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This study examines the effort of one higher education college in China to see how it secures external funding resources to enhance its educational programs. The college is known for its success in getting external funding in addition to public revenue appropriations. The researchers took a case study approach by first reviewing the current literature to find out what has been done by other universities worldwide to secure external funding. Data in this study were retrieved by reviewing relevant documents in the college files. Additionally, five college administrators were interviewed to solicit their experiences in seeking external funding for the college. The findings of this study disclosed that the college administrators and staff have contributed tremendous effort to secure external resources to help achieve the college goals. The findings were also discussed relating to the current literature and the implications for educational planning.

This article discusses how a new APRS service-learning model was implemented in a new service-learning project in the traditional Chinese medicine (TCM) orthopedics curriculums at three Hong Kong institutions. The APRS model adopting flipped learning approach consists of four cyclic stages, including Application, Practice, Reflection and Self-regulated learning. Qualitative and quantitative findings in this study reveal that TCM students gained confidence in applying discipline knowledge/skills and improved in various areas, including cross-cultural competence, communication, problem-solving and collaboration. Drawing evidence from this study, possible factors contributing to positive impacts on student learning in the APRS model are the "strong connectivity" (including clear alignment with programme, profession, institutional missions and traditional Chinese philosophy "xiushen"), "reinforced motivation" (student autonomy and buy in) and "structured organisation" (strong network among participating parties and use of a centralised electronic platform). The APRS service-learning model is a culture-based approach helping students reconnect Confucian "xiushen" to the discipline knowledge and the real-life application in the Hong Kong context. This model may also be applicable to other Asian contexts where the Confucian culture prevails.

Sub-degree education is one of the key higher education sectors in Hong Kong. With the effect of managerialism, tertiary institutions tend to transition from a collegial toward a managerial model, and have shifted from teaching-intensive institutions to research-intensive ones. In this study, two key research questions are addressed: to what degree can managerialism influence organisational change? To what degree and how will an exogenous force generate organisational development? To answer the research questions, we present a case study at "Hong Kong College" via 15 face-to-face, semi-structured interviews with the administrative staff, academic staff, department head, and a visiting scholar. The key research findings identified the difficulties or obstacles experienced in carrying out research or scholarly activities, the long-term impacts on the workplace of staff and sub-degree institutions changing from teaching to research, the advantages of the staff and institutions regarding their working areas in the process of new research directions, and the driving forces for enriching a research culture in sub-degree institutions. Academic and managerial implications are also provided in the paper.

Researchers in science education lacks valid and reliable instruments to assess students' "disciplinary" and "epistemic" reading of scientific texts. The main purpose of this study was to develop and validate a Reading in Science Holistic Assessment (RISHA) to assess students' holistic reading of scientific texts. RISHA measures students' content, procedural, and epistemic domains of reading two texts, one history-of-science text and another socio-scientific text. The initial 24-item RISHA was administered to 161 Grade 9 students from 3 schools. The multidimensional Rasch partial credit model was used to analyze the reliability and validity of RISHA. All items demonstrated good fit and reliability. According to logit scores generated for each domain in Rasch analysis, students in our study performed better in content domain and less well in the epistemic domain. Students also performed significantly better in the epistemic domain of the socio-scientific text than in the history-of-science text. RISHA provides accurate measures in various domains of reading scientific texts and various contexts of scientific texts. We propose that RISHA could potentially be applied to studying the effect of reading-science intervention or predictors of students' performance in each domain of reading scientific texts.

ChatGPT becomes a prominent tool for students' learning of science when students "read" its scientific texts. Students read to learn about climate change misinformation using ChatGPT, while they develop critical awareness of the content, linguistic features as well as nature of AI and science to comprehend these texts. In this exploratory study, we investigated students' reading performance in comprehending two ChatGPT-generated socio-scientific texts, with one focusing on cognitive-epistemic aspects of climate science and another one focusing on social-institutional aspects of climate science. We theorized such reading of ChatGPT-generated outputs as encompassing the content-interpretation, genre-reasoning and epistemic-evaluation domains. Combining Rasch partial-credit model and qualitative analysis, we explored and investigated how a total of 117 junior secondary students (grades 8 to 9) read such texts. Moreover, we also examined how 55 students' holistic reading of socio-scientific texts on climate change in a ChatGPT scenario changes after a reading-science intervention. Our findings indicate that the content-interpretation was the easiest while the epistemic-evaluation domains were the most difficult. Interestingly, after the reading-science intervention, many students developed their tentative view on nature of science when they evaluated ChatGPT's claims; while a small increase in number of students discussed reliability and non-epistemic nature of AI when they evaluated ChatGPT's claims in relation to climate change. The findings also drive a pedagogical model that improves students' holistic reading of socio-scientific texts generated by ChatGPT.

The purpose of this study is to examine the predictive effects of epistemological beliefs about science and informal reading of scientific texts on students' future-oriented optimism on the issue of climate change. Future-oriented climate change optimism is defined as encompassing "hope" and "anticipation" about the climate future. To identify the relationships among variables, structural equation modelling was conducted on the PISA dataset on 15-year-old students from Denmark, the UK and Finland which have the top three Environmental Protection Index. Students of all three countries demonstrated a consistently low optimism about the future of climate change. Also, the findings indicated that students' epistemological beliefs about science had a significantly negative predicting effect on their future-oriented climate change optimism across all three countries, while their informal reading of scientific texts had a significantly positive predictive effect on their future-oriented climate change optimism in Denmark and the UK. Across all three countries, 15-year-old students' awareness of the issue of climate change plays a significantly negative mediating role between their epistemological beliefs about science and their optimism in the future climate, as well as their informal reading of scientific texts and their optimism in the future climate. This calls for a new curricular environmental-science education model that addresses how students' informal science reading and epistemological beliefs about science can address future-oriented climate change optimism which might in turn impact young people's action competence to address the issues of climate change.

This study examined the developmental process of children's computational thinking using block-based programming tools, specifically algorithmic thinking and debugging skills. With this aim, a group of children (N = 191) from two primary schools were studied for two years beginning from the fourth grade, as they engaged in our block-based programming curriculum in their primary schools. A mixed-methods multiple case study was designed with pre- and posttests, classroom observations and postintervention interviews. The statistical results showed that students' algorithmic thinking and debugging skills significantly increased through our intervention, with girls gaining more on algorithmic thinking. During the students' learning process, we found that they demonstrated behavioral, affective, and cognitive engagement while acquiring these skills in schools. This study presents the key to student engagement contributing to the process of computational thinking development, with implications for the design of future computational learning in primary school.

The home math environment is vital for early math development. Yet, there is limited understanding of how parents translated their attitudes towards helping children learn math (HCLM) into actions to influence their young children's math-related outcomes. Thus, the present study examined whether parents' perceived competence, value, and pressure about HCLM contributed to young children's math competence through parents' interest in HCLM, home math activities, and children's interest in math. One hundred forty-seven parents were surveyed about their attitudes, practices, and their children's math interest. Meanwhile, their children were individually tested on applied math problem solving. Results showed that parents' perceived competence and value about HCLM predicted their interest in HCLM, while parents' pressure about HCLM predicted children's math interest. Parents' interest in HCLM is positively linked to children's applied math problem solving via children's math interest. This study shed light on the importance of promoting parents' positive attitudes towards HCLM.

Mastery motivation predicts achievement, but intricacies amongst preschoolers are unclear. In keeping with the Specificity Principle, school-age, and adolescent research demonstrates the importance of considering the "setting conditions" in which mastery motivation is observed. Here, Singaporean 4-year-olds' (N = 63) mastery-motivation-related behaviour (MMRB) (e.g. signs of persistence, focus, and pleasure) in mathematical and non-mathematical activities were observed. Relations between numeracy and MMRB during a mathematical game (outcome relevant setting) were determined, controlling for MMRB in other activities (outcome irrelevant settings). Association between MMRB during the mathematical game and receptive language (outcome irrelevant setting) was also examined. Consistent with the Specificity Principle, MMRB during the mathematical game was (i) associated with numeracy, after controlling for MMRB in other activities and (ii) did not predict language. Enhancing preschoolers' experiences, especially when implemented in contexts related to areas targeted for improvement, may benefit outcomes. These skills acquired in early life can become important predictors of future ability.

Background: Parents' high academic expectations are positively associated with young children's mathematical abilities. However, minimal attention has been devoted to whether, and how, different ways of conveying the performance targets would result in different outcomes. Aims: The current study investigated whether and how parents' perfectionistic strivings and concerns were associated with young children's mathematical abilities through home mathematical activities, children's approach motivation to learn mathematics, and children's avoidance motivation to learn mathematics. Sample: Participants included 211 kindergarteners in Hong Kong and their parents. Methods: Data were collected through individual child tests and parent questionnaires. Results: Structural equation modelling revealed that parents' perfectionistic strivings had a direct positive link with children's mathematical abilities, an indirect link via approach motivation to learn mathematics, and an indirect link via home mathematical activities, and then approach motivation. Parents' perfectionistic concerns had a direct negative link with children's mathematical abilities, an indirect link via approach motivation to learn mathematics, and an indirect link via avoidance motivation to learn mathematics. Conclusions: Early childhood practitioners are recommended to raise parents' awareness of how to communicate high-performance targets to children in a constructive manner.

Enhancers, critical regulatory elements within the human genome, are often transcribed into enhancer RNAs. The dysregulation of enhancers leads to diseases collectively termed enhanceropathies. While it is known that enhancers play a role in diseases by regulating gene expression, the specific mechanisms by which individual enhancers cause diseases are not well understood. Studies of individual enhancers are needed to fill this gap. This study delves into the role of APOE-activating noncoding RNA, AANCR, in the central nervous system, elucidating its function as a genetic modifier in Alzheimers Disease. We employed RNA interference, RNaseH-mediated degradation, and single-molecule RNA fluorescence in situ hybridization to demonstrate that mere transcription of AANCR is insufficient; rather, its transcripts are crucial for promoting APOE expression. Our findings revealed that AANCR is induced by ATM-mediated ERK phosphorylation and subsequent AP-1 transcription factor activation. Once activated, AANCR enhances APOE expression, which in turn imparts an inflammatory phenotype to astrocytes. These findings demonstrate that AANCR is a key enhancer RNA in some cell types within the nervous system, pivotal for regulating APOE expression and influencing inflammatory responses, underscoring its potential as a therapeutic target in neurodegenerative diseases.

STUDY DESIGN: Multicenter, international prospective study. OBJECTIVE: This study investigated the clinical outcome up to 2 years after multi-level spinal deformity surgery in the elderly by reporting the minimal clinically important difference (MCID) of EuroQol 5-dimensions (EQ-5D), EQ-VAS, and residential status. METHODS: As an ancillary study of 219 patients ≥60 years with spinal deformity undergoing primary instrumented fusion surgery of ≥5 levels, this study focuses on EQ-5D (3-L) as the primary outcome and EQ-VAS and residential status as secondary outcomes. Data on EQ-5D were compared between pre-operatively and postoperatively at 10 weeks, 12 months, and 24 months. An anchor-based approach was used to calculate the MCID. RESULTS: The EQ-5D index and EQ-VAS, respectively, improved significantly at each time point compared to pre-operatively (from .53 (SD .21) and 55.6 (SD 23.0) pre-operatively to .64 (SD .18) and 65.8 (SD 18.7) at 10 weeks, .74 (SD .18) and 72.7 (SD 18.1) at 12 months, and .73 (SD .20) and 70.4 (SD 20.4) at 24 months). 217 (99.1%) patients lived at home pre-operatively, while 186 (88.6%), 184 (98.4%), and 172 (100%) did so at 10 weeks, 12 months, and 24 months, respectively. Our calculated MCID for the EQ-5D index at 1 year was .22 (95% CI .15-.29). CONCLUSIONS: The EQ-5D index significantly increased at each time point over 24 months after ≥5 level spinal deformity surgery in elderly patients. The MCID of the EQ-5D-3 L was .22. Patients living at home pre-operatively can expect to be able to live at home 2 years postoperatively.

It remains a challenge to produce soft robots that can mimic the responsive adaptability of living organisms. Rather than fabricating soft robots from bulk hydrogels,hydrogels are integrated into the interfacial assembly of aqueous two-phase systems to generate ultra-soft and elastic all-aqueous aquabots that exhibit responsive adaptability, that can shrink on demand and have electrically conductive functions. The adaptive functions of the aquabots provide a new platform to develop minimally invasive surgical devices, targeted drug delivery systems, and flexible electronic sensors and actuators.

The process model of vocational identity was well applied in various Western countries to study the vocational identity process and statuses of college students. However, such research is limited in Hong Kong. Moreover, the relation between vocational identity development and academic performance was inconclusive in the literature, and it was also not tested among Hong Kong students. In light of these, the current study aimed to empirically identify and validate vocational identity statuses among a sample of 576 sub-degree students in Hong Kong using the vocational identity process model. Relations of vocational identity processes and statuses with perceived academic performance were also tested. Six vocational identity statuses were empirically derived in the Hong Kong Chinese context. Vocational identity statuses also differentiate perceived academic performance. Moreover, we found that career flexibility and self-doubt were significantly related to perceived academic performance. Implications of the results for theory and practice are discussed.

This paper reports on a qualitative study which investigated a group of student teachers' emotions in their second language (L2) learning experiences, with particular attention to the mediating role of language ideologies. The findings revealed that the participants reported both positive emotions (enjoyment and pride) and negative emotions (anxiety, frustration and embarrassment) in their L2 learning experiences. In particular, these different emotions were found to be mediated by multiple and sometimes conflicting language ideologies, including the ideology of native-speakerism, the World Englishes ideology and the ideology of language as a tool for communication. The findings also showed that the different emotions evoked in the participants' L2 learning experiences not only impacted on their identities as L2 learners and L2 users/communicators in divergent ways, but also shaped their goals and agentive efforts in their subsequent L2 learning. Overall, the analysis points to the complex, dynamic and reciprocal relationship between emotions, language ideologies, identities and agency in understanding the affective dimension of L2 learning in a more holistic manner. It also calls attention to the potential of incorporating reflections on L2 learning experiences in student teachers' professional development programmes in order to enhance their emotional awareness for L2 learning and teaching.

The era of information and communication technology (ICT) has popularized adolescents' digital reading activities in their daily lives. Most prior studies focused on identifying significant factors that foster digital reading performance. Although educational quality is of great concern, it is crucial to consider the issue of educational equity in the digital world. Our study aims to unfold the mediating roles of ICT-related psychological needs between economic, social, and cultural status (ESCS) and digital reading performance. A multilevel mediation analysis was adopted for 36,490 students from six high-performing Asian regions participating in the Programme for International Student Assessment (PISA). The results indicated that perceived ICT autonomy significantly mediated the relationship in most Asian regions, while perceived ICT competence yielded mixed roles. Interestingly, the suppression effects were detected between ESCS, ICT in social interaction, and digital reading. Our research findings offer fresh insights into narrowing the digital divide in the online reading environment for adolescents.

Although services are critical for many transition-aged youth, it is unclear the extent to which autistic youth participate in decisions about their services. By exploring the perceptions of autistic youth about their role in services, interventions can be developed to improve their participation. In this study, we interviewed 43 transition-aged youth with autism to explore their involvement in decisions about services. Most youth reported not being involved in decision making about the types and modalities of disability services. When youth were involved in decisions, the services were often related to education. Although youth reported that their parents typically spearheaded decisions about services, youth also reported that their parents often listened to their input. Implications for research, policy, and practice are discussed.

Parents of individuals with autism face many challenges in accessing appropriate services and supports for their offspring. Parents also play vital roles in advocating for their offspring's rights and needs. Furthermore, despite advocacy programs becoming increasingly common, it remains unclear how to best foster advocacy among parents of individuals with autism. To this end, we examined the associations among knowledge, empowerment, and three types of advocacy activities (i.e. individual, peer, and systemic) among 185 parents of transition-aged youth with autism using structural equation modeling. Results show that empowerment has a greater impact on advocacy than knowledge. Significant direct and indirect effects of individual advocacy activities on peer advocacy activities, and peer advocacy activities on systemic advocacy activities were also confirmed. Implications for research and practice are discussed.

Going down a slide, dancing to music, and pushing someone on a tire swing are more than simply "play activities" or a means to staying physically fit. Engagement in motor play provides important opportunities for preschoolers to develop a variety of skills, including gross motor, social, communication, and cognitive skills. However, during the past several years, since the identification of the COVID-19 virus, no guidelines have been available to ensure that gross motor content is addressed while simultaneously meeting the educational needs of preschoolers with and without disabilities during virtual learning. The purpose of this study was to understand the benefits and challenges that 26 preschool teachers faced as they attempted to embed motor play into their curriculum during virtual learning. All teachers worked in inclusive preschool settings and interviews were conducted between March-June 2021. Constant comparative analysis and emergent coding were used to interpret the data. Findings revealed that school readiness skills were the primary focus of virtual learning. Teachers indicated that motor play can help expand students' pre-academic skills, be fun and motivating for children, and help students be more focused and attentive. Some logistical barriers (e.g., technology, limited physical spaces, limited resources) need to be addressed in order to successfully teach motor play in a virtual format. Study findings suggest policies and guidelines need to be established to provide young children with high quality and accessible virtual instruction. Implications for research and practice are discussed.

This study examined mothers' tendency to base their self-esteem on their children's accomplishments (i.e., child-based worth) and its potential implications for their parenting practices. Child-based worth was assessed in three domains of development: virtue, academic competence, and physical appearance. Participants were 302 mothers (age range: 21-69) of early to middle adolescents (age range: 10-17; 59% girls) in the United States. Mothers completed a survey about their child-based self-worth and use of autonomy-supportive and controlling practices. Results showed that mothers of adolescents tended to base their self-worth on children's academic competence to a greater extent, compared to virtue and physical appearance. Child-based worth in virtue and physical appearance were associated with heightened psychological control, after adjusting for covariates. In addition, mothers who based their self-worth on their children's physical appearance tended to show dampened autonomy support. Findings suggest that the implications of mothers' child-based worth for their parenting practices may vary depending on the domain of children's development.

The benefits of using digital storytelling are well documented in the literature. Whether and how these advantages can be extended to digital story-writing, especially for young learners, remains underexplored. Recent advancement in technology has the potential of streamlining the stages of planning and revising in a process approach to second language writing. The present study examined how English teachers in two Hong Kong primary schools adopted a process approach to teach digital story-writing. They planned eight writing lessons for 10 Primary 3-4 classes. Students were taught to use Google Slides to write their stories on iPads and complete a recording in small groups, which were then published on an online platform. Findings from focus-group interviews, lesson observations and student writings revealed that students were highly engaged in the lessons, and their writings also had fewer grammatical mistakes. However, they rarely engaged in meaningful dialogues during group work, whilst some teachers also expressed concerns about time constraints and their own readiness to use digital story-writing, which may hinder successful implementation of this innovative approach in classroom settings. Implications of how digital story-writing can be effectively deployed on young learners are discussed.

Background Study: Previous systematic reviews concluded that online professional-learning communities (OPLCs) have positive effects on teachers' development, but explored neither the technological affordances that make this possible nor the potential negative impacts of technology use in OPLCs. Objectives: The aim of this study is to systematically analyse previous research on teachers' OPLCs, and thus help answer the question of what technological affordances (dis)empower members of teachers' OPLCs, and how they do so. Methods: This study applied the systematic-review method. A total of 28 studies were identified and analysed using rigorously defined inclusion and exclusion criteria. The results are reported as a synthesis. Results and Conclusions: First, in theme, the selected articles primarily focused on features of OPLCs and of teachers' knowledge. Second, mixed-methods approaches were commonly used in the sampled research, and the number of studies employing advanced statistical methods and machine learning increased over time. And third, the reviewed studies' findings suggest that technology supports 'bottom-up' teachers' communities (as distinct from 'top-down' professional development organized by educational authorities) in seven ways: that is, by promoting collaboration opportunities, expanding the participants' networks, facilitating knowledge sharing, delivering support more rapidly, providing emotional support, allowing ubiquitous learning, and enabling multiple modes of participation.

Services are important for many individuals with autism to achieve meaningful post-school outcomes. To understand how to improve service access, it is important to measure services in ways that capture whether an individual's needs are truly being met. Yet, most measures of service access are simplistic, without fully taking into account the vast heterogeneity among those on the autism spectrum. In this manuscript, we highlight the key issues, challenges, and considerations in measuring service access. We provide ways a service access measure can address some of these issues while also suggesting further ways to improve the measurement of services. We conclude with implications for research, policy, and practice.

Peers can play an invaluable role in helping a student to learn, and peer support is a means to help collaborative students learn well in teams. Students who communicate well with peers understand multiple points of view, and peer support allows students to achieve a shared goal. In higher education, a student can enroll on an undergraduate program directly after completing high school/secondary school or as a transfer student after finishing an associate degree/a higher diploma. Compared to direct-entry students, transfer students are believed to have more psychological issues and receive less peer support because they spend less time in university. However, there is a lack of studies to investigate the factors affecting peer support among direct-entry and transfer students in higher education. This article is aimed at addressing this research gap. The online questionnaire survey was conducted in 2018 with 1,819 responses. Through regression analysis, the results indicated that teaching for understanding & encouraging learning, alignment & constructive feedback, deep & organized approach, social connections, and heard of English learning centre are related to peer support. In addition, self-efficacy, generic skills, and general support & advising may help to explain the differences between direct-entry and transfer students. Despite the two different admission pathways, the majority of the explanatory variables of peer support are common and the whole learning experience influences students' perception on peer support. This study suggests strategies and resource allocation to cope with their differences so as to encourage peer support in universities.

OBJECTIVES: Childhood cancer survivors may experience complex health issues during transition and long-term follow-up (LTFU); therefore, high-quality healthcare is warranted. Care coordination is one of the essential concepts in advanced healthcare. Care coordination models vary among childhood cancer survivors in transition and LTFU. This study aimed to identify care coordination models for childhood cancer survivors in transition and LTFU and synthesise essential components of the models. DESIGN: This scoping review was guided by the methodological framework from Arksey and OMalley and was reported with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic literature search was conducted on six databases using possible combinations of terms relevant to childhood cancer survivors, transition/LTFU and care coordination model. Data were analysed by descriptive and content analysis. DATA SOURCES: The literature search was first conducted in May 2023 and updated in May 2024. Six databases including Medline, PubMed, Embase, Web of Science, CINAHL and Cochrane Library were searched; meanwhile, a hand search was also conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies relevant to describing any models, interventions or strategies about care coordination of transition or LTFU healthcare services among childhood cancer survivors were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened and included studies. Basic information as well as care coordination model-related data in the included studies were extracted. Descriptive summary and content analysis were used for data analysis. RESULTS: In the 20 545 citations generated by the search strategy, seven studies were identified. The critical determinants of the models in the included studies were the collaboration of the multidisciplinary team, integration of the navigator role and the provision of patient-centred, family-involved, needs-oriented clinical services. The main functions of the models included risk screening and management, primary care-based services, psychosocial support, health education and counselling, and financial assistance. Models of care coordination were evaluated at patient and clinical levels. Based on this review, core concepts of successful care coordination models for childhood cancer survivors in transition or LTFU were synthesised and proposed as the 3 I framework: individualisation, interaction and integration. CONCLUSION: This scoping review summarised core elements of care coordination models for childhood cancer survivors transition and LTFU. A proposed conceptual framework to support and guide the development of care coordination strategies for childhood cancer survivors transition and LTFU care was developed. Future research is needed to test the proposed model and develop appropriate care coordination strategies for providing high-quality healthcare for childhood cancer survivors transition and LTFU.

STUDY DESIGN: Clinical case series. OBJECTIVE: To describe the cause, treatment and outcome of 6 cases of perioperative spinal cord injury (SCI) in high-risk adult deformity surgery. SETTING: Adult spinal deformity patients were enrolled in the multi-center Scoli-RISK-1 cohort study. METHODS: A total of 272 patients who underwent complex adult deformity surgery were enrolled in the prospective, multi-center Scoli-RISK-1 cohort study. Clinical follow up data were available up to a maximum of 2 years after index surgery. Cases of perioperative SCI were identified and an extensive case review was performed. RESULTS: Six individuals with SCI were identified from the Scoli-RISK-1 database (2.2%). Two cases occurred intraoperatively and four cases occurred postoperatively. The first case was an incomplete SCI due to a direct intraoperative insult and was treated postoperatively with Riluzole. The second SCI case was caused by a compression injury due to overcorrection of the deformity. Three cases of incomplete SCI occurred; one case of postoperative hematoma, one case of proximal junctional kyphosis (PJK) and one case of adjacent segment disc herniation. All cases of post-operative incomplete SCI were managed with revision decompression and resulted in excellent clinical recovery. One case of incomplete SCI resulted from infection and PJK. The patients treatment was complicated by a delay in revision and the patient suffered persistent neurological deficits up to six weeks following the onset of SCI. CONCLUSION: Despite the low incidence in high-risk adult deformity surgeries, perioperative SCI can result in devastating consequences. Thus, appropriate postoperative care, follow up and timely management of SCI are essential.

Recent studies indicate that Generative Pre-trained Transformer 4 with Vision (GPT-4V) outperforms human physicians in medical challenge tasks. However, these evaluations primarily focused on the accuracy of multi-choice questions alone. Our study extends the current scope by conducting a comprehensive analysis of GPT-4Vs rationales of image comprehension, recall of medical knowledge, and step-by-step multimodal reasoning when solving New England Journal of Medicine (NEJM) Image Challenges-an imaging quiz designed to test the knowledge and diagnostic capabilities of medical professionals. Evaluation results confirmed that GPT-4V performs comparatively to human physicians regarding multi-choice accuracy (81.6% vs. 77.8%). GPT-4V also performs well in cases where physicians incorrectly answer, with over 78% accuracy. However, we discovered that GPT-4V frequently presents flawed rationales in cases where it makes the correct final choices (35.5%), most prominent in image comprehension (27.2%). Regardless of GPT-4Vs high accuracy in multi-choice questions, our findings emphasize the necessity for further in-depth evaluations of its rationales before integrating such multimodal AI models into clinical workflows.

Multiple myeloma is characterized by frequent clinical relapses after conventional therapy. Recently, chimeric antigen receptor (CAR) T cells targeting B-cell maturation antigen (BCMA) has been established as a treatment option for patients with relapsed or refractory disease. However, although >70% of patients initially respond to this treatment, clinical relapse and disease progression occur in most cases. Recent studies showed persistent expression of BCMA at the time of relapse, indicating that immune-intrinsic mechanisms may contribute to this resistance. Although there were no preexisting T-cell features associated with clinical outcomes, we found that patients with a durable response to CAR T-cell treatment had greater persistence of their CAR T cells than patients with transient clinical responses. They also possessed a significantly higher proportion of CD8+ T-effector memory cells. In contrast, patients with short-lived responses to treatment have increased frequencies of cytotoxic CD4+ CAR T cells. These cells expand in vivo early after infusion but express exhaustion markers (hepatitis A virus cellular receptor 2 [HAVCR2] and T-cell immunoglobulin and mucin domain-containing-3 [TIGIT]) and remain polyclonal. Finally, we demonstrate that nonclassical monocytes are enriched in the myeloma niche and may induce CAR T-cell dysfunction through mechanisms that include transforming growth factor β. These findings shed new light on the role of cytotoxic CD4+ T cells in disease progression after CAR T-cell therapy.

BACKGROUND: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. METHODS: This study was conducted over two stages (January 2022-July 2023). The first phase involved a survey to MASCC-MSG members (January 2022-May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023-May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. FINDINGS: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). INTERPRETATION: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. FUNDING: No funding was received.

Antibodies are critical tools for research into extracellular vesicles (EVs) and other extracellular nanoparticles (ENPs), where they can be used for their identification, characterization, and isolation. However, the lack of a centralized antibody platform where researchers can share validation results thus minimizing wasted personnel time and reagents, has been a significant obstacle. Moreover, because the performance of antibodies varies among assay types and conditions, detailed information on assay variables and protocols is also of value. To facilitate sharing of results on antibodies that are relevant to EV/ENP research, the EV Antibody Database has been developed by the investigators of the Extracellular RNA Communication Consortium (ERCC). Hosted by the ExRNA Portal (https://exrna.org/resources/evabdb/), this interactive database aggregates and shares results from antibodies that have been tested by research groups in the EV/ENP field. Currently, the EV Antibody Database includes modules for antibodies tested for western Blot, EV Flow Cytometry, and EV Sandwich Assays, and holds 110 records contributed by 6 laboratories from the ERCC. Detailed information on antibody sources, assay conditions, and results is provided, including negative results. We encourage ongoing expert input and community feedback to enhance the databases utility, making it a valuable resource for comprehensive validation data on antibodies and protocols in EV biology.

The efficacy of supervised deep learning in medical image analyses, particularly in pathology, is hindered by the necessity for extensive manual annotations. Annotating images at the gigapixel level manually proves to be a highly labor-intensive and time-consuming task. Semi-supervised learning (SSL) has emerged as a promising approach that leverages unlabeled data to reduce labeling efforts. In this work, we introduce Semi-Path, a practical SSL framework enhanced with active learning (AL) for gigapixel pathology tasks. Unlike existing methods that treat SSL and AL as independent components where AL incurs significant computational complexity to SSL, we propose a deep fusion of SSL and AL into a unified framework. Our framework introduces Informative Active Annotation (IAA) that employs a SSL-AL iterative structure to effectively extract knowledge from unlabeled pathology data. This structure significantly minimizes labeling efforts and computational complexity. Then, we propose Adaptive Pseudo-Labeling (APL) to address heterogeneity in class distribution, and prediction difficulty that are often observed in real-world pathology tasks. We evaluate Semi-Path on pathology image classification and segmentation tasks over three datasets that include WSIs from breast, colorectal, and brain tissues. The experimental results demonstrate the consistent superiority of Semi-Path over state-of-the-art methods.