Definition Of Guidelines Research Articles

English language teaching and specific learning disorders: A case study

<p>The study of a foreign language for students with Specific Learning Disorders (SLDs) can often be a tremendous challenge, making this process extremely complex (most of the difficulties arise from spelling and lexis with major consequences for reading, writing and pronunciation). This also entails a challenge for educators and educational institutions having the task of responding to students’ needs by becoming more flexible and equipped to understand, value and adapt to the differences of their students in order to provide them with quality and inclusive education and equal learning opportunities. The purpose of this paper is to present a study conducted among university students with SLDs with the aim to identify approaches and teaching strategies to foster effective and meaningful English language learning. The underlying intention is to provide useful insight into future trends and definitions of guidelines and viable strategies in the field of education and SLDs. Therefore, 82 university students with SLDs were randomly assigned either to an experimental group (EG, <em>n</em> = 41) who received English lessons designed according to their individual needs and based on compensatory measures, or to a control group (CG, <em>n</em> = 41) who participated in conventional English lessons. Results suggest that the students who benefited from a variety of individualised supports were able to improve their foreign language skills.</p>

Screening for pulmonary arterial hypertension in patients with systemic sclerosis in the era of new pulmonary arterial hypertension definitions.

This study compares the performance of three composite pulmonary arterial hypertension (PAH) screening tools in a real-life SSc cohort, according to both the previous 2015 ESC/ERS guideline and the recent 2022 ESC/ERS guideline haemodynamic criteria. Consecutive SSc patients without a previous diagnosis of pulmonary hypertension (PH) were screened for PAH using the European Society of Cardiology/European Respiratory Society (ESC/ERS), DETECT, and Australian Scleroderma Interest Group (ASIG) algorithms. Right heart catheterisation (RHC) referral performances for PAH were compared according to the 2022 ESC/ERS PAH criteria. Thirty-five of the 81 patients required RHC; 15 (18.5%) according to ESC/ERS, 27 (33.3%) according to DETECT, and 25 (31%) according to ASIG. The final diagnoses were no-PH in 17 patients, WHO group 1 PH (PAH) in 8 patients, WHO group 2 PH in 8 patients, and WHO group 3 PH in 2 patients. When the hemodynamic criteria of the previous ESC/ERS guideline were applied, only one patient was diagnosed with PAH. The sensitivities of the algorithms for the diagnosis of PAH were 62.5% for ESC/ERS, 75% for DETECT, 87.5% for ASIG according to the 2022 ESC/ERS guideline definition, and 100% for all according to the previous ESC/ERS guideline. With the recent criteria, PAH diagnosis in patients with SSc increased by 1.8-fold. Current algorithms for screening PAH are less sensitive with these revised criteria. Although the ASIG algorithm seems more sensitive, it can still miss the diagnosis. The multimodal/algorithmic approach seems to be the best option for predicting PAH.

The value of NLR versus MLR in the short-term prognostic assessment of HBV-related acute-on-chronic liver failure.

Systemic inflammation is associated with the development and progression of hepatitis B-associated acute-on-chronic liver failure (HBV-ACLF). The neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic biomarker in patients with HBV-ACLF. However, the role of the monocyte-to-lymphocyte ratio (MLR) as a prognostic inflammatory biomarker in multiple diseases is rarely mentioned in HBV-ACLF. We included a total of 347 patients with HBV-ACLF who met the definition of the Chinese Guidelines for the Diagnosis and Treatment of Liver Failure (2018 edition). Among them, 275 cases were included retrospectively, and 72 cases were collected prospectively. Clinical characteristics and laboratory examination data were collected from medical records within 24h after diagnosis to calculate MLR and NLR levels, and lymphocyte subpopulation counts were collected in prospectively included patients. Of the 347 patients with HBV-ACLF, 128 patients in the non-surviving group had a mean age of 48.87±12.89years; 219 patients in the survival group had a mean age of 44.80±11.80years and a combined 90-day mortality rate of 36.9%. The median MLR was higher in the non-survivors than in the survivors (0.690 vs 0.497, P<0.001). MLR values were significantly associated with 90-day mortality in HBV-ACLF (OR 6.738; 95% CI 3.188-14.240, P<0.001). The AUC for the predictive power of the combined MLR and NLR analysis for HBV-ACLF was 0.694, and the calculated MLR threshold was 4.495. In addition, in the analysis of peripheral blood lymphocyte subsets in HBV-ACLF, a significant decrease in the number of circulating lymphocytes was found in HBV-ACLF patients in the non-surviving group (P<0.001), with a predominant decrease in the number of CD8+T cells and no significant difference in the number of CD4+T cells, B cells or NK cells. Increased MLR values are associated with 90-day mortality in patients with HBV-ACLF, and the MLR may serve as a potential prognostic indicator for patients with HBV-ACLF. Decreased CD8+T-cell counts may be associated with poor survival in patients with HBV-ACLF.

Comparative Evaluation of Mineralized Bone Allografts for Spinal Fusion Surgery.

The primary objective of this review is to evaluate whether the degree of processing and the clinical utility of commercially available mineralized bone allografts for spine surgery meet the 2020 US Food and Drug Administration's (FDA) guideline definitions for minimal manipulation and homologous use, respectively. We also assessed the consistency of performance of these products by examining the comparative postoperative radiographic fusion rates following spine surgery. Based on the FDA's criteria for determining whether a structural allograft averts regulatory oversight and classification as a drug/device/biologic, mineralized bone allografts were judged to meet the Agency's definitional descriptions for minimal manipulation and homologous use when complying with the American Association of Tissue Banks' (AATB) accredited guidelines for bone allograft harvesting, processing, storing and transplanting. Thus, these products do not require FDA medical device clearance. Radiographic fusion rates achieved with mineralized bone allografts were uniformly high (>85%) across three published systematic reviews. Little variation was found in the fusion rates irrespective of anatomical location, allograft geometry, dimensions or indication, and in most cases, the rates were similar to those for autologous bone alone. Continued utilization of mineralized bone allografts should be encouraged across all spine surgery applications where supplemental grafts and/or segmental stability are required to support mechanically solid arthrodeses.

Protocol for the development of the Expert consensus on sedation and analgesia for neurocritical care patients (2023)

To further standardize the sedation and analgesia treatment for neurocritical care patients, the National Center for Healthcare Quality Management in Neurological Diseases and Chinese Society of Critical Care Medicine organized national experts in this fields to form Working group of the Expert consensus on sedation and analgesia for neurocritical care patients in order to update the Expert consensus on sedation and analgesia for patients with severe brain injury (2013) based on evidence-based medicine. This update aims to provide scientific guidance for the clinical diagnosis and treatment of neurocritical care patients. The working group followed the definition of clinical practice guidelines by the Institution of Medicine (IOM) and the World Health Organization guidelines development handbook and Guidelines for the formulation/revision of clinical guidelines in China (2022) to register and draft the Expert consensus on sedation and analgesia for neurocritical care patients. The working group will strictly adhere to the consensus development process to formulate and publish the Expert consensus on sedation and analgesia for neurocritical care patients (2023). This protocol primarily introduces the development methodology and process of the Expert consensus on sedation and analgesia for neurocritical care patients (2023), including the purpose of the update, the target population, the composition of the consensus development working group, the presentation and collection of clinical questions, evidence evaluation and summarization, and the generation of recommended opinions. This will make the consensus development process more standardized and transparent.

#4360 FACTORS ASSOCIATED TO RENAL REMISSION IN CRESCENTIC GLOMERULONEPHRITIS

Abstract Background and Aims Impaired renal function is one of the most relevant factors associated to crescentic glomerulonephritis (CGN) prognosis. However, renal remission has not yet been defined and clinicians are required to use systemic scores (such as BVAS) to predict severity. In this retrospective study, we aim to describe the associated factors to long-term chronic dialysis incidence and survival in CGN. Method We included all biopsy-proven CGN of our center between 2004 and 2022. At baseline, demographics, treatments and comorbidities were collected. Renal function was assessed by glomerular filtration rate (GFR) using CKD-EPI equation, quantification of proteinuria and demonstration of hematuria. During follow-up (median 1486, interquartile range [25-3082] days) renal and vital status was evaluated. Factors associated to dialysis requirement were assessed using Cox regression models. A combined endpoint of death and dialysis was established. Factors associated to the combined endpoint were assessed. Results We included 47 CGN (77% female, 67±15 years). Of them, 35 (75%) presented positive ANCA antibodies, 3 (6%) positive glomerular basement membrane (GBM) antibodies, 8 (17%) ANCA and GBM antibodies and one (2%) presented negative autoimmunity. Induction treatment was based on prednisone and cyclophosphamide in 43 patients (91%), prednisone and rituximab in 3 (6%) and prednisone alone in one (2%). At admission, median CKD-EPI was 11 (11-21) ml/min/1.73 m2, proteinuria was 1030 (552-1872) mg/g and 43 (91%) patients presented hematuria. Nineteen patients (40%) required dialysis at admission. Following the definition of KDIGO guidelines for renal remission, 28 (64%) patients achieve it at 6 months. During follow-up, fifteen patients (36%) started chronic dialysis. Factors associated to chronic dialysis were the type on CGN (dual ANCA and GBM and GBM (+) vs ANCA (+), p = 0.003), CKD-EPI at admission (p = 0.001), AKIN (p = 0.050), requirement of dialysis at admission (p&amp;lt;0.001), percentage of crescents (p = 0.037), proteinuria at admission (p = 0.046) and remission after induction treatment (p&amp;lt;0.001). Twenty-four patients (53%) died or needed dialysis during follow-up. Factors associated to this combined endpoint were CKD-EPI at admission (p = 0.017), type on CGN (dual ANCA and GBM vs others, p = 0.003) (Figure 1), debut in dialysis (p&amp;lt;0.001), remission after induction treatment (p&amp;lt;0.001). An adjusted Cox regression model demonstrated that the need for dialysis or death during follow-up was independently associated to not achieving remission after induction (i.e. 6 months) (HR 8.78, 95%CI (2.88-26.7), p&amp;lt;0.001) and requirement of dialysis at debut (HR 3.96, 95%CI [1.15-13.6], p = 0.029). Conclusion The requirement of dialysis at debut and not achieving remission after induction are independent predictors of death or need for chronic dialysis in CGN.

ASSOCIATION OF HIGH NORMAL BLOOD PRESSURE DEFINED BY DIFFERENT CRITERIA WITH ALL-CAUSE AND CARDIOVASCULAR MORTALITY

Objective: To evaluate the association of the all-cause and cardiovascular mortality with the guideline-based classification criteria and systolic blood pressure (SBP)-based classification for high normal blood pressure. Design and method: We collected data from the NHANES Database,which is a large, serial, cross-sectional survey designed to be nationally representative of the civilian adult population in the United States Inclusion Criteria: SBP &gt; 90mmHg; Without any antihypertensive treatment; Having complete record for a history of major cardiovascular-related disease including hypertension, coronary heart disease, myocardial infarction, heart failure, stroke, diabetes and hyperlipemia. All the participants were divided into 3 groups according to the latest guidelines or systolic blood pressure. Group1: Normotensivel; Group2: High normal blood pressure; Group3: Hypertension Results: By grouping population according to guideline definition, in terms of all-cause mortality and cardiovascular death, there was no significant difference between population with normal blood pressure (NT) and with high normal blood pressure (HNBP). But both groups had significantly lower risk compared with hypertension group (HTN). Multivariate Cox regression results indicated the lowest risk of all-cause mortality in the HNBP group and no difference in risk of all-cause mortality between the NT and HTN groups, which was illogical and inconsistent with real-world clinical practice. By grouping population according to SBP, we found that the grouping better distinguished all-cause and cardiovascular mortality among groups. Multivariate COX regression analysis found that NT and HNBP groups had no difference in risk of all-cause and cardiovascular death. The restricted cubic spline curve of DBP showed the lowest HR were found when DBP was between 83 and 95 mmHg, which were defined as high normal blood pressure or hypertension according to guideline-directed classification. This result may be the primary reason for the difference between guideline and SBP-directed classification. Conclusions: In this study, our analysis showed that the blood pressure based on SBP had a higher association with both all-cause mortality and cardiovascular mortality than the guide-directed definition. DBP inclusion could be a confounding factor for the classification. People with high normal blood pressure did not show a worse prognosis than those with normal blood pressure.

Impact of catheter ablation on atrial fibrillation burden and symptoms in patients with hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Fibrillation (AF) is more common in patients with hypertrophic cardiomyopathy (HCM) and is often very symptomatic in this cohort. The impact of catheter ablation (CA) in this context is controversial with low success rates using the guideline mandated end-point of freedom from arrhythmia. Purpose To determine whether CA of AF in patients with HCM would be associated with a significant reduction in AF burden and symptoms. Methods Patients diagnosed with HCM undergoing CA of AF between February 2017 and June 2021 were identified from a prospective, single-centre registry. Patients with CIED in situ were selected. Patients were followed up for objective evaluation of symptom severity. Interval device interrogation and remote CIED monitoring was used to determine first AF/AT recurrence and percentage AF/AT burden on continuous rhythm monitoring 12-months before and after CA. Results Of 257 HCM patients undergoing CA of AF, 33 had CIEDs and were followed up for 32±15 months. The mean age was 56.4±10.2 years and 22 (67%) were male. The maximal wall thickness on echocardiography was 1.7±0.3cm and LA diameter was 4.8±0.9. The left ventricular ejection fraction was 50±15%. 17 (52%) patients had paroxysmal AF and 16 (48%) had persistent AF of which 6 (18%) were longstanding persistent AF. Mean AF burden prior to CA was 36.9±26.5% and 24 (73%) reported EHRA III-IV symptom severity. AF recurred in 27 (82%) patients with a median time to first recurrence of 8 (3-17) months. AF burden significantly reduced after index AF CA (27% (7,59) to 2% (0, 41)) (Z=-2.2, p= 0.03)) and reduced further when allowing for repeat procedures in 10 (30%) patients to 0% (0-30%). This represented a &amp;gt;50% relative reduction in 22 (67%) patients and &amp;gt;95% relative reduction in 16 (48%) patients. This correlated with a reduction in symptom score with 20 (60.6%) patients reporting a change of ≥1 EHRA class, and 20 (60.6%) patients reporting EHRA class I-IIa status at 12 months. A positive relationship was seen on regression analysis, with a 16.4% absolute reduction in AF burden associated with a reduction of one EHRA class. (R2= 0.206, F=7.5, p=0.01). Amongst the 24 (72%) patients who had an AF/AT recurrence after the final procedure who would conventionally be called failures by guideline definitions, 11 (45.8%) patients improved by ≥ 1 EHRA class and 11 (45.8%) were class I-IIa. Conclusion Although AF recurrence is common after CA in HCM patients, there is a significant reduction in AF burden and symptoms in a majority of patients. A more comprehensive evaluation of AF burden, symptoms, quality of life and impact on hard end-points is needed to determine the utility of CA in this context.

Disagreement of ESC guidelines from 2016 and 2021 and HFA-PEFF and H2 FPEF scores in diagnosis of heart failure with preserved ejection fraction in atrial fibrillation patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure with preserved ejection fraction (HFpEF) frequently coexists with atrial fibrillation (AF). The gold-standard test for HFpEF diagnosis remains invasive assessment of left ventricular end-diastolic pressures but noninvasive diagnostic scoring systems have been developed to aid accurate diagnosis. However, the diagnosis of HFpEF in patients with AF is more difficult because some diagnostic criteria for HFpEF may be associated with AF instead of HFpEF per se. Purpose To compare the guidelines and scoring systems for HFpEF diagnosis in patients with AF, and to indicate the most relevant clinical and echocardiographic parameters supporting the diagnosis of HFpEF in an AF cohort. Methods Consecutive patients with paroxysmal or persistent AF scheduled for catheter ablation were included. Clinical characteristics and transthoracic echocardiography examination was collected at baseline visit. The European Society of Cardiology (ESC) guidelines from 2016 and 2021 as well as scoring systems (HFA-PEFF and H2FPEF scores) were used to diagnose HFpEF. In the H2FPEF score, patients with AF alone, score of 3, were assessed as group with the low risk for HFpEF (instead of intermediate risk according to the H2FPEF score), as all enrolled patients had AF. Multiple logistic regression was performed to find optimal parameters predicting HFpEF, that was defined as diagnosis of HFpEF according to all following scores: ESC guidelines from 2016 and 2021 and high risk in HF2FPEF and HF-PEFF scores. Results We analysed 325 patients (median age 65 [59-72], 36% women). Considerable differences were observed in HFpEF diagnoses when stratifying patients according to ESC 2016 and ESC 2021 guideline definitions; the percentage of HFpEF patients reduced from 55% (n=180) to 28% (n=90). The agreement of HF2PEF score relative to HFA-PEFF score was 46% (n=25/55), 54% (n=115/213) and 35% (n=20/57) of patients regarding low, intermediate and high risk for HFpEF, respectively. Overall, 5.8% of patients (n=19) had HFpEF (Figure 1). These 19 patients were older (median age 70 vs 65, p&amp;lt;0.001), had more often persistent AF (63% vs 30%; p&amp;lt;0.001) and vascular disease (37% vs 14%, p=0.017) as compared to those without HFpEF. Based on multiple logistic regression, higher values of N-terminal-pro hormone BNP (NT-proBNP; OR 1.02, 95CI 1.01-1.03) and LA volume index (LAVI; OR 1.13, 95%CI 1.04-1.23) were independent predictors of having HFpEF in AF population. The NT-proBNP of 45 pmol/L and LAVI of 45ml/kg2 were ideal cutoffs and constructed a model to predict HFpEF which fitted with a concordance index of 0.91 (95% CI 0.87–0.94) (Figure 2). Conclusions The differences in HFpEF definition in the guidelines and various scoring systems lead to considerable difference in stratification of HFpEF in AF patients. In our population, just 5.8% of AF patients were diagnosed with HFpEF regarding ESC guidelines and high risk for HFpEF in scoring systems.

A study of variation in therapeutic approach to low-risk differentiated thyroid cancer in the UK.

The British Thyroid Association and American Thyroid Association guideline definitions for low-risk differentiated thyroid cancers are susceptible to differing interpretations, resulting in different clinical management in the UK. To explore the national effect of these guidelines on the management of low-risk differentiated thyroid cancers. Anonymised questionnaires were sent to multidisciplinary teams performing thyroidectomies in the UK. Risk factors that multidisciplinary teams considered important when managing low-risk differentiated thyroid cancers were established. Most surgeons (71 out of 75; 94.7 per cent) confirmed they were core multidisciplinary team members. More than 80 per cent of respondents performed at least 30 hemi- and/or total thyroidectomies per annum. A majority of multidisciplinary teams (50 out of 75; 66.7 per cent) followed British Thyroid Association guidelines. Risk factors considered important when managing low-risk differentiated thyroid cancers included: type of tumour histology findings (87.8 per cent), tumour size of greater than 4 cm (86.5 per cent), tumour stage T3b (85.1 per cent) and central neck node involvement (85.1 per cent). Extent of thyroid surgery (e.g. hemi- or total thyroidectomy) was highly variable for low-risk differentiated thyroid cancers. Management of low-risk differentiated thyroid cancers is highly variable, leading to a heterogeneous patient experience.

Insights from 25years of oncogenetics: one person's perspective.

In early 1995, I established the oncogenetics service at the Genetics Institute of the Sheba Medical Center in Israel. The purpose of this article is to describe the key points and issues that were raised throughout my personal journey since then: physician and public awareness; ethical and legal issues; guidelines for oncogenetic counseling; the development of oncogenetic testing within the unique Israeli reality of the limited spectrum of BRCA1 and BRCA2 mutations; high-risk vs. population screening; and the definition and implementation of guidelines for surveillance of asymptomatic mutation carriers. Since 1995, oncogenetics has been transformed from a rare oddity to a pivotal player, and it represents a successful example of implementing personalized preventive medicine by identifying and providing care and by offering means for early detection and risk reduction for adults who are genetically predisposed to develop a potentially life-threatening disease-cancer in this case. Lastly, I outline my personal vision for the possible way forward for oncogenetics.

MP21-18 MISCONCEPTIONS ABOUT WOMEN WITH RECURRENT URINARY TRACT INFECTION IN YOUTUBE EDUCATIONAL VIDEOS; INCONGRUENCE WITH AUA GUIDELINES - HEALTH EQUITY FINDINGS

You have accessJournal of UrologyCME1 Apr 2023MP21-18 MISCONCEPTIONS ABOUT WOMEN WITH RECURRENT URINARY TRACT INFECTION IN YOUTUBE EDUCATIONAL VIDEOS; INCONGRUENCE WITH AUA GUIDELINES - HEALTH EQUITY FINDINGS Mostafa Bondok, Lynn stothers, Andrew Macnab, Vancouver, Canada, Mohamed Bandok, Calgary, Canada, A. Lenore Ackerman, Emma Dixon, Marcia Trochez, Kelsey Petersen, and Rishika Selvakumar Mostafa BondokMostafa Bondok More articles by this author , Lynn stothers Lynn stothers More articles by this author , Andrew MacnabAndrew Macnab More articles by this author , Vancouver Vancouver More articles by this author , Canada Canada More articles by this author , Mohamed BandokMohamed Bandok More articles by this author , Calgary Calgary More articles by this author , Canada Canada More articles by this author , A. Lenore AckermanA. Lenore Ackerman More articles by this author , Emma DixonEmma Dixon More articles by this author , Marcia TrochezMarcia Trochez More articles by this author , Kelsey PetersenKelsey Petersen More articles by this author , and Rishika SelvakumarRishika Selvakumar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stigmatization of health illness is a threat to health equity. Although case control studies demonstrate that commonly suggested hygiene practices do not decrease the incidence of urinary tract infection (UTI) in women, many patient-education sources promote this misconception, & in doing so risk stigmatizing women with UTIs as ‘dirty’ or ‘unclean’. Objective: To document the quality, veracity, & comprehensiveness of recurrent UTI (rUTI) information on YouTube to increase health care workers’ (HCWs) awareness of UTI-related content online, & to identify deficits in understanding, clarify misconceptions & reduce stigmatization risk. METHODS: High-traffic topic search terms were curated by Google Trends to extract 200, of which 45 met inclusion criteria. 5 independent reviewers used a standardized questionnaire based on the AUA rUTI guidelines to assess definition of UTI, marketing content, prophylaxis/prevention strategies, & antibiotic use/stewardship. Statistics: Fleiss kappa (K) assessed Inter-rater reliability (IRR). RESULTS: High variability and incongruency from guideline definitions of UTI (Table 1); the most common prophylactic strategy discussed Cranberry; only 55% discussed increasing fluid intake. Table 2 illustrates commonly recommended hygiene practices: including front to back wiping (25%) K=0.71. 33% promoted other non-evidence-based hygiene practices including expression of uncleanliness of women. CONCLUSIONS: Misleading information for women seeking education on UTI through YouTube is high. Misinformation on hygiene practices is unproductive, & several videos captured HCWs claiming that rUTI results from poor female hygiene practices, creating a health equity concern for women experiencing UTIs. These findings alert HCWs on the need to provide evidence-based recommendations by consulting practice guidelines, such as those provided by the AUA. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e293 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mostafa Bondok More articles by this author Lynn stothers More articles by this author Andrew Macnab More articles by this author Vancouver More articles by this author Canada More articles by this author Mohamed Bandok More articles by this author Calgary More articles by this author Canada More articles by this author A. Lenore Ackerman More articles by this author Emma Dixon More articles by this author Marcia Trochez More articles by this author Kelsey Petersen More articles by this author Rishika Selvakumar More articles by this author Expand All Advertisement PDF downloadLoading ...

Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults.

Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.

Development of a Decision-Making Model to Support the Strategic Environmental Assessment for the Revision of the Municipal Plan of Turin (Italy)

This article presents a decision-making model for assessing the sustainability of urban plans and programmes to envision long-term transformation scenarios through the development of consistency matrices. The tool was tested in a real case study, which is the Strategic Environmental Assessment for the Revision of the General Municipal Plan of the City of Turin (Italy). The changes that have taken place in recent years have highlighted the need for more flexible, dynamic, and streamlined tools that can help the revision of plans and programmes, which are capable also of considering the citizen’s needs. The decision-making model provided in this paper was structured into five phases: normative framing of the environmental assessment procedures; spatial analysis by structures; consistency analysis of conformity between the objectives of the technical proposal of the preliminary draft and the superordinate and coordinated planning; monitoring of the technical proposal through the employment of key indicators; and the definition of guidelines for the General Regulatory Plan of the City of Turin. The tool presented in this work can support planners, municipal technicians, and general public administrations, both in the planning and assessment processes to design and implement sustainable policy recommendations capable of tackling the increasing complexity of urban transformations.

Abstract GS1-10: Primary results from the randomized Phase II RIGHT Choice trial of premenopausal patients with aggressive HR+/HER2− advanced breast cancer treated with ribociclib + endocrine therapy vs physician’s choice combination chemotherapy

Abstract Background: Combination chemotherapy (CT) remains a standard of care in advanced breast cancer (ABC) with aggressive disease features (rapidly progressing or highly symptomatic disease, including life-threatening visceral crisis). To date, no data have been published on a head-to-head comparison of CDK4/6 inhibitor (CDK4/6i) + endocrine therapy (ET) vs combination CT in this patient (pt) population. RIGHT Choice, a randomized, open-label, multi-national, Phase II trial, investigated the efficacy and safety of first-line ribociclib (RIB) + ET vs combination CT in pre/perimenopausal pts with HR+/HER2− ABC with aggressive disease (where combination CT is clinically indicated by physician’s judgment). Here we report the results of the primary endpoint of progression-free survival (PFS) and key secondary endpoints from this study. Methods: Pre/perimenopausal pts with HR+/HER2− ABC (&amp;gt;10% estrogen receptor–positive [ER+]) and no prior systemic therapy for ABC were randomized 1:1 to receive either RIB (600 mg daily, 3 weeks on/1 week off) with letrozole/anastrozole + goserelin or investigator’s choice of CT (docetaxel + capecitabine, paclitaxel + gemcitabine, or capecitabine + vinorelbine). Randomization was stratified by presence of liver metastases and whether the disease-free interval (duration from date of complete tumor resection for primary breast cancer lesion to the date of documented disease recurrence) was less than two years. Pts included in the trial had ABC not amenable to curative therapy for which combination CT was clinically indicated by physician’s judgment (i.e., symptomatic visceral metastases, rapid progression of disease or impending visceral compromise, or markedly symptomatic non-visceral disease). Median PFS (mPFS) and median time to treatment failure (mTTF) were evaluated by Kaplan-Meier methods. Overall response rate (ORR) was also analyzed, with quality of life and biomarker analyses planned. RIGHT Choice is registered at ClinicalTrials.gov (NCT03839823). Results: A total of 222 pts (112 RIB + ET; 110 CT) were enrolled from Feb 2019 to Nov 2021. Pts with symptomatic visceral metastases (n=150; 67.6%), rapid disease progression (n=41; 18.5%), and markedly symptomatic non-visceral metastases (n=31; 14.0%) were included. Overall, 116 pts (52.3%) had visceral crisis based on guideline definitions. A majority of pts (n=190; 85.6%) had tumors that were ≥50% ER+. At data cutoff (Apr 12, 2022), median follow-up was 24.1 mo; 45.5% and 23.6% of pts remained on treatment in the RIB + ET arm and combination CT arm, respectively. The primary endpoint was met, with a statistically significant PFS benefit of ≈1 year for RIB + ET vs combination CT (mPFS, 24.0 vs 12.3 mo; hazard ratio, 0.54; 95% CI, 0.36-0.79; P=.0007). OS data were immature at data cutoff. The mTTF was ≈10 mo longer for RIB + ET vs CT (18.6 vs 8.5 mo; hazard ratio, 0.45; 95% CI, 0.32-0.63). The ORR was similar for RIB + ET vs CT (65.2% vs 60.0%). No new safety signals were observed in pts on RIB. Lower rates of treatment-related serious adverse events (AEs; 1.8% vs 8.0%) and lower rates of discontinuation due to treatment-related AEs (7.1% vs 23.0%) were seen with RIB + ET vs CT, respectively. AEs observed with combination CT were consistent with the published data. Conclusions: This analysis demonstrated a statistically significant and clinically meaningful PFS benefit with RIB + ET over combination CT in the first-line pre/perimenopausal pt population with aggressive HR+/HER2− ABC disease. This is the first study comparing a CDK4/6i + ET vs combination CT and demonstrating the superiority of RIB + ET in aggressive HR+/HER2− ABC. This evidence supports RIB+ ET use as a preferred option for this pt population. Citation Format: Yen-Shen Lu, Eznal Izwadi Bin Mohd Mahidin, Hamdy Azim, Yeşim ERALP, Yoon-Sim Yap, Seock-Ah Im, Julie Rihani, James Bowles, Teresa Delgar Alfaro, Jiwen Wu, Melissa Gao, Khemaies Slimane, Nagi El Saghir. Primary results from the randomized Phase II RIGHT Choice trial of premenopausal patients with aggressive HR+/HER2− advanced breast cancer treated with ribociclib + endocrine therapy vs physician’s choice combination chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS1-10.

SVINnovation Challenge: Fostering Innovation in Vascular and Interventional Neurology

SVINnovation Challenge: Fostering Innovation in Vascular and Interventional Neurology

Safety and Feasibility Assessment of a Pharmacy-Driven AUC/MIC Vancomycin Dosing Protocol in a Multicenter Hospital System.

Vancomycin is used for Gram-positive infections, including methicillin-resistant Staphylococcus aureus. The 2020 vancomycin guidelines described by M. J. Rybak, J. Le, T. P. Lodise, D. P. Levine, et al. (Am J Health Syst Pharm 77:835-864, 2020, https://doi.org/10.1093/ajhp/zxaa036) provided an update on vancomycin dosing, which recommended an optimal area under the concentration-time curve over 24 h to MIC (AUC/MIC) target of 400 to 600. In 2021, a pharmacy-driven AUC/MIC vancomycin dosing protocol was implemented across 12 Sentara Health System hospitals. The primary objective of this study was to assess if the pharmacy-driven AUC/MIC vancomycin dosing protocol led to fewer acute kidney injury (AKI) events than trough-based dosing. Secondary objectives included vancomycin duration, hospital length of stay, administered vancomycin dose during admission, vancomycin labs drawn during standard lab times, and cost. AKI was assessed in two separate ways: (i) modified AKIN (Acute Kidney Injury Network) criteria and (ii) a modified version from the vancomycin guidelines. Inferential statistics were used to analyze the results of this retrospective study. Per the AKIN definition, the rates of AKI were 13.9% (349/2,507) in the trough-based group and 14.9% (369/2,471) in the AUC/MIC-based group (P = 0.309). Per the definition of the vancomycin guidelines, the rates of AKI were 6.7% (169/2,507) in the trough-based group and 7.6% (187/2,471) in the AUC/MIC-based group (P = 0.258). A total of 52% (2,679/5,151) of vancomycin labs were obtained during standard lab times in the AUC group and 24% (1,144/4,766) in the trough group (P < 0.05). There was no difference in AKI events between AUC and trough dosing. Use of contrast dye may confound these results. AUC/MIC dosing was associated with more lab draws during standard times, a larger number of labs drawn per person, and less total use of vancomycin. IMPORTANCE In this article, we report that there were no differences in rates of acute kidney injury between trough-based vancomycin dosing and AUC/MIC-based vancomycin dosing across 12 hospitals. AUC/MIC dosing resulted in more vancomycin lab draws during standard lab draw times compared to trough dosing, thus making it more convenient for health care personnel. This study includes all uses for vancomycin, including empirical use, and all patient severity levels. Therefore, this research reflects real-world use of vancomycin in hospitals. AUC/MIC dosing is supported by various infectious disease societies. However, the feasibility of incorporating AUC/MIC dosing in hospitals is undetermined. This study is unique in that it includes hospitals of various sizes (small community hospitals and an academic teaching hospital), and it includes a feasibility component. Therefore, this study has broad applicability to other hospitals across the United States. This original research includes the clinical application of vancomycin in a multicenter health system.

University–industry cooperation: a taxonomy of intermediaries

AbstractThe fragmentation of the literature on intermediaries between the university and industry has led to a disorganised and confused theoretical landscape. This research addresses this gap in the literature by proposing an analytical tool that can be used as guidance. For this purpose, this work provides a taxonomy of these intermediaries and classifies them into five different classes. To this end, we review 125 studies on university–industry cooperation (UIC) intermediaries. In addition to the general and innovation-related information, we extracted specific data related to the relevant UIC intermediaries from each article, i.e. the type(s) of intermediary addressed and its identified functions. This taxonomy is based on twenty-two functions identified in the UIC intermediary literature and thirteen UIC intermediary types. The five proposed classes of intermediaries are specialised in five different roles. This integrative background can be applied in future research and in the definition of policy-based guidelines.

Defining and Regulating Peri-Urban Areas through a Landscape Planning Approach: The Case Study of Turin Metropolitan Area (Italy)

Peri-urbanization is a global phenomenon strongly linked to socio-demographic and settlement dynamics. Although peri-urbanization is a topic widely debated in academic literature, especially in the field of urban and regional planning, there is no universal definition, and different types and interpretations of peri-urban areas can be found in the literature. Identifying physical limits and boundaries, as well as defining what is peri-urban and what is not, are important issues for planning these spaces at city and metropolitan levels but are not easy to solve due to their heterogeneity. Establishing land use rules for peri-urban areas is a crucial issue for maintaining and fostering primary and vital ecosystem services, especially in terms of functions provided to urban core areas. Developing a replicable method to identify and regulate peri-urban areas, exportable to other European countries, is the aim of this study. In this paper, the authors propose a method applied to the case study of Turin (Italy), based on a collaborative and place-based approach, the identification of certain peri-urbanization conditions, and the definition of rules and guidelines for peri-urban areas, in order to support decision-makers at different levels. These planning tools were adopted by the recent General Territorial Plan of the Turin Metropolitan Area (TMA). In conclusion, the authors highlighted not only the strengths and possible limitations of this method but also the role of the landscape planning approach in terms of the protection and management of peri-urban areas, considering some of the new challenges that will likely involve future peri-urban research and planning practices.

Profissionais de apoio à inclusão escolar: quem são e o que fazem esses novos atores no cenário educacional?

ABSTRACT The study is a part of the dissertation published by the author, whose general objective was to describe and analyze the profile and performance of school inclusion support professionals in different municipal contexts, involving five municipalities, three in the state of Bahia and two in the state of São Paulo. Thirty school inclusion support professionals participated in the study, through focus groups. The objective of this article was to analyze administrative aspects and functions performed by these school inclusion support professionals in the school context. Despite gaps in the literature, the theoretical framework used was sufficient to support the research. The results showed: precariousness in the profile and performance of professionals, support service adopted indiscriminately, bad working conditions, function deviation, professional without an adequate profile, precariousness, and privatization of support for school inclusion. In addition to pointing out that school inclusion support professionals are, in some situations, the only professionals, when they should be part of a support network, the importance of this professional is pointed out for a portion of students from the special education target audience. However, there is a need for: definition of guidelines, improvement of working conditions, definition of job attributions, continuing education, and supervision.