Relevant Distinctions Research Articles

Embracing ambivalence and hesitation: a Ricoeurian perspective on anticipatory choice processes at the end of life.

Especially older adults are increasingly stimulated to think about, talk about and record their preferences with regard to future (health)care decisions, preferably in a pro-active manner. In this paper, I analyse these anticipatory choice processes. My goal is twofold: Firstly, to provide a deeper understanding of what it actually means to decide in advance about end-of-life treatments or options. Secondly, to make a theoretical contribution to bioethics and ACP-theories by rethinking the concept of end-of-life choices from a phenomenological viewpoint. To achieve this, I start by presenting a case narrative that elucidates how these anticipatory choices are lived. Secondly, I map out a theoretical framework about choice based on the phenomenology of the will of Paul Ricoeur. Finally, guided by this Ricoeurian framework, I investigate the potential meaning of choice in the context of contemporary advance care planning trajectories. The analysis demonstrates that choice and agency always imply notions of passivity and uncontrollability. It also indicates the significant value of hesitation and ambivalence. Moreover, it highlights the importance of the notion of co-responsibility in the context of anticipated end-of-life choices, and the relevant distinction between a (willed) choice and a wish. To improve care and support regarding end-of-life trajectories and to promote meaningful conversations, it is imperative to integrate these underrated elements more substantially in our theories, language and practical approaches. I conclude by suggesting that, in order to do justice to the real-life complexities, we might even need to revise the notion of advance 'directives'.

Ontology After Folk Psychology; or, Why Eliminativists Should Be Mental Fictionalists

ABSTRACTMental fictionalism holds that folk psychology should be regarded as a kind of fiction. The present version gives a Lewisian prefix semantics for mentalistic discourse, where roughly, a mentalistic sentence “p” is true iff “p” is deducible from the folk psychological fiction. An eliminativist version of the view can seem self‐refuting, but this charge is neutralized. Yet a different kind of “self‐effacing” emerges: Mental fictionalism appears to be a mere “parasite” on a future science of cognition without contributing anything substantial. The paper then rebuts the objection, illustrating that prefix semantics resolves a lingering problem for eliminativism from Boghossian. The problem is that eliminativists seem unable to adopt realism about neuroscience, for such realism implies that neuroscientific statements represent reality accurately. However, a deflationary version of prefix semantics allows the eliminativist to draw an ontologically relevant distinction (roughly) between truths that have a storytelling prefix and those that do not. (Deflationism means there is no implication that the unprefixed sentences robustly represent reality). The overarching lesson is that eliminativists need to approach ontology carefully so as to avoid self‐refutation; however, prefix‐semantical mental fictionalism provides the resources for them to do so.

Comparative analysis of the yields of dicentrics and chromosomal translocations

Purpose Chromosomal dicentrics and translocations are commonly employed as biomarkers to estimate radiation doses. The main goal of this article is to perform a comparative analysis of yields of both types of aberrations. The objective is to determine if there are relevant distinctions between both yields, allowing for a comprehensive assessment of their respective suitability and accuracy in the estimation of radiation doses. Materials and methods The analysis involved data from a partial-radiation simulation study with the calibration data obtained through two scoring methods: conventional and PAINT modified. Subsequently, a Bayesian bivariate zero-inflated Poisson model was employed to compare the posterior marginal density of the mean of dicentrics and translocations and assess the differences between them. Results When employing the conventional method of scoring, the findings indicate that there is no notable disparity between the yield of observed translocations and dicentrics. However, when utilizing the PAINT modified method, a notable discrepancy is observed for higher doses, indicating a relevant difference in the mean number of the two types of aberrations. Conclusions The choice of scoring method significantly influences the analysis of radiation-induced aberrations, especially when distinguishing between complex and simple chromosomal formations. Further research and analysis are necessary to gain a deeper understanding of the factors and mechanisms impacting the formation of dicentrics and translocations.

Impact of age on tumor characteristics and treatment outcomes in pediatric Differentiated Thyroid Carcinoma.

There is a tendency to use data generated for adults in the management of pediatric Differentiated Thyroid Carcinoma, neglecting the clinical peculiarities of this condition in childhood. This study aimed to assess and compare the clinical-epidemiological characteristics and their significance in the evolution of thyroid carcinoma diagnosed in childhood across different age groups. Seventy-seven patients diagnosed with Differentiated Thyroid Carcinoma (DTC) up to 21 years old were selected and divided into different age groups: up to 10 years, 11 to 18 years, and 19 to 21 years old. Clinical-epidemiological data and their influence in the disease progression were analyzed and compared across age groups. Patients diagnosed below 10 years of age were associated with tumors showing extrathyroidal extension, metastasis in regional lymph nodes, higher levels of stimulated thyroglobulin in the diagnostic iodine-131 whole-body scan (WBS), and under TSH suppression in the last assessment. Additionally, pulmonary metastasis were associated in both diagnostic and post-radioiodine dose WBSs in these younger patients. Analysis of findings in the post-radioiodine therapy WBS revealed significant differences between all age groups (p = 0.0029). The time of diagnosis was identified as a factor associated with an excellent response in subgroups up to 18 years and up to 21 years. No factors associated with dynamic responses over the 1st, 3rd and 5th years of follow-up and the persistence/recurrence of the disease were identified in the subgroup up to 18 years. In the subgroup up to 21 years, having an incomplete structural response in the 3rd year of follow-up increased the chances of recurrent or persistent response by 5.5 times, and by 32.6 times if found in the 5th year of follow-up. Younger patients exhibited more aggressive tumor characteristics and underwent more rigorous treatment. However, treatment response and disease status in the last assessment, whether free or recurrent/persistence, were similar when comparing the age groups of 11 to 18 and 19 to 21 years. Nonetheless, responses obtained in the 3rd and 5th years post-treatment emerged as factors associated with the persistence/recurrence of the disease in the last assessment in the age group up to 21 years but not in patients diagnosed up to 18 years, a relevant distinction considering the tumor behavior in defining the pediatric age range in thyroid cancer.

Impact of acquisition volume on cone beam computed tomography imaging of marginal bone: an ex vivo study.

The current study explores whether there is a clinically relevant distinction in the measurement of marginal bone loss when comparing high-dose (HD) versus low-dose (LD) cone beam computed tomography (CBCT) protocols in small and large acquisition volumes. Material and Methods: CBCTs of four human cadaveric preparates were taken in HD and LD mode in two different fields of view 8 × 8 cm2 (LV) and 5 × 5 cm2 (SV). In total, 43 sites of 15 teeth were randomly chosen, and marginal bone loss was measured twice in all protocols at 43 sites of 15 teeth by one calibrated investigator. Bland-Altman plots and Lin's concordance correlation coefficient (CCC) were calculated to assess the extent of agreement of the measurements. Additionally, the rater scored the certainty in each of the measurements. For HD-CBCT CCC of measurements obtained using SV versus LV was 0.991. CCC of measurements obtained using SV versus LV of LD-CBCT was 0.963. Both CCC values indicated excellent agreement between the two volumes in both protocols. CCC also indicated high intramodality correlation between HD-CBCT and LD-CBCT independent of the acquisition volume (0.963 - 0.992). Bland-Altman plots also indicated no substantial differences. Results of certainty scoring showed significant differences (p = 0.004 (LV), p < 0.001(SV)) between the LD and HD-CBCT. Accuracy of measurements of bone loss shows no clinical noticeable effects depending on the CBCT volume in this ex vivo study. There appears to be no relevant advantage of SV over LV, neither in HD-CBCT nor in LD-CBCT and additionally no relevant advantage of HD versus LD in visualizing marginal bone loss.

Exploratory analysis of the enforcement actions of the foreign corrupt practices act of the United States

The purpose of this research is to analyze corporate bribery in international business through a case study, in particular, a series of enforcement actions carried out in compliance with the Foreign Corrupt Practices Act of the United States between 2011 and 2022. For this purpose, an exploratory research approach was followed, focused on answering the following questions: What motivates the offering of bribes around obtaining and maintaining business in international business? What relevant distinctions can be made to better understand this phenomenon? Based on the results of the case studies, a series of categories are proposed, the analysis of which may help to promote the private sector's capacity to prevent this illicit activity by facilitating the identification of risky activities or processes and possible mechanisms for their control.

Effect of transcranial direct current stimulation in the initial weeks post-stroke: a pilot randomized study.

This study aimed at assessing the alterations in upper limb motor impairment and connectivity between motor areas following the post-stroke delivery of cathodal transcranial direct current stimulation sessions. Modifications in the Fugl-Meyer Assessment scores, connectivity between the primary motor cortex of the unaffected and affected hemispheres, and between the primary motor and premotor cortices of the unaffected hemisphere were compared prior to and following six sessions of cathodal transcranial direct current stimulation application in 13 patients (active = 6; sham = 7); this modality targets the primary motor cortex of the unaffected hemisphere early after a stroke. Clinically relevant distinctions in Fugl-Meyer Assessment scores (≥9 points) were observed more frequently in the Sham Group than in the Active Group. Between-group differences in the alterations in Fugl-Meyer Assessment scores were not statistically significant (Mann-Whitney test, p=0.133). ROI-to-ROI correlations between the primary motor cortices of the affected and unaffected hemispheres post-therapeutically increased in 5/6 and 2/7 participants in the Active and Sham Groups, respectively. Between-group differences in modifications in connectivity between the aforementioned areas were not statistically significant. Motor performance enhancements were more frequent in the Sham Group compared to the Active Group. The results of this hypothesis-generating investigation suggest that heightened connectivity may not translate into early clinical benefits following a stroke and will be crucial in designing larger cohort studies to explore mechanisms underlying the impacts of this intervention. ClinicalTrials.gov Identifier: NCT02455427.

Impact of the El Niño on Fire Dynamics on the African Continent

Several studies investigated the occurrence of fires in Africa with numerical modeling or applied statistics; however, only a few studies focused on the influence of El Niño on the fire risk using a coupled model. The study aimed to assess the influence of El Niño on wildfire dynamics in Africa using the SPEEDY-HYCOM model. El Niño events in the Eastern Tropical Pacific were classified via sea surface temperature (SST) anomaly based on a predefined climatology between 1961 and 2020 for the entire time series of SST, obtaining linear anomalies. The time series of the SST anomalies was created for the region between 5° N and 5° S and 110° W and 170° W. The events were defined in three consecutive 3-month periods as weak, moderate, and strong El Niño conditions. The Meteorological Fire Danger Index (MFDI) was applied to detect fire hazards. The MFDI simulated by the SPEEDY-HYCOM model for three El Niño categories across different lagged months revealed relevant distinctions among the categories. In the case of ‘Weak’, the maximum variability of fire risk observed at time lags (0, -3, -6, and -9 months) was primarily in Congo, Gabon, and Madagascar. The ‘Moderate’ pattern had similar characteristics to ‘Weak’ except for the lag-6 months and its occurrence in the equatorial zone of Africa. ‘Strong’ showed a remarkable impact in East Africa, resulting in high fire risk, regardless of time lags. Precipitation and evaporation simulations (SPEEDY-HYCOM) indicated that El Niño categories in Africa need particular attention in the central, southern, and southeastern regions emphasizing the significance of lag-0 and lag-6 (evaporation) as well as lag-0, lag-6, and lag-9 (precipitation). The SPEEDY-HYCOM coupled model in conjunction with the MFDI was efficient in assessing climate variabilities in Africa during El Niño events. This model allows the analysis and prediction of wildfire risks based on El Niño events, providing crucial information for wildfire management and prevention. Its simulations uncover significant variations in risks among different El Niño categories and lagged months, contributing to the understanding and mitigation of this environmental challenge.

Reframing the Debate over Performance-Enhancing Drugs: The Reasonable Athlete Argument

ABSTRACT Two of the major arguments against performance-enhancing drugs (PEDs), appealing to fairness and the protection of athletes’ health, have serious flaws. First, there is no relevant moral distinction between the use of PEDs and the use of other performance enhancers that introduce unfairness and that we accept nonetheless. Second, prohibiting PEDs for athletes’ own good ignores the fact that adult athletes are constantly making tradeoffs to improve performance and pursue excellence, including sacrificing their health. We should not paternalistically impose our values on them. On the other side, arguments to allow ‘safe’ PEDs provide no normative criterion to determine the acceptable level of risk, thus begging the question. The reasonable athlete argument solves both sets of problems: it justifies a ban on some performance-enhancing drugs based on health and fairness, while avoiding paternalism, and it also establishes a non-arbitrary standard to determine which drugs ought to be allowed. First, if unsafe PEDs were allowed, some athletes would refuse to take them out of concern for their health. This is a reasonable decision even though it would put them at a competitive disadvantage against athletes who choose to use unsafe PEDs. It would be unfair for clean athletes to suffer a competitive disadvantage for acting reasonably. Therefore, PEDs that pose significant health risks should be prohibited for all athletes. Second, it would be unreasonable for athletes to refuse, on principle, relatively safe and effective PEDs, so a blanket prohibition is also unjustified. Which drugs and which doses to allow should be determined not by athletes’ actual choices but by the hypothetical choices of the reasonable athlete. The resulting sport-specific drug policy would carve a justifiable middle path between complete prohibition and complete permission.

Walking path images from real-time location data predict degree of cognitive impairment

BackgroundWe propose a novel approach that uses spatial walking patterns produced by real-time location systems to classify the severity of cognitive impairment (CI) among residents of a memory care unit. MethodsEach participant was classified as “No-CI”, “Mild-Moderate CI” or “Severe CI” based on their Mini-Mental State Examination scores. The location data was distributed into windows of various durations (5, 10, 15 and 30 min) and transformed into images used to train a custom convolutional neural network (CNN) at each window size. Class Activation Mapping was applied to the top-performing models to determine the features of images associated with each class. ResultsThe best performing model achieved an accuracy of 87.38 % (30-min window length) with an overall pattern that larger window sizes perform better. The class activation maps were effectively consolidated into a Cognitive Impairment Classification Value (CICV) score that distinguishes between No-CI, Mild-Moderate CI, and Severe CI. ConclusionThe class activation maps show that the CNN made relevant and intuitive distinctions for paths corresponding to each class. Future work should validate the proposed techniques with participants who are well-characterized clinically, over larger and diversified settings, and towards classification of neuropsychiatric symptoms such as motor agitation, mood, or apathy.

Gledaj (TV) i uči? Važnost (utjelovljenog) kulturnog kapitala u objašnjenju klasične i digitalne medijske pismenosti

This paper aims to identify whether dimensions of cultural capital affect traditional and media literacy by using survey data collected in 2022 as part of the project Medijsko obrazovanje je važno (N=1033). Using Bourdieu's theoretical framework, three dimensions of cultural capital were operationalised as independent variables: objectified (number of books in the household), embodied (taste in TV programmes), and institutionalised (level of education) cultural capital. Traditional media literacy was operationalised as critical reading of media messages, while digital media literacy was operationalised as creating online digital content. Both of these variables were used as dependent variables in the analysis. Following principal component analysis (PCA), hierarchical regression analysis was conducted to establish whether cultural capital has explanatory power for both dimensions of media literacy. The results point to the statistically significant role of objectified cultural capital in explaining traditional media literacy, although that explanation’s statistical power remains questionable. Digital media literacy exhibited no statistically significant connection with all three cultural capital dimensions. However, additional analysis points to the relevance of digital skills as a more potent factor in explaining traditional and digital media literacy. Overall, digital capital represents a more relevant distinction factor than users’ classic cultural capital in a contemporary media environment. The implications of this data point to the conclusion that media literacy is primarily shaped through various forms of digital capital, although the role of television should not be neglected when developing future programmes in media literacy.

Black box algorithms in mental health apps: An ethical reflection.

Mental health apps bring unprecedented benefits and risks to individual and public health. A thorough evaluation of these apps involves considering two aspects that are often neglected: the algorithms they deploy and the functions they perform. We focus on mental health apps based on black box algorithms, explore their forms of opacity, discuss the implications derived from their opacity, and propose how to use their outcomes in mental healthcare, self-care practices, and research. We argue that there is a relevant distinction between functions performed by algorithms in mental health apps, and we focus on the functions of analysis and generation of advice. When performing analytic functions, such as identifying patterns and making predictions concerning people's emotions, thoughts, and behaviors, black box algorithms can be better than other algorithms to provide information to identify early signs of relapse, support diagnostic processes, and improve research by generating outcomes that lead to a better understanding of mental health. However, when carrying out the function of providing mental health advice, black box algorithms have the potential to deliver unforeseen advice that may harm users. We argue that the outcomes of these apps may be trustworthy as a complementary source of information, but express caution about black box algorithms that give advice directly to users. To reap the benefits of mental health apps based on black box algorithms and avoid unintended consequences, we critically need to know whether these algorithms are fulfilling the function of providing mental health advice.

Voicing singlish from the “middle”: Indexical hybridities of class, race, language, and Singaporeanness

AbstractThe long‐governing People's Action Party in Singapore, cautious of the appeal of Marxist‐type class analyses, recognizes political mileage in promoting the myth of a homogenous “class blind” society. Popular uptakes of this perspective are seen online in parodic uses of new terms high SES and low SES to counter the suggestion that socioeconomic status (SES) is a relevant distinction in Singapore. Such parodies are nevertheless deeply classed, as middle‐class subjectivity emerges through the negation of class‐based extremes (Hall, 2021). This article argues that Singlish has become a powerful instrument for sustaining middle‐class normativity. Its positioning by invested listening subjects (Inoue, 2006) as a hybrid language that equally encompasses speakers of diverse linguistic backgrounds obscures not just class relations but also the central linkage that lies at the heart of a raciolinguistic perspective (Rosa and Flores, 2017). Once class and race are co‐naturalized in this way, speakers can use Singlish to perform an “authentic Singaporeanness,” but this performance is in turn facilitated by a metapragmatic narrative that motivates which forms become enregistered as Singlish.

Definition of a clear margin in breast conserving therapy: Splitting hairs or relevant distinction?

Definition of a clear margin in breast conserving therapy: Splitting hairs or relevant distinction?

“Never having the right to make a mistake, I think that’s the hardest part of being an official”: Exploring young sport officials’ experiences of abuse and their related coping mechanisms

Although officials form an integral part of the sporting world, they are likely to experience abuse during their involvement. Research on abuse toward sport officials has primarily been conducted with adults and elite-level officials. Very little is known about young officials whose experiences may be different yet crucial in developing preventative measures tailored to their specific needs and context. Our goal was to document experiences of abuse by young officials aged between 14 and 20 years old. A total of 27 participants completed interviews on the nature of the abuse they experienced, the resulting consequences, and how they coped with those experiences. The findings from the thematic analysis highlighted descriptions of frequent abuse, of lower intensity, and of a psychological nature such as being yelled at or insulted. Participants described using both short-term coping strategies during the event of abuse, such as giving a warning, as well as long-term strategies to make sense of their experience, such as rationalization. Our study adds to the current literature by underlining similarities of young officials’ experiences with those of adults, such as type and frequency of abuse, while also identifying relevant distinctions in terms of perceived organizational support and consequences. In sum, our results suggest that abuse toward officials is deeply ingrained in the sport context and not only at the professional level. This reinforces the need for increased recognition of young officials’ reality within a broader cultural shift delegitimizing abuse in all forms toward officials of all ages and levels. Lay summary: We interviewed 27 young sport officials, aged between 14 and 20 years old, to document their experience of abuse. The results highlight both similarities with adult officials and important differences. More attention should be given to the reality of young officials operating at the grassroots level.

Body Integrity Dysphoria and “Just” Amputation: State-of-the-Art and Beyond

Abstract This paper presents the foundation upon which the contemporary knowledge of body integrity dysphoria (BID) is built. According to the World Health Organisation’s International Classification of Diseases, 11th edition (ICD-11), the main feature of BID is an intense and persistent desire to become physically disabled in a significant way. Three putative aetiologies that are considered to explain the insurgence of the condition are discussed: neurological, psychological and postmodern theories. The concept of bodily representation within the medical context is highlighted, with the concept of dysphoria, which was brought to the fore with the introduction of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and the ICD-11. Contemporary issues of “justice” are addressed to identify ethically relevant distinctions between BID and sex reassignment surgery. It is argued that there is no ethically relevant difference between the BID actor’s desire for invasive surgical intervention and the wish of gender dysphoric individuals to undergo sex reassignment surgery procedures. Some BID actors self-mutilate, and this presents medical professionals with difficult choices regarding whether or not to intervene in order to satisfy the BID patient’s desire. Both abstention and intervention may lead to severe ethical complications for doctors and patients despite the positive outcomes in terms of quality of life for BID individuals who manage to undergo such procedures.

Maximal syntactic/semantic divergence in deadjectivals: Evidence from Romance

AbstractThis article explores semantic and syntactic properties of a set of Romance deadjectival verbs sharing comparable derivational morphology. I note: (i) asymmetries between languages where the choice of verbalizer does not become a significant variable; (ii) languages where the use of the verbalizer is associated with distinct syntactic and semantic properties. In Italian, the verbalizer defines a maximal structural contrast in a nontrivial derivation. Italian and Catalan verbs pattern as statives. Yet lack of eventivity and scalarity in Italian defines an empirically relevant distinction between stative types reflected by syntax (unergative behaviour correlated with lack of affected theme/change-of-state denotation). This differentiates Italian from Spanish or Catalan forms in not showing two key properties: (i) unaccusativity/transitivity; (ii) change-along-scale entailment. A continuum from minimally to maximally different aspectual and syntactic configurations obtains. Although the focus is set on deadjectival verbs and the unusual properties of Italian -ggiare, the results are extendable to further data.

Does being religious or not matter? A qualitative investigation of community fundraising events

PurposeIn the extant literature, the concepts of charity and philanthropy have been differentiated based on the belief that charity stems from religious motivations and philanthropy is often secular in origin. Accordingly, this paper aims to investigate whether there is a distinction between managerial practices regarding the given concepts as emphasized in the conceptual discussions.Design/methodology/approachTo see the managerial practices, the authors determined bazaars, community fundraising events organized by nonprofit organizations (NPOs), as the research field. Then, this study followed the general systematic of qualitative research. Accordingly, the authors conducted 44 interviews with experienced bazaar organizers from 10 NPOs in total. Furthermore, four days of participant observation with field notes were made in each bazaar, which lasted from 7 to 10 days. This study also used archival data as a secondary data source and then analyzed all data with a content analysis technique.FindingsThis study found that the field practices mainly do not support the distinction drawn over the conceptual discussions. Both concepts are nouns describing the act of giving and helping the needy. They are actively performed based on different motives (religion-based and secular).Originality/valueThe relevant distinction is limited to the conceptual discussions and has not been supported by the findings obtained from the field. Also, most of the studies on helping were carried out in the Western context. Studies conducted outside these cultures are quite limited. The value of the current study lies in the fact that it was conducted in a cultural context different from the Western cultures and paves the pathway for future research.

Review of Copan and Jamison, What Would Jesus Really Eat?

Paul Copan and Wes Jamison’s recent book, What Would Jesus Really Eat?, attempts to offer moral and theological vindication for the factory farm industry and, more generally, for eating animals. It thereby aims to provide “comfort” for Christians to “overlook animal suffering” and, if they choose, to continue eating factory-farmed meat. In this review, I argue that various key arguments in the book rest on questionable premises and elide relevant distinctions. As a result the key thesis of the book—that Christians are permitted to eat meat, including from factory farms—has not been vindicated over against arguments to the contrary. I finish by offering a few strategies for pursuing a more conscientious diet and suggest that Christian philosophers can do more to serve the aims of conscientious consumption.

Immunological and Genomic Analysis Reveals Clinically Relevant Distinctions between Angiosarcoma Subgroups.

Angiosarcomas (AS) are extremely rare and aggressive vascular malignancies subdivided in de novo primary AS (pAS) and secondary AS (sAS). We hypothesize that the combination of immunological and genomic profiles significantly differs between primary and secondary AS, with potential impact on treatment strategies and a role for immunotherapy. Tumor-infiltrating lymphocytes were analyzed using multiplex immunohistochemistry from 79 pAS and 178 sAS. Median cell density was significantly higher in sAS for CD3+ T-cells (p < 0.001), CD8+ cytotoxic T-cells (p = 0.033), CD4+ T-helper cells (p < 0.001) and FoxP3+ T-regulatory cells (p < 0.001). CD20+ B-cell density was comparable (p = 0.417). Comprehensive genomic profiling was performed in 25 pAS and 25 sAS. A (likely) pathogenic mutation was detected in 80% of pAS vs. 88% of sAS (p = 0.702). Amplifications were found in 15% of pAS vs. 84% of sAS (p < 0.001). DNA damage response (DDR) pathway mutations (p = 0.021) and MYC amplifications (p < 0.001) were predominantly seen in sAS. In conclusion we observed a clear and clinical relevant distinction in immune infiltration and genomic profiles between pAS and sAS. The T-cell infiltrated tumor microenvironment and frequent DDR gene mutations, especially in sAS, warrant clinical trials with immunotherapy.