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BACKGROUND: The risk of recurrence is overestimated by the Kaplan-Meier method when competing events, such as death without recurrence, are present. Such overestimation can be avoided by using the Aalen-Johansen method, which is a direct extension of Kaplan-Meier that accounts for competing events. Meningiomas commonly occur in older individuals and have slow-growing properties, thereby warranting competing risk analysis. The extent to which competing events are considered in meningioma literature is unknown, and the consequences of using incorrect methodologies in meningioma recurrence risk analysis have not been investigated. METHODS: We surveyed articles indexed on PubMed since 2020 to assess the usage of competing risk analysis in recent meningioma literature. To compare recurrence risk estimates obtained through Kaplan-Meier and Aalen-Johansen methods, we applied our international database comprising ~ 8,000 patients with a primary meningioma collected from 42 institutions. RESULTS: Of 513 articles, 169 were eligible for full-text screening. There were 6,537 eligible cases from our PERNS database. The discrepancy between the results obtained by Kaplan-Meier and Aalen-Johansen was negligible among low-grade lesions and younger individuals. The discrepancy increased substantially in the patient groups associated with higher rates of competing events (older patients with high-grade lesions). CONCLUSION: The importance of considering competing events in recurrence risk analysis is poorly recognized as only 6% of the studies we surveyed employed Aalen-Johansen analyses. Consequently, most of the previous literature has overestimated the risk of recurrence. The overestimation was negligible for studies involving low-grade lesions in younger individuals; however, overestimation might have been substantial for studies on high-grade lesions.

Treatment-refractory meningiomas have a dismal prognosis and limited treatment options. Meningiomas express high-densities of somatostatin receptors (SSTR), thus potentially susceptible to antitumorigenic effects of somatostatin analogues (SSA). Evidence for SSA in meningiomas is scarce, and it is unclear if published literature would either (1) support wider use of SSA, if (2) more evidence is desirable, or if (3) available evidence is sufficient to discard SSA. We addressed the need for more evidence with a systematic review and meta-analysis. We performed an individual patient data (IPD) meta-analysis. Main outcomes were toxicity, best radiological response, progression-free survival, and overall survival. We applied multivariable logistic regression models to estimate the effect of SSA on the probability of obtaining radiological disease control. The predictive performance was evaluated using area under the curve and Brier scores. We included 16 studies and compiled IPD from 8/9 of all previous cohorts. Quality of evidence was overall ranked "very low." Stable disease was reported in 58% of patients as best radiological response. Per 100 mg increase in total SSA dosage, the odds ratios for obtaining radiological disease control was 1.42 (1.11 to 1.81, P = 0.005) and 1.44 (1.00 to 2.08, P = 0.05) for patients treated with SSA as monodrug therapy vs SSA in combination with everolimus, respectively. Low quality of evidence impeded exact quantification of treatment efficacy, and the association between response and treatment may represent reverse causality. Yet, the SSA treatment was well tolerated, and beneficial effect cannot be disqualified. A prospective trial without bias from inconsistent study designs is warranted to assess SSA therapy for well-defined meningioma subgroups.

There is growing agreement that feedback should be understood as a contextual and social process, rather than as receipt of teacher comments on students' work. This reframing brings with it new complexities, and it can be challenging for researchers and practitioners to adopt a process perspective when making sense of feedback practices in naturalistic settings. This paper takes the nascent notion of "feedback encounter" and proposes it as an analytical lens for understanding and analysing feedback processes. Based on a rich dataset from a cross-national digital ethnographic study of student feedback experiences, the paper identifies three categories of feedback encounters - "elicited," "formal" and "incidental" - and explores how they are experienced by students, in relation to perceived usefulness, control and self-exposure. Furthermore, the paper investigates how individual feedback encounters may interconnect to form simple and complex sequences, revolving around distinct uncertainties or dilemmas. This operationalization of feedback encounters builds the foundations of a framework that can help researchers and practitioners make sense of authentic feedback processes in naturalistic settings. Such a framework is useful because it offers a structured way of analysing processes that are inherently complex and unfolding.

To understand how the digitalization of higher education influences the inter-relationship between students, teachers, and their broader contexts, research must account for the social, cultural, political, and embodied aspects of teaching and learning in digital environments. "Digital ethnography" is a research method that can generate rich contextual knowledge of online experiences. However, how this methodology translates to higher education is less clear. In order to explore the opportunities that digital ethnography can provide in higher education research, this paper presents a methodological review of previous research, and discusses the implications for future practice. Through a systematic search of five research databases, we found 20 papers that report using digital ethnographies to explore teaching and learning in higher education. The review synthesizes and discusses how data collection, rigour, and ethics are handled in this body of research, with a focus on the specific methodological challenges that emerge when doing digital ethnographic research in a higher education setting. The review also identifies opportunities for improvement--especially related to participant observation from the student perspective, researcher reflexivity in relation to the dual teacher-researcher role, and increased diversity of data types. This leads us to conclude that higher education research, tasked with understanding an explosion of new digital practices, could benefit from a more rigorous and expanded use of digital ethnography.