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Abstract Background Delirium is a common and reversible neurobehavioral condition with significant morbidity and mortality ramifications for older patients. Consequentially, clear guidelines exist pertaining to its swift identification and management. However, studies suggest that adherence to these guidelines are poor. This audit aimed to evaluate compliance to the National Institute for Health and Care Excellence’s (NICE) delirium guidelines in an Acute Senior Health Unit (ASHU) and to present a single centre experience of a low-cost ward-based intervention for improving delirium guideline adherence. Methods A retrospective observational audit was conducted on patients admitted to ASHU between 01/07/2023 and 30/07/2023. Data on delirium assessments, diagnoses and causes of delirium were obtained through retrospective database searches. Posters and education based multidisciplinary team (MDT) interventions were designed and initiated following grounded thematic literature analysis and ward discussion. A methodically equivalent audit was then conducted between 01/09/2023 and 30/09/23. Data was anonymised and blinded and analysis was performed on SPSS V12.0. Results A total of 128 patients were included in the study. Initial audit revealed suboptimal compliance with NICE recommendations. Chi-square test of independence found that patients were statistically more likely to receive a full delirium assessment (1.9% vs. 56.6%, p = 0.001) and formal diagnosis (5.8% vs. 27.6%, p = 0.002) after the ward-based intervention. Conclusion This study provides limited evidence in favour of low-cost MDT based interventions for improving adherence to NICE delirium guidelines and provides a 5-step framework for future studies. This study also explores the potential patient implications of these interventions. A repeat audit should be conducted to ensure lasting and sustainable change is achieved. Trial registration/clinical trial number AUDI003614.

Using stakeholder theory, this article introduces a framework to inform decision making with respect to the regulation of on-premise signs. Because signage resides in a broader, shared environment and its regulation largely takes place at the local level of government, it can be considered unique among most other marketing-related communications. On-premise signs are important to individual businesses and the communities in which they are used, but at the same time, they are “out in the world,” cannot be avoided, and may not be relevant to or welcomed by many consumers who are exposed to them. A transformative consumer research lens is applied in this article to arrive at regulatory recommendations that balance the interests of the business with the interests of consumers, the general public, and other stakeholders.

Abstract In the first part of this paper, I want to look at the ethical implications of Hartmut Rosa’s Resonance theory for a critical theory of society. I know that this widening of the scope of critical theory is an important objective which Hartmut has pursued. Then I will look at some of the sources of resonance theory in the poetry of the Romantic period. These still provide the basis for important Resonanzachsen today. At the end of this essay, I deal with the issue of the epistemic status of the convictions this poetry inspires.

This work is a translation of the first chapter from Charles Taylor's book “Modern Social Imaginaries”. The author focuses on the hypothesis that we will be able to shed the light on both initial and contemporary contradictions in the understanding of modernity, if we take into account that modernity is inextricably linked with a certain kind of social imaginary. Distinctions between multiple modernities should be as well understood in terms of social imaginaries involved. Central to Western modernity is a new conception of the social moral order. Initially formed in the minds of several influential intellectuals, this concept later started to shape social imagination of different social groups, and then of societies. Nowadays the modern moral order has become so self-evident to us that it is difficult to consider it as just one of the possible concepts. One of the results of this order dominating over other conceptions in our social imaginary was the emergence of certain social forms that characterize the essence of Western modernity: a market economy, the public sphere, self-government, etc.

Abstract Introduction: The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) has long affected millions of individuals across the globe. Historically, the prevalence of this disease is particularly noted within the African continent. Before the coronavirus disease 2019 (COVID‐19) pandemic, many African countries struggled to effectively manage the increasing burden associated with HIV/AIDS. There is now a need to reassess this in a COVID‐19 pandemic context so that the impact of COVID‐19 on HIV/AIDS healthcare within Africa can be adequately evaluated. Methods: Data collection was performed on the PubMed, Ovid MEDLINE and Embase bibliographical databases with a predefined search strategy. Searches were performed in blind duplicate and all articles considering COVID‐19 and HIV/AIDS within African healthcare were considered. Results: The COVID‐19 pandemic has severely exacerbated the many issues surrounding HIV/AIDS care within many African countries. These impacts are noticeable in medical, psychological, and socio‐political contexts. Conclusions: Before efforts are made to improve the provision of HIV/AIDS and COVID‐19 care within Africa, it is important that this issue is brought to the attention of the scientific and clinical community so that the continent can receive the necessary support and aid.

Aims: Examine: (1) If length of symptoms (LS) of children with osteosarcoma has improved in the last 15 years (2) Is delay in diagnosis related to the presence of metastases at presentation? (3) The impact of delay in diagnosis on prognosis. Methods: 250 consecutive patients with a diagnosis of osteosarcoma of bone treated at a national bone tumor treatment center between 2004 and 2018 were studied retrospectively. Three groups comprising those diagnosed over a five-year period (Group 1: 2004–2008, Group 2: 2009–2013; Group 3: 2014–2018) were studied. Results: There were 126 males and 124 females with a mean age 12.2 years. The median LS for all patients was eight weeks. The median LS for Group 3 was significantly shorter than that for other groups. Development of metastasis during follow-up period was significantly less in Group 3 compared to the other groups. Overall survival gradually improved over the whole study period. There was no difference in the proportion presenting with metastases at diagnosis between the three groups. The survival rates in patients with LS shorter than 4 weeks was better than those with LS longer than 4 weeks, irrespective of the study time period. Conclusions: There has been an improvement in the LS in patients diagnosed with osteosarcoma over the last 15 years. The development of metastasis during follow-up has reduced and the overall survival in the last 15 years has improved. LS longer than 4 weeks is associated with a poorer prognosis.

Neuroanatomy is a notoriously challenging subject for medical students to learn. Due to the coronavirus disease-19 (COVID-19) pandemic, anatomical education transitioned to an online format. We assessed student performance in, and attitudes toward, an online neuroanatomy assessment compared to an in-person equivalent, as a marker of the efficacy of remote neuroanatomy education. Participants in the National Undergraduate Neuroanatomy Competition (NUNC) 2021 undertook two online examinations: a neuroanatomically themed multiple-choice question paper and anatomy spotter. Students completed pre- and post-examination questionnaires to gauge their attitudes toward the online competition and prior experience of online anatomical teaching/assessment. To evaluate performance, we compared scores of students who sat the online (2021) and in-person (2017) examinations, using 12 identical neuroradiology questions present in both years. Forty-six percent of NUNC 2021 participants had taken an online anatomy examination in the previous 12 months, but this did not impact examination performance significantly (p > 0.05). There was no significant difference in examination scores between in-person and online examinations using the 12 neuroradiology questions (p = 0.69). Fifty percent of participants found the online format less enjoyable, with 63% citing significantly fewer networking opportunities. The online competition was less stressful for 55% of participants. This study provides some evidence to suggest that student performance is not affected when undertaking online examinations and proposes that online neuroanatomy teaching methods, particularly for neuroradiology, may be equally as effective as in-person approaches within this context. Participants perceived online examinations as less stressful but raised concerns surrounding the networking potential and enjoyment of online events.

Cerenkov Emission (CE) during external beam radiation therapy (EBRT) from a linear accelerator (Linac) has been demonstrated as a useful tool for radiotherapy quality assurance and potentially other applications for online tracking of tumors during treatment delivery. However, some of the current challenges that are impacting the potential of CE are related to the limited detection sensitivity and the lack of flexible tools to fit into an already complex treatment delivery environment. Silicon photomultiplier (SiPM) solid-state devices are new promising tools for low light detection due to their extreme sensitivity that mirrors photomultiplier tubes and yet have a form factor that is similar to silicon photodiodes, allowing for improved flexibility in device design that may help in the process of wider clinical applicability. In this paper, we assess the feasibility of using SiPMs to detect CE during EBRT from a Linac and contrast their performance with commercially available silicon photodiodes (PDs). We demonstrate the feasibility of the SiPM-based probes for standard dosimetry measurements. We also demonstrate that CE optical signals can be detected from tissue depths about five times greater than that for standard probes based on PDs, making our SiPM probe an enabling technology of CE measurements, particularly for deep tissue applications.

Cytokines elicit pleiotropic and non-redundant activities despite strong overlap in their usage of receptors, JAKs and STATs molecules. We use IL-6 and IL-27 to ask how two cytokines activating the same signaling pathway have different biological roles. We found that IL-27 induces more sustained STAT1 phosphorylation than IL-6, with the two cytokines inducing comparable levels of STAT3 phosphorylation. Mathematical and statistical modeling of IL-6 and IL-27 signaling identified STAT3 binding to GP130, and STAT1 binding to IL-27Rα, as the main dynamical processes contributing to sustained pSTAT1 levels by IL-27. Mutation of Tyr613 on IL-27Rα decreased IL-27-induced STAT1 phosphorylation by 80% but had limited effect on STAT3 phosphorgylation. Strong receptor/STAT coupling by IL-27 initiated a unique gene expression program, which required sustained STAT1 phosphorylation and IRF1 expression and was enriched in classical Interferon Stimulated Genes. Interestingly, the STAT/receptor coupling exhibited by IL-6/IL-27 was altered in patients with systemic lupus erythematosus (SLE). IL-6/IL-27 induced a more potent STAT1 activation in SLE patients than in healthy controls, which correlated with higher STAT1 expression in these patients. Partial inhibition of JAK activation by sub-saturating doses of Tofacitinib specifically lowered the levels of STAT1 activation by IL-6. Our data show that receptor and STATs concentrations critically contribute to shape cytokine responses and generate functional pleiotropy in health and disease.

Introduction The previously published SYNTAX III REVOLUTION trial demonstrated that clinical decision-making between coronary artery bypass graft (CABG) and percutaneous coronary intervention based on coronary CT angiography (CCTA) had a very high agreement with the treatment decision derived from invasive coronary angiography (ICA). The study objective of the FASTTRACK CABG is to assess the feasibility of CCTA and fractional flow reserve derived from CTA (FFRCT) to replace ICA as a surgical guidance method for planning and execution of CABG in patients with three-vessel disease with or without left main disease.Methods and analysis The FASTTRACK CABG is an investigator-initiated single-arm, multicentre, prospective, proof-of-concept and first-in-man study with feasibility and safety analysis. Surgical revascularisation strategy and treatment planning will be solely based on CCTA and FFRCT without knowledge of the anatomy defined by ICA. Clinical follow-up visit including CCTA will be performed 30 days after CABG in order to assess graft patency and adequacy of the revascularisation with respect to the surgical planning based on non-invasive imaging (CCTA) with functional assessment (FFRCT) and compared with ICA. Primary feasibility endpoint is CABG planning and execution solely based on CCTA and FFRCT in 114 patients. Primary safety endpoint based on 30 day CCTA is graft assessment and topographical adequacy of the revascularisation procedure. Automatic non-invasive assessment of functional coronary anatomy complexity is also evaluated with FFRCT for functional Synergy Between percutaneous coronary intervention With Taxus and Cardiac Surgery Score assessment on CCTA. CCTA with FFRCT might provide better anatomical and functional analysis of the coronary circulation leading to appropriate anatomical and functional revascularisation, and thereby contributing to a better outcome.Ethics and dissemination Each patient has to provide written informed consent as approved by the ethical committee of the respective clinical site. Results will be submitted for publication in peer-reviewed journals and will be disseminated at scientific conferences.Trial registration number NCT04142021.

Online anatomical resources are rising in popularity since the COVID-19 pandemic, but the pedagogical principles and effectiveness of their use remain unclear. This article aims to demonstrate evidence-informed ways in which fellow educators can create engaging online learning resources in clinical neuroanatomy and compare the effectiveness of text-based and online learning resources. Data were analyzed from the Soton Brain Hub (SBH) YouTube page. Separately, a cross-sectional study comparing the learning gain of using text-based and video resources was done. The knowledge gain and retention were compared between groups using a pre-teaching and post-teaching multiple choice questions. YouTube analytics showed the average time a viewer spends on a video was found to be highly correlated to the length of the video, r = 0.77, p < 0.001 (0.69-0.82). The cross-sectional study indicated a significant difference in mean normalized learning gain of video resources 61.9% (n = 53, CI 56.0-67.7%) versus text resources 49.6% (n = 23, CI 39.1-60.1%) (p = 0.030). However, there was no difference in retained learning gain between video resources 39.1% (n = 29, CI 29.2-49.0%) versus text-based 40.0% (n = 13, CI 23.9-56.1%) (p = 0.919). Students engage most with short videos less than 5 min which reduces the intrinsic load of learning. Online resources are as effective as text-based resources in providing learning gain and retention. In the future, the continued rise in popularity of online learning resources may result in further reduction in traditional face-to-face teaching.

Receiving, accommodation and education of children with immigrant background is one of the challenging issues in almost all the metropolitan areas in many countries. In our study we are exploring the impact of demographic changes on political agendas, legal frames, educational approaches, research findings and student achievement in the field of education of linguistic minorities in Oslo, Norway and Los Angeles, USA. Although there are significant historical and socio economical differences between Los Angeles and Oslo, many of the educational challenges facing the educational policy makers and the linguistic minority students are quite similar.

Receiving, accommodation and education of children with immigrant background is one of the challenging issues in almost all the metropolitan areas in many countries. In our study we are exploring the impact of demographic changes on political agendas, legal frames, educational approaches, research findings and student achievement in the field of education of linguistic minorities in Los Angeles, USA and Oslo, Norway. Although there are significant historical and socio economical differences between Los Angeles and Oslo, many of the educational challenges facing the educational policy makers and the linguistic minority students are quite similar.

Harnessing knowledge on the physical and natural conditions that affect our health, general livelihood and sustainability has long been at the core of scientific research. Health risks of ionising radiation from exposure to radon and radon decay products in homes, work and other public places entail developing novel approaches to modelling occurrence of the gas and its decaying products, in order to cope with the physical and natural dynamics in human habitats. Various data modelling approaches and techniques have been developed and applied to identify potential relationships among individual local meteorological parameters with a potential impact on radon concentrations—i.e., temperature, barometric pressure and relative humidity. In this first research work on radon concentrations in the State of Qatar, we present a combination of exploratory, visualisation and algorithmic estimation methods to try and understand the radon variations in and around the city of Doha. Data were obtained from the Central Radiation Laboratories (CRL) in Doha, gathered from 36 passive radon detectors deployed in various schools, residential and work places in and around Doha as well as from one active radon detector located at the CRL. Our key findings show high variations mainly attributable to technical variations in data gathering, as the equipment and devices appear to heavily influence the levels of radon detected. A parameter maximisation method applied to simulate data with similar behaviour to the data from the passive detectors in four of the neighbourhoods appears appropriate for estimating parameters in cases of data limitation. Data from the active detector exhibit interesting seasonal variations—with data clustering exhibiting two clearly separable groups, with passive and active detectors exhibiting a huge disagreement in readings. These patterns highlight challenges related to detection methods—in particular ensuring that deployed detectors and calculations of radon concentrations are adapted to local conditions. The study doesn’t dwell much on building materials and makes rather fundamental assumptions, including an equal exhalation rate of radon from the soil across neighbourhoods, based on Doha’s homogeneous underlying geological formation. The study also highlights potential extensions into the broader category of pollutants such as hydrocarbon, air particulate carbon monoxide and nitrogen dioxide at specific time periods of the year and particularly how they may tie in with global health institutions’ requirements.

Hay dos maneras de interpretar la Modernidad; a través de un enfoque cultural o a través de una enfoque acultural. La explicación acultural de la Modernidad conlleva considerar que diferentes espacios gegráficos afrontan un mismo tipo de cambio histórico. Al contrario una visión cultural subraya la existencia de modernidades múltiples construidas a través de procesos históricos distintos.

In 2013, Governor Jerry Brown and the California legislature radically restructured the state’s school funding system and accountability systems with a weighted student formula and a mandated local planning process in each district. The new law substitutes local politics and grassroots agency for state-driven mandates and compliance reviews. While the Local Control Funding Formula has had immediate impact, early evaluations suggest that districts like the new system and are earnest in their implementation efforts, but it will take years to assess the effect of the multi-indicator Local Control Accountability Plans. Simultaneously, the state is implementing the Common Core State Standards and the associated Smarter Balanced Assessment Consortium tests, which make creating local accountability plans more complicated.

Se presenta una comparación de los resultados obtenidos al usar 2 métodos de segmentación de imagen en lesiones ateroscleróticas de la aorta torácica; uno supervisado y el otro no supervisado. La segmentación se empleó con preprocesamiento y sin preprocesamiento. Se presentan las ventajas que origina este tipo de procedimiento en la discriminación de las diferentes lesiones, a saber: estrías adiposas, placas fibrosas, placas complicadas y placas calcificadas. Se constata que en todos los casos los algoritmos no supervisados fueron superiores a los supervisados.A comparison of the results obtained on using 2 image segmentation methods in arteriosclerotic lesions of the thoracic aorta is presented. One of these methods was supervised and the other wasn't. The segmentation was used with preprocessing and without preprocessing. The advantages of this type of procedure for the discrimination of different lesions, such as adipoid striae, fibrous plates, complicated plates, and calcified plates, are explained. It is shown that in every case the non-supervised algorithms were high than those supervised.

In 2013, Governor Jerry Brown and the California legislature radically restructured the state's school funding system and accountability systems with a weighted student formula and a mandated local planning process in each district. The new law substitutes local politics and grassroots agency for state-driven mandates and compliance reviews. While the Local Control Funding Formula has had immediate impact, early evaluations suggest that districts like the new system and are earnest in their implementation efforts, but it will take years to assess the effect of the multi-indicator Local Control Accountability Plans. Simultaneously, the state is implementing the Common Core State Standards and the associated Smarter Balanced

Receiving, accommodation and education of children with immigrant background is one of the challenging issues in almost all the metropolitan areas in many countries. In our study we are exploring the impact of demographic changes on political agendas, legal frames, educational approaches, research findings and student achievement in the field of education of linguistic minorities in Oslo, Norway and Los Angeles, USA. Although there are significant historical and socio economical differences between Los Angeles and Oslo, many of the educational challenges facing the educational policy makers and the linguistic minority students are quite similar.

Receiving, accommodation and education of children with immigrant background is one of the challenging issues in almost all the metropolitan areas in many countries. In our study we are exploring the impact of demographic changes on political agendas, legal frames, educational approaches, research findings and student achievement in the field of education of linguistic minorities in Los Angeles, USA and Oslo, Norway. Although there are significant historical and socio economical differences between Los Angeles and Oslo, many of the educational challenges facing the educational policy makers and the linguistic minority students are quite similar.