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Abstract Introduction Vulnerably housed individuals access emergency departments (EDs) more frequently than the general population. Despite Canada’s universal public health care system, vulnerably housed persons face structural barriers to care and experience discrimination from healthcare providers. This study examines how vulnerably housed persons perceive their experience of care in the ED and Urgent Care Center (UCC) in Kingston, Ontario and aims to develop strategies for improving care for this group. Methods As part of a larger mixed-methods study, narratives were collected from participants attending the ED/UCC as well as community-based partner organizations, asking them to describe an experience of a recent ED visit (

Background and purposePrevious studies suggest that mechanisms and outcomes in patients with COVID-19-associated stroke differ from those in patients with non-COVID-19-associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors.MethodsA cross-sectional, international multicenter retrospective study was conducted in consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable-adjusted analysis was conducted.ResultsIn this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p

BackgroundThe mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke.ObjectiveTo describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort.MethodsWe conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020.ResultsThe total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002).ConclusionCOVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

Learning outcomes are predominantly framed in narrow and measurable terms, with students as decontextualised learners. As an alternative, the paper outlines a capabilitarian approach, building a four-dimensional matrix for reconceptualising learning outcomes. It is made up of a varied, multi-dimensional set of opportunities, processes and outcomes to enable students to flourish and become people who can live fulfilling and connected lives in and beyond higher education. The matrix dimensions are made up of a capability set, corresponding functionings, material resources and conversion processes, underpinned by Constitutional and human development values. The paper draws on a project on higher education outcomes in South Africa, especially the longitudinal life history data. It makes the case for a reparative futures orientation which might dismantle the colonial-apartheid past and present, and outlines key capabilitarian concepts. The social and higher education context is sketched, followed by a focus on the capability set and what data supports its value to students.

We pursued the hypothesis that specific glycans can be used to distinguish breast cancer stem cells (CSCs) and influence their function. Comparison of CSCs and non-CSCs from multiple breast cancer models revealed that CSCs are distinguished by expression of α2,3 sialylated core2 O-linked glycans. We identified a lectin, SLBR-N, which binds to O-linked α2,3 sialic acids, that was able to enrich for CSCs in vitro and in vivo. This O-glycan is expressed on CD44 and promotes its interaction with hyaluronic acid, facilitating CD44 signaling and CSC properties. In contrast, FUT3, which contributes to sialyl Lewis X (sLeX) production, is preferentially expressed in the non-CSC population, and it antagonizes CSC function. Collectively, our data indicate that SLBR-N can be more efficient at enriching for CSCs than CD44 itself because its use avoids the issues of CD44 splicing and glycan status. These data also reveal how differential glycosylation influences CSC fate.

BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p

Current epistemic governance analyses in higher education ignore systemic power relations between Northern and Southern researchers. This paper does focus on previous approaches to understanding epistemic governance, but rather moves beyond these towards a Southern evaluative and prospective comprehension. The paper is primarily theoretical. We draw on Fricker's theorizing of epistemic justice, but note the importance of the institutional. Amartya Sen's capability approach enables envisioning possibilities for change at individual and systemic levels, placing agency and epistemic freedoms at the centre of epistemic governance to foster solidarity and reflexive actions for change. To make the case, the paper explores testimonial and hermeneutical (including hermeneutic obstruction) injustices in research, presenting unfair practices and the unjust consequences for scholars in the South arising from 'the colonial epistemic structure'. The paper proposes that this structure, and its West-centric episteme, shapes epistemic governance which, among other effects, invisibilizes race and racism and is unable to account for the experiences of Southern subjects. The paper concludes by suggesting that it is a moral responsibility in higher education to exercise reasoned agency to promote equal epistemic opportunities, especially for those situated on the wrong side of the epistemic line. This requires epistemic humility and ethical responsibility.

South Africa still faces inequalities with regard to access to higher education opportunities. Foregrounding student voices at one university, the paper compares how students from diverse socio-economic backgrounds make decisions about going to university. The focus is on those who have succeeded, but ideas can be extrapolated regarding those who do not make it. The argument draws on Amartya Sen's capability approach to explore individual stories and the interactions between agency and the intersectional conversion conditions of possibility which shape the capability for university access. Narrative interviews show how students are enabled or constrained in their educational decision-making in relation to selves, schooling, family and income. Some implications are suggested for enhancing access, while not making claims for South African higher education as a whole.

Background: Persons with disabilities (PWD) are more likely to visit the emergency department (ED) and often have complex health needs when accessing care in the ED. Yet there is limited understanding of ED care experiences among PWD, especially in a Canadian context. The aim of this study was to examine the ED care experiences of PWD in contrast to a comparison group in Kingston, Ontario to better understand their health care needs. Methods: A mixed-methods study with a community-based participatory approach examining participants' past ED care experiences (within 24 months) was conducted in Kingston, ON. Quantitative data from those with disabilities and those from the comparison group were compared using chi squared tests to identify differences between groups. An inductive and deductive thematic analysis approach was used to identify themes in the shared qualitative data. Convergence of findings across quantitative and qualitative data was undertaken. Results: A total of 175 participants identified as having a disability. In contrast with the comparison group (N = 949), PWD were more likely to report being given too little attention to their needs (p < 0.001), that it was more important to be treated with kindness/respect than to receive the best possible medical care (p < 0.001), to report feelings of disrespect and/or judgement (p < 0.001), and that better understanding of personal identity/situation/culture and better communication would improve ED care. Qualitative analysis highlighted the following themes: poor communication between PWD and health care providers (HCP), compassionate medical care received, perceived HCP negative attitudes/beliefs related to having a disability and substance misuse, and perceived HCP lack of knowledge/skill to treat the unique health needs of PWD. Conclusion: Findings highlight the need to improve ED care for PWD. Future quality improvement initiatives should focus on incorporating a deeper understanding of disability into medical education and emergency medicine (EM) residency education, designing curricula that emphasize cultural humility, and implementing community-based placements providing opportunities for health professionals to work with and learn from PWD. [ABSTRACT FROM AUTHOR]

This paper draws on the compelling example of a political movement in South Africa in the 1960s and 1970s to explore both how epistemic justice conditions of possibility and of failure play out in practice. It provides a springboard to understand how and why failures of epistemic justice matter tremendously for democratic and inclusive lives and how the historical example can point us in the direction of higher education as a space for Amartya Sen's redressable injustices if underpinned by Miranda's Fricker's core capability of epistemic contribution being available pedagogically to all. The paper engages with ideas, practices and actions fostered by Black Consciousness against apartheid as both a hermeneutical and a testimonial injustice in South Africa, with both having a relational structure of giving and receiving, as Fricker argues and as Jose Medina elaborates by extending the structure to include the communicative and participatory. The paper then shows the importance of these conceptual frames to transformative higher education practices and how such practices might contribute to more epistemic justice in higher education.

There is a gap in research on access to universities in South Africa. The research that exists focuses on quantitative methodologies, although some qualitative studies are now emerging. These research methodologies, although necessary and substantial for the development of equity measures and policies, might be less successful in their impact on the local context, on research participants and in expanding what counts as knowledge in the university. In this paper, participatory research, which has not been used to research access, is explored. The paper seeks to go beyond the instrumentalization of research participants -- especially those from low-income households -- highlighting the potential of using multi-strategy research, in which participatory elements are included as a way to foster both participants' human development and local impact. Drawing on a research project on access to higher education in South Africa, the paper demonstrates that by including participatory elements (in this case photovoice) has the potential to operationalize Appadurai's notion of the 'right to research' among undergraduates. Using data, including processes, observations, workshops, interviews, and visual narratives from a participatory photovoice project, the findings highlight how methodological plurality creates space for locally and relevant knowledge production, challenging epistemic barriers and fostering human development among the research participants.

In order to understand how students from low-income rural backgrounds in South Africa experience higher education and the opportunities and obstacles they encounter, the paper draws on two waves of interviews with 30 students currently studying at three large urban universities. Using concepts of capabilities and functionings, monetary resources and 'capitals', the paper outlines common factors which shape rural students' well-being and their agency in accessing an urban university. Student voices indicate the particular importance of being able to exercise the functioning of navigating and manoeuvring through unfamiliar and often intimidating institutions. The discussion also indicates that it is the intersection of rurality and low income which shapes, even if it does not over-determine, their lives at university. It is suggested that universities could do more to support these students' well-being, and to recognise the agency and admirable determination which students bring to the challenges they face.