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Purpose: This study aims to answer the following questions: (1) Why have attempts to transplant Western vocational education models failed? (2) Is there anything we can learn from the experiences of Eastern Asian countries when developing their own vocational education models? Design/Approach/Methods: This study reviews the history of transplanting Western skill formation schemes into developing countries, an often-failed die-hard practice supported by both bilateral and multilateral donors. Findings: Our findings suggest that developing countries should design their technical and vocational education and training systems based on their unique cultural, sociological, and economic contexts. It offers two alternative pathways based on the experiences of the People's Republic of China and the Republic of Korea. Originality/Value: These East Asian examples could broaden the perspectives of policymakers in developing countries aspiring to develop functional skill formation schemes.

Tutors in higher education are receiving and responding to student disclosures that include racism, anxiety, loneliness, legal disputes, family upheavals, physical, emotional, and mental health, bereavement, legal battles, and harassment. In many cases, this caring aspect of the tutor role is not acknowledged, allocated time in job descriptions, or accurately remunerated. This qualitative study explored how tutors experienced and managed student disclosures, the personal and professional impact of responding to disclosures, and how tutors believed they could be better supported. Data was collected from two cohorts of participants tutoring at a University in Aotearoa New Zealand. Using interviews and questionnaires and analysed by reflexive thematic analysis. Our findings showed that our participants believed they were positioned vulnerably between a rock and a hard place. At the rock, tutors were told to follow university guidelines and refer distressed students to over-loaded course coordinators or over-subscribed support services. At the hard place, tutors were often the first to be disclosed to, because of their front-facing positioning at the university and once they had heard the disclosure felt it was unethical not to try and help. Tutors believed they could assist students with personal challenges if their precarious positioning within the university was protected and strengthened and if appropriate support was provided by their university through training, time, and remuneration. Findings have implications for higher education providers to reconsider how tutors are supported to support students.

Abstract Background Physician burnout is rising, especially among academic physicians facing pressures to increase their clinical workload, lead administrative tasks and committees, and be active in research. There is a concern this could have downstream effects on learners’ experiences and academic physician’s ability to teach learners on the team. Methods A 29-question RedCap survey was electronically distributed to 54 attending physicians within an academic learning health system who oversaw the General Medicine inpatient teaching services during the 2022–2023 academic year. The aims were to assess this cohort of attending physicians’ experiences, attitudes, and perceptions on their ability to effectively teach learners on the team, feeling valued, contributors to work-life balance and symptoms of burnout, Fisher’s Exact Tests were used for data analysis. Results Response rate was 56%. Attendings splitting time 50% inpatient / 50% outpatient felt that team size and type of admissions model affected their ability to effectively teach learners (p = 0.022 and p = 0.049). Attendings with protected administrative time felt that non-patient care obligations affected their ability to effectively teach the learners (p = 0.019). Male attendings and attendings with ≤ 5 years of General Medicine inpatient teaching experience felt less valued by residency leadership (p = 0.019 and p = 0.026). 80% of attendings experienced emotional exhaustion, and those with > 10 weeks on a General Medicine inpatient teaching service were more likely to experience emotional exhaustion (p = 0.041). Attendings with > 10 weeks on a General Medicine inpatient teaching service and those who were a primary caregiver were more likely to experience depersonalization (p = 0.012 and p = 0.031). 57% of attendings had reduced personal achievement. Conclusions Institutions should seek an individual and organizational approach to professional fulfillment. Special attention to these certain groups is warranted to understand how they can be better supported. Further research, such as with focus groups, is needed to address these challenges.

Emuella Flood,1 Susan McCutcheon,2 Kathleen Beusterien,3 deMauri S Mackie,3 Stella Mokiou,1 Xavier Guillaume,3 Emily Mulvihill3 1Patient Centered Science, AstraZeneca, Gaithersburg, MD, USA; 2Global Medical Affairs, AstraZeneca, Cambridge, UK; 3Health Division, Cerner Enviza, an Oracle Company, Kansas City, MO, USACorrespondence: Emily Mulvihill, Health Division, Cerner Enviza, an Oracle Company, 2800 Rock Creek Parkway, Kansas, MO, USA, Tel +1 314-724-9386, Email emily.mulvihill@cernerenviza.comPurpose: Patients with early breast cancer (eBC) are increasingly provided with different options, which may involve a sequence of different treatments and treatment modalities, and eligibility for certain adjuvant treatments depending upon pre-surgical and surgical outcomes. This study examined patient preferences around aspects of treatment decision-making in eBC.Patients and Methods: A total of 452 patients with self-reported eBC in Germany (n=151), Italy (n=151), and Japan (n=150) completed an online survey about physician interactions and treatment side effects. The survey included best-worst scaling (BWS) to assess prioritization of 13 statements reflecting aspects of treatment decision-making. In a series of choice tasks, participants chose their most and least preferred options among subsets of 4 statements. Hierarchical Bayesian modeling was used to estimate BWS preference scores for each statement. BWS scores were based on the number of times a statement was chosen as most versus least preferred; scores total 100 for each patient.Results: The most preferred aspects of treatment decision-making were “treatment aggressiveness matches personal risk” (mean BWS score = 13.49), “being told about what is coming” (13.18), deciding based on “own surgical outcome” (11.90), “avoiding unnecessary treatment” (10.35), and “involving in treatment decisions” (9.44). The least preferred aspects were “not being asked about treatment decisions along the way” (3.27) and “receiving the same treatment as other patients” (3.41). Patients in Japan preferred “being told about what is coming”, “deciding based on own surgical outcome”, “avoiding unnecessary treatment”, and being “involved in decisions” more than patients in Italy and Germany. Patients in Germany were more satisfied with their physician interactions and care, although their outcomes were not always better than those in Italy and Japan.Conclusion: Patients value individualized treatment tailored to their risk of recurrence and tolerance of side effects, highlighting the need for focused patient education about options, to encourage their engagement.Plain Language Summary: New treatment pathways based on promising biomarkers are being studied in early breast cancer. This study aimed to understand the importance that patients may place on different features describing how decisions are made along potential treatment pathways for early breast cancer. Participants in Italy, Germany, and Japan were asked to compare various aspects of treatment decision-making and choose those that were most and least important to them. Among the aspects tested, the top 4 were similar across countries: the desire to receive treatment with a level of aggressiveness that matches their individual prognosis, the need to receive adequate and timely information about their upcoming treatment, the need to tailor treatment decisions based on their individual surgery outcomes, and a desire to avoid overtreatment. Not being involved in treatment decisions was the least preferred of the aspects. Patients in Germany and Italy most valued the ability to tailor the aggressiveness of their treatment based on their individual risk of recurrence, whereas patients in Japan prioritized being knowledgeable and prepared for their treatment journey. The results from this study emphasize patients’ desire to be adequately informed about available treatment choices for early breast cancer, to avoid unnecessary treatments, and to be involved in treatment decisions. Keywords: breast cancer, patient perspective, patient priorities, shared decision-making, patient satisfaction

Abstract Objective Describe the screening, referral, and treatment delivery associated with an opt-out tobacco treatment program (TTP) implemented in six hospitals varying in size, rurality and patient populations. Methods Between March 6, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to six hospitals affiliated with the Medical University of South Carolina were screened for smoking status. The hospitals ranged in size from 82 to 715 beds. Those currently smoking were automatically referred to one of two tobacco treatment options: 1) Enhanced care (EC) where patients could receive a bedside consult by a trained tobacco treatment specialist plus an automated post-discharge follow-up call designed to connect those smoking to the South Carolina Quitline (SCQL); or 2) Basic care (BC) consisting of the post-discharge follow-up call only. An attempt was made to survey patients at 6-weeks after hospitalization to assess smoking status. Results Smoking prevalence ranged from 14 to 49% across the six hospitals; 6,000 patients were referred to the TTP.The delivery of the bedside consult varied across the hospitals with the lowest in the Charleston hospitals which had the highest caseload of referred patients per specialist. Among patients who received a consult visit during their hospitalization, 50% accepted the consult, 8% opted out, 3% claimed not to be current smokers, and 38% were unavailable at the time of the consult visit. Most of those enrolled in the TTP were long-term daily smokers.Forty-three percent of patients eligible for the automated post-discharge follow-up call answered the call, of those, 61% reported smoking in the past seven days, and of those, 34% accepted the referral to theSCQL. Among the 986 of patients surveyed at 6-weeks after hospitalization quit rates ranged from 20%-30% based on duration of reported cessation and were similar between hospitals and for patients assigned to EC versus BC intervention groups. Conclusion Findings demonstrate the broad reach of an opt-out TTP. Elements of treatment delivery can be improved by addressing patient-to-staffing ratios, improving systems to prescribe stop smoking medications for patients at discharge and linking patients to stop smoking services after hospital discharge.

IntroductionNarrowed tracheal lumen diameter (TLD) in dogs caused by congenital hypoplasia or acquired tracheal stenosis can result in adverse health effects. Standardized tracheal scores calculated from radiographic measurements have been used to assess tracheal diameter however comparisons have not been made to characterize differences in tracheal lumen among breeds.MethodsThe main objective of this study was to compare tracheal scores at three regions of the trachea among non-brachycephalic dogs, non-bulldog brachycephalic dogs, and bulldogs. Medical records and thoracic radiographs of clinically normal dogs were reviewed. The TLDs 79 of three different tracheal regions (caudal cervical, thoracic inlet, and intrathoracic) were standardized by the manubrium length (ML) and thoracic inlet distance (Ti-D) to calculate the manubrium and thoracic inlet tracheal indexes (M-TI and Ti-TI) at each region. Statistical analysis was used to analyze the differences in tracheal scores among the three breed populations.ResultsOverall, M-TI and Ti-TI varied significantly (p

Despite the functional impact of cognitive deficit in people with psychosis, objective cognitive assessment is not typically part of routine clinical care. This is partly due to the length of traditional assessments and the need for a highly trained administrator. Brief, automated computerised assessments could help to address this issue. We present data from an evaluation of PsyCog, a computerised, non-verbal, mini battery of cognitive tests. Healthy Control (HC) (N = 135), Clinical High Risk (CHR) (N = 233), and First Episode Psychosis (FEP) (N = 301) participants from a multi-centre prospective study were assessed at baseline, 6 months, and 12 months. PsyCog was used to assess cognitive performance at baseline and at up to two follow-up timepoints. Mean total testing time was 35.95 min (SD = 2.87). Relative to HCs, effect sizes of performance impairments were medium to large in FEP patients (composite score G = 1.21, subtest range = 0.52–0.88) and small to medium in CHR patients (composite score G = 0.59, subtest range = 0.18–0.49). Site effects were minimal, and test-retest reliability of the PsyCog composite was good (ICC = 0.82–0.89), though some practice effects and differences in data completion between groups were found. The present implementation of PsyCog shows it to be a useful tool for assessing cognitive function in people with psychosis. Computerised cognitive assessments have the potential to facilitate the evaluation of cognition in psychosis in both research and in clinical care, though caution should still be taken in terms of implementation and study design.

Abstract With improvements in survival for patients with metastatic cancer, long-term local control of brain metastases has become an increasingly important clinical priority. While consensus guidelines recommend surgery followed by stereotactic radiosurgery (SRS) for lesions >3 cm, smaller lesions (≤3 cm) treated with SRS alone elicit variable responses. To determine factors influencing this variable response to SRS, we analyzed outcomes of brain metastases ≤3 cm diameter in patients with no prior systemic therapy treated with frame-based single-fraction SRS. Following SRS, 259 out of 1733 (15%) treated lesions demonstrated MRI findings concerning for local treatment failure (LTF), of which 202 /1733 (12%) demonstrated LTF and 54/1733 (3%) had an adverse radiation effect. Multivariate analysis demonstrated tumor size (>1.5 cm) and melanoma histology were associated with higher LTF rates. Our results demonstrate that brain metastases ≤3 cm are not uniformly responsive to SRS and suggest that prospective studies to evaluate the effect of SRS alone or in combination with surgery on brain metastases ≤3 cm matched by tumor size and histology are warranted. These studies will help establish multi-disciplinary treatment guidelines that improve local control while minimizing radiation necrosis during treatment of brain metastasis ≤3 cm.

Abstract Background A large body of evidence suggests that some people have a strong, obsessive attachment to a favorite celebrity. The absorption-addiction model attempts to account for this extreme attachment, sometimes labeled “celebrity worship.” According to the model, a small portion of celebrity admirers (“celebrity worshipers”) become absorbed in the personal lives of celebrities to compensate for perceived personal or social deficiencies. The purpose of this study is to examine how the absorption-addiction model relates to broader psychological theories that include non-celebrity contexts. Specifically, we examine how the absorption-addiction model relates to three theories: empty-self theory, extremism theory, and the dualistic model of passion. Methods Participants (N = 399; 77.94% women, M age = 19.91 years, SD = 3.24) completed an online questionnaire measuring attraction to favorite celebrities. Constructs representing the three broader theories were compared to a measure of attraction to one’s favorite celebrity. Results Sense of emptiness, obsessive passion, and extremism were positively associated with celebrity attraction. The strongest association was found with extremism, though the effect was moderate. Conclusions These findings suggest that extremism theory is the best fit of the three broader theories explaining celebrity worship, although its contribution to understanding celebrity worship is modest.

The objective was to identify the firms’ short-run and long-run strategies that contributed to firms’ development, job creation and economic growth of local economies, and employees’ and customers’ satisfaction across all Butler’s stages of development. The results indicate that the firms have been successful supporting environmental sustainability, conservation of natural resources, and protection of cultural elements of local communities. During the Covid-19 shutdown, the female entrepreneurs assessed past strategies, invested in development and production of new and better-quality products and services, advanced employees’ and entrepreneurial skills, and transformation of digital and production infrastructure. The study identified the importance of government policies critical for entrepreneurship success, particularly during global crises. The paper illustrates several lessons focused specifically on fostering a supportive work environment that enables firms to endure through and successfully recover from market shocks or global crises. The study concludes that all female entrepreneurs were experienced, motivated, visionary, goal-oriented, and innovative regarding their entrepreneurial undertakings while focusing on understanding the needs and maximizing employee and customer satisfaction. The resiliency they developed enabled them to stay focused on their goals and maintain successful operations while facing insufficient financial and non-financial support, market challenges, and global crises.

The media's adherence to “if it bleeds, it leads” has resulted in global dominance of negative news (e.g., stories of corruption, fraud, shootings, terrorism, and war). The appetite for negative news is fueled by negativity bias, which compels people to prioritize negative over positive stories. This cross-cultural study, inspired by media effect theories such as Cultivation Theory, explored the links between problematic consumption of negative news (doomscrolling), existential anxiety, pessimistic views about human nature, and belief about a just world in two distinct cultures. Participants included convenience samples of Iranian (n = 620) and American (n = 180) university-student social media users. Doomscrolling was associated with elevated levels of existential anxiety in both samples. Additionally, misanthropy was positively associated with doomscrolling only in the Iranian sample. Aligned with the Media-induced PTSD Hypothesis and the Shattered Assumption Theory, our findings suggest that prolonged exposure to negative news can contribute to the development of existential anxiety. Current news framing with its overemphasis on negativity could fuel doomscrolling-inspired existential concerns.

Aims While dopamine antagonists are an effective treatment for positive psychotic symptoms, they are rarely effective when it comes to treating the cognitive (memory, learning, planning, etc.) and negative (avolition and social withdrawal) symptoms of the disorder. Furthermore, for a sizeable proportion, standard dopamine antagonists are not effective for positive symptoms either. As such, refractory symptoms are a major burden for patients, carers, and clinical services. Methods To address this, The TUNE-UP (Treating Unmet Needs in Psychiatry) clinic in Oxford was established in September 2023 as an innovative solution aiming to: (A) Undertake an in-depth assessment of cognitive, negative, and positive symptoms; (B) Identify potentially modifiable causative factors contributing to refractory symptoms (e.g., cholinergic burden, sleep disturbances, physical comorbidities, affective symptoms); and (C) Implement management plans including community clozapine initiation where appropriate. We have analysed data from the clinic's initial five months of operation to establish a baseline understanding of our patient population and identify trends in symptoms. Results In the first five months of operations, 21 referrals were accepted comprising 80.9% males (mean age 43.3 years, SD 13.7). 3 were referred for cognitive symptoms, 1 for negative and cognitive symptoms, 11 for positive symptoms, 3 for medication optimisation, and 3 for clozapine re-titration. Of those fully assessed (N = 17), mean total symptom scores measured using the Positive and Negative Syndrome Scale (PANSS) were of mild/moderate severity (70.5, SD 18.4). Objective cognitive testing via the Screen for Cognitive Impairment in Psychiatry (SCIP) demonstrated a total mean score of 54.1 (SD 12.1), markedly below what would be expected in a matched control population (76.3). Cognitive scores were lower in those of older age (r = −0.62, p = 0.01). Subjective experience of cognitive impairment was measured using the Subjective Scale to Investigate Cognition in Schizophrenia, poor subjective cognition was associated with more severe negative symptoms (r = 0.57, p = 0.03), but not objective SCIP results (r = 0.12, p = 0.85). Conclusion Refractory positive symptoms remain a priority for clinicians, but cognitive and negative symptoms are highly prevalent reinforcing the need for a comprehensive approach. Routine structured assessment of all symptom domains is feasible in clinical practice. Future work should examine the longitudinal impact of various interventions on different symptom domains.

Summary: Astrocyte endfeet enwrap brain vasculature, forming a boundary for perivascular glymphatic flow of fluid and solutes along and across the astrocyte endfeet into the brain parenchyma. We evaluated astrocyte sensitivity to shear stress generated by such flow, finding a set point for downstream calcium signaling that is below about 0.1 dyn/cm2. This set point is modulated by albumin levels encountered in cerebrospinal fluid (CSF) under normal conditions and following a blood-brain barrier breach or immune response. The astrocyte mechanosome responsible for the detection of shear stress includes sphingosine-1-phosphate (S1P)-mediated sensitization of the mechanosensor Piezo1. Fluid flow through perivascular channels delimited by vessel wall and astrocyte endfeet thus generates sufficient shear stress to activate astrocytes, thereby potentially controlling vasomotion and parenchymal perfusion. Moreover, S1P receptor signaling establishes a set point for Piezo1 activation that is finely tuned to coincide with CSF albumin levels and to the low shear forces resulting from glymphatic flow.

Abstract Background Frailty is a complex condition that primary care providers (PCPs) are managing in increasing numbers, yet there is no clear guidance or training for frailty care. Objectives The present study examined eConsult questions PCPs asked specialists about patients with frailty, the specialists’ responses, and the impact of eConsult on the care of these patients. Design Cross-sectional observational study. Setting ChamplainBASE™ eConsult located in Eastern Ontario, Canada. Participants Sixty one eConsult cases closed by PCPs in 2019 that use the terms “frail” or “frailty” to describe patients 65 years of age or older. Measurements The Taxonomy of Generic Clinical Questions (TGCQ) was used to classify PCP questions and the International Classification for Primary Care 3 (ICPC-3) was used to classify the clinical content of each eConsult. The impact of eConsult on patient care was measured by PCP responses to a mandatory survey. Results PCPs most frequently directed their questions to cardiology (n = 7; 11%), gastroenterology (n = 7; 11%), and endocrinology (n = 6; 10%). Specialist answers most often pertained to medications (n = 63, 46%), recommendations for clinical investigation (n = 24, 17%), and diagnoses (n = 22, 16%). Specialist responses resulted in PCPs avoiding referral in 57% (n = 35) of cases whereas referrals were still required in 15% (n = 9) of cases. Specialists responded to eConsults in a median 1.11 days (IQR = 0.3–4.7), and 95% (n = 58) of cases received a response within 7 days. Specialists recorded a median of 15 min to respond (IQR = 10–20), with a median cost of $50.00 CAD (IQR = 33.33 – 66.66) per eConsult. Conclusions Through the analysis of questions and responses submitted to eConsult, this study provides novel information on PCP knowledge gaps and approaches to care for patients living with frailty. Furthermore, these analyses provide evidence that eConsult is a feasible and valuable tool for improving care for patients with frailty in primary care settings.

Abstract Palmitic acid (PAM) can be provided in the diet or synthesized via de novo lipogenesis (DNL), primarily, from glucose. Preclinical work on the origin of brain PAM during development is scarce and contrasts results in adults. In this work, we use naturally occurring carbon isotope ratios (13C/12C; δ13C) to uncover the origin of brain PAM at postnatal days 0, 10, 21 and 35, and RNA sequencing to identify the pathways involved in maintaining brain PAM, at day 35, in mice fed diets with low, medium, and high PAM from birth. Here we show that DNL from dietary sugars maintains the majority of brain PAM during development and is augmented in mice fed low PAM. Importantly, the upregulation of hepatic DNL genes, in response to low PAM at day 35, demonstrates the presence of a compensatory mechanism to maintain total brain PAM pools compared to the liver; suggesting the importance of brain PAM regulation.

Abstract Neurocognitive deficits are a core feature of psychotic disorders, but it is unclear whether they affect all individuals uniformly. The aim of this systematic review and meta-analysis was to synthesize the evidence on the magnitude, progression, and variability of neurocognitive functioning in individuals with first-episode psychosis (FEP). A multistep literature search was conducted in several databases up to November 1, 2022. Original studies reporting on neurocognitive functioning in FEP were included. The researchers extracted the data and clustered the neurocognitive tasks according to the seven Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains and six additional domains. Random-effect model meta-analyses, assessment of publication biases and study quality, and meta-regressions were conducted. The primary effect size reported was Hedges g of (1) neurocognitive functioning in individuals at FEP measuring differences with healthy control (HC) individuals or (2) evolution of neurocognitive impairment across study follow-up intervals. Of 30,384 studies screened, 54 were included, comprising 3,925 FEP individuals and 1,285 HC individuals. Variability analyses indicated greater variability in FEP compared to HC at baseline and follow-up. We found better neurocognitive performance in the HC group at baseline and follow-up but no differences in longitudinal neurocognitive changes between groups. Across the 13 domains, individuals with FEP showed improvement from baseline in all studied domains, except for visual memory. Metaregressions showed some differences in several of the studied domains. The findings suggest that individuals with FEP have marked cognitive impairment, but there is greater variability in cognitive functioning in patients than in HC. This suggests that subgroups of individuals suffer severe disease-related cognitive impairments, whereas others may be much less affected. While these impairments seem stable in the medium term, certain indicators may suggest potential further decline in the long term for a specific subgroup of individuals, although more research is needed to clarify this. Overall, this study highlights the need for tailored neurocognitive interventions for individuals with FEP based on their specific deficits and progression.

Through a series of conversations, Fintan McCutcheon and Joanna Haynes explore McCutcheon's reflections on school leadership in the contexts of the Educate Together movement (in the Republic of Ireland) and, specifically, in his aspiration to build an optimally democratic school in Balbriggan. Much of the academic and professional literature on school leadership depicts the role of school leaders as expressing a strong vision for the school, with charismatic communication and strategic skills, and putting explicit emphasis on high educational standards. On the ground, the school leader is required to maintain executive governance standards, is accountable to a range of hierarchies and audiences and is in a custodian role to traditions of school culture and human resource relationships. Taken together, these academic, professional and contractual obligations can corral the school leader into practice of limited scope, obstructed by protocol, risk-averse and curtailed in creativity and, in relation to developing a democratic school, lacking in the necessary room for innovation. The conversation focuses on the rough ground of incident and messiness, identified through critical moments of school life when the aspirations to be democratic, to lead democratically, to teach democracy and to create a sustaining democratic school culture are lived-out. Through this dialogue, the conversants observe a practice of school leadership grounded in practical reason. The dialogue touches on and threads congruence between the on-the-ground risk-taking, rule-breaking, action orientation, nuanced dialogue, passionate engagement and deep reflection that characterise day-to-day school leadership practice. It concludes with ideas concerning the dynamics of forms of democracy that can prevail.