Small Sample Size Research Articles

The course of acute low back pain: a community-based inception cohort study.

Acute low back pain (LBP) is increasingly recognized for its potential recurrent nature and long-term implications. This community-based inception cohort study aimed to delineate trajectories of acute LBP over one year and investigate associated biopsychosocial variables. One hundred seventy-six participants with acute LBP were monitored at 5 follow-up time points over 52 weeks. Pain trajectories were identified using a latent class linear mixed model, and their associations with baseline biopsychosocial factors were evaluated through multinomial logistic regression. Four distinct LBP trajectories were discerned: "mild/moderate fluctuating pain" (54.0%), "delayed recovery by week 52" (6.2%), "persistent moderate pain" (33.0%), and "moderate/severe fluctuating pain" (6.8%). Increased baseline pain intensity and history of LBP episodes were significantly linked with less favorable trajectories. Contrary to expectations, psychological variables like stress, anxiety, and depression did not significantly associate with unfavorable trajectories. This study underscores the heterogeneity of acute LBP's course over a year, challenging the conventionally benign perception of the condition. Recognizing these distinct trajectories might enable more tailored, effective clinical interventions for LBP patients. The small sample size of certain trajectories may influence the generalizability of the results. Acute LBP can manifest in different trajectories, with nearly half of the participants experiencing less favorable trajectories. Baseline pain intensity and previous episodes of LBP emerged as key factors, whereas psychological variables had no discernible influence. Recognition of these trajectories may be necessary for improved patient management and targeted interventions.

Comparing hybrid models for recognising objects in thermal images at nighttime

This research aims to revolutionize urban object recognition by developing cloud-based Python programs using intelligent algorithms. Unlike current models that focus on colour enhancement in nighttime thermal images, this work addresses the critical challenge of accurate object detection in urban landscapes. The proposed method incorporates a binary generative adversarial network (GAN) generator that can switch bidirectionally between daytime colour (DC) and nighttime infrared (NTIR) images. memory-based visual image memory (MVAM), system extracts important descriptive information from urban landscape images, reducing problems related to small sample sizes. This discussion presents a comprehensive improvement and evaluation of a deep learning image classification pipeline using Google Colab, demonstrating advanced image processing. Using TensorFlow, Keres and scikit image libraries combined with advanced algorithms such as DenseNet121 and MobileNetV2 presents a clear approach. We created a Bidirectional GAN + MVAM for object recognition in this work. Our method performed well, with an accuracy of 81.43%, precision of 51.16, recall of 50.11, and F-score of 46.37. The systematic presentation of the code presents a careful strategy to ensure optimal performance, stability, and efficiency of deep learning and image processing tasks.

Assessment of efficacy and safety of dose-dense doxorubicin and cyclophosphamide (ddAC) in combination with immunotherapy in early-stage triple-negative breast cancer.

This study aimed to assess safety and efficacy of a modified KEYNOTE 522 protocol, which incorporated pembrolizumab every 6weeks, allowing for concomitant dose-dense (14day) doxorubicin and cyclophosphamide (ddAC). By optimizing this dosing, the intention of this modified protocol was to improve pathologic complete response (pCR) rates in a population associated with a poorer prognosis. This was a retrospective, single-center, cohort study. Patients were included if they had early stage, triple-negative breast cancer, and received at least one dose of AC. The entire cohort received neoadjuvant chemotherapy including weekly carboplatin and paclitaxel with pembrolizumab every 3weeks for 12weeks (4 cycles). The group then received either ddAC with pembrolizumab 400mg every 6weeks, or AC with pembrolizumab 200mg every 3weeks. The primary objective was pCR rate at time of surgery. This study assessed outcomes in 25 patients over 34months. The pCR rate in the pembrolizumab, AC 3-week cohort was 64.3% versus 81.8% in the ddAC and 6-week pembrolizumab group. No pembrolizumab-associated grade 3-4 adverse events occurred in the either cohort. Despite seeing an increased incidence of grade 3-4 toxicities in the ddAC arm, this did not result in additional chemotherapy delays or dose reductions. This study demonstrated tolerability and a potential for favorable outcomes with this patient population, making this modified KEYNOTE 522 protocol a reasonable treatment approach. Larger, prospective studies are warranted to assess the feasibility of this dosing and true optimization of patient outcomes given the small sample size of this study.

A novel hybrid model for species distribution prediction using neural networks and Grey Wolf Optimizer algorithm

Neural networks are frequently employed to model species distribution through backpropagation methods, known as backpropagation neural networks (BPNN). However, the complex structure of BPNN introduces parameter settings challenges, such as the determination of connection weights, which can affect the accuracy of model simulation. In this paper, we integrated the Grey Wolf Optimizer (GWO) algorithm, renowned for its excellent global search capacity and rapid convergence, to enhance the performance of BPNN. Then we obtained a novel hybrid algorithm, the Grey Wolf Optimizer algorithm optimized backpropagation neural networks algorithm (GNNA), designed for predicting species’ potential distribution. We also compared the GNNA with four prevalent species distribution models (SDMs), namely the generalized boosting model (GBM), generalized linear model (GLM), maximum entropy (MaxEnt), and random forest (RF). These models were evaluated using three evaluation metrics: the area under the receiver operating characteristic curve, Cohen’s kappa, and the true skill statistic, across 23 varied species. Additionally, we examined the predictive accuracy concerning spatial distribution. The results showed that the predictive performance of GNNA was significantly improved compared to BPNN, was significantly better than that of GLM and GBM, and was even comparable to that of MaxEnt and RF in predicting species distributions with small sample sizes. Furthermore, the GNNA demonstrates exceptional powers in forecasting the potential non-native distribution of invasive plant species.

Clinical status and future prospects of neoadjuvant immunotherapy for localized mismatch repair-deficient cancers: a review.

Frameshift mutations accumulate in cancers related to mismatch repair deficiency (dMMR), which has the potential to produce various neoantigens, representing a distinct subset of cancers that respond considerably to immunotherapy. In recent years, robust evidence has supported the first-line application of immunotherapy for patients with metastatic dMMR cancers, which provoked extensive investigations of the feasibility and efficacy of immunotherapy in the up-front settings, including neoadjuvant therapy. Several completed trials with small sample sizes suggested that neoadjuvant immunotherapy can achieve an impressively high complete response rate, for the first time offering the potential of systemic therapy to cure cancer without the need for surgical resection. However, a difficult dilemma emerges, clinicians are now facing selection between the standard of care with well evidence for proficient MMR but suboptimal for dMMR cancers and the emerging immunotherapy with promising results but only based on a limited number of patients with shorter duration of follow-up. This review aims to provide a comprehensive summary for biological rationale and clinical status of neoadjuvant immunotherapy in patients with dMMR cancers. Furthermore, I elaborate on particular issues that must be taken into consideration for further advancement in the field.

If it is adequate, it is not affordable: stakeholder perceptions on opportunities and constraints for pension reform in Indonesia

PurposeThe purpose of the study is to emphasise the urgent need for pension policy reform within Indonesia’s social security system.Design/methodology/approachThe methodology employed in this research includes qualitative techniques such as in-depth interviews and thematic content analysis.FindingsThe findings suggest various measures for pension reform, including revising eligibility criteria, adjusting benefit designs to cover housing and transportation costs, promoting Defined Benefit Plans, enforcing compliance, addressing insufficient contributions, advocating for transparency, and aligning social assistance programs with pension system enhancements. However, there is a trade-off between the adequacy of pension benefits and the amount of resources required.Research limitations/implicationsThis study is limited by the need for more individuals knowledgeable about pension issues in Indonesia, primarily due to their high-ranking positions, making access challenging and potentially compromising the small sample size in research.Practical implicationsThe research underscores the importance of maintaining policy consistency. It proposes a gradual increase in pension contributions as a pivotal strategy to ensure sustained financial security for retirees, particularly in the face of fiscal constraints. Also, the government should undertake comprehensive reforms, encompassing the revision of eligibility criteria, adjustment of minimum benefit designs, encouragement of employer contributions and effective management of compliance issues.Social implicationsSocial implications emphasise the importance of enhancing the financial security of retirees within Indonesia’s ageing population.Originality/valueThe originality and value of the research lie in guiding pension reform from the viewpoint of key policymakers involved in Indonesia’s pension system.

Covariate adjustment and estimation of difference in proportions in randomized clinical trials.

Difference in proportions is frequently used to measure treatment effect for binary outcomes in randomized clinical trials. The estimation of difference in proportions can be assisted by adjusting for prognostic baseline covariates to enhance precision and bolster statistical power. Standardization or g-computation is a widely used method for covariate adjustment in estimating unconditional difference in proportions, because of its robustness to model misspecification. Various inference methods have been proposed to quantify the uncertainty and confidence intervals based on large-sample theories. However, their performances under small sample sizes and model misspecification have not been comprehensively evaluated. We propose an alternative approach to estimate the unconditional variance of the standardization estimator based on the robust sandwich estimator to further enhance the finite sample performance. Extensive simulations are provided to demonstrate the performances of the proposed method, spanning a wide range of sample sizes, randomization ratios, and model specification. We apply the proposed method in a real data example to illustrate the practical utility.

Efficacy and safety of spironolactone versus bicalutamide in female pattern hair loss: A retrospective comparative study.

Female-pattern hair loss (FPHL) is characterized by decreased scalp hair density, thinning of hair shafts, and progressive miniaturization of hair follicles. To compare the safety and efficacy of spironolactone versus bicalutamide in female pattern hair loss [FPHL]. The study design was retrospective, and all eligible females aged between 18 years and 50 years with FPHL were included. We identified 120 patients from our database who fulfilled the inclusion and exclusion criteria, and patients were then categorized into two groups, Group A comprising patients who were taking 100 mg of spironolactone once daily and Group B comprising patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2% in both groups. Patient were analysed at approximately at 24 weeks from the commencement of the treatment. Mean reduction in hair loss severity score on Sinclair scale was 19.51% in spironolactone group compared to 28.20% in bicalutamide group at 24 weeks, which was statistically significant. On global photographic assessment, marked improvement was seen in bicalutamide group compared to spironolactone group (p = 0.139). Our study, though limited by its retrospective design and small sample size, showed that bicalutamide has greater efficacy and better safety profile in comparison to spironolactone in the treatment of FPHL.

Efficacy and safety of topical capsaicin in the treatment of osteoarthritis pain: A systematic review and meta-analysis.

Osteoarthritis (OA) affects hundreds of millions of people worldwide. The objective was to critically appraise the efficacy and safety of topical capsaicin in reducing pain in OA. MEDLINE (PubMed) and Embase (Ebsco) were searched from inceptions until February 2023. The eligibility criteria included randomized controlled trials (RCTs), evaluating topical capsaicin in OA patients. Standard Cochrane methods were used to extract data and to appraise eligible studies. Eight double-blind RCTs involving 498 patients were included. Five trials (62.5%) were at an overall low risk of bias, and three (37.5%) were at a high risk of bias. Meta-analysis showed that, in various OA patients, compared with placebo, topical capsaicin (0.0125%-5%) may reduce pain severity measured with visual analog scale (standardized mean difference = -0.84, 95% confidence intervals [CIs] = -1.48 to -0.19, p = 0.01; eight studies). However, topical capsaicin may increase burning sensation at the application site (risk ratio = 5.56, 95% CI = 1.75-17.69, p = 0.004, numbers needed to harm = 3; five studies) when compared with placebo. Limitations include short study durations, small sample sizes, high heterogeneity, and overall low-to-very-low certainty of the evidence. Topical capsaicin may reduce OA pain at follow-ups of up to 3 months. Larger trials, potentially evaluating capsaicin in combination with phytopharmaceuticals having anti-inflammatory effects, with longer follow-ups might be needed to reduce the existing uncertainties. Topical capsaicin might be recommended for short-term management of pain in OA patients intolerant to nonsteroidal anti-inflammatory drugs.

Mapping recurrent mosaic copy number variation in human neurons

When somatic cells acquire complex karyotypes, they often are removed by the immune system. Mutant somatic cells that evade immune surveillance can lead to cancer. Neurons with complex karyotypes arise during neurotypical brain development, but neurons are almost never the origin of brain cancers. Instead, somatic mutations in neurons can bring about neurodevelopmental disorders, and contribute to the polygenic landscape of neuropsychiatric and neurodegenerative disease. A subset of human neurons harbors idiosyncratic copy number variants (CNVs, “CNV neurons”), but previous analyses of CNV neurons are limited by relatively small sample sizes. Here, we develop an allele-based validation approach, SCOVAL, to corroborate or reject read-depth based CNV calls in single human neurons. We apply this approach to 2,125 frontal cortical neurons from a neurotypical human brain. SCOVAL identifies 226 CNV neurons, which include a subclass of 65 CNV neurons with highly aberrant karyotypes containing whole or substantial losses on multiple chromosomes. Moreover, we find that CNV location appears to be nonrandom. Recurrent regions of neuronal genome rearrangement contain fewer, but longer, genes.

A Wireless Noninvasive Blood Pressure Measurement System Using MAX30102 and Random Forest Regressor for Photoplethysmography Signals

Hypertension, often termed “the silent killer”, is associated with cardiovascular risk and requires regular blood pressure (BP) monitoring. However, existing methods are cumbersome and require medical expertise, which is worsened by the need for physical contact, particularly during situations such as the coronavirus pandemic that started in 2019 (COVID-19). This study aimed to develop a cuffless, continuous, and accurate BP measurement system using a photoplethysmography (PPG) sensor and a microcontroller via PPG signals. The system utilizes a MAX30102 sensor and ESP-WROOM-32 microcontroller to capture PPG signals that undergo noise reduction during preprocessing. Peak detection and feature extraction algorithms were introduced, and their output data were used to train a machine learning model for BP prediction. Tuning the model resulted in identifying the best-performing model when using a dataset from six subjects with a total of 114 records, thereby achieving a coefficient of determination of 0.37/0.46 and a mean absolute error value of 4.38/4.49 using the random forest algorithm. Integrating this model into a web-based graphical user interface enables its implementation. One probable limitation arises from the small sample size (six participants) of healthy young individuals under seated conditions, thereby potentially hindering the proposed model’s ability to learn and generalize patterns effectively. Increasing the number of participants with diverse ages and medical histories can enhance the accuracy of the proposed model. Nevertheless, this innovative device successfully addresses the need for convenient, remote BP monitoring, particularly during situations like the COVID-19 pandemic, thus making it a promising tool for cardiovascular health management.

Empowering children as active and responsible citizens: A dramatic journey towards global citizenship

AbstractThis article investigates three key moments from a sequence of learning facilitated within a Singapore preschool. Delivered as part of a wider study aimed at identifying the value of dramatic pedagogies for developing young children's global competence, the learning sequence was facilitated by the researcher—an experienced early childhood drama educator. The learning experiences were designed to be responsive to the children's interests and ideas, with an emphasis on ensuring their active participation and agency. Analysis of the data was supported using the 2018 Organisation for Economic Co‐operation and Development Global Competence Framework and the Elements of Drama model. Despite limitations such as the small sample size, the findings suggest that for these children, dramatic pedagogies were effective in providing opportunities for engagement with the complex ideas associated with global competence and sustainable development. However, analysis also reveals that in order to be effective, careful management of the elements of drama is required. The article concludes by outlining implications for educators and public policy‐makers interested in identifying pedagogies suitable for developing young children's global competence and supporting their awareness of the importance of sustainable development.

Association Between Vitamin D and Asymptomatic Hyperuricaemia Among Adults––An Observational Study

Introduction: The relationship between Vitamin D levels and asymptomatic hyperuricaemia is gaining attention due to its potential implications for public health. This study investigates this association, focussing on the interplay between Vitamin D, serum uric acid and parathyroid hormone (PTH) levels in adults. Materials and Methods: This cross-sectional observational study, conducted from April to June 2023, involved 100 adult participants (65 males, 35 females) from the general population. Participants were selected based on specific inclusion and exclusion criteria. Data collection included a comprehensive questionnaire, physical examinations and blood sample analysis. Vitamin D levels were measured using liquid chromatography-tandem mass spectrometry, uric acid levels through an enzymatic colorimetric test, and PTH levels via a chemiluminescent immunoassay. Statistical analysis was performed using SPSS version 25.0, IBM Corp, Chicago, IL, USA. Results: The study found an inverse correlation between Vitamin D and serum uric acid levels. Participants with lower Vitamin D levels had higher serum uric acid and PTH levels. The mean serum Vitamin D level was 32.17 ng/mL, and the mean serum uric acid level was 9.99 mg/dL. The study categorised Vitamin D levels as deficient, insufficient and sufficient, observing significant variations in PTH and uric acid levels across these categories. Conclusion: The study suggests a significant relationship between Vitamin D levels and serum uric acid concentrations in adults, with implications for the management of asymptomatic hyperuricaemia and related metabolic conditions. Despite limitations, such as the cross-sectional design and small sample size, this study highlights the potential significance of Vitamin D levels in the management of asymptomatic hyperuricaemia and related metabolic disorders.

Applications of natural language processing tools in the surgical journey

BackgroundNatural language processing tools are becoming increasingly adopted in multiple industries worldwide. They have shown promising results however their use in the field of surgery is under-recognised. Many trials have assessed these benefits in small settings with promising results before large scale adoption can be considered in surgery. This study aims to review the current research and insights into the potential for implementation of natural language processing tools into surgery.MethodsA narrative review was conducted following a computer-assisted literature search on Medline, EMBASE and Google Scholar databases. Papers related to natural language processing tools and consideration into their use for surgery were considered.ResultsCurrent applications of natural language processing tools within surgery are limited. From the literature, there is evidence of potential improvement in surgical capability and service delivery, such as through the use of these technologies to streamline processes including surgical triaging, data collection and auditing, surgical communication and documentation. Additionally, there is potential to extend these capabilities to surgical academia to improve processes in surgical research and allow innovation in the development of educational resources. Despite these outcomes, the evidence to support these findings are challenged by small sample sizes with limited applicability to broader settings.ConclusionWith the increasing adoption of natural language processing technology, such as in popular forms like ChatGPT, there has been increasing research in the use of these tools within surgery to improve surgical workflow and efficiency. This review highlights multifaceted applications of natural language processing within surgery, albeit with clear limitations due to the infancy of the infrastructure available to leverage these technologies. There remains room for more rigorous research into broader capability of natural language processing technology within the field of surgery and the need for cross-sectoral collaboration to understand the ways in which these algorithms can best be integrated.

Voices of the unhoused from Santa Fe, New Mexico: A mixed methods study of health status, substance use, and community harm reduction program perspectives

No published studies have examined the community service priorities and harm reduction perspectives of unhoused people in Santa Fe, New Mexico. We conducted a mixed methods pilot study of 56 unhoused people at community locations in Santa Fe to: (1) assess the current prevalence of chronic medical conditions and substance use; (2) highlight community service priorities; and (3) explore views of innovative community harm reduction programs. Our first hypothesis was there would be high prevalence of chronic medical conditions, for which we found high prevalence of post-traumatic stress disorder, major depression, substance use disorders, chronic pain, and hypertension. Our second hypothesis was that we would find top community service priorities of housing, food, and health care. We found long- and short-term housing and food, but not healthcare, top priorities. Our third hypothesis was that we would find mixed support for community harm reduction initiatives like managed alcohol programs and overdose prevention centers. We found positive, not mixed, support for these community harm reduction programs among Santa Fe’s unhoused. Unhoused study participants ranged in age 27–77 years, with lifetime years unhoused from less than one year to 63 years. Study limitations included small sample size, convenience sampling, and descriptive results. Policies and program initiatives supporting additional Housing First options, managed alcohol programs, and overdose prevention centers in the Santa Fe community are clearly indicated to increase engagement with this vulnerable population. Future research should focus on inclusion of the perspectives of the unhoused in the design, conduct, evaluation, and dissemination of community programs to meet the needs of the unhoused, with re-defined outcomes to include changes in quality of life, program engagement, demarginalization, and future goals and plans, beyond currently utilized health and social service program outcome measures.

Radiation enhancement using focussed ultrasound-stimulated microbubbles for breast cancer: A Phase 1 clinical trial.

Preclinical studies have demonstrated that tumour cell death can be enhanced 10- to 40-fold when radiotherapy is combined with focussed ultrasound-stimulated microbubble (FUS-MB) treatment. The acoustic exposure of microbubbles (intravascular gas microspheres) within the target volume causes bubble cavitation, which induces perturbation of tumour vasculature and activates endothelial cell apoptotic pathways responsible for the ablative effect of stereotactic body radiotherapy. Subsequent irradiation of a microbubble-sensitised tumour causes rapid increased tumour death. The study here presents the mature safety and efficacy outcomes of magnetic resonance (MR)-guided FUS-MB (MRgFUS-MB) treatment, a radioenhancement therapy for breast cancer. This prospective, single-center, single-arm Phase 1 clinical trial included patients with stages I-IV breast cancer with in situ tumours for whom breast or chest wall radiotherapy was deemed adequate by a multidisciplinary team (clinicaltrials.gov identifier: NCT04431674). Patients were excluded if they had contraindications for contrast-enhanced MR or microbubble administration. Patients underwent 2 to 3 MRgFUS-MB treatments throughout radiotherapy. An MR-coupled focussed ultrasound device operating at 800 kHz and 570 kPa peak negative pressure was used to sonicate intravenously administrated microbubbles within the MR-guided target volume. The primary outcome was acute toxicity per Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Secondary outcomes were tumour response at 3 months and local control (LC). A total of 21 female patients presenting with 23 primary breast tumours were enrolled and allocated to intervention between August/2020 and November/2022. Three patients subsequently withdrew consent and, therefore, 18 patients with 20 tumours were included in the safety and LC analyses. Two patients died due to progressive metastatic disease before 3 months following treatment completion and were excluded from the tumour response analysis. The prescribed radiation doses were 20 Gy/5 fractions (40%, n = 8/20), 30 to 35 Gy/5 fractions (35%, n = 7/20), 30 to 40 Gy/10 fractions (15%, n = 3/20), and 66 Gy/33 fractions (10%, n = 2/20). The median follow-up was 9 months (range, 0.3 to 29). Radiation dermatitis was the most common acute toxicity (Grade 1 in 16/20, Grade 2 in 1/20, and Grade 3 in 2/20). One patient developed grade 1 allergic reaction possibly related to microbubbles administration. At 3 months, 18 tumours were evaluated for response: 9 exhibited complete response (50%, n = 9/18), 6 partial response (33%, n = 6/18), 2 stable disease (11%, n = 2/18), and 1 progressive disease (6%, n = 1/18). Further follow-up of responses indicated that the 6-, 12-, and 24-month LC rates were 94% (95% confidence interval [CI] [84%, 100%]), 88% (95% CI [75%, 100%]), and 76% (95% CI [54%, 100%]), respectively. The study's limitations include variable tumour sizes and dose fractionation regimens and the anticipated small sample size typical for a Phase 1 clinical trial. MRgFUS-MB is an innovative radioenhancement therapy associated with a safe profile, potentially promising responses, and durable LC. These results warrant validation in Phase 2 clinical trials. clinicaltrials.gov, identifier NCT04431674.

Cortical grey matter volume differences in children with developmental coordination disorder compared to typically developing children

IntroductionThe cause of Developmental Coordination Disorder (DCD) is unknown, but neuroimaging evidence suggests that DCD may be related to altered brain development. Children with DCD show less structural and functional connectivity compared to typically developing (TD) children, but few studies have examined cortical volume in children with DCD. The purpose of this study was to investigate cortical grey matter volume using voxel-based morphometry (VBM) in children with DCD compared to TD children.MethodsThis cross-sectional study was part of a larger randomized-controlled trial (ClinicalTrials.gov ID: NCT02597751) that involved various MRI scans of children with/without DCD. This paper focuses on the anatomical scans, performing VBM of cortical grey matter volume in 30 children with DCD and 12 TD children. Preprocessing and VBM data analysis were conducted using the Computational Anatomy Tool Box-12 and a study-specific brain template. Differences between DCD and TD groups were assessed using a one-way ANOVA, controlling for total intracranial volume. Regression analyses examined if motor and/or attentional difficulties predicted grey matter volume. We used threshold-free cluster enhancement (5,000 permutations) and set an alpha level of 0.05. Due to the small sample size, we did not correct for multiple comparisons.ResultsCompared to the TD group, children with DCD had significantly greater grey matter in the left superior frontal gyrus. Lower motor scores (meaning greater impairment) were related to greater grey matter volume in left superior frontal gyrus, frontal pole, and right middle frontal gyrus. Greater grey matter volume was also significantly correlated with higher scores on the Conners 3 ADHD Index in the left superior frontal gyrus, superior parietal lobe, and precuneus. These results indicate that greater grey matter volume in these regions is associated with poorer motor and attentional skills.DiscussionGreater grey matter volume in the left superior frontal gyrus in children with DCD may be a result of delayed or absent healthy cortical thinning, potentially due to altered synaptic pruning as seen in other neurodevelopmental disorders. These findings provide further support for the hypothesis that DCD is related to altered brain development.

Mental Health Support Is an Unmet Need for Long-Term Burn Survivors: A Web-Based Survey.

A National Trauma Research Action Plan identified the involvement of burn survivors as critical informants to determine the direction of research. This study employed a web-based survey to identify care gaps in a sample of burn survivors. We surveyed burn survivors from around the United States through social media and email contact with the Phoenix Society for Burn Survivors. We elicited demographic info, burn history, and unmet needs. Statistical analysis was performed to test our hypothesis that lack of access to mental health support/professionals would be identified as an unmet need in long-term burn survivors. Of 178 survey respondents, most were at least ten years removed from the date of their burn injury (n=94, 53%). Compared to those less than 3 years from their burn injury, individuals greater than 10 years were at least 5 times more likely to note lack of access to mental health support [11-20 years OR 8.7, p< 0.001; >20 years OR5.7, p=0.001]. 60% of Spanish speakers reported lack of support group access was among their greatest unmet needs, compared to 37% of English speakers (p=0.184). This study highlights the need for ongoing access to mental health resources in burn survivors. Our findings emphasize that burn injury is not just an acute ailment, but a complex condition that evolves into a chronic disease. Additional studies should focus on the experiences of Spanish-speaking burn survivors, given small sample size leading to a likely clinically significant but not statistically different lack of access to support groups.

Oh, the Places They’ll Go: A Geographic Analysis of Gubernatorial Campaigns

Geography has long played a significant role in American electoral politics. Candidates engage in “retail politics” by visiting fairs, festivals, schools, churches, and businesses, to meet and greet potential voters. However, systematically understanding where candidates are actually going has plagued prior work due to small sample sizes and lack of data availability. Presidential elections have been used with success in previous scholarship, but there are few viable candidates to compare within a single cycle. Utilizing competitive gubernatorial elections, this work attempts to address these deficiencies by utilizing social media posts to track multiple candidates in real-time across the 2018 campaign cycle at the state level. The paper tests competing theories of candidate engagement regarding travel decisions: do candidates (1) focus their attention on their partisan base or (2) try to attract independent or “swing” voters? Following an original and intensive data collection effort, we identified location-specific information for over 4700 campaign stops made by major-party candidates across seventeen states. Our results lend support to candidates spending time with their respective bases of partisan support, with Republicans going to rural areas with non-college educated individuals while Democrats travel to urban counties with a more diverse electorate.

Analysis and Suggestions on the Challenges Faced by Kindergarten Teachers in Cooperative Learning Models from a Sociocultural Theory Perspective

The purpose of this empirical study is to identify and address the challenges faced by kindergarten teachers in guiding and implementing collaborative inquiry learning in early childhood group settings from a socio-cultural theoretical perspective. The research was conducted in kindergartens located in Chengxiang, Putian. This study employed interviews to explore teachers' understanding and perception of collaborative learning in groups, as well as the specific issues encountered during its implementation. The research methodology utilized semi-structured interviews with a small sample size of 9 participants, following qualitative research techniques. The main findings of this study offer solutions to the practical problems encountered by kindergarten teachers in organizing and implementing collaborative learning in early childhood groups in third-tier cities, based on Vygotsky's socio-cultural theory. It is important to note that the findings are derived from a limited sample size. Finally, this study concludes by providing practical educational recommendations from the perspective of Vygotsky's socio-cultural theory.