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This is an ethnographic study of how two Japanese kindergartens are implementing the yōhoichigenka policy aimed at reforming the Japanese early childhood education system. The cases of these two kindergartens demonstrate what happens when a top-down mandate reaches the level of individual programs. The programs creatively find ways of responding to the reform mandate and to social change while maintaining what their administrators view as their pedagogical traditions. This paper also argues for the value of ethnographic methods to show how local programs are creative, resistant, and pragmatic in how they deal with top down pressures and directives.

Introduction: COVID‐19 has triggered a global pandemic and is an emerging situation. Diabetes has been associated with significant mortality in SARS and MERS‐COV infections. Patients with diabetes are at risk of COVID‐19 triggering diabetic emergencies due to known and unknown mechanisms. There is little evidence overviewing the clinical course of COVID‐19 patients who either present or have diabetic emergencies during their disease course. Methods: We conducted a retrospective case analysis of all patients admitted to our hospital during the COVID‐19 pandemic. The inclusion criteria were all patients receiving treatment for COVID‐19 and either presenting with a diabetic emergency on admission or developing an emergency during their admission. Data collected for the study were all routinely collected data as part of the admission. We compared these data to nine patients with no COVID‐19. Results: Thirty patients received treatment for a diabetic emergency, of which 21 also received treatment for COVID‐19. Significant differences were found between pH and bicarbonate on admission between RT‐PCR‐positive and both RT‐PCR‐negative and non‐COVID‐19 patients. Other results approaching significance include ALP and eGFR. Discussion: Patients suffering from COVID‐19 and diabetes concurrently can suffer from profound metabolic disturbance, with a significant difference in inpatient mortality. However further, prospective detailed investigation into biochemical processes is needed to fully elucidate underlying mechanisms that affect these patients' outcomes. [ABSTRACT FROM AUTHOR]

Type 2 diabetes (T2D) is characterized by insulin resistance (IR) and dysregulated insulin secretion. Glucagon-like peptide-1 receptor agonist liraglutide promotes insulin secretion, whereas thiazolidinedione-pioglitazone decreases IR. This study aimed to compare the efficacies of increasing insulin secretion vs decreasing IR strategies for improving myocardial perfusion, energetics, and function in T2D via an open-label randomized crossover trial. Forty-one patients with T2D (age 63 years [95% CI: 59-68 years], 27 [66%] male, body mass index 27.8 kg/m2) [95% CI: 26.1-29.5 kg/m2)]) without cardiovascular disease were randomized to liraglutide or pioglitazone for a 16-week treatment followed by an 8-week washout and a further 16-week treatment with the second trial drug. Participants underwent rest and dobutamine stress 31phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance for measuring the myocardial energetics index phosphocreatine to adenosine triphosphate ratio, myocardial perfusion (rest, dobutamine stress myocardial blood flow, and myocardial perfusion reserve), left ventricular (LV) volumes, systolic and diastolic function (mitral in-flow E/A ratio), before and after treatment. The 6-minute walk-test was used for functional assessments. Pioglitazone treatment resulted in significant increases in LV mass (96 g [95% CI: 68-105 g] to 105 g [95% CI: 74-115 g]; P = 0.003) and mitral-inflow E/A ratio (1.04 [95% CI: 0.62-1.21] to 1.34 [95% CI: 0.70-1.54]; P = 0.008), and a significant reduction in LV concentricity index (0.79 mg/mL [95% CI: 0.61-0.85 mg/mL] to 0.73 mg/mL [95% CI: 0.56-0.79 mg/mL]; P = 0.04). Liraglutide treatment increased stress myocardial blood flow (1.62 mL/g/min [95% CI: 1.19-1.75 mL/g/min] to 2.08 mL/g/min [95% CI: 1.57-2.24 mL/g/min]; P = 0.01) and myocardial perfusion reserve (2.40 [95% CI: 1.55-2.68] to 2.90 [95% CI: 1.83-3.18]; P = 0.01). Liraglutide treatment also significantly increased the rest (1.47 [95% CI: 1.17-1.58] to 1.94 [95% CI: 1.52-2.08]; P = 0.00002) and stress phosphocreatine to adenosine triphosphate ratio (1.32 [95% CI: 1.05-1.42] to 1.58 [95% CI: 1.19-1.71]; P = 0.004) and 6-minute walk distance (488 m [95% CI: 458-518 m] to 521 m [95% CI: 481-561 m]; P = 0.009). Liraglutide treatment resulted in improved myocardial perfusion, energetics, and 6-minute walk distance in patients with T2D, whereas pioglitazone showed no effect on these parameters (Lean-DM [Targeting Beta-cell Failure in Lean Patients With Type 2 Diabetes]; NCT04657939) [ABSTRACT FROM AUTHOR]

Background: More young people with gender dysphoria (GD) are undergoing hormonal intervention starting with gonadotropin-releasing hormone analogue (GnRHa) treatment. The impact on bone density is not known, with guidelines mentioning that bone mineral density (BMD) should be monitored without suggesting when. This study aimed to examine a cohort of adolescents from a single centre to investigate whether there were any clinically significant changes in BMD and bone mineral apparent density (BMAD) whilst on GnRHa therapy. Methods: A retrospective review of 70 subjects aged 12–14 years, referred to a national centre for the management of GD (2011–2016) who had yearly dual energy X-ray absorptiometry (DXA) scans. BMAD scores were calculated from available data. Two analyses were performed, a complete longitudinal analysis (n=31) where patients had scans over a 2-year treatment period, and a larger cohort over the first treatment year (n=70) to extend the observation of rapid changes in lumbar spine BMD when puberty is blocked. Results: At baseline transboys had lower BMD measures than transgirls. Although there was a significant fall in hip and lumbar spine BMD and lumbar spine BMAD Z-scores, there was no significant change in the absolute values of hip or spine BMD or lumbar spine BMAD after 1 year on GnRHa and a lower fall in BMD/BMAD Z-scores in the longitudinal group in the second year. Conclusions: We suggest that reference ranges may need to be re-defined for this select patient cohort. Long-term BMD recovery studies on sex hormone treatment are needed. [ABSTRACT FROM AUTHOR]

In this article, the authors present multiple interpretations of a transcript of a discussion with a group of Turkish-German girls in a kindergarten in Berlin, Germany. These five-year-old girls make statements suggesting they experience alienation from their non-Turkish classmates and teachers, and the wider German society. The authors argue that the meanings of these statements should not be taken at face value. Instead, they employ interpretive strategies borrowed mostly from Mikhail Bakhtin and interpretive frameworks taken from Judith Butler, and post-colonial theory and Critical Race Theory to suggest that the girls' utterances can be usefully seen as having a performative dimension and as expressing tensions around immigration that can be found in the larger society. [ABSTRACT FROM AUTHOR]

Objectives: To compare the manual dexterity and composure under pressure of people in different hospital staff roles using a buzz wire game., Design: Prospective, observational, comparative study (Tremor study)., Setting: Leeds Teaching Hospitals NHS Trust, Leeds, UK, during a three week period in 2024., Participants: 254 hospital staff members comprising of 60 physicians, 64 surgeons, 69 nurses, and 61 non-clinical staff., Main Outcome Measures: Successful completion of the buzz wire game within five minutes and occurrence of swearing and audible noises of frustration., Results: Of the 254 hospital staff that participated, surgeons had significantly higher success rates in completing the buzz wire game within five minutes (84%, n=54) compared with physicians (57%, n=34), nurses (54%, n=37), and non-clinical staff (51%, n=31) (P<0.001). Time-to-event analysis showed that surgeons were quicker to successfully complete the game, independent of age and gender. Surgeons exhibited the highest rate of swearing during the game (50%, n=32), followed by nurses (30%, n=21), physicians (25%, n=60), and non-clinical staff (23%, n=14) (P=0.004). Non-clinical staff showed the highest use of frustration noises (75%), followed by nurses (68%), surgeons (58%), and physicians (52%) (P=0.03)., Conclusions: Surgeons showed greater dexterity, but higher levels of swearing compared with other hospital staff roles, while nurses and non-clinical staff showed the highest rates of audible noises of frustration. The study highlights the diverse skill sets across hospital staff roles. Implementation of a surgical swear jar initiative should be considered for future fundraising events., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Percutaneous coronary intervention is increasingly guided by coronary physiology and optimized using intravascular imaging. Pressure-based measurements determine the significance of a stenosis using hyperemic or nonhyperemic pressure ratios (eg, the instantaneous wave-free ratio). Intravascular ultrasound and optical coherence tomography provide cross-sectional and longitudinal detail regarding plaque composition and vessel characteristics. These facilitate lesion preparation and optimization of stent sizing and positioning. This review explores the evidence-base and practical aspects of coregistering pressure gradient assessment and intravascular imaging with angiography. We then discuss gaps in the evidence and what is needed to help integrate these techniques into clinical practice., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Arrhythmias are an increasingly common cause of hospital admissions worldwide. Late detection of arrhythmias is associated with a significantly increased risk of cardiovascular complications. Early identification and management of life-threatening arrhythmias is paramount to reduce mortality. Wearable technologies are now widespread among the general population, providing a continuous output of healthcare data. However, this data are not routinely integrated into clinical practice. Here, we begin by outlining the current landscape in wearable technology for aiding arrhythmia detection; we then consider the clinical impact of wearable technology for both clinicians and patients; we further highlight the latest and emerging trials in wearable technology for arrhythmia detection and finally postulate the wider implications of the expansion of such cardiac devices., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)