Alternative Modality Research Articles

Comparison of the diagnostic performance of non-contrast MR angiography and planar V/Q scintigraphy for pulmonary embolism: a systematic review and meta-analysis.

To conduct a meta-analysis of the diagnostic performance of non-contrast magnetic resonance pulmonary angiography (NC-MRPA) and ventilation-perfusion (V/Q) scintigraphy for the detection of acute pulmonary embolism (PE). Systematic searches of electronic databases were conducted from 2000 to 2024. Primary outcomes were per-patient sensitivity and specificity of NC-MRPA and V/Q scintigraphy. The pooled sensitivities, specificities, and 95% confidence intervals (95% CI) were calculated using a random-effect analysis. Summary receiver-operating characteristic (SROC) curves and the area under the curve (AUC) were obtained. A total of 3709 studies (1941 NC-MRPA studies) were identified through systematic searches, with eight published MRI and nine published V/Q investigations meeting inclusion criteria. The results showed that NC-MRPA had a pooled sensitivity of 0.88 (95% CI: 0.83-0.91) and specificity of 0.97 (95% CI: 0.93-0.98), yielding an AUC of 0.92 (95% CI: 0.85-0.96). V/Q scanning had a pooled sensitivity of 0.81 (95% CI: 0.76-0.85) and specificity of 0.84 (95% CI: 0.74-0.91), yielding an AUC of 0.87 (95% CI: 0.75-0.91). The pooled proportion of non-diagnostic tests for V/Q scans (34.7%, 95% CI: 30.8-38.7) was greater than that of NC-MRPA studies (3.31%, 95% CI: 1.65-4.97). This meta-analysis suggests that NC-MRPA is more specific than V/Q scintigraphy for the detection of PE, with comparable accuracy and sensitivity. NC-MRPA yielded fewer non-diagnostic scans than V/Q scintigraphy and is a feasible alternative imaging modality for diagnosing PE in patients for whom intravenous contrast administration poses a substantive risk. Question V/Q lung scintigraphy has been used as a reserve, alternative modality for patients who cannot undergo CT pulmonary angiography. Findings Non-contrast MR angiography (MRA) is a feasible alternative for diagnosing PE in patients for whom intravenous iodinated contrast administration poses a substantial risk. Clinical relevance Non-contrast MRA provides similar sensitivity and superior specificity to V/Q scintigraphy for diagnosing PE, without ionizing radiation exposure.

CT angiography of acute aortic syndrome in patients with chronic kidney disease.

The term acute aortic syndrome (AAS) refers to a range of different entities, including dissection, intramural haematoma and penetrating atherosclerotic ulcer. Patients with chronic renal disease and particularly those with dominant polycystic kidney disease are susceptible to this pathology, given the underlying renal arteriopathy and hypertension. Imaging plays a crucial role in diagnosing, grading and guiding management of these patients, with computed tomography angiography (CTA) being on the frontline. Albeit of overlapping of imaging findings between these conditions, specific imaging characteristics help discriminate and guide treatment. Given the nephrotoxic contrast agent involved, tailored CTA protocols or alternative imaging modalities such as MRI or US are necessary in this patient population. This review article discusses the main imaging findings of entities found in the spectrum of AAS, as well as the appropriate use and protocol of imaging modalities, focusing on the appropriate use of nephrotoxic contrast agents, the preservation of renal function and maintenance of optimal diagnostic accuracy.

Risk of hospital inpatient opioid overdose (RHINOO): a review of factors impacting naloxone administration in patients receiving opioids.

Opioid medications remain a common treatment for acute pain in hospitalized patients. This study aims to identify factors contributing to opioid overdose in the inpatient population, addressing the gap in data on which patients are at higher risk for opioid-related adverse events in the hospital setting. A retrospective chart review of inpatients receiving at least one opioid medication was performed at a large academic medical center from January 1, 2022, through December 31, 2022. Patients who received naloxone were designated as the overdose group, while those who received opioids without naloxone served as the control group. Suspected risk factors were included in a multivariable direct logistic regression model to identify patients at higher risk for opioid-related adverse events. The review included 11,050 admitted patients who received an inpatient opioid, of whom 130 received naloxone. Analysis revealed that patients with creatinine clearance (CrCl) < 60 mL/min, co-administered benzodiazepine, body mass index (BMI) > 30 kg/m2, underlying pulmonary disease, obstructive sleep apnea, chronic opioid use, and/or substance use disorder were at higher risk for requiring naloxone. These factors significantly influenced the likelihood and magnitude of in-hospital opioid overdose. These validated risk factors should be considered when administering opioid analgesics in the inpatient setting. Consideration should be given to reducing the dose and/or frequency of opioids in addition to the use of alternative analgesic modalities for patients with these risk factors to mitigate the risk of opioid-related adverse events. Incorporating these considerations into clinical practice can enhance patient safety and outcomes.

Effects of Variable Ventilation on Gas Exchange in an Experimental Model of Capnoperitoneum: A Randomized Crossover Study.

The rapid advancement of minimally invasive surgical techniques has made laparoscopy a preferred alternative because it reduces postoperative complications. However, inflating the peritoneum with CO2 causes a cranial shift of the diaphragm decreasing lung volume and impairing gas exchange. Additionally, CO2 absorption increases blood CO2 levels, further complicating mechanical ventilation when the lung function is already compromised. Standard interventions such as lung recruitment maneuvers or increasing positive end-expiratory pressures can counteract these effects but also increase lung parenchymal strain and intrathoracic pressure, negatively impacting cardiac output. The application of variability in tidal volume and respiratory rate during mechanical ventilation to mimic natural breathing has shown benefits in various respiratory conditions. Therefore, we aimed to evaluate the short-term benefits of variable ventilation (VV) on gas exchange, respiratory mechanics, and hemodynamics during and after capnoperitoneum, compared to conventional pressure-controlled ventilation (PCV). Eleven anaesthetized rabbits were randomly assigned to PCV or VV. Oxygenation index (Pao2/FiO2), arterial partial pressure of carbon dioxide (Paco2), and respiratory mechanical parameters were assessed after a 15-minute-long ventilation period before, during, and after capnoperitoneum. According to a crossover design, after measurements at the 3 different stages, the ventilation mode was changed, and the entire sequence was repeated. Capnoperitoneum compromised respiratory mechanics, decreased oxygenation, and caused CO2-retention compared to baseline measurements under both ventilation modalities (P < .05, for all). Application of VV resulted in lower Pao2/FiO2 (405. 5 ± 34.1 (mean ± standard deviation [SD]) vs 370. 5 ± 44.9, P < .001) and higher Paco2 (48. 4 ± 5.1 vs 52. 8 ± 6.0 mm Hg, P = .009) values during capnoperitoneum compared to PCV. After abdominal deflation and a lung recruitment maneuver, VV proved more beneficial for CO2 removal than PCV (41. 0 ± 2.3 vs 44. 6 ± 4.3mmHg, P = .027). No significant difference was observed in the respiratory mechanical or hemodynamic parameters between the ventilation modalities under the same conditions. The detrimental effects of capnoperitoneum on gas exchange were more pronounced with VV. However, after the release of capnoperitoneum, VV significantly improved CO2 clearance. Therefore, VV could possibly be considered as an alternative ventilation modality to restore physiological gas exchange after, but not during, capnoperitoneum.

Mean Differences for 3 Delivery Modalities of the Healthy Eating, Staying Active As We Age Curriculum for Older Adults.

To assess the mean differences in outcomes of 3 delivery modalities of a nutrition education program targeting older adults. A natural experiment was conducted from March 2020 to September 2021, with presurveys and postsurveys used to assess dietary and physical activity behaviors. Results were analyzed using descriptive statistics, t tests, and ANOVA, with a Bonferroni-corrected significance threshold at P < 0.001. There were 3 groups: in-person (n = 212), Zoom (n = 61), and phone (n = 104). Respondents aged > 70 years and in rural areas were more likely to be enrolled in person (P < 0.001). Across all modalities, there were significant improvements from before to after for most outcomes. The phone group reported significantly larger mean differences than the in-person group for fruit, vegetable, and whole grain consumption (P < 0.001). Healthy Eating, Staying Active as We Age can be delivered across all modalities. Future practitioners can use the findings to consider alternative modalities that may better meet the needs of their audience.

Towards Campus Integrity: Integrating Anti-Corruption Education with Islamic Religious Education

The widespread corruption in Indonesia is a major obstacle to the country's economic and social progress. Instilling anti-corruption values in the next generation is a critical responsibility of higher education institutions. This study looks at how Islamic Religious Education classes in Indonesian universities have begun to incorporate lessons about against corruption. The faculty and students of Bhinneka PGRI University participated in a qualitative case study. Documentation, in-depth interviews, participant observation, and focus groups were used to obtain facts. The findings demonstrated that a number of strategies were employed to incorporate anti-corruption education into Islamic Religious Education courses. These included reviewing the curriculum and syllabus, creating interactive teaching materials and methods, and organising student activities to promote a culture that rejects corruption. Integrity, compassion, autonomy, discipline, responsibility, hard work, simplicity, courage, and fairness are nine anti-corruption principles that were found to be included in the course materials. Additionally, a number of successful learning strategies were implemented, including learning through projects, learning in context, learning in collaboration, learning through discovery, value clarification tools, and modelling good behaviour. Students are encouraged to cultivate their character and integrity through the incorporation of anti-corruption instruction within Islamic Religious instruction classes. This will equip them to take on leadership roles in the fight against corruption in the future. University syllabi should incorporate anti-corruption education, according to this report, and additional research into alternative learning modalities should be pursued to foster an anti-corruption culture on campus.

Breast density assessment via quantitative sound-speed measurement using conventional ultrasound transducers.

The aim is to assess the feasibility and accuracy of a novel quantitative ultrasound (US) method based on global speed-of-sound (g-SoS) measurement using conventional US machines, for breast density assessment in comparison to mammographic ACR (m-ACR) categories. In a prospective study, g-SoS was assessed in the upper-outer breast quadrant of 100 women, with 92 of them also having m-ACR assessed by two radiologists across the entire breast. For g-SoS, ultrasonic waves were transmitted from varying transducer locations and the image misalignments between these were then related analytically to breast SoS. To test reproducibility, two consecutive g-SoS acquisitions each were taken at two similar breast locations by the same operator. Measurements were found highly repeatable, with a mean absolute difference ± standard deviation of 3.16 ± 3.79 m/s. Multiple measurements were combined yielding a single g-SoS estimate per each patient, which strongly correlated to m-ACR categories (Spearman's = 0.773). The g-SoS values for categories A-D were 1459.6 ± 0.74, 1475.6 ± 15.92, 1515.6 ± 27.10, and 1545.7 ± 20.62, with all groups (except A-B) being significantly different from each other. Dense breasts (m-ACR C&D) were classified with 100% specificity at 78% sensitivity, with an area under the curve (AUC) of 0.931. Extremely dense breasts (m-ACR D) were classified with 100% sensitivity at 77.5% specificity (AUC = 0.906). Quantitative g-SoS measurement of the breast was shown feasible and repeatable using conventional US machines, with values correlating strongly with m-ACR assessments. Question Breast density is a strong predictor of risk for breast cancer, which frequently develops in dense tissue regions. Therefore, density assessment calls for refined non-ionizing methods. Findings Quantitative global speed-of-sound (g-SoS) measurement of the breast is shown to be feasible using conventional US machines, repeatable, and able to classify breast densitywith high accuracy. Clinical relevance Being effective in classifying dense breasts, where mammography has reduced sensitivity, g-SoS can help stratify patients for alternative modalities. Ideal day for mammography or MRI can be determined by monitoring g-SoS. Furthermore, g-SoS can be integrated into personalized risk assessment.

Diagnosis and treatment of obstructive sleep apnea

Obstructive sleep apnoea (OSA) is a prevalent disorder characterized by repeated episodes of partial or complete upper airway collapse during sleep, resulting in intermittent hypoxia, hypercapnia, and sleep fragmentation. Common in middle-aged and older adults, its pathogenesis is multifactorial, encompassing obesity, craniofacial abnormalities, altered upper airway muscle function, pharyngeal neuropathy, and fluid redistribution to the neck. These episodes trigger sympathetic activation, oxidative stress, and systemic inflammation, contributing to daytime sleepiness, road traffic accidents, and a spectrum of cardiovascular and metabolic comorbidities such as hypertension, arrhythmias, coronary artery disease, stroke, and diabetes mellitus. The efficacy of therapy in reversing chronic sequelae remains uncertain. Continuous positive airway pressure (CPAP) is the first-line treatment in severe cases, although patient adherence varies between 60–70%. Alternative modalities, including bi-level positive airway pressure, adaptive servo-ventilation, oral appliances, and surgical interventions, may be employed. Weight reduction and combined treatment strategies hold promise but require validation in well-designed randomized controlled trials.

Targeting DOT1L and EZH2 synergizes in breaking the germinal center identity of Diffuse Large B-cell Lymphoma.

Differentiation of antigen-activated B cells into pro-proliferative germinal center (GC) B cells depends on the activity of the transcription factors MYC and BCL6, and the epigenetic writers DOT1L and EZH2. GCB-like Diffuse Large B Cell Lymphomas (GCB-DLBCLs) arise from GCB cells and closely resemble their cell of origin. Given the dependency of GCB cells on DOT1L and EZH2, we investigated the role of these epigenetic regulators in GCB-DLBCLs and observed that GCB-DLBCLs synergistically depend on the combined activity of DOT1L and EZH2. Mechanistically, inhibiting both enzymes led to enhanced derepression of PRC2 target genes compared to EZH2 single treatment, along with the upregulation of BCL6 target genes and suppression of MYC target genes. The sum of all these alterations results in a 'cell identity crisis', wherein GCB-DLBCLs lose their pro-proliferative GC identity and partially undergo PC differentiation, a state associated with poor survival. In support of this model, combined epi-drugging of DOT1L and EZH2 prohibited the outgrowth of human GCB-DLBCL xenografts in vivo. We conclude that the malignant behavior of GCB-DLBCLs strongly depends on DOT1L and EZH2 and that combined targeting of both epigenetic writers may provide an alternative differentiation-based treatment modality for GCB-DLBCL.

CAR/CSAR Practice Statement on Pelvic MRI for Endometriosis.

The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and interpretation for advanced imaging modalities associated with diagnosing endometriosis. Advanced pelvic ultrasound is essential in diagnosing and mapping pelvic endometriosis, but pelvic MRI serves as an excellent imaging tool in instances where access to advanced ultrasound is limited, or an alternative imaging modality is required. Despite the known utility of MRI for endometriosis, there is no consensus on imaging protocol and patient preparation in Canada. To improve patient care and support excellence in imaging, the Working Group has developed recommendations for the use of pelvic MRI to assess for endometriosis with an aim to standardize MRI technique for use in both community and academic practices across Canada. The guidelines provide recommendations regarding imaging technique and patient preparation for pelvic MRI, along with suggestions for structured reporting of pelvic MRI for endometriosis.

Care for end-stage kidney disease in China: progress, challenges, and recommendations.

This review comprehensively evaluates China's progress in care of end-stage kidney disease (ESKD) by identifying achievements and gaps, reviewing ESKD-related policy initiatives, and proposing policy recommendations. In the past decade, China has made laudable progress in access to ESKD care with narrowed difference between the number of patients needing and receiving kidney replacement therapies (KRT). China has also experienced significant improvements in clinical quality and outcomes of ESKD care. These achievements stem from concerted efforts in advocating effective policies, increasing fiscal subsidies, re-designing health insurance schemes, encouraging healthcare delivery from both public and private sectors, and improving quality regulation. However, challenges remain, including inequitable access to care across regions and groups, and suboptimal quality and outcomes in some underdeveloped areas. To address these gaps, we recommend reforming the financing policy, adopting quality-based payment methods, strengthening quality monitoring system, improving chronic kidney disease prevention and management, and developing alternative KRT modalities.

The Role of Quercetin for the Treatment of Endometriosis and Endometrial Cancer: A Comprehensive Review.

Endometrial glands and stroma can be seen outside the uterine cavity in endometriosis, a gynecological disorder linked to estrogen dependency. Hormonal therapies, surgical excision, and non-steroidal anti-inflammatory drug therapy are among the traditional endometriosis treatments, however, various side effects limit their efficacy. Therefore, it is vital to research complementary and alternative therapeutic modalities to decrease the side effects of conventional therapies. While the search for the best endometriosis treatment continues, the focus is being paid to the assistance provided by polyphenols, notably quercetin. A broad spectrum of health-improving benefits of quercetin includes interactions with endometriosis-related molecular targets such as cell proliferation, apoptosis, invasiveness, inflammation, and oxidative stress. According to already-known research, medicines that mimic the physiological effects of quercetin are good candidates for creating novel endometriosis therapies. This review aims to comprehensively review quercetin's potential as a non-pharmacological treatment for endometriosis by interacting with several cellular and molecular targets.

National Trends and Outcomes of Pedal Bypass Surgery

ObjectiveThe technical demands associated with pedal bypass (PB) surgery place it at risk of underutilization and may be limiting its widespread adoption as a valuable revascularization modality. This study aims to evaluate trends in PB performance, assess its outcomes, and compare its results between high- and low-volume centers. MethodsAll patients receiving a PB between 2003 and 2023 were identified in the Vascular Quality Initiative (VQI) infrainguinal bypass (IIB) module. The ratio of PB to total IIB performed was calculated for each year and trended over the study period. Centers performing PB were categorized according to their annual PB volume into tertiles of low-volume centers (LVC, <2 PB/year), medium-volume centers (MVC, 2-4 PB/year), and high-volume centers (HVC, >4 PB/year) for comparison. Patient characteristics and outcomes were compared using the χ2 or Fisher exact test as appropriate for categorical variables and the analysis of variance test or Kruskal-Wallis test as appropriate for continuous variables. Cox regression analysis was used to study the association between center volume and the primary outcomes of primary patency, primary-assisted patency, secondary patency, reintervention, amputation, and major adverse limb events (MALE), defined as the composite outcome of amputation and/or reintervention. ResultsA total of 3466 patients received a PB during the study period. The ratio of PB to IIB dropped from 14% to 4% between 2003 and 2023. Primary, primary-assisted, and secondary patency rates were 65%, 76%, and 80%, respectively, and limb salvage rate was 83% at 1 year. Nineteen percent of centers performing IIBs in the VQI did not perform any PBs during the study period. Of the 246 centers performing PBs, 78% were LVC, 15% were MVC, and only 7% were HVC. On Cox regression analysis, HVCs were associated with a lower risk of primary patency loss (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.66-0.95; P = .010), reintervention (HR, 0.75; 95% CI, 0.60-0.95; P = .016), amputation (HR, 0.77; 95% CI, 0.61-0.98; P = .034), and MALE (HR, 0.78; 95% CI, 0.66-0.93; P = .005) compared with LVCs. No difference in secondary patency between high- and low-volume centers was observed (P = .680). ConclusionsThe utilization of PB operations experienced a four-fold decrease over the past 20 years, despite favorable patency and limb salvage outcomes. Centers with a higher operative volume in PB achieve better outcomes than LVCs, and accordingly, patients with extensive tibioperoneal disease may benefit from evaluation at centers with documented expertise in PB before resorting to an alternative revascularization modality or a major limb amputation.

Face-to-face or face-to-screen: A quantitative comparison of conferences modalities.

The COVID-19 pandemic forced a societal shift from in-person to virtual activities, including scientific conferences. As society navigates a "new normal," the question arises as to the advantages and disadvantages of these alternative modalities. We introduce two new comprehensive datasets enabling direct comparison between virtual and in-person conferences: the first, from a series of nine small conferences, encompasses over 12,000 pairs of potential scientific collaborators across five virtual and four in-person meetings on a range of scientific topics; the expressed goal of these conferences is to create novel collaborations. The second dataset, from a series of three large physics conferences, encompasses >250,000 possible pairs of scientific collaborators. Our study provides quantitative insight into benefits and drawbacks of virtual and in-person conferences for team formation, community building, and engagement. We demonstrate the causal role of formal interaction on team formation across both modalities. Our findings show that formal interaction impacted team formation significantly more in virtual settings, while informal interaction played a larger role at in-person conferences as compared with virtual. We show that a nonlinear memory model for predicting team formation based on interaction outperforms seven alternative models. The model suggests that prior knowledge and interaction time contribute to catalyzing collaborations in both settings. Our results underscore the critical responsibility of organizers for optimizing professional interactions, whether virtual or in-person.

Patients’ Comfort with Opioid Use and Disposal Post-Operatively After Outpatient Anterior Cruciate Ligament Reconstruction: A Gender-Based Analysis

BACKGROUND: Despite legislative efforts to curb inappropriate prescribing, opioid-related adverse events and deaths persist. Prior research has demonstrated that pain perception and response to analgesic medications may vary between genders, underlining the importance of a gender-based analysis in postoperative opioid management. Furthermore, orthopedic surgery remains a significant contributor to opioid prescriptions, however, little is known about patient-specific perspectives regarding opioid usage after knee surgery. This study aimed to assess patients' comfort with postoperative opioid use and explore pre-existing knowledge of opioid disposal, with a specific focus on analyzing differences between genders. METHODS: All patients scheduled for outpatient anterior cruciate ligament (ACL) reconstruction by the senior author between August 2018 and July 2019 were identified and enrolled in the study. At ten days postoperatively a 7-question, multiple choice paper survey created by the authors was administered in person to each patient. The survey inquired about their use of the medications, any concerns, alternative pain control modalities, and their method of disposal of any remaining prescription pain medication. Patient survey responses were collected, and descriptive and inferential statistics of responses were performed for the overall cohort and per gender. RESULTS: A total of 47 patients (15 males and 32 females) were included in the final study cohort with a 100% response rate. 100% of respondents reported having remaining medication 10 days after surgery. There were no significant differences in responses based on gender. The primary concern with opioid use was addiction risk (43%) while the second most common response was that they had no concerns (28%). Females reported an increased frequency of concern about disposal methods. 72% of patients discontinued medication due to no longer being in pain. Females more frequently discontinued use because they were no longer in pain while males more frequently discontinued due to other concerns. Various disposal methods were used with 40% of males and 13% of females keeping medications in the house most commonly “just in case” they needed it. CONCLUSION: Both males and females exhibited similar concerns and preferences regarding postoperative pain management, with observed but non-significant differences in medication use and disposal practices. These findings emphasize the value of gender-aware education in opioid misuse prevention efforts.

Experience in sports and music influences motor imagery: Insights from implicit and explicit measures.

Motor imagery (MI) can be an effective strategy for learning and enhancing movement or as an alternative training modality when physical practice is compromised. Individual differences in MI ability are widely documented but the role of experience in different activities in influencing MI is not well understood. The present study examined how experience in activities associated with the use of MI influences implicit and explicit MI. Participants completed a hand laterality judgement task (N=84) and a MI questionnaire (MIQ-3; N=59) online. These implicit and explicit measures of MI were analysed in relation to frequent experience in individual sports/exercise, team sports, dance, and playing a musical instrument. The majority of participants reported using both visual and kinesthetic MI within their activities. Across activities, frequent experience was associated with more accurate hand laterality judgement, as well as increased biomechanical constraint effects, particularly for hands viewed from the palm. In relation to the different activity types, significant effects were found for individual and team sports and music, but not dance. Participants' level of training was associated with ratings of explicit MI (MIQ-3). Experience in activities that utilise MI influences implicit MI, while formal training may have a stronger influence on explicit MI. Activity-specific effects on MI may reflect differences in kinesthetic and visual experience of the different hand surfaces.

A fully automated measurement of migration percentage on ultrasound images in children with cerebral palsy.

Migration percentage (MP) is the gold standard to assess the severity of hip displacement in children with cerebral palsy, which is measured on anteroposterior hip radiographs. Recently, the ultrasound (US) method has been developed as a safe alternative imaging modality to image and monitor children's hips. However, measuring MP on US images (MPUS) is time-consuming, challenging, and user-dependent. This study aimed to develop machine learning algorithms to automatically measure MPUS and validate the algorithms with MPXray. A combination of signal filtering, convolution neural networks (CNNs), and UNets was applied to segment the regions of interest (ROI), detect edges or feature points, and select the desired US frames. A total of 62 hips including both coronal and transverse scans per hip were acquired, out of which 36 with applying augmentation method were utilized for training, 8 for validation, and 18 for testing. The intraclass correlation coefficient (ICC2,1) and the mean absolute difference (MAD) between the automated MPUS versus manual MPXray were 0.86 and 6.5% ± 5.5%, respectively. To report the MPUS, it took an average of 104s/hip. This preliminary result demonstrated that MPUS was able to extract automatically within 2min with a clinical acceptance accuracy (10%).

School dropout, lag and repetition: strategies for inclusive and sustainable education in the framework of public policies

This study examines the structural factors that contribute to school lag and dropout in students from vulnerable areas. Factors include community violence, economic precariousness, and complex family dynamics, within the context of the post-pandemic impact. Through interviews, participatory observation, and documentary analysis, the experiences of students, teachers, and educational authorities are collected to identify patterns of exclusion. The results show that the socioeconomic context that affects students' motivation, attendance, and school performance, especially in areas with gang presence, is a lack of safe transportation, and poor access to basic services. The pandemic amplified these difficulties by affecting skills such as reading, writing, and math, generating a significant lag as well as an emotional disconnection from school. Although the Ministry of Education implements welfare programs, such as subsidies for food and transportation, their effectiveness is limited in the face of the magnitude of the needs, which generates dissatisfaction in the community. In response, alternative modalities have been explored, such as homeschooling and playful learning programs, as well as interventions in mathematics education that seek to strengthen basic and practical skills, although their impact is still uncertain. This study highlights the need for educational public policies that address the structural causes of dropout and offer early intervention strategies, safe school environments, and teaching methods that connect theory with practice, promoting quality education for all.

Diagnostic performance of contrast-enhanced ultrasound in traumatic solid organ injuries in children: a systematic review and meta-analysis.

Blunt abdominal trauma (BAT) is a significant contributor to pediatric mortality, often causing liver and spleen injuries. Contrast-enhanced computed tomography (CT), the gold standard for diagnosing solid organ injury, poses radiation risks to children. Contrast-enhanced ultrasound (CEUS) may be a promising alternative imaging modality. To evaluate the diagnostic utility of CEUS for detecting solid organ injuries following BAT in the pediatric population. A systematic review and meta-analysis were conducted through a thorough literature search in PubMed, Scopus, Web of Science, and Embase databases up to October 1, 2023. Diagnostic accuracy metrics were aggregated using a bivariate model, and subgroup meta-analysis compared CEUS accuracy across various organs. Meta-analysis from four studies, including 364 pediatric patients, revealed a pooled sensitivity of 88.5% (95%CI 82.5-92.6%) and specificity of 98.5% (95%CI 94.9-99.6%), with an area under the curve of 96% (95%CI 88 - 99%). Splenic injuries showed higher sensitivity than liver injuries (P-value < 0.01), while kidney assessments demonstrated higher specificity (P-value < 0.05). This study highlights the diagnostic potential of CEUS for pediatric solid organ injuries caused by BAT. Further large-scale studies are needed due to the limited number and sample size of the included studies.

Alternate mutation modalities in models of population dynamics

Alternate mutation modalities in models of population dynamics