Standard Evaluation Research Articles

Minimum Fascia-Tumour Distance for Differentiating Deep Lobe From Superficial Lobe Benign Parotid Tumours: A Retrospective Study and Meta-Analysis.

This study was designed to evaluate the diagnostic efficacy of the minimum fascia-tumour distance (MFTD) in distinguishing deep-lobe benign parotid tumours from superficial-lobe tumours through both an original study and a meta-analysis. In this study, we performed a retrospective analysis of data from 91 patients who had been diagnosed with benign parotid tumours. The MFTD values were sourced from preoperative ultrasound examinations. The locations of these tumours were confirmed through surgical findings. We assessed the diagnostic accuracy of MFTD by utilising receiver operating characteristic (ROC) curves. Additionally, we conducted a systematic review of the pertinent literature and performed a diagnostic meta-analysis to ascertain the overall diagnostic efficacy of MFTD in identifying benign parotid tumours. Patients with tumours in the deep lobe had a significantly greater MFTD than patients with tumours in the superficial lobe. Using a cutoff value of 3.50 mm for MFTD, we found an AUC of 0.93, a sensitivity of 81.8%, and a specificity of 98.8%. Our meta-analysis included seven studies covering a total of 1689 tumours. The pooled values for sensitivity, specificity, and diagnostic odds ratio (OR) of MFTD were 81.0%, 89.0%, and 32.2, respectively. The AUC of the summarised ROC curve of MFTD was 0.90. The MFTD demonstrated reliable diagnostic accuracy in identifying deep-lobe benign parotid tumours and may be incorporated into standard evaluations before parotidectomy.

Measurement Matters: A Metrological Approach to Renal Preimplantation Biopsy Evaluation to Address Uncertainty in Organ Selection.

Preimplantation biopsy combines measurements of injury into a composite index to inform organ acceptance. The uncertainty in these measurements remains poorly characterized, raising concerns variability may contribute to inappropriate clinical decisions. We adopted a metrological approach to evaluate biopsy score reliability. Variability was assessed by performing repeat biopsies (n = 293) on discarded allografts (n = 16) using 3 methods (core, punch, and wedge). Uncertainty was quantified using a bootstrapping analysis. Observer effects were controlled by semi-blinded scoring, and the findings were validated by comparison with standard glass evaluation. The surgical method strongly determined the size (core biopsy area 9.04 mm2, wedge 37.9 mm2) and, therefore, yield (glomerular yield r = 0.94, arterial r = 0.62) of each biopsy. Core biopsies yielded inadequate slides most frequently. Repeat biopsy of the same kidney led to marked variation in biopsy scores. In 10 of 16 cases, scores were contradictory, crossing at least 1 decision boundary (ie, to transplant or to discard). Bootstrapping demonstrated significant uncertainty associated with single-slide assessment; however, scores were similar for paired kidneys from the same donor. Our investigation highlights the risks of relying on single-slide assessment to quantify organ injury. Biopsy evaluation is subject to uncertainty, meaning each slide is better conceptualized as providing an estimate of the kidney's condition rather than a definitive result. Pooling multiple assessments could improve the reliability of biopsy analysis, enhancing confidence. Where histological quantification is necessary, clinicians should seek to develop new protocols using more tissue and consider automated methods to assist pathologists in delivering analysis within clinical time frames.

Screening and Identification Quality Markers for Antioxidant Activity of Tetrastigma hemsleyanum from Different Origins using Spectrum-effect Correlation Analysis

Background:: Tetrastigma hemsleyanum (THL) is a traditional medicinal plant with various biological activities, it has been validated that several THL extracts have strong pharmacological activities. Until now, there is no complete and systematic germplasm identification and quality evaluation standard. Objective:: Establishing fingerprint spectra of THL from different sources, evaluating their antioxidant activity and identifying quality markers. Methods:: In this paper, establishing fingerprints and identifying quality markers through UPLC-QTOF- MS/MS. The antioxidant capacity of forty-one batches of THL from multiple regions was determined by 1,1-Diphenyl-2-picrylhydrazyl radical (DPPH), 2,2'-Azinobis-(3-ethylbenzthiazoline-6- sulphonate) (ABTS), and Ferric reducing antioxidant power (FRAP) assays. Results:: The results indicated that THL methanol extracts showed good antioxidative activity and eight THL samples, including THL aerial parts, showed high antioxidative activity. Besides, Ultra Performance Liquid Chromatography (UPLC) fingerprints of THL from different places were established and chromatographic peaks probably correlated with antioxidant capacity were screened by principal component analysis (PCA) and partial least square regression (PLS) analysis. Conclusion:: The chemical constituents of these peaks were identified as possible quality markers for THL quality evaluation. In this study, twelve effective substances were preliminarily determined, such as isovitexin, L-epicatechin, procyanidin B, sitosterol, etc.

Compact convolutional transformer for subject-independent motor imagery EEG-based BCIs

Motor imagery electroencephalography (EEG) analysis is crucial for the development of effective brain-computer interfaces (BCIs), yet it presents considerable challenges due to the complexity of the data and inter-subject variability. This paper introduces EEGCCT, an application of compact convolutional transformers designed specifically to improve the analysis of motor imagery tasks in EEG. Unlike traditional approaches, EEGCCT model significantly enhances generalization from limited data, effectively addressing a common limitation in EEG datasets. We validate and test our models using the open-source BCI Competition IV datasets 2a and 2b, employing a Leave-One-Subject-Out (LOSO) strategy to ensure subject-independent performance. Our findings demonstrate that EEGCCT not only outperforms conventional models like EEGNet in standard evaluations but also achieves better performance compared to other advanced models such as Conformer, Hybrid s-CViT, and Hybrid t-CViT, while utilizing fewer parameters and achieving an accuracy of 70.12%. Additionally, the paper presents a comprehensive ablation study that includes targeted data augmentation, hyperparameter optimization, and architectural improvements.

Medical students attitudes towards patients with disability: a scale validation study

BackgroundDisparities in health outcomes among persons with disabilities (PWD) are influenced by preventable factors including negative attitudes and discriminatory practices of healthcare professionals and the limited training of medical students in working with PWD.ObjectiveThe purpose of this study was to validate the “Medical Students’ Attitudes Towards Patients with Disabilities” (MSA-PWD) scale among Lebanese medical students and identify associated factors.MethodA scale validation study was conducted as part of the standard internal evaluation process at the medical school, using a cross-sectional design based on a qualitative content validity process, involving students from years 1 to 4. The study included questions from previous tools, and others encouraging students to reflect on their encounters with PWD and share their insights. Statistical procedures were applied to assess the reliability and validity of the tool, including construct validity, convergent validity, known-group validity, and trend analysis.ResultsAfter a careful selection of the related items, the MSA-PWD scale demonstrated high construct validity and internal consistency, along with good convergent validity and known-group validity. Factor 1 of the scale was able to differentiate between different enrollment years of medical students, correlating with the self-assessment tool for confidence in dealing with PWD and clinical experience scenarios.ConclusionThe “Medical Students’ Attitudes Towards Patients with Disabilities” scale validated in this study is a comprehensive instrument that can distinguish between different medical school enrollment classes. The newly developed scale was valid, and reliable.

Novel deep learning algorithm demonstrates strong performance for detection and quantification of breast arterial calcification and associates with cardiovascular disease

Abstract Background Breast arterial calcification (BAC) on mammography is associated with cardiovascular disease (CVD).1, 2 Given mammography is widely used as part of national breast cancer screening programs, routine reporting of BAC could address current limitations of CVD detection in women. Fully automated artificial intelligence (AI) software can facilitate seamless integration of BAC assessment alongside standard radiological evaluation of mammograms. and advancement in AI imaging software may result in clinically significant, superior BAC detection. Purpose To evaluate the performance of a deep-learning, fully-automated BAC detection algorithm against gold standard human BAC detection, and to evaluate its association with cardiovascular risk and disease. Methods A cohort of 285 women (mean age 61) with 2D digital mammography and CVD assessment with either an anatomic or functional test were evaluated. Cardiovascular risk factors were obtained from medical records. Visual BAC (vBAC) was assessed as present/absent by independent reviewers and BAC was scaled by an algorithm incorporating size, length, density and location (aBAC, 0-100). Diagnostic performance of vBAC and aBAC were compared and expressed as area under the receiver operator characteristic curve (AUC). Cardiovascular risk factor and disease prevalence was compared between vBAC and aBAC with CVD status defined by either abnormal anatomical or functional testing. Results The prevalence of vBAC and aBAC were 30.5% and 59.6%, respectively. The algorithm showed excellent discrimination for BAC detection compared with vBAC (AUC 0.92 [95% CI 0.89-0.98]), with sensitivity 94% and negative predictive value 96%. Interpretation took on average 144 seconds/patient with vBAC and 10 seconds/patient with aBAC (p<0.001). We identified 88 discordant cases (vBAC negative, aBAC positive), which were all represented by ‘faint’ BAC scores (<25). aBAC detected a greater proportion of patients with traditional cardiac risk factors, particularly in women <65 years (Figure 1). CVD was present in 136 (48%), among whom 37.5% were detected by vBAC and 61.7% by aBAC. CVD was present in 42% of the 88 discordant cases. Increasing BAC score was associated with increased relative risk of CVD presence (Figure 2). Conclusion Algorithmic scoring of BAC demonstrates a high performance and is faster to perform when compared to vBAC. Furthermore, it identifies greater proportion of women with higher cardiovascular risk and those with prevalent CVD. Lastly, aBAC detects ‘faint’ (visually missed) lesions that may have significant clinical implications.

Population-based physical activity promotion with a focus on health equity: evidence challenges

Abstract Issue Physical activity (PA) approaches that target the entire population hold great promise for public health particularly in terms of health equity due to their broad reach. During the process of developing national recommendations for PA and PA promotion in Germany, followed by a partial update, it became evident that there is limited evidence regarding population-based PA interventions with a focus on health equity. Our objective was to present an overview of the underlying reasons for this scarcity of evidence. Methods The methodology used in the development of the German recommendations to identify evidence for population-based health equity interventions was applied. Five scientific databases were searched for reviews published between 2015-2021. References of the included reviews were checked for additional reviews. Publications without any focus on health equity were not considered. The identified evidence was summarized narratively, followed by a description of existing challenges in evaluating. Results Our search yielded 4,411 reviews, of which 79 met the inclusion criteria but 75 were excluded because approaches did not focus on the whole population, or did not address health equity. Two reviews were found in the search for gray literature. Thus, the result is a total of 6 articles. None of these reviews reported the application of a theory. The consideration of quality criteria used before, during and after the practical implementation of interventions is not common. The complexity of population-based approaches proved to be a challenge. Conclusions Overall, there is a need for more emphasis on health equity in the implementation and evaluation of population-based PA approaches. The consideration of a theoretical underpinning of such complex approaches in complex systems and the application of standardised quality criteria are an important prerequisite for the generation of evidence. Key messages • There is little evidence of population-based PA approaches aimed at health equity. • A standardized and comprehensive evaluation assessment that is accepted by all public health stakeholders is needed.

Multimodal human-computer interaction in interventional radiology and surgery: a systematic literature review.

As technology advances, more research dedicated to medical interactive systems emphasizes the integration of touchless and multimodal interaction (MMI). Particularly in surgical and interventional settings, this approach is advantageous because it maintains sterility and promotes a natural interaction. Past reviews have focused on investigating MMI in terms of technology and interaction with robots. However, none has put particular emphasis on analyzing these kind of interactions for surgical and interventional scenarios. Two databases were included in the query to search for relevant publications within the past 10 years. After identification, two screening steps followed which included eligibility criteria. A forward/backward search was added to identify more relevant publications. The analysis incorporated the clustering of references in terms of addressed medical field, input and output modalities, and challenges regarding the development and evaluation. A sample of 31 references was obtained (16 journal articles, 15 conference papers). MMI was predominantly developed for laparoscopy and radiology and interaction with image viewers. The majority implemented two input modalities, with voice-hand interaction being the most common combination-voice for discrete and hand for continuous navigation tasks. The application of gaze, body, and facial control is minimal, primarily because of ergonomic concerns. Feedback was included in 81% publications, of which visual cues were most often applied. This work systematically reviews MMI for surgical and interventional scenarios over the past decade. In future research endeavors, we propose an enhanced focus on conducting in-depth analyses of the considered use cases and the application of standardized evaluation methods. Moreover, insights from various sectors, including but not limited to the gaming sector, should be exploited.

Immune-checkpoint myocarditis phenotype when using systematic troponin surveillance in cancer patients.

Abstract Background ICI myocarditis, often described as potentially fulminant in registries from specialized centers, lacks sufficient data on its subclinical forms. ESC 2022 guidelines advocate systematic troponin measurements for early detection, resulting in numerous suspected cases of ICI myocarditis. Additionally, many patients receive other potentially cardiotoxic cancer drugs (e.g.,anthracyclines), adding complexity to the management. Purpose To identify factors associated with ICI-myocarditis diagnosis in a single-center unselected cohort referred for suspicion of CV immune-related adverse events(irAEs). Patients underwent standardized evaluation, including serum testing, ECG, echocardiogram, cardiac MRI(CMRi) and multidisciplinary team assessment including cardiology and internal medicine specialists. Coronary imaging and myocardial biopsy (EMB) were performed as needed. ICI-myocarditis diagnosis was adjudicated by expert panel (FC, MM, SH) based on Dallas, ESC, and IC-OS criteria. Results We enrolled 175 consecutive patients from March 2022 to October 2023; 40 (22.89%) were male, with a median age of 61 (IQR 48.0-72.0) years. 92(52.57%) were referred for lone asymptomatic troponin raise, 101 (57.7%) had breast cancer; 142 (81.11%) received other cardiotoxic drugs. We identified 95 (61.71%) patients with CV irAEs at referral (8 had >=2 CV irAEs) with a total of 108 CV irAEs after follow up, including 72 (41.14%) with ICI-myocarditis at referall. No CV deaths occurred within 30 days from referall. Characteristics and univariate analysis are depicted in the Table1. Reasons for referral in the ICI-myocarditis population are depicted in the Figure1. On multivariate regression analysis, prior CV disease history (OR 6.232 [CI 1.204-32.260], p=0.029), EMB (OR 24.969 [5.139-121.32], p=<.0001), IC-OS criteria fulfilled (OR 43.108 [9.222-201.510], p=<.0001), and positive Lake Louise criteria on CMRi (OR 6.583[1.416-30.610], p=0.0163) were associated with myocarditis. In a sub-analysis group of breast cancer patients (largely receiving anthracyclines), ICI-myocarditis was associated on multivariate regression with abnormal ECG (OR 14.227 [CI 1.632-124.040], p=< 0.0163) and EMB (OR 8.508 [CI 2.718-26.638], p=0.0002). The same characteristics were significantly associated with other CV irAEs in the group of breast cancer patients. In the group of patients with cancers other than breast, factors significantly associated with ICI myocarditis diagnosis were: EMB (OR 70.656 [CI 5.970-836.161], 0.0007), and no arterial hypertension (OR 9.554 [CI 1.792-50.940], p= 0.0082). Conclusions The FAST TRACK study highlights the high proportion of patients fulfilling ICI-myocarditis criteria despite no or mild symptoms, mainly referred for troponin elevation. However, subclinical ICI-myocarditis appears to bear good prognosis. Endomyocardial biopsy is key to increase the diagnosis rate of ICI-myocarditis across different cancer populations when mildly symptomatic.Table 1Figure 1

Echocardiographic evaluation of ventricular performance in VA-ECMO weaning: results from a observational monocentric prospective study

Abstract Background Although temporary mechanical circulatory support (MCS) devices are increasingly used in the management of cardiogenic shock (CS), several open question regarding the kind of support and timing of institution/weaning remains open. Echocardiography is widely applied to drive the weaning process and decision although there are no standardized protocols for the trial nor accordance on the parameters to apply. Purpose We sought to evaluate the overall accuracy of echocardiographic indices in predicting successful weaning from VA ECMO in patients with CS. Specifically, we tested total isovolumic time (tIVT), an index of ventricular performance, and longitudinal function (MAPSE) on top of the commonly used parameters (left ventricular ejection fraction, LVEF; left ventricular velocity time integral, LV VTI; TAPSE; right ventricular S’ at tissue Doppler imaging, RV S’). Methods Monocentric prospective study on adults receiving VA-ECMO due to refractory CS and/or cardiac arrest (CA) from 2012 to 2020. Echocardiography was performed at VA-ECMO placement and during the weaning trials. Weaning trials were performed daily, starting 48 hours after VA-ECMO institution, when patients were hemodynamically stable: mean arterial pressure >65 mmHg, no or minimum adrenergic support (vasoactive inotropic score <10), heart rate <110 bpm, lactate <2 mmol/L, and no signs of respiratory distress. Weaning trials were performed with a stepwise decrease of VA-ECMO blood flow until reaching 1 or 1.5 L/min under adequate anticoagulation. Successful weaning was defined as removal of VA-ECMO with no requirement for further MCS in the following 30 days. Results 76 patients were enrolled (23.8% female, 54.2±10.6 years-old), 52.6% due to CA. Median duration of VA-ECMO was 58 hours; 47 (61.8%) had intra-aortic balloon pump (IABP) inserted upfront. In-hospital mortality was 62.4% overall, 40% for CS without CA. 6 of the 32 weaned patients died for multiorgan failure due to septic shock. The baseline echocardiographic parameters associated with successful weaning were (table): stroke volume >13.9 mL (p 0.002), tIVT >23.6 min/sec (p 0.053), LV VTI >6.6 cm (p<0.001), MAPSE >6.15 mm (p 0.001), TAPSE >11 mm (p 0.023), RV S’ >10 cm/s (p 0.012). LVEF did not reach the statistical significance. Figure shows Kaplan-Meier analysis on echocardiographic indices collected at time of cannulation (panel A) and during the last weaning trial (panel B). Conclusions Echocardiography is pivotal in defining cardiac recovery and monitoring the weaning trial. Indices reflecting ventricular performance and delivered flow from LV were associated with weaning success both at VA-ECMO institution and throughout the weaning trials. Considering the known limitations of LVEF (heart rate, loading and left ventricular dyssynchrony dependence), tIVT and MAPSE should be introduced in the standard evaluation of patients in the acute setting.TableFigure

Evaluating healthcare inequalities using ChatGPT4 – The case of potentially inappropriate medication

Abstract Issue/problem Regular and standardized monitoring of healthcare is necessary to inform decision makers and clinicians about healthcare quality. Equity is a fundamental dimension in such evaluations. We aimed to investigate if artificial intelligence (AI) large language models (LLM), such as ChatGPT4, may facilitate routine monitoring of healthcare inequalities using an established framework for healthcare quality and equity evaluation, analysis of individual heterogeneity and discriminatory accuracy (AIHDA). Description of the problem We have previously demonstrated that compared to traditional methods, AIHDA improves the evaluation of healthcare inequity. We asked ourselves if ChatGPT4 could facilitate the standardized application of the AIHDA approach in routine monitoring of healthcare. Results Using strict guidelines, we instructed a GPT model, based on ChatGPT 4, to utilize the AIHDA framework for evaluating healthcare inequalities. To demonstrate the analysis, we used the quality indicator potentially inappropriate medication among elderly and analyzed simulated data of individuals >75-year-old belonging to 36 socioeconomic strata and residing in 21 Swedish regions. The GPT performed an accurate analysis, correctly interpretated the results and formulated an informative short rapport with illustrative tables and figures. Lessons AI appears to facilitate routine monitoring of health care inequity using the AIHDA approach. AI also allows a constructive interaction with the user but, so far, it needs be closely supervised. Key messages • ChatGPT 4 can improve the standardized evaluation of healthcare inequity. • Although the technology is under development and must be used with caution.

4.N. Scientific session: Equity in Child Health: Leveraging Universal Health Promotion Services for Families Amid Uncertainty

Abstract This workshop addresses the urgent need to foster resilience and equity in child health within the context of an increasingly uncertain Europe. Rapid societal changes, exacerbated by events such as the COVID-19 pandemic and heightened risks of conflict, climate change and economic instability, underscore the importance of nurturing environments where children can thrive despite challenging circumstances. The workshop aims to explore strategies for promoting well-being and addressing social inequalities in child health within the context of universal health promotion services, such as school health services and child health clinics. Objectives are to 1) Elucidate the importance and impact of universal health promotion services in addressing social inequalities and promoting equitable opportunities for all children, regardless of background or circumstance; 2) Identify actionable steps for interventions mitigating social inequalities and promoting equitable opportunities focusing on health literacy among parents with immigrant backgrounds; 3) Showcase successful models and initiatives in universal healthcare and health promotion services for children and families, emphasizing early intervention and standardized evaluation tools; and 4) Facilitate dialogue and knowledge exchange among professionals, policymakers, and stakeholders involved in child and adolescent health promotion. This workshop’s added value lies in its multidisciplinary approach, fostering collaboration for innovative solutions in child health resilience and equity. The coherence between presentations lies in their joint focus on addressing social inequalities in the context of universal health promotion services for children and families. Each presentation offers a unique perspective on these themes, contributing to a comprehensive understanding of the challenges and opportunities in child health promotion. • Hanne Nissen Bjørnsen’s presentation on the role of universal services in public health and addressing social inequality sets the stage by examining the structural factors contributing to disparities in child health outcomes. • Kirsti Riiseŕs presentation conveys the importance of user, stakeholder, and community involvement in creating culturally sensitive strategies for effective health promotion services in the context of health literacy among parents with immigrant backgrounds • Kristin Haraldstad’s presentation on Starting Right, an evidence-based assessment of children in municipalities healthcare centers, highlights the importance of early intervention and targeted support in mitigating health inequalities and promoting well-being. Format of the workshop: Three 10-minute presentations followed by a 20-minute moderated discussion to delve into empowerment and equity in child health, encouraging rich idea exchanges. Key messages • Leveraging universal health promotion services effectively empowers children and families while addressing social inequalities amidst periods of uncertainty. • Collaborative, user-centered approaches and evidence-based working strategies are key to promoting equity and building resilience in child health.

Association of Dairy Foods in Acne Vulgaris

Background: Acne vulgaris is one of the most commonly found skin problems affecting teenagers and adolescents. Dietary foods particularly dairy products consist of milk or any of its food made from milk are frequently regarded by patients and clinicians as a cause or aggravator of acne. As there are very limited studies found on this regard, this study was aimed to find the association of dairy foods in acne vulgaris. Methods: This wasa cross-sectional analytical study and was carried out in the Dermatology and Venereology department of Shaheed Suhrawardy Medical College Hospital. Total 260 patients were selected by appropriate inclusion criteria equally into two groups: Group A (diagnosed with acne vulgaris, n=130) and group B (patients not having acne vulgaris, n=130). A thorough history of every patient and face to face interview was taken by a predesigned questionnaire after getting the written informed consent of the patient. Data were collected in predetermined data collection form. Result were subjected to standard statistical evaluation and were analyzed by SPSS-24. Results: According to the age group, majority of the acne patients were between 10-20 years (75.4% in group A and 63.8% in group B, p<0.05), though mean age in both groups were statistically similar (18.53±5.78 and 17.29±4.59 years, respectively). Also, female respondents were predominant in both groups (80.8% and 72.3%). The risk was increased in those with a family history of acne in siblings (OR2.449, p=0.021;95% CI,1.145-5.238) and the risk was reduced in subjects doing physical exercise. Papules (35.4%) and comedones (27.7%) were most common lesion and mostly found in forehead (74.6%) and left (68.5%) and right (63.1%) cheeks. According to global acne severity grading, majority had mild form of acne (83.1%) and use of cosmetics (43.8% vs. 30%), topical steroid (34.6% vs. 16.9%), taking fastfood (24.6% vs. 14.6%) and less water intake (36.9% vs. 18.5%) also significantly higher among acne patients. Multivariate regression analysis showed, dairy products such as whole milk (OR 1.984, p=0.022), chocolate (2.490, p=0.004), chips (OR 3.207, p<0.001), Pizza (OR 2.388, p=0.021) and red meat (OR 3.055, p=0.009) were significant risk for developing acne vulgaris. Also, whole milk (3.050, p=0.01), chocolate (3.817, p=0.004) and pizza (3.822, p=0.005) were independent risk factors for moderate to severe acne. Conclusion: This study found an association between high dairy product consumption and acne in adolescents, indicating that dairy consumption may be a contributing factor for developing acne vulgaris. J Shaheed Suhrawardy Med Coll 2022; 14(2): 25-33

Textual Attributes of Corporate Sustainability Reports and ESG Ratings

While the textual attributes of corporate financial documents, such as annual reports, have been extensively analyzed in the academic literature, those of corporate sustainability reports, which serve as a critical channel for nonfinancial disclosure, are relatively under-explored. Given the increasing importance of Environmental, Social, and Governance (ESG) factors in corporate strategy and stakeholder evaluation, understanding the role of textual attributes in sustainability reporting is crucial. This study examines 10,021 hand-collected sustainability reports from Chinese firms between 2009 and 2021, focusing on six key textual attributes: length, readability, tone, boilerplate language, redundancy, and completeness. Using computational linguistics, we analyze how these attributes evolve over time and their impact on ESG ratings provided by both international (MSCI, FTSE) and domestic (SNSI) agencies. Our findings reveal that the length and completeness of sustainability reports significantly influence ESG scores across agencies, demonstrating a shared appreciation for detailed and transparent disclosures. However, international and domestic rating agencies exhibit differing responses to attributes like tone, boilerplate language, and redundancy. These differences highlight variations in evaluation standards, methodologies, and value orientations between global and local stakeholders. The results emphasize the need for firms to tailor their sustainability disclosures to meet diverse stakeholder expectations. This study contributes to the growing body of literature on nonfinancial reporting by providing empirical evidence on how specific textual characteristics of sustainability reports can shape ESG evaluations, offering insights for both corporate communicators and policymakers.

Study on the clinical effect of meridian massage in the treatment of lumbar disc herniation

To observe the clinical efficacy of meridian massage in the treatment of lumbar disc herniation(LDH). Between July 2020 and April 2023, 82 patients with lumbar disc herniation were selected, including 58 males and 24 females, aged from 23 to 55 years old with an average of (43.76±6.64) years old. According to the different treatment methods, they were divided into observation group and control group with 41 cases in each group. The control group was treated with routine treatment, and the observation group was treated with meridian massage on the basis of routine treatment. In the control group, there were 30 males and 11 females;aged from 22 to 52 years old with an average of (42.27±9.34) years old;the Body mass index (BMI) ranged from 19 to 28 kg·m-2 with an average of(23.82±1.08) kg·m-2;the course of disease ranged from 0.5 to 3.0 years (2.40±0.48) years. There were 28 cases in L4,5 segment and 13 cases in L5S1 segment. In the observation group, there were 28 males and 13 females;the age ranged from 19 to 54 years old (42.19±9.26) years old;the BMI ranged from 18 to 29 kg·m-2 with an average of(23.73±1.15) kg·m-2;the course of disease ranged from 0.6 to 2.8 with an average of(2.56±0.45) years;there were 26 cases in L4,5 segment and 15 cases in L5S1 segment. Visual analogue scale(VAS), Oswestry disability index(ODI), M-JOA score and TCM syndrome score were measured before and after 3 courses of treatment, and the clinical efficacy was evaluated by the standard of curative effect evaluation. After treatment, VAS [(3.24±1.45) vs(4.46±0.64)], ODI [(11.45±1.98)% vs (17.21±2.74)%] and TCM symptom score [(2.03±0.27) vs (3.99± 0.54)] of the observation group were lower than those of the control group. The score of M-JOA [(23.43±2.61) vs (19.37±1.62)] increased (P<0.05). The scores of VAS, ODI and TCM symptoms in the observation group were lower than those in the control group, while the scores of M-JOA were higher than those in the control group (P<0.05). Meridian massage is effective in the treatment of LDH, which can effectivelyrelieve low back pain, improve clinical symptoms and increaselumbar function, which is worthy of clinical promotion.

A comparative analysis of the evaluation system for comprehensive reform of agricultural water prices in China

Water is a fundamental natural resource that affects human and social development, and also plays an important role in modern agricultural production and food security. In China, agricultural water consumption accounts for the majority of the total water consumption. For a long time, China has not fully implemented water pricing and payment for agricultural water, and the lower agricultural water cost have led to the waste of water resource and the rapid conversion of agricultural water to other industries. In order to avoid agricultural water waste and achieve the goal of agricultural sustainable development, the Chinese government has launched a comprehensive reform of agricultural water prices nationwide since 2016. According to the plan, nowadays, the reform will faces overall evaluation and acceptance in 2024 and 2025. However, there is a lack of a relatively unified and flexible nationwide evaluation index system and acceptance measures. In this study, a comparative research of the evaluation system for comprehensive reform of agricultural water prices was developed. Based on existing evaluation and acceptance measures issued by four typical provincial regions, this study compared and analyzed the compliance and similarities and differences of these acceptance measures with national reform policies and requirements. From the aspects of evaluation procedure and index system, a systematic comparative analysis was conducted on the integrity and differences in the four regions. At the same time, suggestions were given for policy-making of national evaluation process and standard. The comparative analysis results showed that the evaluation indices in the four provincial regions have met all the key points of national reform policies and have a complete system, but there were significant differences in the structure of the evaluation index system in different provincial regions. It is recommended to establish a simple, relatively unified and practical national evaluation and acceptance system as soon as possible. In addition, evaluation criteria for individual specific indices should be determined by region based on the differences in economic capacity and agricultural water conservancy facilities conditions.

Research and Consideration on the Reform Path of Practical Teaching Quality Evaluation in the Five-Year System of Higher Vocational Colleges

Practice teaching is an important part of the five-year system of higher vocational personnel training. A perfect practice teaching quality evaluation system is an important measure to test the effect of talent training and promote the continuous improvement of teaching quality. Based on this, this paper studies the reform path of practical teaching quality evaluation in higher vocational colleges for five years. Firstly, it expounds on the significance of the reform of practical teaching quality evaluation, then analyzes the existing problems in the current practical teaching quality evaluation, and puts forward the corresponding reform path given the existing problems. Including scientific formulation of evaluation standards, focus on practical teaching process, establishment of daily evaluation mechanism, construction of five-year continuous training and improvement mechanism, and optimization of teacher team construction, to improve the quality of practical teaching in five-year vocational colleges and cultivate more high-quality and high-skill applied talents for the society.

Using reflection and dialog feedback to promote the development of situated and dynamic pedagogical content knowledge

This study explores the reflection and dialog feedback of preservice teachers (PTs) in a one-semester chemistry teaching design and practice course with the aim of improving their situated and dynamic pedagogical content knowledge (PCK). Using a collective case study method, reflections and dialogs from 18 PTs across six teaching cycles were analyzed. The research results indicate that teaching reflection focuses on five themes: the diversity of student situations, the functionality of teaching contexts, the consistency of teaching content, the construction of teacher‒student dialog, and the progression of subject practice activities. The reflection of the PTs strengthened meaningful teaching content and corresponding specific skills, and effective dialog feedback provided external evaluation standards. The reflection prompted teachers to evaluate from multiple perspectives and levels and provided important insights to promote the development of situated and dynamic PCK. This study concludes with a discussion of the practical implications and potential for future research to develop a situated and dynamic PCK for PTs.

Smartphone-based thermal imaging for pedicled skin flaps: a pilot study toward objective perfusion assessment in facial, head, and neck reconstruction.

This study aims to develop a practical algorithm for utilizing smartphone-based thermal imaging (SBTI) in the perioperative setting and to establish a standardized evaluation method for objectively assessing SBTI images for cutaneous perfusion of pedicled flaps in the face, head, and neck. This prospective conducted study, integrated SBTI into the assessment of 16 patients undergoing reconstructive surgery for face and neck defects. Thermal images were captured at four timepoints: after marking (T1), after flap elevation (T2), upon completion of surgery (T3), and 24h postoperatively (T4). The flap areas were divided into three flap zones and graded based on temperature differences (ΔT), with a grading system where grade 1 indicated perfect perfusion and grades 2 to 5 indicated increasing perfusion impairment. 6 male and 10 female patients aged 64-93 years (mean 78.5 years) undergoing reconstructive pedicled skin flap surgery for facial and neck defects (1 × 1cm to 11 × 8cm) due to diagnoses of malignant cutaneous lesions were investigated. Intraoperative assessments indicated good perfusion across flaps. One postoperative dehiscence occurred in an 83-year-old male with a cervical advancement flap, correlated with a significant temperature difference (ΔT > 4°C) intraoperatively. Statistical analysis revealed a strong positive correlation (p = 0.0003) between clinical assessment grades and ΔT values between specific flap zones at T3. SBTI is an easy-to-apply, low-cost, real-time and reproducible technique for indirect perfusion assessment in pedicled skin flaps of the head and neck region. Further studies are needed implementing this methodology in large and free flaps.

Prevention of Trafficking in Organs, Tissues, and Cells.

Trafficking in human organs, cells, and tissues has long been a source of concern for health authorities and professionals, and several international ethical guidance documents and national laws have affirmed the prohibition of trade in these substances of human origin (SoHOs). However, despite considerable attention to the issue of organ trafficking, this remains a substantial and widespread problem internationally. In contrast, trafficking in cells, tissues, and medical products derived from SoHOs has received comparatively little attention, and the extent and nature of such trafficking remain largely unknown. Consequently, as part of the 2023 Global Summit on Convergence in Transplantation held in Santander, Spain, an ethics working group was assigned the task of formulating actionable recommendations to support the prevention of trafficking in all SoHOs. In reporting on this work, we review factors that may influence the persistent trafficking of SoHOs, explore the potential difficulties associated with the collection and reporting of data about suspected trafficking activities, and argue that more practical and consistent guidance, training, and regulatory frameworks are needed internationally to support effective reporting, sharing of data, and collaborative responses to suspected trafficking cases. We also discuss the importance of psychosocial evaluation of living donors as a strategy to detect and prevent organ trafficking and strive to advance the implementation of this well-established recommendation by outlining minimum standards for psychosocial evaluation of living donors.