Ordinary Practice Research Articles

Minimally invasive interventional guided imaging therapies of musculoskeletal tumors.

Historically, musculoskeletal (MSK) tumors, which include both bone and soft tissue tumors, have been managed as distinct entities. The incidence of metastases, particularly bone metastasis, in patients with MSK tumors can result in the emergence of significant complications such as pain, impairment of vital anatomical structures, or pathological fractures. Given these issues, a diverse team of experts is typically engaged in intricate treatment decision-making concerning the necessity of surgery, radiation, chemotherapy, or a mix of these methodologies. Nevertheless, percutaneous image-guided minimally invasive interventional therapy for MSK tumors represent a promising approach for treating such tumors. Over the past decade, significant progress has been made in this technique, leading to its growing acceptance in ordinary clinical practice. MSK tumors can be effectively treated by the use of ablation techniques, either as standalone procedures or in conjunction with other percutaneous treatments. Various image-guided techniques have been employed to observe the ablation zone and nearby structures, such as fluoroscopy, ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). However, CT is the favored method due to its widespread availability and ability to visualize the tumor and its environs. The procedures employed include ethanol injection, radiofrequency ablation, microwave ablation, cryoablation, and magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU). The technique can be performed in combination with cementation, with or without additional metallic stabilizing devices, depending on the location of the lesion. Improved local tumor control can be attained by combining ablation with bland embolization or transarterial chemoembolization. This article provides an overview of the fundamental elements of minimally invasive interventional guided imaging therapy for MSK malignancies.

The clinical utility and relevance in clinical practice of DSM-5 specifiers for major depressive disorder: A Delphi expert consensus study

Major depressive disorder (MDD) is a heterogeneous syndrome, associated with different levels of severity and impairment on the personal functioning for each patient. Classification systems in psychiatry, including ICD-11 and DSM-5, are used by clinicians in order to simplify the complexity of clinical manifestations. In particular, the DSM-5 introduced specifiers, subtypes, severity ratings, and cross-cutting symptom assessments allowing clinicians to better describe the specific clinical features of each patient. However, the use of DSM-5 specifiers for major depressive disorder in ordinary clinical practice is quite heterogeneous.The present study, using a Delphi method, aims to evaluate the consensus of a representative group of expert psychiatrists on a series of statements regarding the clinical utility and relevance of DSM-5 specifiers for major depressive disorder in ordinary clinical practice. Experts reached an almost perfect agreement on statements related to the use and clinical utility of DSM-5 specifiers in ordinary clinical practice. In particular, a complete consensus was found regarding the clinical utility for ordinary clinical practice of using DSM-5 specifiers. The use of specifiers is considered a first step toward a “dimensional” approach to the diagnosis of mental disorders.

Mental Health Exemptions to Criminal Responsibility

Ill mental health is a key category for exempting individuals from criminal responsibility. Even in cases where a defendant has been found to have carried out the act, if mentally ‘ill enough’, the person could either be fully exempt from criminal responsibility and found not guilty – or be partially exempt and receive a reduced or special sentence on mental health grounds. Such outcomes might entail diversion into mental health treatment, sectioning – or release. In determining whether a mental health exemption is warranted in individual cases, ordinary practice is that psychologists or psychiatrists forensically assess the severity and nature of the accused’s impairment or disorder. While this might seem like a straightforward medical-juridical procedure of establishing evidence, this article uses a modified ‘genealogy of the present’ to show how mental health exemptions to criminal responsibility involve significantly more complexity. Looking to Norway and the UK, this article highlights differences in frameworks and implementation, including on matters of burden and nature of proof, and on causality. The article uses as an example the particular category of terrorism-related cases to bring out some of the contingencies involved. By doing so, the article shows the tensions inherent to the principle and practice of mental health exemptions, and its location between law, medicine, politics and security. Funding AcknowledgementThis research was made possible by a STAIRS grant from the Norwegian Institute of International Affairs (NUPI), as well as by funding from C-REX (Centre for Research on Extremism), University of Oslo.

Molecular Characterization of Advanced-Stage Melanomas in Clinical Practice Using a Laboratory-Developed Next-Generation Sequencing Panel.

Cutaneous melanoma is one of the most lethal tumors among skin cancers, characterized by complex genetic and molecular alterations that result in uncontrolled cell proliferation and metastatic spread. Next-generation sequencing (NGS) enables the simultaneous examination of numerous genes, making this molecular technique essential for melanoma diagnosis, prognostic stratification, and therapy planning. Herein, we present the experience with our laboratory-designed NGS panel for the routine assessment of advanced-stage melanoma. A total of 260 specimens of advanced-stage melanomas were evaluated utilizing a laboratory-developed multi-gene NGS panel, which allowed the investigation of 229 amplicons in 25 oncogene/oncosuppressor genes. The NGS panel proved to be a reliable tool, failing to produce results in only 1.2% of the samples tested. BRAF and TERT were the two more commonly altered genes in 44.0% and 59.9% of samples, respectively. In 59.3% of the mutated cases, at least two concomitant variants were detected. In eight cases, both primary lesion and metastatic disease were analyzed by NGS. In all specimens (8/8, 100%), a perfect concordance in variants harbored by the primary and recurrence lesions was observed. Finally, this study described the validity of a laboratory-developed multi-gene NGS panel built specifically for advanced-stage melanomas in ordinary clinical practice.

The KK Principle and the Strong Notion of Knowledge: Hintikka’s Arguments for KK Revisited

In his Knowledge and Belief (1962), Hintikka establishes his system of epistemic logic with the KK (Knowing that One Knows, in symbols, Kp→KKp) principle (KK for short). However, his system of epistemic logic and the KK principle are grounded upon his strong notion of knowledge, which requires that knowledge is infallible, that is, it makes further inquiry pointless, and becomes ‘discussion-stopper’; knowledge implies truth, to wit, cognitive agents will not be mistaken in their knowledge; cognitive agents will be ‘perfect logicians’, i.e. they have infinitive capability of logical inference. Hintikka calls the argument for KK from the strong notion of knowledge as the ‘transcendental argument’ for KK. Obviously, the strong notion of knowledge is far away from our ordinary conception of knowledge; based on such a strong sense of knowledge, epistemic logic has met the problem of logical omnipotence, and is difficult to apply in our ordinary cognitive practice. Moreover, there is no close connection of the KK principle with internalism or externalism.

Cognitive Profiles Stratified by Education Using Montreal Cognitive Assessment in Parkinson's Disease Patients with Freezing of Gait.

Parkinson's disease (PD) patients with freezing of gait (FOG) may present with complex and heterogeneous cognitive profiles. Owing to limited access to comprehensive neuropsychological battery in ordinary clinical practice, the Montreal Cognitive Assessment (MoCA) is likely to be easily available cognitive data for comparisons among studies. This study aims to explore the cognitive profiles stratified by education using MoCA in PD patients with FOG. PD patients with FOG (FOG+, n = 52) and without FOG (FOG-, n = 71) were included in our study. MoCA items were categorized into five subsections (attention/working memory, executive function, episodic memory, language, and visuospatial function) referring to previously published criteria. Cognitive assessments were compared based on five subsections between groups stratified by three education levels (0-6 years, 7-12 years, and >12 years). The association of cognitive measurements with FOG were analyzed using binary logistic regression models with adjustment for variables. The total scores and subscores of each subsection of MoCA were similar between two groups of each education level. Further detailed analysis showed that a composite measure labeled "Attention/working memory-Composite" (abbreviated to Attention-C), consisting of the scores of four items (target detection task, serial sevens, digit forward and backward, and sentence repetition), were lower significantly in FOG+ group compared with FOG- group in patients with education year ≤6 years. The significant association of Attention-C with FOG held true when controlling for disease duration, but not for H-Y stage, MDS-UPDRS III, HAMA, and HAMD. Overall, our findings gave a hint that Attention-C derived from MoCA might be a potential factor associated with FOG in PD patients with lower education level (education year ≤ 6 years), which will need to be validated in future studies.

The Place of Forensic Accounting in External Audit Practice

This study focused on the place of forensic accounting in external audit practice. The need for auditing was necessitated following separation of ownership from control. Auditing requires the external auditor to carry out an unbiased examination and investigation of the financial statement of any firm with a view to express an opinion on its truth and fairness in accordance. On the other hand, forensic accounting or auditing is a special audit for the purpose of litigation in the court of law. This implied that it required special methodological approach which is completely different from traditional or ordinary audit practice. Hence, this study specifically examined the need, skills, practice of forensic accounting and the relationship between forensic and traditional accountants or auditors. It is a library type of research. It solely employed secondary source of information. Information were obtained from textbooks, Journal articles, seminar papers, thesis etc. Having examined various related literature, it was revealed that the need for forensic accounting was to track crimes in various ways for the purpose of litigation in the court room and it is absolutely different from traditional audit because of exceptional skills required which can enhance external audit practice. It recommended that all professional accountants or practicing accountants should acquire knowledge in forensic accounting skills and all universities should run degree course in forensic accounting in order to aid knowledge of forensic skills in Nigeria.

Calibration of an environmental monitoring system for a radiometabolic therapy ward using Lu-177

Radiopharmaceuticals based on Lu-177 are finding increasing use in radiometabolic therapy. The ordinary practice requires radiation monitoring of the patient. To this end, detectors need to be calibrated in the geometry used and for the radioisotope used. This work presents an experimental investigation coupled with Monte Carlo calculations. This procedure yielded a calibration factor of practical use in everyday clinical practice.

Understanding of sailing rule based on COLREGs: Comparison of navigator survey and automated collision-avoidance algorithm

The Convention on the International Regulations for Preventing Collisions at Sea (COLREGs) comprises rules to prevent collisions at sea and is based on the qualitative rules and ordinary practice of seamen. However, because the criteria of the sailing rule interpretation are different, the problem of misunderstanding occurs owing to the difference in the interpretation between navigators and collision-avoidance algorithm designers. Therefore, this study aims to clarify the collision situations by understanding in the sailing rule interpretation of COLREGs. To identify the understanding of collision situations, we surveyed the navigators’ understanding of collision situations and reviewed the collision-avoidance algorithms used in recent studies. The survey results were analyzed based on head-on and crossing (HC) and crossing and overtaking (OC) situations. Results showed that navigators were unsure about whether the HC situation sailing rule should be applied to incoming vessels from the 008° and whether the overtaking or crossing situation should be applied to coming vessels at 160°. In OC situations, as the angle increased from 130°, it became difficult for navigators to interpret the navigation rules. A notable disparity emerged between the navigators’ understanding and the automated collision-avoidance algorithms. Moreover, it was confirmed that practical navigators exhibited divergent interpretations of these regulations. This study contributes to provide an understanding of COLREGs sailing rules based on the understanding of navigators and researchers.

Effect of Addition a Sodium Deoxycholate as an Edge Activator -for Preparation of Ondansetron HCl Tansfersomal Dispersion

In ordinary clinical practice, poor patient compliance with oral and parenteral drug administration modalities is a prevalent problem. As a result, pharmaceutical research has developed a strong interest in the transdermal route of drug delivery.
 They are non-invasive that can improve patient compliance, however, The barrier function of the skin's top layer presents the biggest challenge for transdermal delivery systems. Transfersomes are vesicles composed of phospholipids and edge activators, used to transport drug from outer skin layer into the systematic circulation through semipermeable membrane. Ondansetron is an anti-emetic medication that has been given parenterally and orally. Formulating this medication as transdermal transfersomes may provoke a great advantage in medical adherence.
 Conclusion; Ondansetron has been successfully delivered transdermally by Using a transfersomal gel formulation by vortexing sonication method.

Nine Explananda in Search of an Explanans

Abstract Intuitively speaking, a multiple artwork is one that admits of multiple ‘instances’ which are capable of playing a particular role in the appreciation of the work. The ‘explananda’ in the title of this article are things that have been proposed as requiring explanation by any adequate ontology of multiple artworks so conceived. This assumes that the ontology of art is in the business of explaining certain things, an assumption I defend. At least nine purported explananda have been proposed in the relevant literature. I begin by offering a preliminary sketch of these explananda, identifying how they are grounded in our ordinary artistic practice and discourse, and how they have structured recent debates in the ontology of art. I next argue that the notion of ‘instance’ must be understood in a particular way if instance multiplicity is to capture the standard distinction between singular and multiple art forms. I then assess the relative significance and implications of the nine explananda for an adjudication of the debates in the ontology of art. I identify problems for the historically dominant ‘type’ theory of multiples, and propose an alternative account that speaks to all nine explananda. I conclude by reflecting on where this leaves us and how we should proceed.

Rejecting Innovation: How Italian Public Employees are Killing Creativity and Digitalisation

Within the general context of new ideas generation, there is a grey area that still concerns the organizational design solutions related to creativity. In fact, if personal characteristics and other community-related issues have been quite explored, some organizational mechanisms still need to be deepened. In this paper, we aim to investigate the impact of professional networks on Innovative Work Behaviour in the local government to achieve public value. We investigate the contribution of creativity in the digitalization of Italian public administration considering the contribution of public employees to developing knowledge management. Moreover, we investigate a community of 190 employees of municipalities divided into three macro categories: deputy employees, Managers and Senior Managers. An OSL regression model has been used to understand to what extent the degree of collaboration and advice among employees and their propensity to adopt digitalization in ordinary practice considering social capital variables. What emerges from the OLS regression is that despite accelerating the ordinary work using the leverage of digitalization and knowledge management, there is the custom of not applying the enormous benefit of process re-engineering and continuing their work attitude in what the economic literature defines as “the comfort zone”. The results consolidate the current literature about the creation of public value showing the resilience of public employees to change their state of mind reflecting any kind of innovation.

Neural Network Approach to Investigating the Importance of Test Items for Predicting Physical Activity in Chronic Obstructive Pulmonary Disease.

Contracting COPD reduces a patient's physical activity and restricts everyday activities (physical activity disorder). However, the fundamental cause of physical activity disorder has not been found. In addition, costly and specialized equipment is required to accurately examine the disorder; hence, it is not regularly assessed in normal clinical practice. In this study, we constructed a machine learning model to predict physical activity using test items collected during the normal care of COPD patients. In detail, we first applied three types of data preprocessing methods (zero-padding, multiple imputation by chained equations (MICE), and k-nearest neighbor (kNN)) to complement missing values in the dataset. Then, we constructed several types of neural networks to predict physical activity. Finally, permutation importance was calculated to identify the importance of the test items for prediction. Multifactorial analysis using machine learning, including blood, lung function, walking, and chest imaging tests, was the unique point of this research. From the experimental results, it was found that the missing value processing using MICE contributed to the best prediction accuracy (73.00%) compared to that using zero-padding (68.44%) or kNN (71.52%), and showed better accuracy than XGBoost (66.12%) with a significant difference (p < 0.05). For patients with severe physical activity reduction (total exercise < 1.5), a high sensitivity (89.36%) was obtained. The permutation importance showed that "sex, the number of cigarettes, age, and the whole body phase angle (nutritional status)" were the most important items for this prediction. Furthermore, we found that a smaller number of test items could be used in ordinary clinical practice for the screening of physical activity disorder.

A victory (of what sort) for strict purist invariantism? Some reflections on Gerken’s On folk epistemology: how we think and talk about knowledge

ABSTRACT Gerken's On Folk Epistemology: How we think and talk about knowledge develops and defends strict purist invariantism about knowledge. Along the way, Gerken argues that less-orthodox competitors to strict purist invariantism are plagued by certain heretofore unrecognized or underappreciated difficulties. Given Gerken's own explicit methodological commitments, this defensive component of the book's project is dialectically crucial. By Gerken's own lights, we ought to be persuaded to embrace strict purist invariantism only if it turns out that the strict purist invariantist is better positioned than their competitors to explain the folk epistemological “inputs” to epistemic theorizing. My own goal here is to articulate some reasons to worry that Gerken's defensive efforts are less-than-fully successful. In particular, I argue that we ought to adopt a more expansive and more nuanced conception of the relevant folk epistemological “inputs.” Moreover, I suggest that, at least insofar as we have reason to embrace a kind of qualified methodological preference for theoretical explanations that vindicate our ordinary epistemic practice, we might well have good reason for favoring (certain of) the alternate theoretical explanations of these inputs that less-orthodox views of knowledge supply over the kind of explanations that Gerken convincingly argues strict purist invariantism can offer.

The time is now to start evaluating biomarkers in the clinic.

The time is now to start evaluating biomarkers in the clinic.

Use of Daridorexant among Patients with Chronic Insomnia: A Retrospective Observational Analysis.

Insomnia is the most prevalent sleep disorder, affecting millions worldwide and taking a heavy toll on patient health with significant social and economic impact. Even though there are multiple different types of insomnia medications and behavioral therapies, there are still many individuals for whom treatment remains ineffective. The objective of this retrospective study was to analyze the effectiveness of daridorexant in a cohort of chronic insomnia patients largely transitioned from GABA-A positive allosteric modulators (benzodiazepines, zolpidem or eszopiclone) or other frequently prescribed insomnia medications (including trazodone, atypical antipsychotics or tricyclic antidepressants). A total of 86 patients were treated in the course of ordinary practice and the primary analytic endpoint was the change in Insomnia Severity Index (ISI) score following ≥ 30 nights of treatment with daridorexant. Results from 80 of the 86 patients with full data (65% female, mean age 53.5 years, 18.8% with comorbid obstructive sleep apnea, 91.3% transitioned from a different medication) showed a mean improvement in ISI score of 7.0 ± 0.54 points (SEM) (p < 0.0001) from 18.0 to 11.0. Overall, 78% of the cohort demonstrated a clinically meaningful improvement as defined by at least a six-point drop in ISI. Total sleep time increased by 54 ± 1.0 min (SEM) (p < 0.0001) from 6.0 h to 6.9 h. Mean sleep latency decreased by 23.9 ± 2.4 min (SEM) (p < 0.0001) from 58.8 min to 34.9 min. Wake after sleep onset decreased by 31.6 ± 3.2 min (SEM) (p < 0.001) from 42.8 min to 11.3 min. Sleep efficiency improved by 10.5 ± 1.1% (SEM) (p < 0.0001) from 79.3% to 89.8%. No significant adverse events were noted during the study duration. Keeping in mind this study's limitations, these data suggest that for insomnia patients with an incomplete response to current therapy, switching to daridorexant is safe and may be an effective alternative treatment.

Primal Familiarity

ABSTRACT This article proposes a concept of primal familiarity, which gives increased importance to a fusion of basic life energy and the everyday happenings in our lives. It expands attention to the vital role that this accentuation of familiarity plays not only in our everyday lives but also in the psychotherapy process and its communal possibilities. It also highlights the concept of ordinary familiarity as a guiding force that illuminates the geography of a lifetime. It expands these principles to create a communal relevance in the form of Life Focus Groups. These groups represent the expansion of ordinary therapeutic practice into the development of lifelong congregations, bringing attention to the nature of living in community, as contrasted with the more personal individual benefits of ordinary psychotherapy. It represents psychotherapy as an heir to religion, and as a force in the communal exploration of the lives people live.

Combination of conservative and surgical methods in the treatment of giant lymphedema of the scrotum: A case report.

Genital lymphedema is a severe, disabling condition associated with a malfunction of the lymphatic system. Primary lymphedema of the scrotum is a variant of congenital dysplasia of lymphatic vessels. Secondary genital lymphedema is much more common and can be caused by parasitic invasion (filariasis) or damage to the lymphatic system during the treatment of cancer (radiation therapy, lymphadenectomy). Healthcare providers are frequently unable to detect and treat this illness successfully in ordinary clinical practice. This paper uses the case of a patient with stage 3 secondary lymphedema (unknown genesis) of both lower extremities and lymphedema of the scrotum, complicated by recurrent erysipelas, a history of lymphorrhoea, impaired skin trophic and multiple papillomatosis, to demonstrate the efficacy of a combination of conservative and surgical methods in the treatment of giant lymphedema of the scrotum. In the treatment, the combination of decongestant physical therapy (CDPT, CDT) according to M. Földi was used at pre-surgery and post-surgery stages, combined with a reconstructive operation, including the removal of the affected tissues of the urogenital region, phalloplasty, and scrotoplasty with rotational skin flaps. A decrease in the circumference of the lowest extremities in the lower leg area by 68 cm on the right and by 69 cm on the left was achieved by conservative treatment. Due to the combination of conservative and surgical treatment, the patient's body weight decreased by 69.4 kg, and the scrotum decreased by 63 cm. Subsequently, the patient fully recovered his sexual function. A combination of complex decongestive physical therapy and surgery is necessary for patients with advanced genital edema. The isolated use of surgical or conservative treatment does not provide a sufficient improvement in the patient's quality of life. Modern plastic surgery technologies enable patients to achieve complete functional and cosmetic recovery, while proper selection and usage of compression hosiery help preserve and improve the outcomes acquired following treatment.

Integrating Indigenous epistemologies into mainstream foreign language teaching

Abstract This study explores teacher perspectives on a government policy that seeks to integrate Indigenous knowledge into mainstream foreign language education in New Zealand schools. Based on in-depth interviews, the study found that language teachers generally support this educational change because trans/languaging involving English and te reo Māori (the Māori language) has become an ordinary practice in their teaching and school lives. However, foreign language teachers expressed a need for discipline-specific materials and professional development to help them integrate mātauranga Māori (Indigenous knowledge of Māori) into their teaching. Their concerns can be understood as a lack of support in interpreting “what,” “how,” and “to what extent” the policy will be implemented. The study suggests using a decolonising approach to help teachers affirm the relevance of Indigenous knowledge in their discipline. It recommends that policymakers adopt a pluriversal stance to ensure that diverse knowledge systems can coexist and interact harmoniously rather than compete with one another in the new National Certificate of Educational Achievement (NCEA) curriculum.

Learning-by-Doing Methodology towards Urban Decarbonisation: An Application in Valletta (Malta)

Since approximately 75% of Europeans currently live in cities, and this number will rise, urban areas are the most important testbeds for energy transition, climate change adaptation measures, and decarbonisation models, on which studies and efforts for concrete change must focus. The teaching of mitigation and adaptation measures to climate change and decarbonisation models has gradually taken up space within university courses. However, the complexity of the decarbonisation issue is raising awareness on the urgency of an interdisciplinary approach that can be conveyed by spatial planning. Currently, this approach is not widespread in Higher Education Institutions in Europe but is nonetheless necessary to let new professional profiles emerge who are able to coordinate different stakeholders, data, and information sources. The Erasmus+ project CITY MINDED (2020–2022) has worked in this direction, by developing and testing a methodology for the design of a structured ordinary practice for teaching urban decarbonisation to students in Higher Education. This practice (at the same time, interdisciplinary, collaborative, experiential, and place-based) aims to offer students a combination of different approaches and working methods to investigate and improve urban neighbourhoods and districts, resulting in the definition of an operative roadmap for decarbonisation in the medium-to-long-term. The aim of this article is to highlight the learning-by-doing experience developed by the project consortium, with reference to the testing of the methodology conducted within an Intensive Course in the City of Valletta (Malta). In particular, the paper illustrates how this experience succeeded in stimulating students with different academic backgrounds to establish connections across disciplines, in raising their awareness about the complexity of city decarbonisation processes. Overcoming the strict time and budget constraints of an EU-funded project, such an approach can be further developed, replicated on theoretical grounds, and implemented within different degree programmes dealing with urban sustainability.