Effective Outcomes Research Articles

Next-generation combination approaches for immune checkpoint therapy.

Immune checkpoint therapy has revolutionized cancer treatment, leading to dramatic clinical outcomes for a subset of patients. However, many patients do not experience durable responses following immune checkpoint therapy owing to multiple resistance mechanisms, highlighting the need for effective combination strategies that target these resistance pathways and improve clinical responses. The development of combination strategies based on an understanding of the complex biology that regulates human antitumor immune responses has been a major challenge. In this Review, we describe the current landscape of combination therapies. We also discuss how the development of effective combination strategies will require the integration of small, tissue-rich clinical trials, to determine how therapy-driven perturbation of the human immune system affects downstream biological responses and eventual clinical outcomes, reverse translation of clinical observations to immunocompetent preclinical models, to interrogate specific biological pathways and their impact on antitumor immune responses, and novel computational methods and machine learning, to integrate multiple datasets across clinical and preclinical studies for the identification of the most relevant pathways that need to be targeted for successful combination strategies.

Prospective Comparison of Conventional External Dacryocystorhinostomy and Endonasal Laser Dacryocystorhinostomy

Background:Epiphora, a common manifestation of chronic dacryocystitis, requires definitive treatment through dacryocystorhinostomy (DCR), a surgical procedure aimed at creating an alternative fluid drainage pathway.This study aimed to assess how effective both external dacryocystorhinostomy (Ex-DCR) and endonasal dacryocystorhinostomy (Endo-DCR) are in managing chronic dacryocystitis, with a specific focus on surgical duration, complication rates, and treatment outcomes. Methods: In this study, sixty participants were prospectively enrolled and evenly divided into two groups. Thirty patients were assigned to the first group and underwent En-DCR surgery, while the second group, also comprising thirty patients, underwent Ex-DCR surgery. Both groups were monitored for a duration of 9 months and assessed for surgical duration, perioperative and postoperative complications, and eventual surgical outcomes. Results: The distribution of patients across age groups and sexes was similar between the two groups (p>0.05). Clinical features such as epiphora, epiphora with discharge, and epiphora with swelling were comparable between groups. En-DCR group demonstrated significantly less intraoperative bleeding (mean:13.5 ml vs 50 ml; p<0.0001) and shorter operative durations (mean: 20 mins vs 37.5 mins; p<0.0001) compared to Ex-DCR group. Complications such as nasal bleeding and hematoma were minimal in both groups, with no significant differences noted. The final outcome, categorized as success (En-DCR vs Ex-DCR: 76.7% vs 83.3%) or failure (23.3% vs 16.7%), did not show a statistically significant difference between the two groups (p>0.05). Conclusion:Both surgical techniques offer feasible alternatives for addressing issues related to nasolacrimal obstruction. J Bangladesh Coll Phys Surg 2024; 42: 355-362

The effects of cultural humility on therapeutic alliance and psychotherapy outcomes: A systematic review and meta‐analysis

AbstractAimThe present review and meta‐analysis sought to synthesise previous findings of studies examining the correlation between therapist cultural humility, the quality of the therapeutic alliance and psychotherapy outcomes.Materials and MethodsThree databases were searched for relevant citations, yielding 548 records for review. After the systematic review of these articles, a final sample of 13 citations was submitted for coding and analysis. A random‐effects meta‐regression model was used to synthesise correlations collected from the final sample of studies. Heterogeneity was assessed using Cochran's Q, I2 and τ2. Publication bias was assessed using contour‐enhanced funnel plots and Egger's test for asymmetry.ResultsThere was a statistically significant, positive correlation between cultural humility and alliance quality (r = .66, 95% CI = [0.64, 0.68]). Similarly, a smaller, yet still statistically significant and positive association between cultural humility and psychotherapy outcomes was also found (r = .39, 95% CI = [0.36, 0.42]). Moderators related to client race, gender and lesbian, gay and bisexual (LGB) status were also examined though nonsignificant.ConclusionSuch results suggest that therapist cultural humility is an important part of a strong working relationship and eventual positive outcomes in psychotherapy regardless of race, gender or LGB status. Thus, efforts should be made to foster cultural humility among therapists.

Primary closure of fasciotomies has a reduced complication rate following compartment syndrome in the paediatric population.

Currently no guidance exists within the literature regarding diagnostic criteria or the long-term outcomes for paediatric patients with acute compartment syndrome (ACS). We conducted a retrospective cohort study reviewing all cases of paediatric ACS managed at a single tertiary referral centre with the aim of characterising the factors responsible for the eventual outcomes. The patient cohort was identified retrospectively by interrogating the hospital coding system for all paediatric patients between January 2014 and November 2022. The electronic emergency department, inpatient and operative notes as well as clinic letters for each patient were reviewed and data collected regarding presentation, associated injuries, management and subsequent complications plus length of follow-up. The data was analysed to determine if differences in presentation or management affected long term outcome. The final cohort consisted of 34 patients with a mean age of tenyears at the time of presentation. The mean time from presentation to fasciotomy was 27.6h (range 3.0 - 66.6). There was an overall complication rate of 37.5% with a mean follow-up period of 21months. Patients who had direct closure of their fasciotomy wounds had a significantly lower complications rate and fewer operations compared to those who healed via other wound coverage methods or secondary intention (p < 0.05). Significantly higher complication rates were observed in patients who were unable to have direct wound closure following emergency fasciotomy. This information may be utilised to rationalise long term treatment plans and in counselling of patients and parents.

Identifying trajectories of change in sleep disturbance during psychological treatment for depression

BackgroundSleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making. MethodThis analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services. ResultsSix distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well. LimitationSingle item on sleep disturbance used, no data on treatment adherence. ConclusionsThese findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance.

Model Relationship Between Performance Criteria And The Most Significant Accounting Of Value-Based Criteria : Economic Added Value (EVA)

Monetary patrons make informed decisions by assessing positive pointers that an association could show from this point forward, rather than relying altogether upon its evident execution. Consequently, this assessment plans to explore the relationship between execution norms and the main worth based estimation: Monetary Added Worth (EVA). Besides, it investigates what future EVA values mean for a bank's overall worth. The audit uses Board Data Examination and OLS Backslide models to assess the backslide condition. The audit separated data from ten banks in the BIST Banks Rundown spreading over the period from 2011 to 2020. In this manner, the Monetary Added Worth (EVA) measures were changed into standardized EVA (SEVA) by parceling EVA by full scale assets. The eventual outcomes of the Standard Least Squares (OLS) backslide assessment showed that the model's illustrative power for the SEVA variable was 71.92%. Extraordinarily, three variables showed positive associations with SEVA: benefit per share (EPS) and TOBINQ at a significance level of 1%, as well as the improvement speed of cost to-bargains at a significance level of 10%. Concerning Board Data Assessment, the SEVA variable showed an illustrative power of 72.14%, with a basic relationship saw among SEVA and the EPS and TOBINQ measures at the 1% significance level. Observational revelations recommend that including future SEVA as a mediator for bank regard holds responsibility, and it is recognized that the SEVA variable can go about as an intermediary measure for bank regard. Concerning Board Data Examination, the SEVA variable displayed a sensible power of 72.14%. Very, its relationship with the pay per share (EPS) and TOBINQ models was seen as immense at the 1% significance level. Careful assessments suggest that the model, which involves future SEVA as a middle person for bank regard, holds ensure. It is recognized that the SEVA variable can go about as a substitute measure for bank regard.

Describing, knotting, tying: developing emerging media documentary in a creative accelerator context

ABSTRACT This article discusses the experiences of six artists participating in a new Australian creative accelerator programme for emerging media documentary. Attending to the processes, perspectives and frames employed by these artists in developing their early-stage projects, the article explores the diverse practice-based methods employed in developing documentary for emerging media formats. The paper argues for the value of attending to process and practice, as key frameworks that set the context for eventual creative outcomes. In doing so, the paper aims to contribute to knowledge about methods to support artists in developing emerging media documentary in a creative accelerator context.

Machining scheme selection technique for feature group based on re-optimized bacterial foraging algorithm

ABSTRACT Machining scheme selection is presently time-consuming and inefficient due to singularity and uncertainty in decision-making. Typically, the selection is based on a singular feature, with eventual outcomes remaining uncertain. In response, this paper proposes a feature-group-oriented re-optimized bacterial foraging algorithm to solve this problem by selecting the optimal machining schemes for multiple similar features in one part at once. Our focus is on designing the re-optimized bacterial foraging algorithm to optimize machining schemes, which considers the processes of chemotaxis, fine-tuning, replication, and adaptive migration with re-optimization. Then, comparative studies with varying weights and algorithms are conducted as an illustration of machining scheme selection for the hole feature-group. The results indicate that the re-optimized bacterial foraging algorithm accurately produces three distinct machining schemes based on varying weights. Additionally, the optimal average value outperforms other algorithms in the comparative study, demonstrating the algorithm’s validity and superiority.

Gender Promotion Gaps and Career Aspirations

Using a representative survey of U.S. lawyers, we document a sizeable gender gap in early partnership aspirations, which explains half of the later gender promotion gap. We further document that the correlation between aspirations and effort provides a “mechanical link” between aspirations and promotion. Early workplace experiences, such as harassment and demeaning comments, are linked to promotion aspirations. Moreover, early aspirations provide insight into eventual promotion outcomes that goes beyond what can be drawn only from expectations. Our study highlights that measuring aspirations and adapting the corporate culture that shapes them are key components for firms to improve workplace environments. This paper was accepted by Joshua Gans, business strategy. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.00715 .

Paper or Tablet? The Impact of Digital Tools on Sketching During Engineering Design Concept Generation

Abstract Sketching is an important tool for engineers during concept generation. Sketch quantity during this early stage of design has been linked with eventual design outcomes and sketch quality has been linked with design perceptions. As such, both are important metrics to track. Prior work has also found gender differences in some of these sketch attributes, and considering gender imbalances in the field, it is important to assess whether there are differences in performance by gender during concept generation and if the use of digital tools exacerbate or mitigate any of these potential differences in performance by gender. Given the increase in use of digital tablets for sketching, it is important to assess how tablet use affects early stage engineering design sketches. This is especially important as tablets can automatically smooth lines and help perfect sketch features, but these features may also take longer to use and may result in fewer sketches produced. This study investigates differences in sketch quality, quantity, and understandability (the effectiveness of the sketch as a communication tool) between sketching on a tablet and sketching with pen on paper during an engineering design concept generation exercise. Results indicate that there is no difference in sketch quantity or understandability between the two tools. However, sketch quality, smoothness, and proportion/accuracy are all higher for the pen and paper condition than for the tablet condition. Finally, no gender differences in performance for either sketch quantity or quality were found.

Assessing Accented Speech with a Data-Based Assessment Framework: The Key to Evidence-based Accent-Management

Background: Foreign-accent Management continues to be a rapidly growing area. However, due to the vast variability and lack of professional regulation in this area of practice, Speech-language Pathologists and English-as-Second-Language teachers grapple with the basics of assessment, setting goals, planning therapy, and identifying successful outcomes for accent Management. Purpose: The purpose of this paper is to introduce practitioners/teachers to a framework of assessment of accent-related communication concerns. The CAAI assessment framework provides major areas to include in assessment of accented speech, along with methods to assess with key examples. Using a proven assessment framework helps identify the key speech and language issues that interfere with communication, thereby setting an useful baseline for effective intervention, numerically tracking progress along the way, and conducting a systematic post-intervention outcome assessment. Methodology: Twenty-two areas of communication are identified and described in detail as key areas to identify accent-related concerns. Pre- and post-therapy assessment data, intelligibility judgments by independent raters, and the clients’ judgments are used to quantitatively diagnose, set goals in therapy, and measure eventual therapy outcomes. Conclusions: Use of a data-driven, objective assessment method helps clinicians to be evidence-based, systematic, and consistent in helping individuals with accented speech. As a result, clients’ goals of clear communication can be met rapidly and efficiently.

Delayed elective total shoulder arthroplasty: causes and eventual outcomes.

The purpose of this study is to identify risk factors for delays in planned total shoulder arthroplasty (TSA) and determine the perioperative outcomes of TSAs that experienced a delay. The American College of Surgeons National Quality Improvement Program (NSQIP) database was queried from 2006 to 2019 for primary TSA. Delayed TSA was defined as surgery that occurred greater than one day after hospital admission. Patient demographics, comorbidities, and post-operative complications were collected and compared; the incidence of delayed TSA was analyzed. The delayed patients were older, had a higher BMI, a higher rate of recent prior major surgery, and more comorbidities. Delayed patients had higher rates of postoperative complications, return to the OR, and 30-day readmission. Between 2006 and 2019, the rate of delayed TSA decreased. Surgeons should take care to ensure that patients with comorbidities undergo thorough preoperative clearance to prevent same-day cancellations and postoperative complications.

The normative reference value of the L test in older adults of age group 60 to 70 years of elderly adults: a cross-sectional study

The normative reference value of the L test in older adults of age group 60 to 70 years of elderly adults: a cross-sectional study

Effect of Day 3 cell number on the live birth rate of vitrified-warmed Day 5 single blastocyst transfer in young women.

Previous studies have reported inconsistent results regarding blastocyst selection with a high day 3 (D3) cell number and the eventual pregnancy outcomes. Thus, in this study, the relationship between the D3 cell number and clinical outcomes of day 5 single blastocyst transfer (SBT) in vitrified-warmed transfer cycles was investigated. Our retrospective study included 1144day 5 SBT in vitrified-warmed cycles between February 2016 and February 2021. All cycles were the first vitrified-warmed cycles, and the female patients were less than 35 years of age. Based on the D3 cell number, the cycles were divided into four groups, as follows: group A (3-7 cells, n = 130); group B (8-9 cells, n = 621); group C (10-12 cells, n = 328); and group D (13-16 cells, n = 65). The differences in the live birth rate (LBR), clinical pregnancy rate, and miscarriage rate were examined among the four groups. The LBR and clinical pregnancy rate increased with the D3 cell number (P < 0.01). No significant difference was found in the miscarriage rate among the groups (P = 0.055). After adjusting for confounding factors, the LBR was significantly higher in groups C (odds ratio [OR] = 1.477, 95% confidence interval [CI]: 1.124-1.941, P = 0.005) and D (OR = 2.000, 95% CI: 1.166-3.429, P = 0.012) than in group B. A high D3 cell number (> 9 cells) was associated with a high LBR in the vitrified-warmed day 5 SBT cycles of patients < 35 years of age. The cell number of D3 embryos can be an important reference indicator for blastocyst selection. Among blastocysts with the same morphological score, those with > 9 cells on D3 can be preferentially selected for transplantation.

Implemenasi Sistem Sharia Crowdfunding terhadap Efektivitas Penghimpunan Dana Zakat, Infaq dan Shadaqah (Studi pada Wahdah Inspirasi Zakat Kota Makassar)

This investigation intends to sort out how the sharia crowdfunding structure is completed in social occasion zakat, infaq and shadaqah resources at Wahdah Inspirasi Zakat, Makassar City. This sort of assessment uses emotional procedures with a humanistic juridical philosophy, the data sources used are fundamental and discretionary data, then, the data collection strategies used are discernment, gatherings and documentation. The data examination strategies used are data combination, data decline, data show, closures and affirmation. The eventual outcomes of this investigation show that the utilization of the sharia crowdfunding system in social affair zakat, infaq and shadaqah resources at Wahdah Inspirasi Zakat, Makassar City has experienced an addition of up to 80% during the use of crowdfunding because there are 2 models of crowdfunding stages used in get-together zakat, infaq and shadaqah reserves. can assist with expanding the assortment of zis reserves, to be specific boxinfak.id and wiz gifts. boxinfak.id and wiz gifts are utilized in gathering zakat, infaq and shadaqah reserves or muzakki in paying zakat, infaq and sadaqah, utilizing the crowdfunding framework truly helps the amil or muzakki in gathering or paying zakat, infaq and sadaqah.

Pengaruh Work Life Balance, Stress Kerja Dan Etika Kerja Islam Terhadap Kinerja Karyawan Pasca Pandemi Covid – 19 di Bank Muamalat KCU Medan Baru

This exploration plans to figure out how Islamic hard working attitudes, work pressure, and balance between serious and fun activities impact representative execution at Bank Muamalat KCU Medan Baru after the Coronavirus pandemic. This examination is a kind of survey research using a quantitative system. This investigation data was obtained from 34 respondents using an inside and out examination system. Opinion polls are used in the process of gathering information. The data checking procedure in this investigation is genuine checking with the assistance of the SPSS transformation 23.0 program. The exploration's findings indicate that representative implementation is influenced by a combination of work pressure and a hard-work attitude, as well as a balance between fun and serious activities. This is shown by the likely eventual outcomes of the T test and F test.Work pressure tcount (1.082) ttable (1.697) tcount (6.437) ttable (1.697) tcount (0.894) ttable (1.697) tcount (0.894) ttable (1.697) tcount (0.894) ttable (1.697) tcount (0.894) ttable (1.697) ttable (1.697) tcount (0.894) ttable (1.697) ttable (1.697) In the interim the F test produces Fcount (20.086) &gt; Ftable (4.160) and a sig worth of 0.000 &lt; 0.05.

Distinguishing between intrinsic and instrumental sources of the value of choice

Considerable evidence suggests that people value the freedom to choose. However, it is unclear whether this preference for choice stems purely from choice's intrinsic value, or whether people prefer to choose because it tends to provide instrumental information about desirable outcomes. To address this question, participants completed a novel choice task in which they could freely choose to exert choice or not, manipulating the level of instrumental contingency between participants' choices and eventual outcomes, which we operationalized using the information-theoretic concept of mutual information. Across two experiments (N = 100 each), we demonstrate a marked preference for choice, but importantly found that participants' preference for free choice is weakened when actions are decoupled from outcomes. Taken together, our results demonstrate that a significant factor in people's preference for choice is an assumption about the instrumental value of choice, suggesting against a purely intrinsic value of choice.

Clinicopathological features and outcome of secondary steroid resistant nephrotic syndrome: A retrospective analysis.

To determine the clinico-pathological features and long-term outcome of secondary steroid-resistant nephrotic syndrome treated with steroids and calcineurin inhibitors. The retrospective cohort study was conducted at the Sindh Institute of Urology and Transplant, Karachi, in June and July 2023, and comprised data from January 1, 2008, to December 31, 2020, of children aged 1-18 years who developed steroid resistance after initial sensitivity to steroids with at least 1-year of follow-up. Demographics as well as time taken to secondary steroid response were documented. Renal biopsy of all patients with secondary steroid resistance had been performed. Eventual outcomes after treatment with calcineurin inhibitors based on the degree of proteinuria and serum albumin levels were used to categorise complete remission, partial remission and no response. Kidney function, as determined by estimated glomerular filtration rate, was recorded. Data was analysed using SPSS 22. Of the 1,000 patients who underwent renal biopsy for steroid resistance, 48(4.8%) had idiopathic steroid-resistant nephrotic syndrome; 32(66.7%) males, 16(33.3%) females and median age of 5 years (interquartile range: 4-7.3 years). Median age at diagnosis of nephrotic syndrome was 5 years (interquartile range: 3.6-7.3 years). The median time from nephrotic syndrome to secondary steroid-resistant nephrotic syndrome was 23 months (interquartile range: 8.75-44.5 months). Biopsy results at diagnosis showed that 27(56.3%) had minimal change disease. The mean follow-up time was 6.1±3.2 years. Of the 43(89.5%) patients who received cyclosporin for 1 year, 29(67%) obtained complete remission, 5(12%) attained partial remission and no response was seen in 9(21%) patients. Majority of the children had minimal change disease at the time of diagnosis of secondary steroid-resistant nephrotic syndrome. The long-term response with calcineurin inhibitors was favourable at 1 year.

Neurite Growth and Electrical Activity in PC-12 Cells: Effects of H3 Receptor-Inspired Electromagnetic Fields and Inherent Schumann Frequencies

Cells are continually exposed to a range of electromagnetic fields (EMFs), including those from the Schumann resonance to radio waves. The effects of EMFs on cells are diverse and vary based on the specific EMF type. Recent research suggests potential therapeutic applications of EMFs for various diseases. In this study, we explored the impact of a physiologically patterned EMF, inspired by the H3 receptor associated with wakefulness, on PC-12 cells in vitro. Our hypothesis posited that the application of this EMF to differentiated PC-12 cells could enhance firing patterns at specific frequencies. Cell electrophysiology was assessed using a novel device, allowing the computation of spectral power density (SPD) scores for frequencies between 1 Hz and 128 Hz. T-tests comparing SPD at certain frequencies (e.g., 29 Hz, 30 Hz, and 79 Hz) between the H3-EMF and control groups showed a significantly higher SPD in the H3 group (p &lt; 0.050). Moreover, at 7.8 Hz and 71 Hz, a significant correlation was observed between predicted and percentages of cells with neurites (R = 0.542). Key findings indicate the efficacy of the new electrophysiology measure for assessing PC-12 cell activity, a significant increase in cellular activity with the H3-receptor-inspired EMF at specific frequencies, and the influence of 7.8 Hz and 71 Hz frequencies on neurite growth. The overall findings support the idea that the electrical frequency profiles of developing cell systems can serve as an indicator of their progression and eventual cellular outcomes.

Stakeholder engagement in the development of genetically modified mosquitoes for malaria control in West Africa: lessons learned from 10 years of Target Malaria's work in Mali.

From 2012 to 2023, the Malaria Research and Training Center (MRTC), based out of the University of Sciences, Techniques and Technologies of Bamako (USTTB), was part of the Target Malaria research consortium working towards developing novel gene drive-based tools for controlling populations of malaria vector mosquitoes. As part of this work, Target Malaria Mali has undertaken a range of in-depth engagement activities with the communities where their research is conducted and with other stakeholders nationally. These activities were meant to ensure that the project's activities took place with the agreement of those communities, and that those communities were able to play a role in shaping the project's approach to ensure that its eventual outcomes were in line with their needs and concerns. This paper aims to conduct a critical assessment of those 10years of stakeholder engagement in order to identify good practices which can inform future engagement work on gene drive research in West Africa. It sets out a range of approaches and practices that enabled the Target Malaria Mali team to engage a variety of stakeholders, to share information, collect feedback, and determine community agreement, in a manner that was inclusive, effective, and culturally appropriate. These can be useful tools for those working on gene drive research and other area-wide vector control methods in West African contexts to ensure that their research is aligned with the interests of the communities who are intended to be its ultimate beneficiaries, and to allow those communities to play a meaningful role in the research process.