Prior Statements Research Articles

Utility of ADC Values for Differentiating Uterine Sarcomas From Leiomyomas: Systematic Review and Meta-Analysis.

BACKGROUND. Uterine sarcomas are rare; however, they display imaging features that overlap those of leiomyomas. The potential for undetected uterine sarcomas is clinically relevant because minimally invasive treatment of leiomyomas may lead to cancer dissemination. ADC values have shown potential for differentiating benign from malignant uterine masses. OBJECTIVE. The purpose of this study was to perform a systematic review of the diagnostic performance of ADC values in differentiating uterine sarcomas from leiomyomas. EVIDENCE ACQUISITION. We searched three electronic databases (the MEDLINE, Embase, and Cochrane databases) for studies distinguishing uterine sarcomas from leiomyomas using MRI, including ADC values, with pathologic tissue confirmation or imaging follow-up used as the reference standard. Data extraction and QUADAS-2 quality assessment were performed. Sensitivity and specificity were pooled using hierarchical models, including bivariate and hierarchical summary ROC models. Metaregression was used to assess the impact of various factors on heterogeneity. EVIDENCE SYNTHESIS. Twenty-one studies met the study inclusion criteria. Pooled sensitivity and specificity were 89% (95% CI, 82-94%) and 86% (95% CI, 78-92%), respectively. The area under the summary ROC curve was 0.94 (95% CI, 0.92-0.96). The context of the ADC interpretation (i.e., used as a stand-alone assessment vs integrated as part of multiparametric MRI [mpMRI]) was the only factor found to account significantly for heterogeneity (p = .01). Higher specificity (95% [95% CI, 92-99%] vs 82% [95% CI, 75-89%]) and similar sensitivity (94% [95% CI, 89-99%] vs 88% [95% CI, 82-93%]) were observed when ADC was evaluated among mpMRI features rather than as a stand-alone ADC assessment. ADC cutoff values ranged from 0.87 to 1.29 × 10-3 mm2/s but were not associated with statistically different performance (p = .37). Pooled mean ADC values for sarcomas and leiomyomas were 0.904 × 10-3 mm2/s and 1.287 × 10-3 mm2/s, respectively. CONCLUSION. As part of mpMRI evaluation of uterine masses, a mass ADC value of less than 0.904 × 10-3 mm2/s may be a useful test-positive threshold for uterine sarcoma, consistent with the findings of a prior expert consensus statement. Institutional protocols may influence locally selected ADC values. CLINICAL IMPACT. Using ADC as part of mpMRI assessment improves detection of uterine sarcoma, which could influence candidate selection for minimally invasive treatments. TRIAL REGISTRATION. Prospective Register of Systematic Reviews CRD42024499383.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors.

Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication. The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention. As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.

Reversing the Presumption: Admitting Prior Inconsistent Statements for Their Truth

Reversing the Presumption: Admitting Prior Inconsistent Statements for Their Truth

Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes.

Emergency Department (ED) crowding is defined as a situation wherein the demands of emergency services overcome the ability of a department to provide high-quality care within an appropriate time frame. There is a need for solutions, as the harms of crowding impact patients, staff, and healthcare spending. An overview of ED crowding was previously published by our group, which outlines these global issues. The problem of overcrowding in emergency departments has emerged as a global public health concern, and several healthcare agencies have addressed the issue and proposed possible solutions at each level of emergency care. There is no current literature summarizing the extensive research on interventions and solutions, thus there is a need for data synthesis to inform policymakers in this field. The aim of this overview was to summarize the interventions at each level of emergency care: input, throughput, and output. The methodology was supported by the current PRIOR statement for an overview of reviews. The study summarized twenty-seven full-text systematic reviews, which encompassed three hundred and eight primary studies. The results of the summary displayed a requirement for increasing studies in input and output interventions, as these showed the best outcomes with regard to ED crowding metrics. Moreover, the results displayed heterogeneous results at each level of ED care; these reflected that generally solutions have not been matched to specific problems facing regional centres. Thus, individual factors need to be considered when implementing solutions in Emergency Departments.

Reporting misstatements as revisions: An evaluation of managers' use of materiality discretion

AbstractIn recent years, firms reporting revisions of prior financial statements outnumber those reporting restatements. Misstatements that are material to prior periods are required to be reported as restatements, whereas immaterial errors can be reported as revisions. Based on SEC guidance and widely used materiality benchmarks, I find a significant percentage (29%) of revisions are suspect in that they meet at least one materiality criterion. These suspect revisions are 15% to 29% more likely to be reported when managers have a strong incentive to avoid restatements—when they face the threat of a compensation clawback for reporting a restatement. This result is especially salient when the clawback policy does not require misconduct for recoupment and when the error correction significantly reduces prior period net income. Overall, this evidence suggests that some managers use materiality discretion opportunistically to report misstatements as revisions instead of restatements.

Unconventional Usage of Gender-Based Japanese Sentence-Final Particles: A Study of wa and no in Youth Conversations

Japanese society’s traditional gender norms are reflected by sentence-final particles (SFPs) in daily conversation. However, recently, Japanese young people have started to use gendered SFPs in “unclassical” ways. This study mainly examines the usage of the so-called “female” SFPs wa and no by male speakers. In total, 68 cases of wa (43 by male speakers and 25 by female speakers) and 84 cases of no (47 by male speakers and 37 by female speakers) usage were collected from casual conversations of Japanese college students in TalkBank, a public linguistic database. This study demonstrates that the “female” SFPs wa and no are used more frequently by male speakers than by female speakers. Different from the female speakers’ usage to soften the utterances and enhance conversational rapport, wa and no used by male speakers perform other functions. In particular, wa directly indexes self-centeredness, serving the speaker to express emotion, share personal ideas, or perform speech acts such as teasing or amae in a self-focused way, while no directly indexes truthfulness, which allows the speaker to share a story in a vivid tone, reconfirm the speaker’s prior statement, or provide the speaker’s explanation/reasoning in an assertive tone. This study suggests that the new, unconventional gender-based usages of SFPs reveal the social changes in gender dynamics in modern Japanese society, which should not be overlooked in language education.

Post-operative nausea and vomiting prophylaxis: A meta-review on systematic reviews and meta-analyses

Introduction: Postoperative nausea and vomiting (PONV) are common complications in surgical patients undergoing general anesthesia, and multiple strategies have been suggested to prevent them.
 Objective: To describe the available evidence on the effectiveness of pharmacological and non-pharmacological strategies for preventing PONV in adults undergoing surgery under general anesthesia, as reported in previous meta-analyses and systematic reviews.
 Methodology: An overview of systematic reviews and meta-analyses was conducted. Searches were performed in PubMed, EBSCO, EMBASE, Cochrane Database, Science Direct, and Scopus, without restrictions as to gender, clinical condition, or date of publication, including articles in Spanish, French, and English only. Two reviewers independently and in duplicate did the screening, data extraction, quality evaluation, and risk of bias assessment according to AMSTAR-2. The PRISMA and PRIOR statements were followed for reporting. PROSPERO registration number CRD42021251999.
 Results: Out of 80 candidate articles, three were viable for meta-analysis. 1.5 mg to 18 mg doses of Dexamethasone showed a significant reduction in the risk of PONV, with a RR of 0.48 (95 % CI 0.41-0.57; p<0.001), I2=63 % (p=0.07), and a NNTc of 5 and 7. Other effective strategies included the use of acoustic stimulation/acupuncture/acupressure, 5HT3 antagonists, NK1 antagonists, gabapentinoids, haloperidol, droperidol, metoclopramide, midazolam, mirtazapine, among others. The risk of publication bias was low.
 Conclusion: Different strategies are effective for PONV prophylaxis in surgeries under general anesthesia. Dexamethasone shows the best available evidence at the moment. The documented methodological quality suggests the need for better studies to establish the effectiveness of the strategies.

A Brief Discussion of Contract Formation Judgment

This article agrees that the parties and the unanimity of intent together constitute the elements of contract formation. In general, it is more appropriate to adopt the doctrine of representation to judge and grasp the unanimity of intent. Whether silence constitutes an expression of intent should be considered in the specific circumstances, whether silence is sufficient to infer the meaning of the parties, such as the existence of prior statements or trade practices. In this paper, we try to sort out the elements of the main rule of contract formation - the rule of offer and promise, in order to clarify the path of judging contract formation.

Emergency department crowding: an overview of reviews describing measures causes, and harms

Background: Crowding in Emergency Departments (EDs) has emerged as a global public health crisis. Current literature has identified causes and the potential harms of crowding in recent years. The way crowding is measured has also been the source of emerging literature and debate. We aimed to synthesize the current literature of the causes, harms, and measures of crowding in emergency departments around the world. Methods: This overview of reviews was guided by the PRIOR statement, and involved Pubmed, Medline, and Embase searches for eligible systematic reviews. A risk of bias and quality assessment, using the JBI tool, were performed for each included review, and the results were synthesized into a narrative overview. A total of 13 systematic reviews were identified, each targeting the measures, causes, and harms of crowding in global emergency departments. Results: The reviews addressed the current state of the literature regarding crowding in EDs and displayed that while an abundance of research is available, there is a need for further research to standardize measurements and make recommendations. Amongst the results is that the measures of crowding were heterogeneous, even in geographically proximate areas, and that temporal measures are being utilized more frequently. It was identified that many measures are associated with crowding, and the literature would benefit from standardization of these metrics to promote improvement efforts and the generalization of research conclusions. These standardized metrics may effectively be used to track crowding in geographically proximate centers, as well as to evaluate the impact of interventions and solutions on crowding in emergency departments. The major causes of crowding were grouped into patient, staff, and system-level factors; with the most important factor identified as outpatient boarding. A common theme in the causes of crowding was that issues were not universal; therefore, it is imperative to understand the issues relating to crowding in your center, the stage of treatment that it represents, and the actions that can be taken to reduce it. The harms of crowding include impacts to patients, healthcare staff, and healthcare service and spending. This harm may further exacerbate crowding, therein creating a cycle of poor healthcare delivery. Thus, it is imperative that systems target local solutions which can improve crowding in emergency care. Advice and Lessons Learned: This overview was intended to synthesize the current literature on crowding for relevant stakeholders, to assist with advocacy and solution-based decision making. The major conclusions from the overview were as follows: There is an abundance of current available research, especially on the measures of crowding, but a standard of metrics is required to standardize research results and accurately evaluate solutions to crowding. Crowding has a significant impact on patient care, employee satisfaction, and cost to the healthcare system, with worsening impacts on each factor as crowding worsens. The causes of crowding are heterogeneous, and solutions should be tailored to local healthcare systems. This is especially important considering the fact that a common theme was that many solutions were not tailored to the local causes of crowding. This project provides a broad overview on the topic of crowding and synthesizes the current evidence. The information contained within it provides a framework for concerted evidence informed efforts to reduce crowding in Emergency Departments.

The Narrators who were Mentioned by Al-Dahabi in his Book Al-Kashif (Youjhal): A Critical Study

This paper: the narrators whom Al-Dhahabi said in Al-Kashef (ignoring them) a critical study), contains the study of a group of (13) narrators who studied the life of Imam Al-Dhahabi in brief, in terms of his name, ancestry, surname, birth, death, and books, and scholars who had praised him. It also included the study of the narrators arranged according to the letters of the dictionary; the study tackles the narrators by mentioning the full name of the narrator and mentioning his surname and title, if any, as well as his description and whoever narrated it. Then the speech of Imam Al-Dhahabi about him, followed by a study of the status of that narrator with criticism and the modification. Then the most prior and proper statement in his case is stated. The results are mentioned the main sources and references that the researcher referred to (get benefit from it in the search), and God guide to the straight path.

Emergency department crowding: an overview of reviews describing measures causes, and harms.

Crowding in Emergency Departments (EDs) has emerged as a global public health crisis. Current literature has identified causes and the potential harms of crowding in recent years. The way crowding is measured has also been the source of emerging literature and debate. We aimed to synthesize the current literature of the causes, harms, and measures of crowding in emergency departments around the world. The review is guided by the current PRIOR statement, and involved Pubmed, Medline, and Embase searches for eligible systematic reviews. A risk of bias and quality assessment were performed for each review, and the results were synthesized into a narrative overview. A total of 13 systematic reviews were identified, each targeting the measures, causes, and harms of crowding in global emergency departments. Key among the results is that the measures of crowding were heterogeneous, even in geographically proximate areas, and that temporal measures are being utilized more frequently. It was identified that many measures are associated with crowding, and the literature would benefit from standardization of these metrics to promote improvement efforts and the generalization of research conclusions. The major causes of crowding were grouped into patient, staff, and system-level factors; with the most important factor identified as outpatient boarding. The harms of crowding, impacting patients, healthcare staff, and healthcare spending, highlight the importance of addressing crowding. This overview was intended to synthesize the current literature on crowding for relevant stakeholders, to assist with advocacy and solution-based decision making.

On a concessive reading of the rise-fall-rise contour: contextual and semantic factors

This paper presents three auditory rating experiments on the rise-fall-rise contour (RFR). Experiment 1 provides experimental evidence that the RFR makes disagreeing with a prior statement more natural than neutral intonation would. Additionally, the data show that the RFR exhibits a valence asymmetry, noted by Göbel (2019): the amelioration of a disagreement is greater when the RFR is used in a positive reply to a negative statement than in a negative reply to a positive statement. Experiments 2 and 3 investigate factors contributing to this asymmetry, showing that it disappears in replies to questions and is weakened when the reply contains an additive particle. Based on these results, we argue that the RFR has a scalar meaning, following Göbel (2019), with the relevant scale being contextually determined and resulting in an ambiguity resembling the Focus-particle at least.

Tranexamic acid in emergency medicine. An overview of reviews.

Tranexamic acid (TXA) is a common haemorrhage control agent in both emergency department (ED) settings and intra-operatively. While efficacy and potential harms are well-studied, there are no overviews of reviews completed on TXA efficacy in the ED setting. We set out to provide an overview of systematic reviews on TXA efficacy in trauma, gastrointestinal bleeding, and subarachnoid haemorrhage in the ED setting, with outcomes including short and long-term mortality, thromboembolic (TE) events, and whether bleeding continued. Our review is guided by the PRIOR statement. We searched Pubmed, Medline, and EMBASE using broad search terms for systematic reviews, and calculated pooled relative-risk ratios using random and fixed-effects modelling from these studies. A risk-of-bias assessment was also completed for each review. We identified 13 systematic reviews for inclusion, with a variety of different outcomes. We identified improvements in 24-h mortality for trauma (RR 0.88, 95% CI 0.84-0.92) and gastrointestinal bleeds (RR 0.30, 95% CI 0.23-0.39), and decreased long-term gastrointestinal bleed mortality (RR 0.57, 95% CI 0.48-0.69). We also identified an increase in TE risk in gastrointestinal bleeding scenarios (RR 1.45, 95% CI 1.09-1.94), but no other clinical scenarios. TXA is effective in reducing mortality following trauma and gastrointestinal bleeds, however, there is limited evidence at this time to support TXA administration in the context of subarachnoid haemorrhage. TE risk is elevated when used in gastrointestinal bleeds. Selective use in high-risk patients may be warranted. TXA should strongly be considered in management in ED and prehospital settings.

USPSTF: Taking vitamin, mineral, and multivitamin supplements doesn't prevent CVD and cancer

USPSTF: Taking vitamin, mineral, and multivitamin supplements doesn't prevent CVD and cancer

Uptake of Voluntary Occupational Health Care-Assessments of German Occupational Health Physicians and Employees.

Workers’ health surveillance is considered essential for employees’ health and protection against hazardous working conditions. It is one part of occupational health care and thus one of four pillars of holistic workplace health management. In Germany, employers are obliged to provide mandatory and voluntary occupational health care (OHC) to employees, dependent on the defined occupational hazards. However, employees are not obliged to make use of voluntary OHC. No empirical information is available about the uptake of voluntary OHC by employees and the influencing factors in Germany. Thus, we carried out an explorative multi-perspective study with qualitative and quantitative elements to get insights from the view of occupational health physicians (OHPs) and employees. We conducted a survey among OHPs based on prior statements from two focus group discussions. A multivariate logistic regression analysis was performed to detect enablers and barriers regarding employee uptake of the offered voluntary OHC. We used extended qualitative methods among employees instead of an analogous survey. In total, 460 OHPs participated in the survey (response rate 29.1%), and 25 employees took part in interviews. Most of the employees had not heard the term voluntary OHC before, and only a few remembered respective occupational health care after explanatory request. In total, 78% of the OHPs assessed that employees always/mostly take up voluntary OHC. The most important attributed reason for non-uptake was that employees see no need for occupational health care when they feel healthy. The most important enabler for the perceived high uptake of voluntary OHC in the regression analysis was a positive attitude of the OHP toward voluntary OHC. While OHPs perceived that voluntary OHC was accepted by a majority of employees, this was not confirmed by the interviews with selected employees. This could indicate that the OHP respondents overestimated the amount of uptake. Since it became clear that employees are often unfamiliar with the terminology itself, we see a need for more and better information regarding the objectives and content of occupational health care to improve this important pillar of workplace health management.

Unsupervised Editing for Counterfactual Stories

Creating what-if stories requires reasoning about prior statements and possible outcomes of the changed conditions. One can easily generate coherent endings under new conditions, but it would be challenging for current systems to do it with minimal changes to the original story. Therefore, one major challenge is the trade-off between generating a logical story and rewriting with minimal-edits. In this paper, we propose EDUCAT, an editing-based unsupervised approach for counterfactual story rewriting. EDUCAT includes a target position detection strategy based on estimating causal effects of the what-if conditions, which keeps the causal invariant parts of the story. EDUCAT then generates the stories under fluency, coherence and minimal-edits constraints. We also propose a new metric to alleviate the shortcomings of current automatic metrics and better evaluate the trade-off. We evaluate EDUCAT on a public counterfactual story rewriting benchmark. Experiments show that EDUCAT achieves the best trade-off over unsupervised SOTA methods according to both automatic and human evaluation. The resources of EDUCAT are available at: https://github.com/jiangjiechen/EDUCAT.

What Was the President’s Standpoint and When Did He Take It? A Normative Pragmatic Study of Standpoint Emergence in a Presidential Press Conference

In contrast to views that treat positions and standpoints as defining the scope of argumentation, our normative pragmatic approach sees positions and standpoints as interactionally emergent products of argumentative work. Here, this is shown in a detailed case study of a question-answer session in which former US President Donald J. Trump was pressed by journalists to express and defend his standpoint on the Charlottesville protests by neo-Nazis and White nationalists. Trump repeatedly evaded efforts to pin down his standpoint; however, with each of his answers to the questions, his built-up position circumscribed the range of possible standpoints he could take. To the end, he avoided backing down from any prior statement expressing his standpoint, while also preserving a degree of maneuverability regarding what his standpoint amounted to.

Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association.

Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Data also suggest that HF may develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population; HF may also be the first presentation of cardiovascular disease in many individuals with diabetes. Given that during the past decade, the prevalence of diabetes (particularly type 2 diabetes) has risen by 30% globally (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise. The scope of this American Diabetes Association consensus report with designated representation from the American College of Cardiology is to provide clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes, with the goal to ensure access to optimal, evidence-based management for all and to mitigate the risks of serious complications, leveraging prior policy statements by the American College of Cardiology and American Heart Association.

Perception of prosodic cues to correct mistakes, in listeners with normal hearing and with cochlear implants

Prosody is used to mark important information in speech yet is not an integral part of speech recognition testing among people with hearing difficulty. While a listener may correctly perceive words spoken, they may not perceive meaningful emphasis on a certain word, which could be critically important in a variety of everyday situations. This study introduces a new paradigm for assessing perception of prosodic cues in listeners with normal hearing and with cochlear implants, who have notorious difficulty perceiving pitch. Stimuli consisted of spoken sentences where one word (in various sentence positions) was emphasized in a manner that indicated that a prior statement was incorrect in a specific way. Participants used a visual analog scale to mark the timing and degree of emphasis aligned with the target words. Here, the perceptual data are linked with acoustic measures of voice pitch contour, intensity, duration, and vocal quality to characterize how contrastive stress cues are recovered by listeners with and without hearing impairment.

Genetic counseling access for parents of newborns who screen positive for cystic fibrosis: Consensus guidelines.

A risk associated with cystic fibrosis newborn screening (CFNBS) is parental misunderstanding of genetic information generated by the over 6600 positive screens reported annually in the United States. CFNBS algorithms incorporating DNA analysis can generate genetic information that requires clinical interpretation and has significance for the newborn, parents, and other relatives. Engagement between CF care centers and trained genetic counseling providers, such as licensed and/or certified genetic counselors (GCs), is variable and limited in providing information to CFNBS positive (CFNBS+) families. Using a modified Delphi process, a workgroup of CFNBS experts developed recommendation statements for engagement of genetic counseling services in CF care centers where CFNBS + diagnostic evaluations are performed. Statements were assessed over three rounds of surveys, one face-to-face meeting, and through public feedback. Seventeen statements achieved >80% consensus (range: 82%-100%). The workgroup affirmed prior CFF policy statements recommending genetic counseling for parents of infants with CFNBS+. The remaining statements addressed infrastructure and logistics of genetic counseling services, including defining appropriate training for genetic counseling providers and counseling content, establishing a path to equal access to genetic counseling providers across CF care centers, and setting a standard for client-centered CFNBS genetic counseling that is respectful of diverse patient needs and autonomy. Implementation of client-centered genetic counseling for CFNBS+families in CF care centers by providers with expertise in both CF and genetic counseling will require efforts to further define core concepts, enhance the education of providers, and develop opportunities for access via telemedicine.