controls who were well matched for age (P = .9) and tumor size (P = .6) were included. BRCA1 and BRCA2 carriers had similar median RSs (P = .6) and risk category stratification (P = .3). The median RS was higher for cases versus controls (24 vs 16; P < .0001). Risk stratification also differed by mutational status (P = .0002). Cases had more high-risk disease (28% vs 7%) and intermediate-risk disease (56% vs 36%) and less low-risk disease (16% vs 57%). Cases were more likely than controls to receive ACRx (74% vs 46%; P = .002).Conclusions: Germline BRCA-associated hormone receptor-positive breast cancer may be associated with intrinsically less favorable biology. Few affected carriers have RS indicating a clear absence of benefit from ACRx. The increased use of ACRx and benefit from ACRx in BRCA carriers may mitigate otherwise inferior outcomes. [ABSTRACT FROM AUTHOR]

This article contributes to a growing appreciation and understanding of both the ways to include exposure to Comparative and International Education (CIE) in undergraduate teacher education as well as to how students take up and respond creatively to opportunities for comparative exploration. In order to make space for comparative education in the already oversubscribed pre-service teacher’s program of study, we (1) explore a strategy to use a required undergraduate social foundations’ class for pre-service teachers at a large public university as a platform for comparative education, and (2) share the lessons learned from creating space for students to express their international and comparative curiosities. We open the article by introducing the “grafting” strategy to make space for the comparative; we then turn to the ways we employed a pedagogical tool we call “drawing out” to allow students to make comparative connections by responding to our deliberate, comparative prompts. We found that by embracing the grafting approach we created opportunities for students to make their own conclusions about the value of comparative considerations and to express their organic interest in the international to better understand domestic developments and options. [ABSTRACT FROM AUTHOR]

Introduction: Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. Methods: This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs) and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events. Results: A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years) and were more likely to be male (42.4% vs. 30.4%). TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours), to incur less cost (median $449.83 vs. $1147.70), and to be exposed to less radiation (median 7.18 vs. 16.6mSv). No patient in either group had a related 30-day revisit. Conclusion: Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation. [ABSTRACT FROM AUTHOR]

Establishing legal protection for forest areas is the most common policy used to limit forest loss. This article evaluates the effectiveness of seven Indonesian forest protected areas introduced between 1999 and 2012. Specifically, we explore how the effectiveness of these parks varies over space. Protected areas have mixed success in preserving forest, and it is important for conservationists to understand where they work and where they do not. Observed differences in the estimated treatment effect of protection may be driven by several factors. Indonesia is particularly diverse, with the landscape, forest and forest threats varying greatly from region to region, and this diversity may drive differences in the effectiveness of protected areas in conserving forest. However, the observed variation may also be spurious and arise from differing degrees of bias in the estimated treatment effect over space. In this paper, we use a difference-in-differences approach comparing treated observations and matched controls to estimate the effect of each protected area. We then distinguish the true variation in protected area effectiveness from spurious variation driven by several sources of estimation bias. Based on our most flexible method that allows the data generating process to vary across space, we find that the national average effect of protection preserves an additional 1.1% of forest cover; however the effect of individual parks range from a decrease of 3.4% to an increase of 5.3% and the effect of most parks differ from the national average. Potential biases may affect estimates in two parks, but results consistently show Sebangau National Park is more effective while two parks are substantially less able to protect forest cover than the national average. [ABSTRACT FROM AUTHOR]

From the early 20th century, immunotherapy has been studied as a treatment modality for cancers, including in children. Since then, developments in monoclonal antibodies and vaccine therapies have helped to usher in a new era of cancer immunotherapeutics. However, efficacy of these types of therapies has been limited, mostly in part due to low tumor immunogenicity, cancer escape pathways, and toxicities. As researchers investigate the cellular and molecular components of immunotherapies, mechanisms to improve tumor specificity and overcome immune escape have been identified. The goal of immunotherapy now has been to modulate tumor escape pathways while amplifying the immune response by combining innate and adaptive arms of the immune system. Although several limiting factors have been identified, these recent advances in immunotherapy remain at the forefront of pediatric oncologic therapeutic trials. Immunotherapy is now coming to the forefront of precision treatment for a variety of cancers, with evidence that agents targeting immunosuppressive mechanisms for cancer progression can be effective therapy [1-3]. In this review, we review various types of immunotherapy, including the cellular biology, limitations, recent novel therapeutics, and the application of immunotherapy to pediatric oncology. [ABSTRACT FROM AUTHOR]

Delving into the "black box" of schooling can help us better understand the paradoxical reality that schooling for girls can be simultaneously empowering and disempowering. Despite recent interest in developing innovative research methodologies within the field of comparative education, there has been less attention to and reflexivity about the use of critical and participatory research methodologies as a way to gain insight into school processes that lead to dis/empowerment. This article details the use of photovoice methodology with rural, marginalized, adolescent-aged girls in Western India, with particular attention to collaboration, power sharing, and the production of "voice." Through a case study of a group of girls in Gujarat, this article illustrates how photovoice methodology can act as an important analytical heuristic to illuminate the relationship between schooling and girls' empowerment and how photovoice as a method might itself contribute to the empowerment process of girls. [ABSTRACT FROM AUTHOR]

In an era of globalization, multifaceted and complex changes have increasingly interconnected geographically dispersed places. A central question of globalization studies concerns whether top-down forces of globalization are forging a global culture or whether processes of globalization from below are able to push back against homogenization by appropriating global forces rather than simply being overwhelmed by them. In this paper, I develop the concept of intentional spaces to show how ideas move globally and how local communities appropriate these ideas, revealing the actual practices that happen in the middle of top-down and bottom-up processes of globalization. I identify three types of ‘intentional spaces’ – physical, pedagogical, and ideological – to document the middle: where top down global forces meet local responses, and how these processes unfold. These intentional spaces enable processes of globalization from below, particularly the development of a mode of critical education that is both political and anti-hegemonic. This critical education empowers local people to adapt global/Western perspectives and influences to indigenous perspectives and practices, creating its own discourses of globalization. I use the context of the trans-Himalayan region of Ladakh to consider how national and international forces intersect with the local, and how local communities re-envision their participation in a modern, global economy. [ABSTRACT FROM PUBLISHER]

May-Thurner syndrome (MTS) has been recognized as a clinical entity for almost six decades. The true incidence rate of MTS is unknown and perhaps ranges from 22 to 32% according to the autopsy studies in the early twentieth century. However, MTS related deep venous thrombosis (DVT) accounts for only 2%-3% of all lower limb DVTS. In MTS, the left common iliac vein is compressed against the fifth lumbar vertebrae by the right common iliac artery, as it crosses in front of the vein. Chronic pulsation of the artery is thought to cause elastin, collagen deposition, and intimal fibrosis leading to formation of venous spur and venous thrombosis. MTS can present as acute or chronic DVT leading to pulmonary embolism (PE), chronic leg pain, chronic ulcers, or skin pigmentation changes. In this case report we have described an interesting case of a 28-year-old Caucasian female who presented for evaluation of shortness of breath (SOB) associated with cough for one week. SOB was found to be secondary to massive bilateral pulmonary embolism resulting from extensive MTS related DVT of the left lower extremity. Patient underwent pharmacomechanical treatment with local thrombolysis, thrombectomy, and venoplasty along with stent placement that extended to inferior vena caval junction. Subsequently patient was discharged on coumadin. MTS should be considered in differentials when faced with a case of unilateral DVT particularly in younger age group. [ABSTRACT FROM AUTHOR]

Introduction: Cyclin-dependent-kinase 4/6(CDK4/6) inhibitors are widely used as a first-line systemic treatment for patients with hormone receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cancer. Although many patients with metastatic breast cancer require palliative radiotherapy (RT), there are limited data on the safety of combining a CDK4/6 inhibitor with palliative RT. Case Report: Presented is a case of acute high-grade radiation dermatitis with low-dose palliative RT following administration of palbociclib. A 49-year-old woman with newly diagnosed hormone receptor-positive invasive ductal carcinoma of the left breast presented with lytic bone lesions in the left femur and lumbar spine. The patient initiated treatment with goserelin, tamoxifen, and palbociclib. She underwent prophylactic surgical fixation of the left femur and received post-operative RT encompassing the entire surgical nail (30 Gy/10 fractions) and palliative RT to the lumbar spine for pain relief (20 Gy/5 fractions). During cycle 4, palbociclib was stopped 3 days prior to the start of RT to reduce the risk of toxicity risk. However, 16 days after starting RT, she developed painful erythematous papules and bullae with moist desquamation on the left groin and lumbar spine. Management & Outcome: Her symptoms were managed with topical Aquaphor-lidocaine, silver sulfadiazine, and aluminum acetate soaks. Dermatitis subsided to dry desquamation within 2 weeks. The patient denied late toxicity at 11 months follow-up. Discussion: Larger retrospective or prospective studies are needed to further elucidate the safety of combined CDK4/6 inhibitors and RT. In the meantime, special precautions are warranted in patients receiving combined therapy. [ABSTRACT FROM AUTHOR]

In recent years, more and more attention has been paid to international education in schools in the USA. Education professionals, business leaders, and politicians realize that schools and school leaders must identify multiple opportunities for students to interact with and experience a global society. Nationally, there has been a considerable investment of funds by several key foundations and much political talk about the need to push American education towards a model of schooling that expressly responds to the need for internationally competent citizens. Using mixed methodology design, this study is fueled by a desire to better understand several overarching elements in international education. In short, the authors of this paper posit that no further research, policy formation, or program development within the realm of international education for public schools can be undertaken until an understanding of the current state of international education and the capacity for internationalization is empirically explored. [ABSTRACT FROM AUTHOR]

Comparative findings from girls' education projects in Gujarat, India, and Shaanxi, China, are used to explore two questions: How and under what conditions does schooling contribute to girls' instrumental and intrinsic empowerment? What does it mean to become an educated rural girl in contexts where girls are marginalized? A review of scholarship on empowerment, and the role of schools in enabling that process, is followed by an examination of the school/empowerment link in the case study projects, which to varying degrees have succeeded in assisting girls to gain resources, capabilities, experiences, and networks that expand the lenses through which they see themselves and their authority in the world. Three intertwining processes that affect schooling's potential to enable girls' empowerment include: 1.) expanding educational access and opportunities; 2.) declining cultures and economies of son preference; and 3.) shifting levels of "trust" in schools as a critical "good" for girls' futures. Our designation of participating girls as "millennials" refers both to the era in which they are coming of age, and to how their capabilities, aspirations, and identifications as schoolgirls, daughters, and laborers have been shaped by global, national, and local reinterpretations of the world's Millennium Development Goals. [ABSTRACT FROM AUTHOR]

Dysembryoplastic neuroepithelial tumour (DNET) is an uncommon mixed glioneuronal tumour. DNET is classified as Grade I neoplasm in revised World Health Organization classification of tumors of the nervous system. DNET is commonly seen in the temporal lobe of children and young adults with features of pharmacoresistant complex partial seizures. Tumors arising in association with DNETs are rare. Only two cases of pilocytic astrocytoma (PA) arising in DNETs are reported. Surgical excision is the only successful management with favourable prognosis. The development of recurrence and malignancy after subtotal or even after complete excision challenges the premise of stability and highlights the importance of close clinical follow up. Here, a case of DNET with area of PA is described which helps in understanding the pathogenesis and biological behavior of DNET. [ABSTRACT FROM AUTHOR]

Psychosis of Alzheimer's disease (PAD) forms part of the behavioural and psychological symptoms of dementia (BPSD). PAD includes symptoms of psychosis such as hallucinations or delusions, and may be associated with agitation, negative symptoms or depression. Even though the US FDA has not approved any medication for the treatment of PAD, atypical antipsychotics have been widely used and favoured by geriatric experts in the management of the condition in view of their modest efficacy and relative safety. However, the recent FDA warnings regarding the cardiac, metabolic, cerebrovascular and mortality risks associated with the use of these drugs in elderly patients with dementia have caused serious concerns regarding their use. Nevertheless, until an effective and safe medication is approved by the regulatory agencies for PAD, clinicians do not have a better choice than atypical antipsychotics for the management of the serious symptoms of this condition. [ABSTRACT FROM AUTHOR]

The authors discuss the role of dermatologists in the diagnosis and management of coronavirus disease 2019 coagulopathy. Topics mentioned include prothrombotic state in patients with active and recent infection, the correlation between skin manifestations of COVID-19 coagulopathy and severity of disease, and the baseline index of suspicion for thrombotic events in COVID-19 patients.

Abstract: Objective: The goal of this study was to assess the barriers to gynecologic care for adolescents with disability in this state. Design: Providers of gynecologic care in Utah were surveyed to assess existing conditions, attitudes, and comfort levels regarding this population. Results: The survey was completed by 136 gynecologic clinicians (50% return rate). The comfort level among surveyed clinicians in providing gynecological care to disabled adolescents was relatively low, even for routine screening. Respondents identified the following as barriers to providing this care: time, reimbursement, inadequate knowledge, and disability-related issues (office access and preference to not serve this population). Suggested solutions included: continuing education programs, consultation to practices on serving both youth and individuals with disability, and better billing mechanisms. Conclusion: While many of the surveyed clinicians are comfortable providing care to adolescents with disability, a substantial number are not. Respondents perceive many barriers to providing care to this population, though the barriers appear modifiable. Potential interventions were identified which should be tested for their effectiveness in improving access to quality care for this underserved population. [Copyright &y& Elsevier]