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IntroductionWhile several studies have examined stroke public knowledge and awareness in individual countries within the Middle East and North Africa (MENA) region, none have provided a comprehensive cross-country assessment.PurposeTo assess public stroke knowledge and awareness among Arabic-speaking adults in seven MENA countries and identify associated factors.Materials and methodsAn online cross-sectional survey was self-administered by the public population in Iraq, Lebanon, Sudan, Jordan, United Arab Emirates, Syria, and Saudi Arabia (April 2021–2023). Associations of stroke risk factors, early symptoms, and consequences with socio-demographics and medical history were analyzed using logistic regression models.ResultsOf 4,090 participants (58.3% females), 42.9% identified four out of five correct answers related to general stroke knowledge. Only 25.2% identified all stroke risk factors, 24.7% recognized all symptoms, and 37.5% knew all possible consequences. Results show consistent pattern of high identification for at least one risk factor and consequences across all countries (96.3 to 99.8% and 86.2 to 100%, respectively), with varying levels of early symptom identification (56.8 to 97.9%). Females were more likely to identify a stroke risk factor, symptom, and consequence compared to males (OR = 2.525, 2.474, and 2.302, respectively, p

Several triage systems have been developed, but little is known about their performance in low-resource settings. Evaluating and comparing novel triage systems to existing triage scales provides essential information about their added value, reliability, safety, and effectiveness before adoption. This study included children aged < 15 years who presented to the emergency departments of two public hospitals in Kenya between February and December 2021. We compared the performance of Emergency Triage Assessment and Treatment (ETAT) guidelines and Smart Triage (ST) models (ST model with independent triggers, and recalibrated ST model with independent triggers) in categorizing children into emergency, priority, and non-urgent triage categories. Sankey diagrams were used to visualize the distribution of children into similar or different triage categories by ETAT and ST models. Sensitivity, specificity, negative and positive predictive values for mortality and admission were calculated. 5618 children were enrolled, and the majority (3113, 55.4%) were aged between one and five years of age. Overall admission and mortality rates were 7% and 0.9%, respectively. ETAT classified 513 (9.2%) children into the emergency category compared to 1163 (20.8%) and 1161 (20.7%) by the ST model with independent triggers and recalibrated model with independent triggers, respectively. ETAT categorized 3089 (55.1%) children as non-urgent compared to 2097 (37.4%) and 2617 (46.7%) for the respective ST models. ETAT classified 191/395 (48.4%) admitted patients as emergencies compared to more than half by all the ST models. ETAT and ST models classified 25/49 (51%) and 39/49 (79.6%) deceased children as emergencies. Sensitivity for admission and mortality was 48.4% and 51% for ETAT and 74.9% and 79.6% for the ST models, respectively. Smart Triage shows potential for identifying critically ill children in low-resource settings, particularly when combined with independent triggers and performs comparably to ETAT. Evaluation of Smart Triage in other contexts and comparison to other triage systems is required.

Infectious diseases in neonates account for half of the under-five mortality in low- and middle-income countries. Data-driven algorithms such as clinical prediction models can be used to efficiently detect critically ill children in order to optimize care and reduce mortality. Thus far, only a handful of prediction models have been externally validated and are limited to neonatal in-hospital mortality. The aim of this study is to externally validate a previously derived clinical prediction model (Smart Triage) using a combined prospective baseline cohort from Uganda and Kenya with a composite endpoint of hospital admission, mortality, and readmission. We evaluated model discrimination using area under the receiver-operator curve (AUROC) and visualized calibration plots with age subsets (< 30 days, ≤ 2 months, ≤ 6 months, and < 5 years). Due to reduced performance in neonates (< 1 month), we re-estimated the intercept and coefficients and selected new thresholds to maximize sensitivity and specificity. 11595 participants under the age of five (under-5) were included in the analysis. The proportion with an endpoint ranged from 8.9% in all children under-5 (including neonates) to 26% in the neonatal subset alone. The model achieved good discrimination for children under-5 with AUROC of 0.81 (95% CI: 0.79-0.82) but poor discrimination for neonates with AUROC of 0.62 (95% CI: 0.55-0.70). Sensitivity at the low-risk thresholds (CI) were 85% (83%-87%) and 68% (58%-76%) for children under-5 and neonates, respectively. After model revision for neonates, we achieved an AUROC of 0.83 (95% CI: 0.79-0.87) with 13% and 41% as the low- and high-risk thresholds, respectively. The updated Smart Triage performs well in its predictive ability across different age groups and can be incorporated into current triage guidelines at local healthcare facilities. Additional validation of the model is indicated, especially for the neonatal model.

En la escritura de Mario Bellatin la imagen de autor se presenta como cierto vacío constitutivo. Sin embargo, su ficción ha insistido en establecerse muchas veces en relación con otros creadores. Es el caso de Marcel Duchamp (“Duchamp post mortem”), Frida Kahlo (Demerol), Yukio Mishima (Biografía ilustrada) y Daniel Link (“Antiprólogo”), entre otros. Al abordar cada caso hay un procedimiento que se repite: la imagen del creador que ha sido incorporado a la ficción es reproducida por un pequeño dispositivo pedagógico. Por consiguiente, el presente trabajo propone un recorrido por esta figura con el fin de interrogar la imagen de autor producida por el sistema creativo de Mario Bellatin junto al procedimiento de la repetición como experiencia estética y ética.

Models for digital triage of sick children at emergency departments of hospitals in resource poor settings have been developed. However, prior to their adoption, external validation should be performed to ensure their generalizability. We externally validated a previously published nine-predictor paediatric triage model (Smart Triage) developed in Uganda using data from two hospitals in Kenya. Both discrimination and calibration were assessed, and recalibration was performed by optimizing the intercept for classifying patients into emergency, priority, or non-urgent categories based on low-risk and high-risk thresholds. A total of 2539 patients were eligible at Hospital 1 and 2464 at Hospital 2, and 5003 for both hospitals combined; admission rates were 8.9%, 4.5%, and 6.8%, respectively. The model showed good discrimination, with area under the receiver-operator curve (AUC) of 0.826, 0.784 and 0.821, respectively. The pre-calibrated model at a low-risk threshold of 8% achieved a sensitivity of 93% (95% confidence interval, (CI):89%-96%), 81% (CI:74%-88%), and 89% (CI:85%-92%), respectively, and at a high-risk threshold of 40%, the model achieved a specificity of 86% (CI:84%-87%), 96% (CI:95%-97%), and 91% (CI:90%-92%), respectively. Recalibration improved the graphical fit, but new risk thresholds were required to optimize sensitivity and specificity.The Smart Triage model showed good discrimination on external validation but required recalibration to improve the graphical fit of the calibration plot. There was no change in the order of prioritization of patients following recalibration in the respective triage categories. Recalibration required new site-specific risk thresholds that may not be needed if prioritization based on rank is all that is required. The Smart Triage model shows promise for wider application for use in triage for sick children in different settings.

IntroductionStroke, a leading cause of morbidity and mortality globally, demands heightened awareness and knowledge for effective preventive strategies and tailored response. Sudan is classified as a low income country with a low rate of literacy, lack of knowledge, and awareness about diseases. Thus, this study aimed to assess stroke awareness and knowledge among Sudanese population, and identify the associated factors influencing awareness.MethodsA cross-sectional study conducted between October and November 2022 through a self-administered online survey distributed via various social media platforms. The study involved adults aged 18 years and above through snow-ball sampling technique. The survey covered general awareness and knowledge concerning stroke risk factors, consequences, and the appropriate responses taken during acute stroke attacks.ResultsA total of 410 participants were enrolled in the study, majority (93.4%) were from urban area and had university degree (92.4%). Furthermore, 92.2% were aware about stroke and 74.9% were able to recognize the symptoms of stroke. Only 40.2% identified all correct answers, 96.3, 92.3, and 95.1% recognized at least one risk factor, early symptom, and consequences, respectively. Females were significantly more than males able to identify at least one risk factor. Almost all participants (99.5%) perceived stroke as a serious disease (99.5%). Notably, 86.3% would promptly transport a suspected stroke patient to the hospital. The multivariable analysis showed that females versus males and patients with depression versus without depression had significantly higher odds to identify at least one risk factor (OR of 14.716 [95% CI 1.901; 113.908] and 0.241 [95% CI 0.059; 0.984], respectively).ConclusionThe study concluded that stroke knowledge and awareness among Sudanese population is suboptimal. Furthermore, early stroke recognition and intake of the appropriate management strategies are lacking which highlights the need for targeted education and awareness campaigns.

Introduction Medical errors are an unfortunate certainty with emotional and psychological consequences for patients and health care providers. No standardized medical curriculum on how to disclose medical errors to patients or peers exists. The novel HEEAL (honesty/empathy/education/apology-awareness/lessen chance for future errors) curriculum addresses this gap in medical education through a multimodality workshop. Methods This 6-hour, two-part curriculum incorporated didactic and standardized patient (SP) simulation education with rapid cycle deliberate practice (RCDP). The morning focused on provider-patient error disclosure; the afternoon applied the same principles to provider-provider (peer) discussion. Summative simulations with SPs evaluated learners' skill baseline and improvement. Formative simulations run by expert simulation educators used RCDP to provide real-time feedback and opportunities for adjustment. Medical knowledge was measured through pre- and postintervention multiple-choice questions. Learners' confidence and attitude towards medical errors disclosure were surveyed pre- and postintervention with assistance of the Barriers to Error Disclosure Assessment tool, revised with the addition of several questions related to provider-provider disclosure. Results Fourteen medical students participated in this pilot curriculum. Statistical significance was demonstrated in medical knowledge (p = .01), peer-disclosure skills (p = .001), and confidence in medical error disclosure (p < .001). Although there was improvement in patient-disclosure skills, this did not reach statistical significance (p = .05). Discussion This curriculum addresses the need for designated training in medical error disclosure. Learners gained knowledge, skills, and confidence in medical error disclosure. We recommend this curriculum for medical students preparing for transition to residency.

Abstract Hydrocephalus occurs when the cerebrospinal fluid (CSF) accumulates in the cerebral ventricles. This is due to either obstruction in the CSF flow, decreasing its absorption by the arachnoid villus to the Dural venous sinuses, or increasing production of the CSF. The most disproportionately and severely affected by the disease consequences are African children. This is because of the high incidence of postinfectious hydrocephalus and spinal dysraphism compared with other world children. The health care system in Africa has access to 488 neurosurgeons which represents less than 1% of the global neurosurgeons, thus pediatric hydrocephalus is considered an emerging public health problem in Africa because of the difficulty of the patient's access to proper care. Numerous studies conducted in Africa have revealed a significant imbalance in the distribution of neurosurgical resources across the continent. Specifically, South Africa and North Africa collectively account for 86% of the total practicing neurosurgeons, indicating a pronounced concentration of these specialized medical professionals in these regions. Having an abundance of case studies regarding hydrocephalus is vital to increase our awareness and understanding. Hydrocephalus should gain more priority by current policymakers as an important health concern. This may be achieved by proper resource allocation to ensure better quality means of diagnosis, intervention, and rehabilitation.

What if there is a way to transform society and create a more caring, equitable, and connected world? The Power of Partnership (POP) podcast brings you the people who are working to do just that: people who are helping to build a world that values caring, nature, and shared prosperity. They are applying the Partnership ethos, the ground-breaking alternative to Domination systems that are at the root of our most pressing challenges. In this article, POP podcast producer and host Cherri Jacobs Pruitt provides an overview of how the podcast started and what listeners can expect from each episode.

Colorectal cancer represents an important oncological challenge both for its incidence, which makes it an important health problem, and for its biological complexity, which has made clinical results very difficult in terms of outcome for this category of patients. To date these diseases should not be treated as a single entity but it is necessary to distinguish colorectal cancers based on characteristics that nowadays are essential to have greater therapeutic benefits. These include the sideness of the disease, the state of microsatellites, the presence of prognostic and predictive mutations of response to treatments currently available in clinical practice, which are associated with new therapeutic targets. The greatest challenge in the future will be to circumvent the resistance mechanisms that make this disease very difficult to treat with good long-term results by studying effective combination treatments with a good toxicity profile. Once such combinations or targeted treatments are consolidated, it will be desirable to shift the best therapies to the first line treatment to make them immediately accessible to the patient. It will also be essential to refine the selection of patients who can benefit from these treatments.

IntroductionStroke is a major cause of death and disability globally and in Saudi Arabia as well. Prevention and management of stroke depend highly on raising knowledge and awareness about the disease.PurposeThe purpose of this study was to evaluate Saudi adult's knowledge and awareness about stroke and determine the associated factors.Materials and methodsA cross-sectional online survey was conducted in May–July 2022 among Saudi citizens. Assessments of stroke knowledge about risk factors, symptoms, and response to stroke symptoms were evaluated. Logistic regression was conducted to assess the association between the socio-demographic characteristics and knowledge.ResultsA total of 389 participants were enrolled with the majority (81.7%) being male participants. Less than half of the study subjects (43.3%) identified four out of five correct answers related to general knowledge about stroke. Almost all the participants were able to identify at least one risk factor associated with stroke. The majority of the participants (81.2%) believed that physical inactivity was the most common risk factor associated with stroke. Approximately three-quarters of participants considered difficulty speaking and understanding speech, followed by the sudden loss of consciousness as the most common stroke manifestation. Participants with a history of hypertension, dyslipidemia, and obesity had significantly higher odds of identifying at least one early stroke symptom (OR 2.271 [95% CI 1.402 3.677], 2.059 [95% CI 1.273 3.328], and 2.665 [95% CI 1.431 4.963], respectively).ConclusionOur study revealed that participants have good knowledge about stroke. Nonetheless, further efforts are required to raise awareness and educate the public to optimize and ensure better treatment outcomes.

Introduction: While several studies have examined stroke public knowledge and awareness in individual countries within the Middle East and North Africa (MENA) region, none have provided a comprehensive cross-country assessment. Purpose: To assess public stroke knowledge and awareness among Arabic-speaking adults in seven MENA countries and identify associated factors. Materials and methods: An online cross-sectional survey was self-administered by the public population in Iraq, Lebanon, Sudan, Jordan, United Arab Emirates, Syria, and Saudi Arabia (April 2021–2023). Associations of stroke risk factors, early symptoms, and consequences with socio-demographics and medical history were analyzed using logistic regression models. Results: Of 4,090 participants (58.3% females), 42.9% identified four out of five correct answers related to general stroke knowledge. Only 25.2% identified all stroke risk factors, 24.7% recognized all symptoms, and 37.5% knew all possible consequences. Results show consistent pattern of high identification for at least one risk factor and consequences across all countries (96.3 to 99.8% and 86.2 to 100%, respectively), with varying levels of early symptom identification (56.8 to 97.9%). Females were more likely to identify a stroke risk factor, symptom, and consequence compared to males (OR = 2.525, 2.474, and 2.302, respectively, p < 0.001). Employed, urban residents, and those with higher education demonstrated better stroke awareness. Conclusion: The sample showed variable levels of stroke knowledge among the public, underscoring the pressing need for targeted community initiatives, media campaigns, and educational interventions. These efforts are paramount for improving awareness, early detection, and timely response, especially in countries with lower levels of community stroke awareness. [ABSTRACT FROM AUTHOR]

Inflammatory skin diseases, such as psoriasis, atopic dermatitis, and alopecia areata, occur when the regulatory tolerance of the innate immune system is disrupted, resulting in the activation of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) inflammatory signaling pathway by interleukin 6 (IL-6) and other key inflammatory cytokines. JAK inhibitors, such as tofacitinib, bind to these enzymes which are coupled to receptors on cell surfaces and block the transcription of inflammatory cytokine-induced genes. The first topical applications are being marketed, yet insufficient effects regarding indications, such as alopecia areata, suggest that improved delivery technologies could help increase the efficacy. In this study, we used sulfated dendritic polyglycerol with caprolactone segments integrated in its backbone (dPGS-PCL), with a molecular weight of 54 kDa, as a degradable carrier to load and solubilize the hydrophobic drug tofacitinib (TFB). TFB loaded in dPGS-PCL (dPGS-PCL@TFB), at a 11 w/w% loading capacity in aqueous solution, showed in an ex-vivo human skin model better penetration than free TFB in a 30:70 (v/v) ethanol/water mixture. We also investigated the anti-inflammatory efficacy of dPGS-PCL@TFB (0.5 w/w%), dPGS-PCL, and free TFB in the water/ethanol mixture by measuring their effects on IL-6 and IL-8 release, and STAT3 and STAT5 activation in ex vivo skin models of simulated inflamed human skin. Our results suggest that dPGS-PCL@TFB reduces the activation of STAT3 and STAT5 by increasing the penetration of the tofacitinib. However, no statistically significant differences with respect to the inhibition of IL-6 and IL-8 were observed in this short incubation time.

The application of micelles as drug delivery systems has gained a great deal of attention as a means to overcome the current several drawbacks present in conventional cancer treatments. In this work, we highlight the comparison of polymeric and monomeric amphiphilic systems with a similar hydrophilic–lipophilic balance (HLB) in terms of their biocompatibility, aggregation behavior in aqueous solution, and potential in solubilizing hydrophobic compounds. The polymeric system consists of non-ionic polymeric amphiphiles synthesized via sequential RAFT polymerization of polyglycerol first-generation [G1] dendron methacrylate and cholesterol methacrylate to obtain poly(G1-polyglycerol dendron methacrylate)-block-poly(cholesterol methacrylate) (pG1MA-b-pCMA). The monomeric system is a polyglycerol second-generation [G2] dendron end-capped to a cholesterol unit. Both amphiphiles form spherical micellar aggregations in aqueous solution, with differences in size and the morphology in which hydrophobic molecules can be encapsulated. The polymeric and monomeric micelles showed a low critical micelle concentration (CMC) of 0.2 and 17 μg/mL, respectively. The results of our cytotoxicity assays showed that the polymeric system has significantly higher cell viability compared to that of the monomeric amphiphiles. The polymeric micelles were implemented as drug delivery systems by encapsulation of the hydrophobic small molecule doxorubicin, achieving a loading capacity of 4%. In summary, the results of this study reveal that using cholesterol as a building block for polymer synthesis is a promising method of preparation for efficient drug delivery systems while improving the cell viability of monomeric cholesterol.

Canadian Association of Chiefs of Police (CACP) Executive Global Studies 2020–2022 cohort members share the challenges, fears, and pride experienced while exploring the future of policing…for police.

The article focuses on the benefits of involving both experienced GPs and GP registrars in the teaching of medical students. Topics include the advantages of near-peer teaching in general practice, the potential for improving recruitment and retention in the field, and the results of a 2023 pilot program that assessed GP registrar involvement in medical student placements.

Neutropenic enterocolitis is a clinical condition characterized by inflammation of the colic mucosa, usually the caecum, associated with bowel wall thickening in patients with compromised immune system due to chemotherapy treatments. It can occur as well in other clinical conditions that lead to immunosuppression. Clinically, patients present with abdominal pain, fever, and neutropenia on blood tests. A number of major and minor criteria have been suggested for the clinical diagnosis of typhlitis. The most sensitive radiological investigation is represented by a computed tomography scan. There are no guidelines for treatment, but some factors may lead the clinician to medical treatments or prompt surgery as the best choice in that particular patient. The most implicated chemotherapeutic regimens are those based on taxanes. Here, we present a clinical case of a young patient with breast cancer and a review of the state of the art of knowledge regarding neutropenic enterocolitis in adult patients undergoing chemotherapy for the treatment of solid tumors.

The use of biomarkers that influence a targeted choice in cancer treatments is the future of medical oncology. Within this scenario, in recent years, an important role has been played by knowledge of microsatellite instability (MSI), a molecular fingerprint that identifies defects in the mismatch repair system. This knowledge has changed clinical practice in the adjuvant setting of colon cancer, and its role in the neoadjuvant setting in gastric tumours is becoming increasingly interesting, as well as in endometrial cancers in both early and advanced diseases. Furthermore, it has undoubtedly conditioned the first lines of treatment in the metastatic setting in different types of cancers. The incidence of MSI is different in different cancer types, as well as in early cancers versus metastatic disease. Knowing the incidence of MSI in the various histologies can provide insight into the potential use of this biomarker considering its prognostic value, especially in the early stages, and its predictive role with respect to treatment response. In particular, MSI can guide the choice of chemotherapy treatments in the adjuvant setting of colon and perioperative setting in gastric tumours, which could lead to immunotherapy treatments in these patients in both the early stages of the disease and the metastatic setting where the response to immunotherapy drugs in diseases with MSI is now well established. In this review, we focus on colon, gastric and endometrial cancers, and we briefly discuss other cancer types where MSI could have a potential role in oncological treatment decisions.

The purpose of this study is to examine intergenerational learning behaviour within ten Hong Kong families between Generation X parents and their Generation Y children. It tries to investigate intergenerational knowledge exchange, identify the characteristics of learning behaviour and culture in their "learning families". A narrative inquiry approach is adopted asking participants to recall and tell stories describing their personal intergenerational learning experiences. Results indicate that 80% of the participants thought their family is a 'learning family', and intergenerational family learning is happy experience and can be bi-directional. A positive family learning culture facilitates intergenerational learning especially in the Generation Y ? X direction. Learning methodology differs between the two generations due to societal changes and differences in their upbringing. A conceptual framework of intergenerational family learning in relation to lifelong learning is developed. The government and public should re-define teaching and learning practise and promote intergenerational learning even in schools.

In recent years, precision medicine has taken an increasing place in various branches of medical oncology, including colorectal cancer. Among the potentially relevant mutations for this cancer is the KRAS mutation, initially defined as “untargetable”; today, we see the birth of new molecules that target one of the variants of the KRAS mutation, KRAS G12C, having a significant impact on the therapeutic options for other malignancies, such as metastatic lung cancer. This fundamental step forward has stimulated scientific research on other potential targets of KRAS, both indirect and direct, and combination treatments aiming to overcome the mechanisms of resistance to these drugs that decrease in efficacy in colorectal cancer. What was once a negative predictive marker of response to anti-EGFR drugs today has become a potential target for targeted treatments. In turn, the prognostic role of the mutation has become extremely interesting, making it a potentially useful element in therapeutic decision-making, not only regarding oncological treatments but also in a more complex and complete manner within a global vision of the patient, involving other figures on the multidisciplinary team, such as surgeons, radiotherapists, and interventional radiologists.