Lack Of Consensus Research Articles

Dickkopf-related protein 1 as a biomarker of local immune status and worse prognosis of Oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is an infiltrative malignancy characterized by a significantly elevated recurrence rate. Dickkopf-related protein 1 (DKK1), which plays an oncogene role in many cancers, acts as an inhibitor of the Wingless protein (Wnt) signaling pathway. Currently, there is a lack of consensus regarding the role of DKK1 in OSCC or its clinical significance. To examine the role and effect of DKK1 in OSCC. The identification of differentially expressed genes (DEGs) in OSCC was conducted by utilizing databases such as The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). A comprehensive analysis of gene expression profile interactions (GEPIA) and Kaplan-Meier curve were conducted to investigate the associations among DEGs, patient survival and prognosis in individuals with OSCC. The biological function of DKK1 in OSCC was investigated by using molecular biology approaches. The expression of DKK1 was found to be upregulated in OSCC tissues at various stages. High levels of DKK1 expression exhibited a positive correlation with the overall survival (OS) and progression-free survival (PFS) rates among OSCC patients. DKK1 knockdown suppressed the proliferation and induced apoptotic response in OSCC cells. Moreover, DKK1 exerted a positive regulatory effect on HMGA2 expression, thereby modulating cell growth and apoptosis in OSCC. The expression of DKK1 was found to be positively correlated with the infiltration of immune cells in patients with OSCC. Additionally, higher levels of CD4 + T cells were associated with improved 5-year survival rates. DKK1 is a prognostic biomarker for patients with OSCC.

Metabolic syndrome in children and adolescents

Background: Metabolic syndrome is a serious condition associated with multiple diseases. The prevalence of metabolic syndrome is increasing caused by an increase in obesity rates among children and adolescents.Current Concepts: Owing to the various definitions used, there is lack of consensus regarding the diagnostic criteria for metabolic syndrome in children and adolescents. Although the exact pathogenesis remains unclear, insulin resistance and subsequent inflammation are key mechanistic contributors. Metabolic syndrome is characterized by overweight and obesity accompanied by abnormalities in glucose metabolism, dyslipidemia, and hypertension and is associated with other conditions such as fatty liver, polycystic ovary syndrome, and a pro-inflammatory state. Prevention and management of metabolic syndrome can be achieved through lifestyle modifications, behavioral interventions, pharmacotherapy, and surgical interventions.Discussion and Conclusion: Childhood and adolescent obesity serves as a risk factor for metabolic syndrome during later life. Early identification and intervention are important to prevent the progression of metabolic syndrome. Clinicians must identify at-risk children and adolescents and provide guidance for the prevention and management of metabolic syndrome.

Tools for telehealth: A correlational analysis of app-based hearing testing.

Telehealth evaluation of hearing is rapidly evolving; however, the lack of consensus on the most accurate remote hearing test application has made hearing evaluation complicated. The objective of this study was to evaluate the correlation between the pure tone audiometry results obtained from app-based hearing testing programs and a traditional audiogram. A prospective within-subject and between-subject study design was used to correlate audiogram results between app-based hearing programs and a traditional audiogram. All participants completed a traditional audiogram, 1 commercial app-based test (ShoeBox), 2 consumer app-based tests (EarTrumpet and Hearing Test and Ear Age Test [HTEAT]), and a Hearing Handicap Inventory screening version (HHI-S). Testing was conducted in an acoustically controlled environment (traditional) and a quiet room (app-based hearing tests). A total of 39 participants were enrolled in the study (21 with normal hearing and 18 with hearing loss). In patients with normal hearing, only the commercial hearing testing app (ShoeBox) had a statistically significant pure tone average correlation in both ears with traditional audiometry (Right ear-r = 0.7, p = .005, Left ear-r = 0.66, p = .001). Both consumer and commercial apps had statistically significant correlations with both ears in patients with hearing loss (ranging from r = 0.62 to r = 0.9). Regarding accuracy within 10 dB of the pure tone average of the traditional audiogram of all tested ears, the commercial app-based test was accurate in 94% for all ears (normal and hearing loss), while consumer app-based tests were between 14% and 36% for all ears. The HHI-S indicated no hearing impairment in 95% of those with normal hearing and indicated hearing impairment in 89% of those with hearing loss. Commercial-grade app-based pure tone audiometry demonstrates overall strong correlation and accuracy with traditional audiometry. The HHI-S assessment remains a valid and useful tool to predict normal hearing and hearing impairment. 2.

Identifying Population-Level and Within-Hospital Disparities in Surgical Care.

The lack of consensus on equity measurement and its incorporation into quality-assessment programs at the hospital and system levels may be a barrier to addressing disparities in surgical care. This study aimed to identify population-level and within-hospital differences in the quality of surgical care provision. The analysis included 657 National Surgical Quality Improvement Program participating hospitals with over 4 million patients (2014-2018). Multi-level random slope, random intercept modeling was used to examine for population-level and in-hospital disparities. Disparities in surgical care by Area Deprivation Index (ADI), race, and ethnicity were analyzed for five measures: all-case inpatient mortality, all-case urgent readmission, all-case postoperative surgical site infection, colectomy mortality, and spine surgery complications. Population-level disparities were identified across all measures by ADI, two measures for Black race (all-case readmissions and spine surgery complications), and none for Hispanic ethnicity. Disparities remained significant in the adjusted models. Prior to risk-adjustment, in all measures examined, within-hospital disparities were detected in: 25.8-99.8% of hospitals for ADI, 0-6.1% of hospitals for Black race, and 0-0.8% of hospitals for Hispanic ethnicity. Following risk-adjustment, in all measures examined, fewer than 1.1% of hospitals demonstrated disparities by ADI, race, or ethnicity. Following risk adjustment, very few hospitals demonstrated significant disparities in care. Disparities were more frequently detected by ADI than by race and ethnicity. The lack of substantial in-hospital disparities may be due to the use of postoperative metrics, small sample sizes, the risk adjustment methodology, and healthcare segregation. Further work should examine surgical access and healthcare segregation.

Need for consensus on primary endpoints and efficacy definitions in trials for adult acute lymphoblastic leukemia

A lack of consensus on acceptable primary endpoints and definitions of response and survival in Phase II/III efficacy studies for adult acute lymphoblastic leukemia has led to widely different clinical trial designs. Inconsistency in primary endpoint selection and lack of consensus on response, survival endpoints, and adequate follow-up time leads to difficulty interpreting completed studies and developing future trials. Lack of consensus also runs a risk of integrating ineffective or unacceptably toxic regimens into clinical practice and future trials. Increasingly, studies integrating highly-active, targeted agents into chemotherapy are using short-term endpoints of response, MRD-negative response, and early event-free survival without confidence that these endpoints will translate into improved late patient outcomes. This article highlights current consequences and dilemmas caused by this lack of consensus. The hope is to stimulate discussion and ultimately consensus to improve interpretation and application of clinical trial results.

Learning to Implement Dialogic Reading Through Video-Based Online Training: A Preliminary Study.

Dialogic reading (DR) is an evidence-based method for reading with young children that is associated with improvements in children's oral language skills. There is, however, a lack of consensus on (a) how to train educators to deliver the intervention and (b) methods for assessing implementation fidelity. We designed this study to provide preliminary data about the viability of online video modules as an initial training option within a future tiered training model. We employed a within-subject repeated-measures group design to evaluate educators' (N = 20) implementation of DR after viewing training videos. Educators filmed themselves reading three storybooks with a child "as they would typically" to establish pretest reading behaviors. After being given access to a series of DR training videos, the educators recorded themselves reading three storybooks with the child using DR strategies as a posttest measure. Educators improved their use of individual strategies included in the DR instructional sequence at posttest; however, most participants did not consistently follow the entire instructional sequence as designed. Only one educator delivered the complete DR instructional sequence in > 80% of opportunities at posttest. Modifications to video training modules and additional coaching support may be warranted for many educators to achieve the level of implementation fidelity needed to improve the child's oral language skills from the intervention. https://doi.org/10.23641/asha.25749387.

Precocious Puberty and GnRH analogs: Current treatment practices and perspectives amongst US pediatric endocrinologists.

GnRHas are used for treatment of precocious puberty. Over the last decade, several new formulations have been approved. The Drugs & Therapeutics subcommittee of the Pediatric Endocrine Society (PES) undertook a review to ascertain the current treatment options, prescribing behaviors, and practices of GnRHas among pediatric endocrinologists practicing within the United States. The survey consisted of four main subsections: 1. Description of clinical practice; 2. Self-assessment of knowledge base of pediatric and adult GnRHa formulations; 3. Current practice for treating CPP; and 4. Utilization of healthcare resources. There were 223 survey respondents. Pediatric endocrine practitioners were most familiar with the pediatric one-monthly preparation, the three-month preparation, and the histrelin implant (Supprelin®) (61.9%, 71.7%, and 34.5%, respectively), with lower familiarity for 24-week triptorelin intramuscular (Triptodur®) and 22.9% and six-month subcutaneous leuprolide (Fensolvi®). Only 23% of the respondents reported being extremely familiar with the availability of adult formulations, and 25% reported being completely unaware of cost differences between pediatric and adult GnRHa preparations. The implant was the most preferred therapy (44.4%), but in practice, respondents reported a higher percentage of patients were treated with 3-month preparation. While family preference/ease of treatment (87%) was the key determinant for using a particular GnRHa preparation, insurance coverage also played a significant role in the decision (65.5%). Responses regarding assessment for efficacy of treatment were inconsistent, as were practices and criteria for obtaining an MRI. The survey indicated there is more familiarity with older, shorter-acting GnRHas, which are prescribed in greater numbers than newer, longer-acting formulations. There is lack of consensus on the need for CNS imaging in girls presenting with CPP between 6-8 years of age and use of laboratory testing to monitor response to treatment. Insurance requirements regarding CNS imaging and laboratory monitoring are highly variable. Despite having similar constituents and bioavailability there are substantial cost differences between the pediatric and adult formulations and lack of evidence for safe use of these formulations in children. The survey-based analysis highlights the challenges faced by prescribers, while reflecting on areas where further research is needed to provide evidence-based practice guidelines for pediatric endocrinologists.

ТЕКСТОВЫЙ АНАЛИЗ ПРЕДПРИНИМАТЕЛЬСКОЙ ОРИЕНТАЦИИ: ТЕОРИЯ И ПРАКТИКА

Entrepreneurial Orientation (EO) is a key theme in the field of entrepreneurial research, having a profound impact on the development and success of businesses. This paper utilizes a textual analysis approach to comprehensively review the literature on EO, examining the concept from three aspects: the conceptualization of EO, the construction of measurement scales, and empirical research findings. We find that there is debate within the academic community regarding the definition and dimensional structure of EO, the construction and choice of measurement scales, and the mechanisms and moderating factors linking EO to business performance, with no comprehensive consensus achieved. This lack of consensus provides a rich field of options for future theoretical and empirical research on EO. Future studies should focus on achieving theoretical consistency and establishing a dominant academic discourse, while also recommending the integration of alternative measurement tools and improved analytical methods to expand the scope and depth of empirical research. This will enrich the development of EO theory and its application across various economic and social domains.

Women Reservation Bill in Lok Sabha: A Century Long Struggle for Gender Equality

Women in India have been granted various rights over the years to establish gender equality and to improve their number in decision making. Efforts were started when the demand for separate political reservation for women was made in 1920 during the national movement for Independence. It was the Government of India Act, 1935 by which reservation of seats for women was given. The issue was debated at length during the debates of Constituent Assembly. Committee on the Status of Women in India (CSWI) 1971, recommended reservation for women in local bodies. National Perspective Plan for Women 1988-2000 recommended reservation for women in all elected bodies from Panchayats to Parliament that resulted in 73rd and 74th Amendment. To ensure their presence in national and state legislatures, a Bill seeking to reserve seats for women was introduced in 1996 in the Parliament. But due to narrow political interests of different political parties and lack of consensus among them, it could not succeed to get the approval of the Parliament. Finally, the passage of Women Reservation Bill in September 2023 with conditions is a golden moment in Indian Parliamentary history.

Intergenerational transmission of brain structure and function in humans: a narrative review of designs, methods, and findings.

Children often show cognitive and affective traits that are similar to their parents. Although this indicates a transmission of phenotypes from parents to children, little is known about the neural underpinnings of that transmission. Here, we provide a general overview of neuroimaging studies that explore the similarity between parents and children in terms of brain structure and function. We notably discuss the aims, designs, and methods of these so-called intergenerational neuroimaging studies, focusing on two main designs: the parent-child design and the multigenerational design. For each design, we also summarize the major findings, identify the sources of variability between studies, and highlight some limitations and future directions. We argue that the lack of consensus in defining the parent-child transmission of brain structure and function leads to measurement heterogeneity, which is a challenge for future studies. Additionally, multigenerational studies often use measures of family resemblance to estimate the proportion of variance attributed to genetic versus environmental factors, though this estimate is likely inflated given the frequent lack of control for shared environment. Nonetheless, intergenerational neuroimaging studies may still have both clinical and theoretical relevance, not because they currently inform about the etiology of neuromarkers, but rather because they may help identify neuromarkers and test hypotheses about neuromarkers coming from more standard neuroimaging designs.

SLARD consensus for the treatment of focal chondral lesions of the knee

ObjectivesTo establish a consensus of the Latin American knee surgeons from SLARD for treating focal chondral lesions of the knee. MethodsA formal consensus was conducted among three groups of surgeons from the Latin American society of arthroscopy (SLARD) with special interest in cartilage. First, the steering group (n=9), created a list of 21 statements on controversial topics and compiled a review of literature for each topic. Secondly, the rating group (n=19), gave a score to each statement according to their agreement with it, over two rounds (score: 1-9). Median scores and agreement levels were calculated and each statement was categorized as inappropriate, uncertain or appropriate. Finally, the lecture group (n=24), evaluated the appropriateness and clinical relevance for each statement. ResultsDuring the first round, there was strong agreement on 5% of the statements, relative agreement on 14% and lack of consensus on 81% of statements. After the second round, there was strong agreement on 57% of statements, with 43% having relative agreement and no statement having a lack of consensus. The lecture group approved all the statements. ConclusionSLARD arrived at a consensus on the 21 statements proposed. This consensus includes literature review and clinical experience, which represents the expert opinion of a society. Strong agreement was found in the advantage of using arthroscopy to diagnose chondral lesions, pre-injury level as an age modification of treatment, superiority of nanofractures compared to microfractures, advantages of adding scaffolds, benefits of PRP in the midterm and faster return to sport with osteochondral autografts. Level of evidenceIV. What are the new findingsThis is the first formal consensus from SLARD about the treatment of focal chondral lesions of the knee.This consensus includes 55 orthopaedic surgeons from 13 countries in Latin America (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Guatemala, México, Panama, Peru and Uruguay).This consensus about focal chondral lesions presents 21 statements in relation to the actual evidence, but also according to the Latin American context, available resources and experience.

Development and validation of a novel sleep health score in the sleep heart health study

BackgroundThere is a lack of consensus in evaluating multidimensional sleep health, especially concerning its implication for mortality. A validated multidimensional sleep health score is the foundation of effective interventions. MethodsWe obtained data from 5706 participants in the Sleep Heart Health Study. First, random forest-recursive feature elimination algorithm was used to select potential predictive variables. Second, a sleep composite score was developed based on the regression coefficients from a Cox proportional hazards model evaluating the associations between selected sleep-related variables and mortality. Last, we validated the score by constructing Cox proportional hazards models to assess its association with mortality. ResultsThe mean age of participants was 63.2 years old, and 47.6% (2715/5706) were male. Six sleep variables, including average oxygen saturation (%), spindle density (C3), sleep efficiency (%), spindle density (C4), percentage of fast spindles (%) and percentage of rapid eye movement (%) were selected to construct this multidimensional sleep health score. The average sleep composite score in participants was 6.8 of 22 (lower is better). Participants with a one-point increase in sleep composite score had an 10% higher risk of death (hazard ratio = 1.10, 95% confidence interval: 1.08–1.12). ConclusionsThis study constructed and validated a novel multidimensional sleep health score to better predict death based on sleep, with significant associations between sleep composite score and all-cause mortality. Integrating questionnaire information and sleep microstructures, our sleep composite score is more appropriately applied for mortality risk stratification.

Which radial head fractures are best treated surgically?

Despite the common occurrence of radial head fractures, there is still a lack of consensus on which radial head fractures should be treated surgically. The radial head is an important secondary stabilizer in almost all directions. An insufficient radial head can lead to increased instability in varus-valgus and posterolateral rotatory directions, especially in a ligament-deficient elbow. The decision to perform surgery is often not dictated by the fracture pattern alone but also by the presence of associated injury. Comminution of the radial head and complete loss of cortical contact of at least one fracture fragment are associated with a high occurrence of associated injuries. Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization. Displacement (>2 mm) of fragments in radial head fractures without a mechanical block to pronation/supination is not a clear indication for surgery. Mechanical block to pronation/supination and comminution of the fracture are indications for surgery. The following paper reviews the current literature and provides state-of-the-art guidance on which radial head fractures should be treated surgically.

Not so fast: Million-years of metal precipitation in Mississippi Valley type deposits inferred from in-situ petrochronology of hydrothermal carbonates

Mississippi Valley-type (MVT) deposits contain about 20% of global zinc resources and host critical raw materials crucial to the development of green technologies. Despite their economic and strategic importance, there is a lack of consensus on the duration of mineralizing fluid flow events in MVT systems. This study couples in-situ U-Pb dating with Sr-isotope and trace element analysis of syn- and post-ore gangue carbonates to establish: (1) timing and duration, (2) redox evolution, and (3) flow rates of mineralizing fluids in the world-class San Vicente Zn-(Pb) deposit (Peru). New radiometric ages bracket the crystallization of syn-mineralization dolomite, characterized by high Fe and Mn contents and Sr isotopic values overlapping with that of host carbonates, between 103.2 ± 4.1 Ma and 70.6 ± 5.6 Ma. This age interval reveals a direct genetic relationship between flow of mineralizing fluids and late Cretaceous Andean compressional tectonics. Basinal fluid expulsion coeval with known tectonic events continues in the district until Pliocene times, driving episodic crystallization of post-ore hydrothermal carbonates between 61.6 ± 9.3 and 2.7 ± 0.2 Ma. The low Mn and Fe content and high 87Sr/86Sr values characteristic of these post-ore, bedding-parallel and cross-cutting carbonate veins indicate a colder, oxidized environment. Our findings highlight the contribution of paired carbonate geochemistry and U-Pb geochronology in drawing links between tectonic events, fluid expulsion and the waxing and waning of mineralization potential in foreland basins. The results of this study challenge our understanding of timescales in MVT systems and imply that anomalous metal enrichment in basinal fluids over a short temporal interval is not a necessary precondition to form economic-sized, sediment-hosted Zn-Pb deposits. Rather, it is the coexistence of a focused fluid flow in an interconnected aquifer with suitable metal depositional mechanisms over a prolonged period of time (106–107 yr) that allows precipitation of economic amount of base metals at a specific site in the upper crust.

Neural representation of phonological wordform in temporal cortex.

While the neural bases of the earliest stages of speech categorization have been widely explored using neural decoding methods, there is still a lack of consensus on questions as basic as how wordforms are represented and in what way this word-level representation influences downstream processing in the brain. Isolating and localizing the neural representations of wordform is challenging because spoken words activate a variety of representations (e.g., segmental, semantic, articulatory) in addition to form-based representations. We addressed these challenges through a novel integrated neural decoding and effective connectivity design using region of interest (ROI)-based, source-reconstructed magnetoencephalography/electroencephalography (MEG/EEG) data collected during a lexical decision task. To identify wordform representations, we trained classifiers on words and nonwords from different phonological neighborhoods and then tested the classifiers' ability to discriminate between untrained target words that overlapped phonologically with the trained items. Training with word neighbors supported significantly better decoding than training with nonword neighbors in the period immediately following target presentation. Decoding regions included mostly right hemisphere regions in the posterior temporal lobe implicated in phonetic and lexical representation. Additionally, neighbors that aligned with target word beginnings (critical for word recognition) supported decoding, but equivalent phonological overlap with word codas did not, suggesting lexical mediation. Effective connectivity analyses showed a rich pattern of interaction between ROIs that support decoding based on training with lexical neighbors, especially driven by right posterior middle temporal gyrus. Collectively, these results evidence functional representation of wordforms in temporal lobes isolated from phonemic or semantic representations.

BLENDED LEARNING IN THE SYSTEM OF PROFESSIONAL TRAINING OF STUDENTS AT HIGHER MEDICAL EDUCATIONAL INSTITUTIONS

This article explores diverse interpretations, models, and structured concepts of blended learning integrated into the educational curriculum of higher medical institutions. While the overarching definition, models, and conceptualization of blended learning encompass educational approaches that combine aspects of both face-to-face and online learning, leveraging the strengths of each, contemporary realities suggest that the term "blended learning" has evolved into a broader umbrella term. It now encompasses various combinations, such as the integration of different teaching methods, pedagogical approaches, and interactive technologies. However, these amalgamations may not fully encapsulate the essence of blended learning. Given the multitude of interpretations surrounding blended learning, it is imperative for scholars and practitioners to articulate their specific understanding of the concept or consider alternative terminology. Currently, there is a lack of consensus in the literature regarding the detailed development of an appropriate blended learning scenario. Discussions primarily focus on achieving a balanced integration of face-to-face and online education rather than a comprehensive understanding of blended learning itself. Clarifying the components of blended learning enhances comprehension of its underlying principles, including student autonomy in determining when, where, and how they learn, the use of technology to enhance personalization, and the creation of an integrated learning experience where face-to-face and online components are synergistically aligned. Consequently, the incorporation of blended learning into educational programs is viewed as a source of enrichment. It provides an opportunity for teachers at Ukrainian higher medical institutions to approach educational principles creatively, drawing insights from both students and colleagues, each contributing unique perspectives to the educational process.

Simplified Spectrum Score (S3) app for pathogen-agnostic antimicrobial drug spectrum ranking to assess for antimicrobial de-escalation events

Antimicrobial/antibiotic de-escalation (ADE) is a key feature of antimicrobial stewardship programs (ASP) that relies mainly on individual panels for determining ADE events based on subjective ranking of antibiotics’ spectrum activity. The lack of consensus among ASP experts leads to reproducibility issues in the measure of this clinical outcome, making difficult to assess its real impact on patient care. The S3 score (Simplified Spectrum Score) app was developed to allow an objective ranking of antibiotics. Ranking was achieved by developing a database harboring pairs of bacteria-antibiotics for which each molecule was assigned a score based on published and clinically validated data from a recognized international committee. S3 score shows a strong correlation relationship and substantial agreement to a clinically validated spectrum score, and its framework enables any person to use it for ADE detection without assuming prior knowledge or training. In addition, its design enables regular updates and sustainability.

The split ladder of participation: A literature review and dynamic path forward

Participation of people in decision making and tackling complex problems where there is lack of consensus on the science and relevant values continues to be an important research topic. The 2015 Split Ladder of Participation offered a diagnostic and methodological framework cited in 162 papers. This paper addresses the question: What does a literature review of the Split Ladder of Participation reveal about engaging people in policy problems, effecting transformational change, and how can this diagnostic and strategic tool be improved? A systematic literature review revealed papers that disclose transformational change, or triple loop learning requires: strong social science; social and natural interdisciplinary science; and considerations of uncertainty in environmental science together with uncertainty of values and considerations of power. Policy problems with low levels of trust offer opportunities to engage interest and participation in their resolution. Governments over-utilizing methods limiting participation, may lead to lock-in. Focusing on complex, interconnected problems through participation creates an enduring policy and science, interdisciplinary innovation space. Recognizing participation that is plural, amorphous, and fluid draws attention to power, multiple stakeholder framings of complex issues, advances social learning changing values, norms, power, and the very ethics of science (where social and natural/physical scientists acknowledge and share their power with people), and ultimately advances environmental justice.

Technique description: Extraction of engulfed ear-piercing backing – The fast and atraumatic technique

BackgroundEar piercings are a common practice for body modification and self-expression, but they can lead to various complications, including embedded jewelry, infections, and difficulty removing earring backings. Traditional techniques for removing stuck backings involve forceful manipulation, resulting in pain, scarring, and suboptimal cosmetic outcomes. DiscussionIn this technique description, we present an alternative atraumatic technique for the removal of stuck ear-piercing backings. The technique involves injecting a mixture of local anesthetic and a vasoconstrictor, around the backing to create a fluid pocket that loosens the earring post. A special maneuver is then applied using a needle driver allowing for easy gentle removal. If the backing remains embedded, gentle pressure on the earlobe reveals a loop that can be threaded with a syringe needle to propel the backing out. ConclusionsThe proposed atraumatic technique for removing stuck ear-piercing backings offers a satisfactory and less stressful experience for pediatric patients while reducing the need for emergency department referrals. Given the lack of consensus on extraction methods, this technique provides a valuable alternative in the absence of a widely agreed-upon approach. Further research is needed to establish standardized protocols. Nevertheless, adopting this technique has the potential to enhance patient satisfaction and improve outcomes.

Quantum Information: Systems, Their States, and the Use of Variances

Quantum information mobilizes the description of quantum systems, their states, and their behavior. Since a measurement postulate introduced by von Neumann in 1932, if a quantum system has been prepared in two different mixed states represented by the same density operator ρ, these preparations are said to have led to the same mixture. For more than 50 years, there has been a lack of consensus about this postulate. In a 2011 article, considering variances of spin components, Fratini and Hayrapetyan tried to show that this postulate is unjustified. The aim of the present paper is to discuss major points in this 2011 article and in their reply to a 2012 paper by Bodor and Diosi claiming that their analysis was irrelevant. Facing some ambiguities or inconsistencies in the 2011 paper and in the reply, we first try to guess their aim, establish results useful in this context, and finally discuss the use or misuse of several concepts implied in this debate.