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This mixed-methods study examined 220 teachers' responses from a new instrument, the Imagination, Creativity, and Innovation (ICI) Index. ICI Index scores represented teachers' predictions of how students would rate their school's support for student creativity, which was assumed to represent the teachers' perspective of the actual support for student creativity at the school. Teachers of grades 6-8 (n = 55) had significantly lower ICI Index scores than teachers of grades 3-5 (n = 155; p = 0.03, g = 0.35). Regular classroom teachers (n = 151) did not differ significantly from gifted and talented teachers (n = 49) on their ICI scores (p = 0.065). Qualitative analysis found that, when asked to give examples of products, performances, and services produced by students that were points of pride, most teachers discussed their own creative teaching practices rather than student-initiated projects. Most major content areas were represented, and many responses were interdisciplinary. The most common audience was the school community. Time, including scheduled special periods, was commonly discussed as a support for creativity. Teachers with high ICI Index scores usually wrote about how the school community collaborated to provide creative opportunities to all students, whereas teachers with low ICI Index scores reported that support for student creativity was absent or limited to specific groups.

In response to economic distress, schools are increasingly serving as providers and distributors of social service resources. However, even when schools offer resources that respond to needs, they struggle to attain high levels of uptake. We examine the family-level correlates of participation in school-sponsored resources during the early months of the COVID-19 pandemic and find that uptake increases with economic need. In addition, net of need, families who report maintaining communication with parents of their children's classmates take up more resources; and take-up of key meal and digital technology resources is associated with higher levels of take-up of other resources. These findings contribute to efforts to reposition schools as social service hubs by highlighting promising practices to improve resource uptake.

Academic disciplines and professional fields need to engage in ongoing evaluation of their purposes and conceptual frameworks. The complex field of gifted education can benefit from such evaluations, and the refinements that can emerge from them. This article is a discussion between two of the most prominent scholars in the field. The discussion is based on a set of questions that cover much of the field's conceptual and practical territory. While answering the questions, the scholars also respond to each other. They address a wide range of phenomena in the field, including concerns pertaining to identification of the gifted, program development, instructional goals and processes, underrepresentation and other social justice issues, and the need for expansion of ethical awareness, among other topics. The discussion also is framed with some interdisciplinary concepts.

Accurate identification of prostate cancer Gleason grade group remains an important component of the initial management of clinically localized disease. However, Gleason score upgrading (GSU) from biopsy to radical prostatectomy can occur in up to a third of patients treated with surgery. Concern for disease undergrading remains a source of diagnostic uncertainty, contributing to both over-treatment of low-risk disease as well as under-treatment of higher-risk prostate cancer. This review examines the published literature concerning risk factors for GSU from time of biopsy to prostatectomy final pathology. Risk factors identified for Gleason upgrading include patient demographic and clinical factors including age, body mass index, race, prostate volume, and biomarker based assays, including prostate-specific antigen (PSA) density, and testosterone values. In addition, prostate magnetic resonance imaging (MRI) findings have also been associated with GSU. Biopsy-specific characteristics associated with GSU include lower number of biopsy cores and lack of targeted methodology, and possibly increasing percent biopsy core positivity. Recognition of risk factors for disease undergrading may prompt confirmatory testing including repeat sampling or imaging. Continued refinements in imaging guided biopsy techniques may also reduce sampling error contributing to undergrading.

Background: Transarterial chemoembolisation (TACE) and radioembolisation (TARE) can lead to the deterioration of liver function, especially in cases of a high tumour burden, potentially lessening the benefits of subsequent systemic treatments. We aimed to verify whether a high number of previous transarterial treatments modified the outcomes of patients who received sorafenib as a frontline systemic treatment. Methods: A retrospective analysis of a large multicenter dataset containing prospectively collected data of sorafenib-treated patients was conducted. Results: Data from 696 patients were analysed, with 139 patients having received >two transarterial procedures before starting sorafenib. A propensity score matched 139 identified pairs of patients. Having received >two locoregional treatments was independently associated with a shorter survival (hazard ratio 1.325, 95% confidence interval 1.018–1.725, p = 0.039). This pattern was confirmed amongst responders to sorafenib, but not in progressors. A trend toward a higher rate of the permanent discontinuation of sorafenib due to liver failure (18.7 vs. 10.8%, p = 0.089) and a lower rate of eligibility for second-line treatments (24.5 vs. 17.3%, p = 0.184) was observed in patients who had received >two transarterial procedures. Conclusions: Repeated endovascular treatments negatively impacted the survival of HCC patients, especially sorafenib-responders. An early switch to systemic therapies should be considered in cases that are unlikely to respond.

Introduction: Although the clinical benefits of pelvic lymph node dissection (PLND) at the time of radical prostatectomy for prostate cancer remain uncertain, major guidelines recommend PLND based on risk profile. Thus, the objective of this study was to examine the association between PLND and survival among patients undergoing RP stratified by Gleason grade group (GG) with the aim of allowing patients and physicians to make more informed care decisions about the potential risks and benefits of PLND. Materials and methods: From the SEER-17 database, we examined overall (OS) and prostate cancer-specific (PCSS) survival of prostate cancer patients who underwent RP from 2010 to 2015 stratified by GG. We applied propensity score matching to balance pre-operative characteristics including race, age, PSA, household income, and housing status (urban/rural) between patients who did and did not undergo PLND for each GG. Statistical analyses included log-rank test and Kaplan-Meier curves. Results: We extracted a matched cohort from 80,287 patients with GG1-5 who underwent RP. The median PSA value was 6.0 ng/mL, and the median age was 62-years-old. 49,453 patients underwent PLND (61.60%), while 30,834 (38.40%) did not. There was no difference in OS and PCSS between patients who received PLND and those who did not for all Gleason GG (OS–GG1: P = 0.20, GG2: P = 0.34, GG3: P > 0.05, GG4: P = 0.55, GG5: P = 0.47; PCSS–GG1: P = 0.11, GG2: P = 0.96, GG3: P = 0.81, GG4: P = 0.22, GG5: P = 0.14). Conclusions: In this observational study, PLND at the time of RP was not associated with improved OS or PCSS among patients with cGS of 3 + 3, 3 + 4, 4 + 3, 4 + 4, 4 + 5, and 5 + 4. These findings suggest that until definitive clinical trials are completed, prostate cancer patients who have elected RP should be appropriately counseled on the potential risks and lack of proven survival benefit of PLND.

Abstract Background Fermented soy products have shown to possess inhibitory effects on prostate cancer (PCa). We evaluated the effect of a fermented soy beverage (Q-Can®), containing medium-chain triglycerides, ketones and soy isoflavones, among men with localized PCa prior to radical prostatectomy. Methods We conducted a placebo-controlled, double-blind randomized trial of Q-Can®. Stratified randomization (Cancer of the Prostate Risk Assessment (CAPRA) score at diagnosis) was used to assign patients to receive Q-Can® or placebo for 2–5 weeks before RP. Primary endpoint was change in serum PSA from baseline to end-of-study. We assessed changes in other clinical and pathologic endpoints. The primary ITT analysis compared PSA at end-of-study between randomization arms using repeated measures linear mixed model incorporating baseline CAPRA risk strata. Results We randomized 19 patients, 16 were eligible for analysis of the primary outcome. Mean age at enrollment was 61, 9(56.2%) were classified as low and intermediate risk, and 7(43.8%) high CAPRA risk. Among patients who received Q-Can®, mean PSA at baseline and end-of-study was 8.98(standard deviation, SD 4.07) and 8.02ng/mL(SD 3.99) compared with 8.66(SD 2.71) to 9.53ng/mL(SD 3.03), respectively, (Difference baseline – end-of-study, p = 0.36). There were no significant differences in Gleason score, clinical stage, surgical margin status, or CAPRA score between treatment arms (p > 0.05), and no significant differences between treatment arms in end-of-study or change in lipids, testosterone and FACT-P scores (p > 0.05). Conclusions Short exposure to Q-Can® among patients with localized PCa was not associated with changes in PSA levels, PCa characteristics including grade and stage or serum testosterone. Due to early termination from inability to recruit, study power, was not achieved.

Joseph S. Renzulli believes the purpose of gifted education is to increase the reservoir of creative and productive young people who will make innovative contributions to the arts, sciences, and all other areas of human knowledge and productivity and that these contributions will be guided toward making the world a better place for all people. He makes a distinction between what he calls lesson-learning giftedness and creative productive giftedness. While lesson-learning giftedness is all about learning the prescribed material, be able to demonstrate your learning by taking a test or through oral, written, artistic, dramatic, or some other form of expression; creative-productive giftedness is defined as those aspects of human activity and involvement where a premium is placed on the development of original ideas, material, and products that are purposefully designed to have an impact on one or more target audiences. The pedagogy discussed in the article is based on the role that knowledge plays in developing an investigative mindset, high levels of creative productivity, and how the integrated use of three levels of knowledge contribute to the major goal of gifted education.

International students have been a growing presence in U.S. higher education institutions for over a decade. Feelings of belonging play a crucial role in the adjustment of these students to campus life in American universities, and their conationals play a significant role in facilitating this adjustment process. However, the role of belonging and co-national communities in facilitating the persistence of international students toward and beyond degree attainment remains understudied. In our examination of the aspirations of 642 international students across 9 U.S. universities, we establish that stronger feelings of academic and social belonging are associated with a higher likelihood of aspiring to stay in the United States after graduation. In particular, we demonstrate the presence of an academic enclave effect wherein larger communities of co-nationals have a stronger influence on the aspirations of international students with low social belonging but does not affect the aspirations of socially well-integrated international students.

Hamdan Intelligence Scale (HIS) is the first intelligence scale that has been developed and normed in the United Arab Emirates (UAE). This study aimed to examine the refinement, validity, and reliability of HIS in upper elementary grades using the Rasch model. A total of 4,301 students (34.3% Male; 65.7% Female) from grade 4 to 6 (32.1% grade 4; 33.7% grade 5; 34.2% grade 6) were administered to the HIS. The confirmatory factor analysis was first conducted to verify the fitness of the one-factor model of the HIS. The results of validity showed strong correlation coefficients between the HIS and the Aurora-g battery (0.83) and the Raven’s Standard Progressive Matrices (RSPM; 0.86). Moreover, the results of the developmental trends demonstrated that raw scores of the HIS increase with age and grade relatively constantly across composite scores. Unidimensionality was confirmed through the Confirmatory Factor Analysis and Principal Component Analysis of Residuals (PCAR). The low eigenvalues of the first contrast were below 2, and additionally, the infit and outfit mean squares ranged from 0.88 to 1.14 and 0.84 to 1.14. Rasch’s person reliability result of 0.62 was acceptable reliability. The results provided strong support for the validity and reliability of using the Hamdan Intelligence Scale in the UAE environment.

Background & Aims: Sarcopenia is associated with increased morbidity and mortality in patients with cirrhosis, but its definition in current literature is very heterogeneous. We performed a systematic review and meta-analysis to assess the association between mortality and sarcopenia evaluated by computed tomography (CT) in patients with cirrhosis, both overall and stratified for the criteria used to define sarcopenia. Methods: Medline, Embase, Scopus, and Cochrane Library were searched up to January 2023. We included studies assessing sarcopenia presence with CT scans and providing data on the risk of mortality. Adjusted hazard ratios (HRs) and 95% CIs were pooled using a random-effects model. Results: Thirty-nine studies comprising 12,827 patients were included in the meta-analysis. The summary prevalence of sarcopenia was 44% (95% CI 38-50%). The presence of sarcopenia (any definition) was an independent predictor of mortality with an adjusted HR of 2.07 (95% CI 1.81-2.36), and the result was consistent in all subgroup analyses. The prognostic role of the EASL/AASLD criteria was confirmed for the first time with an HR of 1.86 (95% CI 1.53-2.26) (n = 14 studies). The cut-offs used to define sarcopenia based on psoas muscle parameters varied among studies, thus, a subgroup analysis was not feasible. There was no substantial heterogeneity for the main estimates and no significant risk of publication bias. Conclusions: Sarcopenia on CT is associated with a 2-fold higher risk of mortality in patients with cirrhosis. The cut-offs proposed by EASL/AASLD are prognostically relevant and should be the recommended criteria used to define sarcopenia in clinical practice. Impact and implications:: Sarcopenia assessed by the reference standard (computed tomography scan) is an independent predictor of mortality in patients with cirrhosis, with a 2-fold increase in the risk of death in all sensitivity analyses. This finding is particularly valid in patients from Europe and North America, and in transplant candidates. Stratifying for the parameters and cut-offs used, we confirmed for the first time the prognostic impact of the definition proposed by EASL/AASLD, supporting their use in clinical practice. Psoas muscle assessment is promising, but data are still limited and too heterogeneous to recommend its routine use at present.

Providing challenging and engaging learning opportunities is one way to motivate students to learn. In this article, we discuss the contributions of the gifted education field to the development of enrichment pedagogy and identify several different types of these engaging instructional strategies, including interest-based learning pedagogy, differentiation and curriculum compacting, project-based learning, open-ended choice, and the application of creative productivity to students learning. We identify this specialized pedagogy and give examples of how these exciting pedagogical strategies can be implemented in classrooms and by enrichment specialists and school counselors, both for academically talented and for all students. We conclude with a brief overview of research that demonstrates longitudinal benefits for students who are exposed to this type of teaching, suggesting positive outcomes.

Abstract Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most people infected with the virus experience mild to moderate respiratory illness. However, some might become seriously ill and may develop acute respiratory distress syndrome (ARDS), thus requiring non-invasive or invasive mechanical ventilation. Furthermore, COVID-19 disease can involve also other organs and systems, causing several extra-pulmonary manifestations and, thus, negatively influencing the patient’s outcome. Imaging studies play a pivotal role in the monitoring of severely ill patients, especially those admitted to the intensive care unit (ICU), who can develop several potentially life-threatening complications, both from the infection itself and the mechanical supporting system. This widespread utility of imaging modalities calls for a deeper understanding of potential radiologic findings in this disease and the need for multidisciplinary collaboration between radiologists and anesthesiologists to provide actionable guidance to appropriate interventions under such conditions.

In this article, I describe a few personal favorite contributions of Dr. Marcia Gentry, one of the most successful graduates from our doctoral program at the University of Connecticut, as well as a dear friend and collaborator. Marcia focused her life's work on the need to serve underserved and often-neglected populations in our field and implemented programs for these students, focusing on positive change in schools and on reservations. She also developed innovative identification and programming practices to be used in schools as well as summer programs. Marcia's personalized boots-on-the-ground activities, research, and advocacy for numerous Native American students across the country helped develop gifts and talents in diverse groups. Her success in this area resulted in recent years in the application of the same know-how to leadership and change strategies with other diverse groups. Marcia's life's work earned her a place among the top leaders in our field and in this special issue, we celebrate her work and life.

First-generation immigrants (FGIs) are eager to achieve the American dream and acquire the advantages a bachelor's degree affords. FGIs compared to their second-generation, third-generation and native peers fare better educationally. But, this comparison obscures across racial variation within a single-nativity status. As such, it is important to understand what mechanisms might produce inequality in college access among FGIs. One mechanism may be differences in how schools support students for college-going. The content of support may vary if racial stereotypes affect how support is given. Such variations could be decisive for FGIs' educational trajectories. We find that Latinx and black FGIs are less likely than other FGIs to enroll in bachelor-degree programs. The content of school support is a mechanism that can help partially explain this differential for black FGIs. Our findings indicate that how schools support black FGIs for college-going is different and is likely at least implicitly racially biased.

In this article, I describe a series of Five Core Competencies that gifted education specialists should consider integrating into their teaching to respond to the many changes that are taking place in technology, work, and career preparation. Although the focus of this theory is on high- level jobs usually pursued by college graduates and advanced degree students, this work also has relevance for the general-education community because future employment at all levels will require various degrees of proficiency in the Core Competencies discussed below. Students who will pursue college degrees and professional level jobs will need to attain advanced levels of these skills, have the opportunity to explore a wide range of skills, and be able to learn them more rapidly. Students should be placed in learning situations that require the adaptability that is the theme of this article so that they will learn to apply the skills in ways that will lead to success in job-transformational situations. Leadership and advanced-level positions require high levels of both performance and flexibility in the competencies that will be discussed below. The Catch-A-Wave Theory of Adaptability will be introduced with the presentation of background information and a rationale for the theory. The theory itself along with the five Core Competencies included in the theory will follow and then be supplemented with a section that provides strategies and resources for developing those competencies.

Background: Traumatic pelvic injuries are associated with high injury severity scores and significant morbidity and mortality. Active bleeding is the most common cause of death among those patients. Due to limitations of surgery for pelvic hematomas, angiographic treatment is at the forefront of pelvic trauma management. Objective: The present article aims to discuss the available endovascular treatment modalities, and common angiographic treatment strategies and techniques. Conclusion: Interventional radiologists plays a key role in the management of patients with pelvic trauma. New standardized protocols are needed to minimize the time spent on deciding the correct treatment for each patient.

A man in his 40s presented to our Hospital with abdominal pain, jaundice, and pruritus. He had a history of Alagille Syndrome treated with cholecystojejunostomy in the neonatal period because of initial misdiagnosis of biliary atresia. Laboratory investigations showed hyperbilirubinemia (total bilirubin 1.76 mg/dL [

Abstract Background Polycystic ovary syndrome (PCOS) is the most prevalent, chronic endocrine-metabolic disorder of adolescents and young women (AYAs), affecting 5–10% of AYAs worldwide. There is no approved pharmacological therapy for PCOS. Standard off-label treatment with oral contraceptives (OCs) reverts neither the underlying pathophysiology nor the associated co-morbidities. Pilot studies have generated new insights into the pathogenesis of PCOS, leading to the development of a new treatment consisting of a fixed, low-dose combination of two so-called insulin sensitisers [pioglitazone (PIO), metformin (MET)] and one mixed anti-androgen and anti-mineralocorticoid also acting as an activator of brown adipose tissue [spironolactone (SPI)], within a single tablet (SPIOMET). The present trial will evaluate the efficacy, tolerability and safety of SPIOMET, on top of lifestyle measures, for the treatment of PCOS in AYAs. Methods In this multicentre, randomised, double-blind, placebo-controlled, four-arm, parallel-group, phase II clinical trial, AYAs with PCOS will be recruited from 7 clinical centres across Europe. Intention is to randomise a total of 364 eligible patients into four arms (1:1:1:1): Placebo, PIO, SPI + PIO (SPIO) and SPI + PIO + MET (SPIOMET). Active treatment over 12 months will consist of lifestyle guidance plus the ingestion of one tablet daily (at dinner time); post-treatment follow-up will span 6 months. Primary endpoint is on- and post-treatment ovulation rate. Secondary endpoints are clinical features (hirsutism, menstrual regularity); endocrine-metabolic variables (androgens, lipids, insulin, inflammatory markers); epigenetic markers; imaging data (carotid intima-media thickness, body composition, abdominal fat partitioning, hepatic fat); safety profile; adherence, tolerability and acceptability of the medication; and quality of life in the study participants. Superiority (in this order) of SPIOMET, SPIO and PIO will be tested over placebo, and if present, subsequently the superiority of SPIOMET versus PIO, and if still present, finally versus SPIO. Discussion The present study will be the first to evaluate—in a randomised, double-blind, placebo-controlled way—the efficacy, tolerability and safety of SPIOMET treatment for early PCOS, on top of a lifestyle intervention. Trial registration EudraCT 2021–003177-58. Registered on 22 December 2021. https://www.clinicaltrialsregister.eu/ctr-search/search?query=%092021-003177-58 .

The aim of the present study was to test a new oral contrast medium composed of natural components for the magnetic resonance (MR) imaging of small bowel diseases. Between January 2018 and June 2019, 35 patients affected by ileocolic Crohn’s disease (CD) were enrolled in the present study. Each patient underwent two sequential MR enterographies, first with the standard polyethylene glycol (PEG) water solution and, after 3 weeks, with the new natural beverage designed by our team. At the end of the administration of each oral contrast, a satisfaction survey was given to the patients to assess the palatability of both beverages. The intestinal distention and the quality of images were evaluated by two expert radiologists for both studies and the interreader agreement was calculated. According to the satisfaction questionnaire, 97.1% of patients expressed positive judgments regarding the natural beverage (71.4% very good and 25.7% good) whereas only 8.6% of them appreciated the PEG water solution (8.6% good) (p = 0.0001). The degree of intestinal distention was excellent and good in 97.1% of patients after the administration of PEG and in 94.3% of the patients after the administration of the natural beverage, without significant differences between the two products and with almost perfect (k = 0.821) and substantial (k = 0.754) inter-observer variability, respectively. No statistical differences were observed between the two expert radiologists regarding the evaluation of the imaging quality; in particular, they were considered good and excellent in 100% of patients after the administration of PEG water solution and in 97.2% of those who took the natural beverage, with substantial (k = 0.618) and almost perfect (k = 0.858) inter-observer variability, respectively. The new natural beverage demonstrated the same intestinal distension and excellent image quality compared to the synthetic standard oral contrast administered during MRE for small bowel diseases, proving to be a valid alternative with better palatability.