Blinded Review Research Articles

A comparison of drug information question responses by a drug information center and by ChatGPT.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. A study was conducted to assess the accuracy and ability of Chat Generative Pre-trained Transformer (ChatGPT) to systematically respond to drug information inquiries relative to responses of a drug information center (DIC). Ten drug information questions answered by the DIC in 2022 or 2023 were selected for analysis. Three pharmacists created new ChatGPT accounts and submitted each question to ChatGPT at the same time. Each question was submitted twice to identify consistency in responses. Two days later, the same process was conducted by a fourth pharmacist. Phase 1 of data analysis consisted of a drug information pharmacist assessing all 84 ChatGPT responses for accuracy relative to the DIC responses. In phase 2, 10 ChatGPT responses were selected to be assessed by 3 blinded reviewers. Reviewers utilized an 8-question predetermined rubric to evaluate the ChatGPT and DIC responses. When comparing the ChatGPT responses (n = 84) to the DIC responses, ChatGPT had an overall accuracy rate of 50%. Accuracy across the different question types varied. In regards to the overall blinded score, ChatGPT responses scored higher than the responses by the DIC according to the rubric (overall scores of 67.5% and 55.0%, respectively). The DIC responses scored higher in the categories of references mentioned and references identified. Responses generated by ChatGPT have been found to be better than those created by a DIC in clarity and readability; however, the accuracy of ChatGPT responses was lacking. ChatGPT responses to drug information questions would need to be carefully reviewed for accuracy and completeness.

Efficacy, Safety, and Influence on Tumor Microenvironment of Neoadjuvant Pembrolizumab plus Ramucirumab for PD-L1 Positive NSCLC: A Phase 2 Trial (EAST ENERGY).

Angiogenesis inhibitors are known to modify tumor immunity. Combination of angiogenesis inhibitors with immune checkpoint inhibitors (ICIs) has shown efficacy against many types of cancers, including non-small cell lung cancer (NSCLC). We investigated the feasibility of neoadjuvant therapy with pembrolizumab and ramucirumab, a vascular endothelial growth factor (VEGF) receptor-2 antagonist for patients with PD-L1-positive NSCLC and its influence on the tumor microenvironment (TME). Patients with pathologically proven NSCLC with PD-L1-positive, clinical stage IB-IIIA were eligible. Patients received two cycles of pembrolizumab (200 mg/body) and ramucirumab (10 mg/kg) every three weeks. Surgery was scheduled 4 to 8 weeks after the last dose. The primary endpoint was the major pathologic response (MPR) rate by a blinded independent pathology review. The sample size was 24 patients. Exploratory endpoints were evaluated to elucidate the effects of neoadjuvant therapy on TME. The 24 eligible patients were enrolled between July 2019 and April 2022. The MPR rate was 50.0% (90% confidence interval, 31.9-68.1%). Six patients showed pathological complete response. Grade 3 adverse events (AEs) occurred in 9 patients (37.5%), including 3 immune-related AEs (acute tubulointerstitial nephritis in 2 cases and polymyalgia rheumatica in one). There were no grade 4 or 5 AEs. The transcriptome and multiplexed immunohistochemistry results suggested that tumors with greater CD8+ T-cell infiltration and higher expression of effector molecules at the baseline could show better sensitivity to treatment. This new neoadjuvant combination of pembrolizumab plus ramucirumab was feasible and anti-VEGF agents may enhance the effects of ICIs.

A Whimsical Odyssey Through the Maze of Scholarly Reviews

Navigating the often-bumpy road of academic review.

Safety and adherence of early oral immunotherapy for peanut allergy in a primary care setting: a retrospective cross-sectional study

BackgroundPeanut allergy is a common food allergy with potentially life-threatening implications. Early oral immunotherapy for peanut allergy (P-EOIT) has been shown to be effective and safe in research and specialty clinic settings. Provision of P-EOIT in primary care would make it available to more patients. We sought to assess the safety of P-EOIT in a primary care setting by documenting the rates of peanut-related allergic reactions leading to emergency department (ED) visits and use of epinephrine. We also examined adherence by assessing the percentage of patients reaching maintenance phase and continuing ingestion after one year of P-EOIT.MethodsThis retrospective study included all patients aged less than 36 months who started P-EOIT at a primary care allergy clinic in New Brunswick, Canada, from 2016 to 2020. The population included patients who (1) had a history of an allergic reaction to peanuts with a positive skin prick test or positive peanut specific IgE level (ps-IgE) or (2) no history of ingestion and a baseline ps-IgE ≥5 kU/L. Patients had biweekly clinic visits with graded increases in peanut protein up to a maintenance dose of 300 mg of peanut protein daily. A blinded retrospective review of paper charts and electronic medical records was conducted along with phone interviews regarding ED visits and epinephrine use.ResultsAll 69 consented patients reached maintenance dose over a median of 29 weeks, and 66 patients (95.7%) were still regularly consuming peanut protein after 1 year of maintenance. One patient had a peanut ingestion-related ED visit requiring epinephrine during the escalation phase of peanut protein dosing (1.4%). During the first year of maintenance phase, no patients had peanut ingestion-related ED visits nor required epinephrine.ConclusionEarly oral immunotherapy for peanut allergy in a primary care setting appears to be safe and our findings suggest that it does not lead to an increased burden of emergency department visits. Our population had high adherence rates, with the majority achieving maintenance dose and staying on this dose for one year.

Open peer commentary and author response regarding ‘Reconsidering normative interpretations in personality research’

Open peer commentary and author response regarding ‘Reconsidering normative interpretations in personality research’

A Chinese Perspective on Online Gaming Usage and its Impact on Students' Attitudes Toward Learning

In the context of the digital era, online games have become part of the daily life of Chinese middle school students, affecting not only their academic performance and social activities but also significantly influencing their attitudes toward learning. Starting from the current situation of secondary schools in China, this review analyzes online gaming usage, the industry development trend, the cognitive and psychological impact on adolescents, the social impact, and the role of parental involvement and supervision, and explores the impact of online gaming usage on secondary school students' attitudes toward learning. This academic review help educators, parents, and policymakers design interventions that facilitate proper modulation between gaming and academics to promote healthier developmental pathways among middle school students.

Trastuzumab Duocarmazine in Pretreated Human Epidermal Growth Factor Receptor 2-Positive Advanced or Metastatic Breast Cancer: An Open-Label, Randomized, Phase III Trial (TULIP).

Human epidermal growth factor receptor 2 (HER2)-targeted therapy is standard of care for HER2-positive (HER2+) breast cancer, but most patients develop progressive disease with persistent HER2 expression. No definitive treatment guidance currently exists beyond second line. Trastuzumab duocarmazine (T-Duo) is a third-generation, HER2-targeted antibody-drug conjugate that demonstrated efficacy and acceptable safety in phase I studies of heavily pretreated patients with HER2+/HER2-low breast cancer. In this open-label, randomized, phase III trial, T-Duo was compared with physician's choice (PC) in patients with unresectable locally advanced/metastatic HER2+ breast cancer with progression during/after ≥2 HER2-targeted therapies or after trastuzumab emtansine (T-DM1). The primary endpoint was progression-free survival (PFS) by blinded independent central review. In total, 437 patients were randomly assigned 2:1 to T-Duo (n = 291) or PC (n = 146). The median age was 56.0 years (range, 24-86); most patients (93.6%) had metastatic disease. The median time from diagnosis of metastatic disease to trial entry was 3.5 years; the median number of prior HER2-targeted therapies in metastatic setting was three. The median PFS was 7.0 months (95% CI, 5.4 to 7.2) with T-Duo versus 4.9 months (95% CI, 4.0 to 5.5; hazard ratio [HR], 0.64 [95% CI, 0.49 to 0.84]; P = .002) with PC. PFS benefit was maintained across most predefined subgroups. The median overall survival (first analysis) was 20.4 (T-Duo) versus 16.3 months (PC; HR, 0.83 [95% CI, 0.62 to 1.09]; P = .153). Objective response rate was 27.8% (T-Duo) versus 29.5% (PC); other efficacy end points-clinical benefit rate, duration of response, and reduction in target lesion measurement-tended to favor T-Duo. Grade ≥3 treatment-emergent adverse events occurred in 52.8% (T-Duo) versus 48.2% (PC). Treatment with T-Duo was manageable, but tolerability was affected by prevalent ocular toxicity, leading to a higher discontinuation rate in the T-Duo arm. T-Duo significantly reduced the risk of progression in patients with advanced HER2+ breast cancer who have progressed during/after ≥2 HER2-targeted therapies or after T-DM1.

Ultrasound visualization of Botulinum toxin injection: Identifying clinical correlates to optimize outcomes in spasticity management.

Botulinum toxin injections are well established and commonly used for spasticity management. Clinicians strive to optimize outcomes from toxin injections. One potential complication is toxin spread beyond the intended muscle, which can lead to unwanted weakness. The utilization of ultrasound allows direct visualization of target muscles and identification of toxin leakage from the target muscle. Ultrasound evaluation of clinical factors that correlate to toxin leakage have not been studied. To identify cases of botulinum toxin injectate leak beyond the targeted muscle during ultrasound-guided spasticity injections and associate cases of leak with predictive clinical factors, which include muscle size, fibroadipose changes, and number of previous injections. This was a prospective observational study. An outpatient clinic in an academic medical center. Patients who demonstrated wrist flexor spasticity warranting intervention were invited to participate. Patients received standard-of-care spasticity management with injection of onabotulinumtoxinA into the flexor carpi radialis muscle based upon clinical presentation and prescribing guidelines. Ultrasound video was recorded, and a blinded review was conducted by the study team. The primary outcome measure was visualized leak of injectate on recorded ultrasound video. Documented leak was then associated with clinical factors including diameter of the flexor carpi radialis, volume of injectate used, history of prior injections, and fibrotic change of the muscle. The study included 54 patients, 77.8% of whom had an underlying diagnosis of cerebrovascular accident. Injectate leak was observed in 18.5% of injections and could not be confirmed in 9.3% of injections. Multivariable analysis demonstrated increased odds of leak with higher Modified Heckmatt Scale score. No statistically significant increase in leak was noted with higher volume of injectate or smaller muscle diameter. Extramuscular leak of botulinum toxin injection may be associated with fibroadipose muscle change.

Adaptive Sport and Recreational Therapy: A Scoping Review to Explore Practices for the Profession

Adaptive sports provide athletes with disabilities with independent engagement while increasing their physical health and skill-building abilities. Recreational therapy prides itself as the primary discipline implementing adaptive sports for individuals with disabilities, yet efficacy needs to be determined. A scoping review was conducted using recreational therapy/therapeutic recreation online journals, and standardized checklists with predefined criteria to extract details on study design, procedures, outcomes, and study quality. Data were analyzed by three researchers using a structured, blinded review. Four themes emerged about recreational therapy services and adaptive sports: Fostering positive athlete outcomes, the importance of including both components of physical health and skill competency, social benefits for athletes, and facilitation considerations for adaptive sports within recreational therapy services. Findings warrant additional research on adaptive sports and recreational therapy services and recommendations for practice are discussed, such as establishing best practice guidelines for this specialty area.

Proceedings of the 2024 Australasian Road Safety Conference - Hobart, Tasmania, Australia

Proceedings of the 2024 annual Australasian Road Safety Conference held in Hobart, Tasmania, Australia. The proceedings provide the Extended Abstracts and Posters describing research, educational and policing program implementation and policy and management strategies related to all aspects of road safety and especially related to the conference theme of Target 2030: What's the pathway forward? Almost 600 delegates from 20 countries attended the face-to-face conference. Authors of accepted Extended Abstracts represented international and local institutions from all aspects of their respective communities including research centres, private companies, government agencies and community groups. These Extended Abstracts provide an indication of the important work being done in Australia, New Zealand and internationally as part of the United Nations, One UN Vision for Road Safety to reduce the number of crashes on the road by 50 percent by 2030. Almost 200 Extended Abstract manuscripts were accepted for long, short and poster sessions. Each Extended Abstract was peer-reviewed by two experts with relevant expertise. Authors were also provided the option of submitting a Full Paper. Those authors who chose to submit a Full Paper for consideration in the Journal of Road Safety (JRS) could do so based on the outcome of the peer review of their Extended Abstract. Submitted Full Papers undergo peer-review by three independent experts matched by their sector. The matching pairs academic authors iwth academic reviewers and practitioner authors with practitioner reivewers. Inclusion in the JRS follows acceptance by the peer-reviewers.The conference covered a comprehensive range of topics including speed, infrastructure and road design, cyclist safety, motorcyclist safety, pedestrian safety, road safety education, licensing, vehicle design, impairment due to distraction from mobile phones, alcohol, drugs as well as the impacts of climate change on future transport systems road safety, road safety issues for Indigenous people groups across New Zealand and Australia, integrating road safety into local Government, automated enforcement, gig economy road safety, older drivers, etc.

A human model of Buruli ulcer: Provisional protocol for a Mycobacterium ulcerans controlled human infection study.

Critical knowledge gaps have impeded progress towards reducing the global burden of disease due to Mycobacterium ulcerans, the cause of the neglected tropical disease Buruli ulcer (BU). Development of a controlled human infection model of BU has been proposed as an experimental platform to explore host-pathogen interactions and evaluate tools for prevention, diagnosis, and treatment. We have previously introduced the use case for a new human model and identified M. ulcerans JKD8049 as a suitable challenge strain. Here, we present a provisional protocol for an initial study, for transparent peer review during the earliest stages of protocol development. Following simultaneous scientific peer review and community/stakeholder consultation of this provisional protocol, we aim to present a refined protocol for institutional review board (IRB) evaluation.

Blinded independent central review versus local investigator assessment of PFS in RCTs of immunotherapy in advanced cancers: A systematic review and meta-analysis

BackgroundAssessment of Progression-free survival (PFS) events by investigators might be inaccurate in randomized controlled trials (RCTs) with open-label design. We explored differences in PFS evaluated by blinded independent central review (BICR) or local investigator assessment (IA) in trials testing immunotherapy (IO) in advanced cancers. MethodsWe systematically reviewed articles of RCTs investigating IO in advanced tumors, published in PubMed-indexed journals up to December 2023. For each RCT, we collected PFS results by BICR and by local IA. We calculated the discrepancy index (DI) as the ratio of BICR and IA Hazard Ratios (HRBICR/HRIA) for PFS. An overall DI and relative confidence interval (CI) were calculated using a fixed-effect model weighted for the inverse of variance. FindingsOnly 32/140 (22.9 %) RCTs reported both BICR and local IA PFS data, including 17,054 patients. PFS was the sole primary endpoint in 19/32 (59.4 %) and a co-primary endpoint 9/32 (28.2 %) trials. The study design was open label or double-blind in 17/32 (53.1 %) and 15/32 (46.9 %) RCTs, respectively. The overall DI was 1.07 (95 % CI 1.01–1.13; I2 =0, p = 0.02), revealing a more optimistic analysis of results in favor of local IA. In the 17 open-label trials, the overall DI was 1.09 (95 % CI 1.02–1.17, I2 =0, p = 0.02), revealing a more favorable interpretation of PFS results by local investigators. InterpretationWe found a statistically significant difference between BICR and local IA of PFS in trials of IO in cancer. These results suggest that the double assessment is recommended in RCTs testing IO, especially in open-label trials. FundingThis work was supported by the MFAG27826–2022 grant (Dr. Alberto Servetto).

Using authentic student personas to inform academic policy review with the lived experience of students: a case study from Nottingham Trent University

ABSTRACT This case study from Nottingham Trent University describes how an intra-departmental collaborative team used the lived experience of students to inform academic policy review. Drawing on data from Student 2025, a longitudinal study exploring the complexity of student experiences and identities, the team created authentic student personas called Student Voice Profiles and supported colleagues to use them in a pilot workshop to consider academic policy and policy changes. Findings were mixed: the pilot project highlighted areas for further development, including improvements to resources; it also generated considerable interest in the potential application of student personas to a range of teaching and learning enhancements, and demonstrated the value of cross-team collaborative working.

Optimalisasi Pemanfaatan Media Pembelajaran Berbasis TikTok sebagai Upaya Meningkatkan Hasil Belajar Siswa

As technology evolves, social media platforms like TikTok have started to be utilized in education as interactive and engaging tools. The aim of this research is to explore the potential of TikTok as a learning medium to improve student learning outcomes. This study uses a literature review method to analyze various sources related to the use of TikTok in education. Data were collected from five academic journal articles and literature reviews that discuss the use of TikTok in different educational contexts. The data analysis technique used in this study is content analysis, which identifies key themes from the related articles and examines the relationship between TikTok usage and student learning outcomes. The research results show that TikTok can enhance student engagement and motivation in learning and have a positive impact on their learning outcomes. TikTok has the ability to present educational material innovatively and effectively by utilizing an appealing visual format. If used correctly, TikTok can become a valuable learning medium. Thus, TikTok offers teachers the opportunity to create more creative and engaging lessons.

OSAIRIS: Lessons Learned From the Hospital-Based Implementation and Evaluation of an Open-Source Deep-Learning Model for Radiotherapy Image Segmentation

Several studies report the benefits and accuracy of using autosegmentation for organ at risk (OAR) outlining in radiotherapy treatment planning. Typically, evaluations focus on accuracy metrics, and other parameters such as perceived utility and safety are routinely ignored. Here, we report our finding from the implementation and clinical evaluation of OSAIRIS, an open-source AI model for radiotherapy image segmentation that was carried out as part of its development into a medical device. The device contours OARs in the head and neck and male pelvis (referred to as the prostate model), and is designed to be used as a time-saving workflow device, alongside a clinician. Unlike standard evaluation processes, which heavily rely on accuracy metrics alone, our evaluation sought to demonstrate the tangible benefits, quantify utility and assess risk within a specific clinical workflow. We evaluated the time-saving benefit this device affords to clinicians, and how this time-saving might be linked to accuracy metrics, as well as the clinicians' assessment of the usability of the OSAIRIS contours in comparison to their colleagues' contours and those from other commercial AI contouring devices. Our safety evaluation focused on whether clinicians can notice and correct any errors should they be included in the output of the device.We found that OSAIRIS affords a significant time-saving of 36% (5.4 ± 2.1 minutes) when used for prostate contouring and 67% (30.3 ± 8.7 minutes) for head and neck contouring. Combining editing time data with accuracy metrics, we found the Hausdorff distance best correlated with editing-time, outperforming dice, the industry-standard, with a Spearman correlation coefficient of 0.70, and a Kendall coefficient of 0.52. Our safety and risk-mitigation exercise showed that anchoring bias is present when clinicians edit AI-generated contours, with the effect seemingly more pronounced for some structures over others. Most errors, however, were corrected by clinicians, with 72% of the head and neck errors 81% of the prostate errors removed in the editing step. Notably, our blinded clinician contour rating exercise showed that gold standard clinician contours are not rated more highly than the AI-generated contours.We conclude that evaluations of AI in a clinical setting must consider the clinical workflow in which the device will be used, and not rely on accuracy metrics alone, in order to reliably assess the benefits, utility and safety of the device. The effects of human-AI inter-operation must be evaluated to accurately assess the practical usability and potential uptake of the technology, as demonstrated in our blinded clinical utility review. The clinical risks posed by the use of the device must be studied and mitigated as far as possible, and our ‘Mystery Shopping’ experiment provides a template for future such assessments.

Bidirectional association of sleep disorders with chronic kidney disease: a systematic review and meta-analysis.

Published studies have suggested a link between chronic kidney disease (CKD) and sleep disorders, although the exact nature of this association has not been uniformly described. Clarifying this relationship may facilitate evidence-based interventions that address the interplay between these disease entities. Such interventions could prevent obstructive sleep apnea (OSA) from worsening CKD and improve the quality of life for CKD patients by reducing the risk of developing OSA. Therefore, the objective of this meta-analysis is to assess the bidirectional association between sleep disorders and CKD. Following a PROSPERO-registered protocol, three blinded reviewers conducted a systematic review of the Medline/PubMed, Embase, Cochrane Library and Cumulative Index of Nursing and Allied Health (CINAHL) databases for observational studies pertaining to the relationship between sleep disorders and CKD. A meta-analysis was conducted in risk ratios (RRs). From 63 studies (26 777 524 patients), OSA [RR 1.68; 95% confidence interval (CI) 1.45 to 1.93], albuminuria (RR 1.54; 95% CI 1.18 to 1.99), restless leg syndrome (RLS) (RR 1.88; 95% CI 1.48 to 2.38) and insomnia (RR 1.24; 95% CI 1.01 to 1.54) were significantly associated with CKD. There was a significant association between OSA (RR 1.77; 95% CI 1.56 to 2.01) with incident CKD. There was a significant association of OSA (RR 1.74; 95% CI 1.55 to 1.96), RLS (RR 1.73; 95% CI 1.32 to 2.25) and insomnia (RR 1.14; 95% CI 1.03 to 1.27) in patients with CKD compared with healthy controls. CKD was also significantly associated with incident OSA (RR 1.60; 95% CI 1.35 to 1.89). The bidirectional associations of obstructive sleep apnea with CKD remained consistent across different stages of CKD, modes of diagnosis of sleep disorder and geographical region. A bidirectional association was observed between CKD and obstructive sleep apnea, RLS and insomnia. The treatment of sleep disorders may reduce the risk of CKD, and vice versa.

Role of low-impact-factor journals in conservation implementation.

Academic review, promotion, and tenure processes place a premium on frequent publication in high-impact factor (IF) journals. However, conservation often relies on species-specific information that is unlikely to have the broad appeal needed for high-IF journals. Instead, this information is often distributed in low-IF, taxa- and region-specific journals. This suggests a potential mismatch between the incentives for academic researchers and the scientific needs of conservation implementation. To explore this mismatch, we looked at federal implementation of the United States Endangered Species Act (ESA), which requires the use of the "best available science" to list a species as endangered or threatened and thus receive powerful legal protections. In assessing the relationship between academic sources of this "best available science" and ESA implementation, we looked at the 13,292 sources (e.g., academic journals, books, reports, regulations, personal communications, etc.) cited by the second Obama administration (2012-2016) across all ESA listings. We compared the IFs of all 4836 journals that published peer-reviewed papers cited in these listings against their citation frequency in ESA listings to determine whether a journal's IF varied in proportion with its contribution to federal conservation. Most of the peer-reviewed academic articles referenced in ESA listings came from low-IF or no-IF journals that tended to focus on specific taxa or regions. Although we support continued attention to cutting-edge, multidisciplinary science for its ability to chart new pathways and paradigms, our findings stress the need to value and fund the taxa- and region-specific science that underpins actionable conservation laws.

Facial trauma education in radiology: using surgeon feedback as the benchmark for success.

Interpreting CT studies of facial trauma is challenging, and there are often substantial differences in the characterization of complex facial trauma between radiologists and surgeons. We designed a collaborative multidisciplinary project to reconcile differences in facial fracture interpretation through an educational intervention. The effectiveness of this intervention was evaluated through surgeon feedback on radiology reports. Radiology residents, neuroradiology fellows, and neuroradiology attendings were recruited as participants at a single tertiary care academic center. Otolaryngology residents were recruited as evaluators. Participants completed surveys and provided preliminary reports for example cases of facial trauma before and after attending an educational session. Evaluators performed a blinded review of these preliminary reports based on ideal reports developed by surgical and neuroradiology attendings. 26 participants (20 residents, 1 neuroradiology fellow, 5 neuroradiology attendings) completed the study. Six otolaryngology residents participated as evaluators. To assess interrater reliability, three evaluators graded a shared set of 15 reports and demonstrated substantial agreement with a Kendall's W of 0.71. Participants demonstrated significant improvement in overall report accuracy, clarity, and organization. In subunit analysis, there were significant improvements in reporting Le Fort, nasoseptal, and nasoorbitoethmoid fractures. No significant improvements occurred in the reporting of upper face, zygomaticomaxillary complex, or mandibular fractures. In contrast, survey analysis demonstrated significantly improved confidence in interpreting trauma involving all facial subunits. Compared with survey results, surgeon assessment of radiology reports better demonstrated areas of improvement after an educational intervention. A multidisciplinary approach to assessing educational efforts may better evaluate the practical effectiveness of educational interventions.

The diagnostic performance of neck ultrasound in follow-up of advanced stage differentiated thyroid cancer

BackgroundDifferentiated thyroid cancer (DTC) requires long-term follow-up due to the risk of delayed recurrence. Follow-up surveillance involves serial neck ultrasound (US) and thyroglobulin (Tg); however, the optimal frequency and diagnostic performance of neck US outside of specialized thyroid cancer centres in higher risk patients is not well defined. We sought to evaluate the diagnostic performance of US and serial Tg in advanced stage DTC.MethodsWe retrospectively reviewed our thyroid cancer database for patients with stage III and IV DTC from 2006 to 2018, total thyroidectomy, and at least 2 years follow-up to assess recurrence rates. Those with hemi-thyroidectomy or anti-Tg antibodies were excluded. Diagnostic performance of US and Tg were assessed using a composite reference standard of follow-up imaging and pathology. All relevant US were reviewed by a blinded expert radiologist for uniformity.ResultsOf 136 included patients (91 females, mean age 58.9), 26 (19%) had recurrence of DTC over median follow-up of 6.6 years (IQR 5.3–9.3). The sensitivity and specificity of US in diagnosing cervical recurrence were 73.3% (95% CI 0.51–0.96) and 68.3% (95% CI 0.60–0.77) based on historical reports, respectively, and 80% (95% CI 0.60-1.00) and 87.8% (95% CI 0.82–0.93) based on blinded expert review, respectively. Tg had a sensitivity of 95.5% (95% CI 0.89-1.0) and specificity of 96.2% (95% CI 0.92–0.99) in detecting cervical recurrence or distant metastases. False positive US findings on historical US and subsequent review occurred in 38 (28%) and 15 (11%) patients, respectively, while 5 (3.6%) had false positive Tg results.ConclusionSerial Tg has better sensitivity and specificity than US for detecting recurrence of advanced stage DTC. Furthermore, re-interpretation of abnormal findings using structured US reporting with a subspecialized reader may improve diagnostic performance of US and improve its utility in clinical care.

Exploring the Integration of Chinese Music in Western Musicological Literature: Trends, Gaps, and Multicultural Perspectives

The purpose of the article is to analyse Western musicological literature to identify key trends and gaps in existing research on Chinese music as an integral part of the contemporary multicultural educational space. The research methodology is based on content analysis, comparative analysis, and bibliographic review. The primary method is content analysis, involving a systematic review of academic articles, monographs, reviews, and other publications on Chinese music in Western musicological literature. Comparative analysis is used to compare Western research on Chinese music with scholarly work from China and other countries. Bibliographic review helps to identify scientific gaps and trends in Chinese music research. The scientific novelty of the study lies in the comprehensive analysis of Western musicological literature on Chinese music to reveal key trends and gaps in existing research. The use of content analysis, comparative analysis, and bibliographic review allows for the first systematic organisation and comparison of approaches to studying Chinese music in different cultural contexts. The study also provides new insights into the role of Chinese music in the contemporary multicultural educational space, contributing to its integration and popularisation. Conclusions. Over the past three decades, publications on Chinese music within the context of multicultural music education have been irregular. Although the number of studies is not large, it shows moderate activity in the 1990s and early 2000s, with a noticeable increase after 2007 and periods of decline between 2010 and 2014. This indicates the need for further analysis of the reasons behind this dynamic and a deeper exploration of the integration of Chinese music into the Western educational context. The literature review shows that research covers a broad range of educational contexts, from early childhood to higher education and teacher professional development, indicating the potential for integrating Chinese music at various levels of formal education. The review also reveals that research on Chinese music often has a Eurocentric approach, evaluating it through the lens of Western music theory. This limits the full understanding and integration of Chinese musical traditions, highlighting the need for a deeper and more comprehensive approach that would foster an understanding of Chinese music in its own context.