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Introduction A substantial proportion of patients with inflammatory bowel disease (IBD) on intravenous infliximab require dose intensification. Accessing additional intravenous infliximab is labour-intensive and expensive, depending on insurance and pharmaceutical reimbursement. Observational data suggest that subcutaneous infliximab may offer a convenient and safe alternative to maintain disease remission in patients requiring dose-intensified infliximab. A prospective, controlled trial is required to confirm that subcutaneous infliximab is as effective as dose-intensified intravenous infliximab, to identify predictors of disease flare and to establish the role of subcutaneous infliximab therapeutic drug monitoring.Methods and analysis The DISCUS-IBD trial is an investigator-initiated, prospective, multicentre, randomised, open-label non-inferiority study comparing the rate of disease flares in participants randomised to continue dose-intensified intravenous infliximab to those switched to subcutaneous infliximab after 48 weeks. Participants are adult patients with IBD in sustained corticosteroid-free remission on any regimen of dose-intensified infliximab up to a maximum of 10 mg/kg 4-weekly intravenously. Participants allocated to intravenous infliximab will continue infliximab at the same dose-intensified regimen they were receiving at study enrolment. Subcutaneous infliximab dosing will be stratified by prior intravenous infliximab dosing. Clinical (Harvey-Bradshaw Index, partial Mayo score), biochemical (C reactive protein, faecal calprotectin), pharmacokinetic (drug-level±antidrug antibodies) and qualitative data are collected 12-weekly until study conclusion at week 48. 13 sites across Australia will participate in recruitment to reach a calculated sample size of 120 participants.Ethics and dissemination Multisite ethics approval was obtained from the Health District Human Research Ethics Committee (HREC) at The Alfred Hospital under a National Mutual Acceptance (NMA) agreement (HREC/90559/Alfred-2022; Local Reference: Project 618/22, version 1.6, 2 March 2023). Findings will be reported at national and international gastroenterology meetings and published in peer-reviewed journals. DISCUS-IBD was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR) prior to commencing recruitment.Trial registration number ACTRN12622001458729.

AimThe comparative effectiveness of basal insulins has been examined in several studies. However, current treatment algorithms provide a list of options with no clear differentiation between different basal insulins as the optimal choice for initiation.MethodsA comprehensive search of MEDLINE, Embase, Cochrane Library, ISI, and Scopus, and a reference list of retrieved studies and reviews were performed up to November 2023. We identified phase III randomized controlled trials (RCTs) comparing the efficacy and safety of basal insulin regimens. The primary outcomes evaluated were HbA1c reduction, weight change, and hypoglycemic events. The revised Cochrane ROB-2 tool was used to assess the methodological quality of the included studies. A random-effects frequentist network meta-analysis was used to estimate the pooled weighted mean difference (WMD) and odds ratio (OR) with 95% confidence intervals considering the critical assumptions in the networks. The certainty of the evidence and confidence in the rankings was assessed using the GRADE minimally contextualized approach.ResultsOf 20,817 retrieved studies, 44 RCTs (23,699 participants) were eligible for inclusion in our network meta-analysis. We found no significant difference among various basal insulins (including Neutral Protamine Hagedorn (NPH), ILPS, insulin glargine, detemir, and degludec) in reducing HbA1c. Insulin glargine, 300 U/mL (IGlar-300) was significantly associated with less weight gain (mean difference ranged from 2.9 kg to 4.1 kg) compared to other basal insulins, namely thrice-weekly insulin degludec (IDeg-3TW), insulin degludec, 100 U/mL (IDeg-100), insulin degludec, 200 U/mL (IDeg-200), NPH, and insulin detemir (IDet), but with low to very low certainty regarding most comparisons. IDeg-100, IDeg-200, IDet, and IGlar-300 were associated with significantly lower odds of overall, nocturnal, and severe hypoglycemic events than NPH and insulin lispro protamine (ILPS) (moderate to high certainty evidence). NPH was associated with the highest odds of overall and nocturnal hypoglycemia compared to others. Network meta-analysis models were robust, and findings were consistent in sensitivity analyses.ConclusionThe efficacy of various basal insulin regimens is comparable. However, they have different safety profiles. IGlar-300 may be the best choice when weight gain is a concern. In contrast, IDeg-100, IDeg-200, IDet, and IGlar-300 may be preferred when hypoglycemia is the primary concern.

Kichan Yoon,1 Han-Kyoul Kim,2,3 Mankyu Choi,4,5,* Munjae Lee,6,* Mihajlo Jakovljevic7– 9 1The Institute for Democracy, Seoul, Republic of Korea; 2Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea; 3National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yang-Pyeong, Republic of Korea; 4Department of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea; 5BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea; 6Department of Medical Science, Ajou University School of Medicine, Suwon, Republic of Korea; 7Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St Petersburg, 195251, Russia; 8Institute of Comparative Economic Studies, Hosei University, Tokyo, 194-0298, Japan; 9Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, 34000, Serbia*These authors contributed equally to this workCorrespondence: Munjae Lee, Department of Medical Science, Ajou University School of Medicine, Suwon, Republic of Korea, Email emunjae@ajou.ac.kr Mankyu Choi, Department of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea, Email mkchoi@korea.ac.krPurpose: The purpose of this study lies in verifying the effectiveness of the health promotion project which the public health center at the local level conducted by systematically linking the health examination results from the Health Insurance Corporation. We intend to emphasize the importance of linking the health-related public data.Methods: A survey was conducted to measure the effect of improving health behavior using EQ-5D-5L and demographic variables.Results: As a result of the analysis, the residents (3.13) who had experienced the use of public health centers recognized more necessity for the service linked systematically with health checkup data than those (2.93) who had not. In addition, the residents who had experienced the use of public health centers responded that their chronic diseases had improved compared to a year ago (2.78→ 2.93). Next, those (3.04) who had experienced the services linked with health checkup data recognized that their chronic diseases and health conditions had been improved compared to those (2.81) who had not. However, in EQ-5D-5L, after using the service, mobility showed no difference between those who had used the service and those who had not. Furthermore, even in terms of self-management, daily life, etc., the management ability was further improved compared to those who had not used it, before using the service.Conclusion: This study showed the improved health level when the health promotion service of the public health center was provided by systematically linking the health checkup data of the Health Insurance Corporation in Korea. In order to increase the effectiveness of health data-linked projects, it is necessary to prepare guidelines for linking the public health data and to expand the data-linked project. It will be needed to further subdivide the health checkup results to provide customized services, and to secure dedicated personnel to reinforce the system link.Keywords: subjective quality of life, EQ-5D-5L, regional health institutions, public data-linked services, South Korea

This History of Education Society Presidential Address comes at the society's sixtieth anniversary and provides a new conceptual framework that foregrounds recognizing a "racist-blind," and not a color-blind, ideology in the intentional and unequal design our educational past and present. It highlights systemic racism brought on by the dual pandemic moments of COVID-19 and global racial unrest, with a call to action for educational historians to lead in promoting systemic, institutional changes.

We explore investment efficiency before and after a spin‐off to assess whether post‐spinoff managerial structure helps maintain investment efficiency. Our findings reveal that the investment efficiency of parent firms remains significant when there is a clear separation of management between the parent and spun‐off firms. However, a considerable decline in efficiency is observed after the spin‐off in cases where there is overlapping management. This decrease in efficiency is particularly pronounced when the parent and spun‐off firms operate in different industries and are geographically distant from each other. Furthermore, we show that inefficient alignment of incentives for the overlapped management exacerbates this decline in investment efficiency. [ABSTRACT FROM AUTHOR]

Sewon Park,1,2 Kichan Yoon,3,* Munjae Lee4,5,* 1Research Institute for Future Medicine, Samsung Medical Center, Seoul, 06351, South Korea; 2Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea; 3School of Health Policy & Management, Health Science College, Korea University, Seoul, South Korea; 4Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea; 5Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea*These authors contributed equally to this workCorrespondence: Munjae LeeAjou University School of Medicine, 206, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, South KoreaEmail emunjae@ajou.ac.krPurpose: The importance of Korea’s Healthy City Project has recently increased due to the growth of the elderly population and chronic diseases. Consequently, local governments are expanding the project to manage health at the local level; however, because local government resources are limited, efficient business operation is required. Thus, the purpose of this study is to present a plan for effective project management by developing a strategy for a Healthy City Project that is suitable for the scale of local governments.Methods: For efficiency analysis, data were collected from the homepages of 90 local governments that are implementing the Healthy City Project in Korea, and data envelopment analysis (DEA) was conducted using both the CCR model and the BCC model. The input variables for the DEA included budget, manpower, organization, planned projects, and research education. In addition, we selected program, network, and project performance as output variables.Results: Analysis results indicated that the CCR model identified 22 (out of 90) municipalities in which Healthy City Projects are implemented efficiently, while 68 are inefficient. The BCC model identified many more efficient regions than the CCR model; however, the difference was insignificant. Thus, the budget, manpower, planned projects, and network must be increased to improve efficiency.Conclusion: First, to improve the efficiency of the Healthy City Project, a sufficient budget must be secured during its implementation. Second, long- and short-term plans are needed to expand the Healthy City Program. Third, networks must be created for local governments to benchmark Healthy City Projects.Keywords: Healthy City Project, health policy, healthy city network, efficiency, DEA

This historiography chronicles educators' efforts to teach for diversity through heightening awareness of immigrant experiences as well as discrimination against minoritized religious and racial groups in public school classrooms from the 1920s through the 1970s. This curriculum and pedagogical work was couched under various terms, such as intercultural education, intergroup education, human relations, and cultural pluralism. Drawing from published secondary research literature as well as primary archival sources, we aim to disrupt commonly held views that intercultural education/intergroup education met its demise in the 1950s and show how curriculum and pedagogy shifted after the landmark 1954 ruling of "Brown v. Board of Education" toward improving intergroup relations within the context of school desegregation. In the end we identify common themes across the decades that include the failure to recruit and support a diverse teaching force, the importance of teacher-led curriculum and professional development, and the lack of a sustained focus on race and racism in classroom practices.

Objective To estimate the incidence and HRs for bleeding for different dual antiplatelet therapies (DAPT) in a real-world population with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) in England.Design A retrospective, population-based cohort study emulating a target randomised controlled trial (tRCT).Data sources Linked Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES).Setting Primary and secondary care.Participants Patients ≥18 years old with ACS undergoing emergency PCI.Interventions Aspirin and clopidogrel (AC, reference) versus aspirin and prasugrel (AP) or aspirin and ticagrelor (AT); AP evaluated only in patients with ST-elevation myocardial infarction (STEMI).Main outcome measures Primary: any bleeding up to 12 months after the index event (HES- or CPRD- recorded). Secondary: HES-recorded bleeding, CPRD-recorded bleeding, all-cause and cardiovascular mortality, mortality from bleeding, myocardial infarction, stroke, additional coronary intervention and major adverse cardiovascular and cerebrovascular events (MACCE).Results In ACS, the rates of any bleeding for AC and AT were 89 per 1000 person years and 134 per 1000 person years, respectively. In STEMI, rates for AC, AP and AT were 93 per 1000 person years, 138 per 1000 person years and 143 per 100 person years, respectively. In ACS, compared with AC, AT increased the hazard of any bleeding (HR: 1.47, 95% CI 1.19 to 1.82) but did not reduce MACCE (HR: 1.06, 95% CI 0.89 to 1.27). In STEMI, compared with AC, AP and AT increased the hazard of any bleeding (HR: 1.77, 95% CI 1.21 to 2.59 and HR: 1.50, 95% CI 1.10 to 2.05, respectively) but did not reduce MACCE (HR: 1.10, 95% CI 0.80 to 1.51 and HR: 1.21, 95% CI 0.94 to 1.51, respectively). Non-adherence to the prescribed DAPT regimen was 28% in AC (29% in STEMI only), 31% in AP (STEMI only) and 33% in AT (32% in STEMI only).Conclusions In a real-world population with ACS, DAPT with ticagrelor or prasugrel are associated with increased bleeding compared with DAPT with clopidogrel.Trial registration number ISRCTN76607611.

Abstract Background Cognitive impairment and dementia following cerebrovascular disease are increasingly common in the UK. One potential strategy to prevent post-stroke cognitive decline is multimodal vascular risk factor management. However, its efficacy remains uncertain and its application in vulnerable patients with incident cerebrovascular disease and early cognitive impairment has not been assessed. The primary aim of this study was to assess the feasibility of recruitment and retention of patients with early cognitive impairment post-stroke or transient ischaemic attack (TIA) to a trial of enhanced vascular risk factor management combining primary and secondary care. Methods In this single centre, open label trial adults with a recent stroke or TIA and mild cognitive impairment (MCI) were randomised 1:1 to a three-monthly multimodal vascular risk factor intervention jointly delivered by the trial team and General Practitioner (GP), or control (defined as usual care from the GP). Chosen risk factors were blood pressure (BP), total cholesterol, blood glucose (HbA1C) in those with diabetes, and heart rate and adequacy of anticoagulation in those with atrial fibrillation (AF). Similar patients with normal cognition were enrolled in an embedded observational cohort and also received usual care from the GP. Repeat cognitive screening was undertaken in all participants after 12 months. Results Seventy three participants were recruited to the randomised trial and 94 to the observational cohort (21.8% of those screened). From the randomised trial 35/73 (47.9%) dropped out before final follow-up. In all groups guideline based rates of risk factor control were mostly poor at baseline and did not significantly improve during follow-up. The observational cohort demonstrated greater decline in cognitive test scores at 12 months, with no difference between the randomised groups. Conclusions Recruitment to such a study was feasible, but retention of participants was difficult and generally poor rates of risk factor control suggested insufficient application of the intervention. Consequently, successful scaling up of the trial would require protocol changes with less reliance on primary care services. Any future trial should include participants with normal cognition post-stroke as they may be at greatest risk of cognitive decline. Trial registration ISRCTN, ISRCTN42688361 . Registered 16 April 2015.

Abstract Background Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability. Methods We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990–1993 (N = 7635) and 2008–2011 (N = 7762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score = 3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2–6.3%) of the older population in 1990–93 to 9.9% (9.3–10.7%) in 2008–11, adjusted odds ratio of 1.90 (95% CI 1.67–2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergics in CFAS II (16.5% [95% CI 12.0–22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

Despite calls for research into how critical and social justice themes are taught in HRD programs (Byrd, 2015), the current literature tells us little about how future scholars and practitioners are being prepared to face workplace injustice. Recent curricular research examining published curriculum lists and course descriptions have reported no evidence of critical or social justice approaches to HRD being taught (Lim & Rager, 2015; Lim, Song, Choi, & Kim, 2013; Zachmeier, Cho, & Kim, 2014). This project uses qualitative survey methodology informed by critical race theory to critically interrogate HRD curricula. The purpose of this article is to present findings from a study designed to assess how--or if--social justice perspectives are being taught in HRD graduate programs.

Abstract Background Studies suggest that anticholinergic medication or benzodiazepine use could increase dementia risk. We tested this hypothesis using data from a UK cohort study. Methods We used data from the baseline (Y0), 2-year (Y2) and 10-year (Y10) waves of the Medical Research Council Cognitive Function and Ageing Study. Participants without dementia at Y2 were included (n = 8216). Use of benzodiazepines (including nonbenzodiazepine Z-drugs), anticholinergics with score 3 (ACB3) and anticholinergics with score 1 or 2 (ACB12) according to the Anticholinergic Cognitive Burden scale were coded as ever use (use at Y0 or Y2), recurrent use (Y0 and Y2), new use (Y2, but not Y0) or discontinued use (Y0, but not Y2). The outcome was incident dementia by Y10. Incidence rate ratios (IRR) were estimated using Poisson regression adjusted for potential confounders. Pre-planned subgroup analyses were conducted by age, sex and Y2 Mini-Mental State Examination (MMSE) score. Results Dementia incidence was 9.3% (N = 220 cases) between Y2 and Y10. The adjusted IRRs (95%CI) of developing dementia were 1.06 (0.72, 1.60), 1.28 (0.82, 2.00) and 0.89 (0.68, 1.17) for benzodiazepines, ACB3 and ACB12 ever-users compared with non-users. For recurrent users the respective IRRs were 1.30 (0.79, 2.14), 1.68 (1.00, 2.82) and 0.95 (0.71, 1.28). ACB3 ever-use was associated with dementia among those with Y2 MMSE> 25 (IRR = 2.28 [1.32–3.92]), but not if Y2 MMSE≤25 (IRR = 0.94 [0.51–1.73]). Conclusions Neither benzodiazepines nor ACB12 medications were associated with dementia. Recurrent use of ACB3 anticholinergics was associated with dementia, particularly in those with good baseline cognitive function. The long-term prescribing of anticholinergics should be avoided in older people.