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Higher education (HE) policymaking is increasingly concerned with graduate outcomes. Policies often use narrow economic metrics, such as employment rates and salaries, to set strategic goals for HE and assess 'value for money'. Despite this policy relevance, little attempt has been made to assess the academic literature in this area. The field's strengths and weaknesses, areas of focus and level of criticality are unknown, leaving us unable to judge its ability to inform policy. This paper addresses this gap using a novel two-phase scoping review method. Phase 1 assesses literature that explicitly uses the term 'graduate outcome', finding a field that is largely fragmented into subfields. Phase 2 then performs a series of 'top-level' scoping reviews on each sub-field and combines them to assess the 'overall' literature. This 'overall' literature is found to share HE policy's focus on economic graduate outcomes. While several well-developed non-economic subfields exist, such as critical thinking and lifelong learning, these are comparatively small. A limited proportion of the literature considers issues of inequality and other 'critical' topics. If research is to better inform policy in this area, it would be beneficial to develop a broader and more critical research programme. [ABSTRACT FROM AUTHOR]

Spontaneous intracerebral hemorrhage (ICH) is the most devastating type of stroke, and it is associated with high morbidity and mortality. Patients with a spontaneous ICH are routinely admitted to an intensive care unit (ICU). However, an ICU is a valuable and limited resource, and not all patients may require this level of care. The authors conducted a systematic review and meta-analysis evaluating the safety and outcome of admission to a step-down level of care or stroke unit (SU) compared to intensive care in adult patients with low-risk spontaneous ICH. PubMed, Embase, and the Cochrane Library were searched for randomized clinical trials and observational cohort studies. The Mantel–Haenszel method or inverse variance, as applicable, was applied to calculate an overall effect estimate for each outcome by combining the specific risk ratio (RR) or standardized mean difference. Risk of bias was analyzed using the Newcastle–Ottawa Scale. The protocol was registered in PROSPERO (CRD42023481915). The primary outcome examined was in-hospital mortality. Secondary outcomes were unfavorable short-term outcome, length of hospital stay, and (re)admission to the ICU. Five retrospective cohort studies involving 1347 patients were included in the qualitative analysis. Two of the studies had severity-matched groups. The definition of low-risk ICH was heterogeneous among the studies. Admission to an SU was associated with a similar rate of mortality compared to admission to an ICU (1.4% vs. 0.6%; RR 1.66; 95% confidence interval [CI] 0.24–11.41; P = 0.61), a similar rate of unfavorable short-term outcome (14.6% vs. 19.2%; RR 0.77; 95% CI 0.43–1.36; P = 0.36), and a significantly shorter mean length of stay (standardized mean difference − 0.87 days; 95% CI − 1.15 to − 0.60; P < 0.01). Risk of bias was low to moderate for each outcome. The available literature suggests that a select subgroup of patients with ICH may be safely admitted to the SU without affecting short-term outcome, potentially saving in-hospital resources and reducing length of stay. Further studies are needed to identify specific and reliable characteristics of this subgroup of patients. [ABSTRACT FROM AUTHOR]

Background: The Cholangiocarcinoma Screening and Care Program (CASCAP) has been launched since 2013 to detect early-stage cholangiocarcinoma and reduce the disease death. However, the clinical utility of the CASCAP remains unclear. To compare survival outcomes between two time periods: before and after 2013, when significant changes in treatment strategies were implemented, and to evaluate the efficacy of the ultrasound-based screening program, in an Asian region endemic for cholangiocarcinoma. Methods: A single-center retrospective review was conducted in curative-intended resection cholangiocarcinoma from 2002 to 2021. Patents characteristics and survival outcomes were compared between 2002 and 2013 (early period) and 2014 to 2021 (later period). Results: A total of 1091 patients with intrahepatic (n = 624) or perihilar (n = 467) cholangiocarcinoma was included (early period, n = 658; later period, n = 433). Of 66 (15.2%) patients in the later period were referred by the CASCAP. The incidence of early-staged disease (Stage 0 and 1) was lower in early period compared to later period 16.0% versus 29.1% (p < 0.001); that of positive surgical margin was higher in early period 53.7% versus 40.0% (p < 0.001). A median survival time (MST) was 14 months in early and 40 months in later period (p < 0.001). Subgroup analysis by tumor location, the MST was 13 versus 60 months in early and late periods for intrahepatic tumor (p < 0.001), respectively. While MST in perihilar tumor was 18 versus 31 months in early and late periods(p < 0.001), respectively. By presentation, the MST was 51 vs. 38 months, respectively, with screening and usual presentation (p = 0.06). Conclusion: Postoperative survival in CCA patients improved more than doubled during the study period. Moreover, the late period demonstrated enhanced early-stage detection, a higher rate of negative surgical margins, and improved survival outcomes. [ABSTRACT FROM AUTHOR]

Background: The use of information communication technologies such as telemedicine has increased over the years, offering access to specialized healthcare even in remote locations. However, telemedicine in interprofessional team training is seldom included in medical or nursing programs, and little is known about how to practise these scenarios. This study aimed to explore how medical and nursing students experience teamwork when one team member is participating remotely and digitally. Methods: Following interprofessional team training in which one team member participated remotely, focus group interviews were conducted with three teams, each comprising one medical student and two nursing students (n = 9 students in total). The focus group interviews were analysed with thematic content analysis. The Systems Engineering Initiative for Patient Safety model was applied as a theoretical framework and served as a lens in the analysis. Results: Three themes were identified in the analysis: challenging the dynamic of leadership, becoming familiar with a new setting, and finding new strategies to communicate. Conclusions: The results of this study suggest that future physicians and nurses need to enhance their knowledge of practicing teamwork through telemedicine during their education, as the use of telemedicine continues to grow. [ABSTRACT FROM AUTHOR]

Purpose: Design Science (DS) is a relatively new paradigm for addressing complex real-world problems through the design and evaluation of artifacts. Its constituent methodologies are currently being discussed and established in numerous related research fields, such as information systems and management (Hevner et al., 2004). However, a DS methodology that describes the "how to" is largely lacking, not only in the field of OM but in general. The Theory of Constraints (TOC) and its underlying thinking processes (TP) have produced several novel artifacts for addressing ill-structured real-world operations problems (Dettmer, 1997; Goldratt, 1994), but they have not been analyzed from a DS research standpoint. The purpose of this research is to demonstrate how TOC's thinking process methodology can be used for conducting exploratory DS research in Operations and Supply Chain Management (OSCM). Design/methodology/approach: A case study of spare parts replenishment illustrates the use of TOC's thinking processes in DS to structure an initially unstructured problem context and to facilitate the design of a novel solution. Findings: TOC's thinking processes are an effective methodology for problem-solving DS research, enabling the development of novel solutions in initially unstructured and wicked problem situations. Combined with structured CIMO design logic TOC's thinking process offers a systematic method for exploring wicked problems, designing novel solutions, and demonstrating theoretical contributions. Research limitations/implications: The implication for research is that TOC's thinking process methodology can provide important elements of the lacking "how to" methodology for DS research, not only for the field of OM but in general for the field of management. Practical implications: The practical outcome of the research is a novel design for dynamic buffer-based replenishment that extends beyond organizational boundaries. Originality/value: This work shows how the thinking processes can be used in DS research to develop rigorous design propositions for ill-structured problems. [ABSTRACT FROM AUTHOR]

Background: Obstetric Anal Sphincter Injuries (OASI) are associated with significant morbidity. Data regarding induction of labor (IOL) and risk of OASI is conflicting. The objective of this study is to evaluate if IOL increases the odds of OASI when compared to spontaneous labor. Methods: This is a retrospective case–control study in women with term, singleton pregnancies, who had a vaginal delivery at a single, academic center in an urban setting from October 2015 to December 2021. Individuals with the primary outcome, OASI, were identified and matched with controls (no OASI) by delivery date. Results: 303 OASI individuals were identified and matched with 1106 controls. Women with OASI were more likely to be White or Asian, have commercial insurance, and have a previous cesarean delivery (CD). IOL increased the likelihood of OASI by 49% compared to spontaneous labor (OR 1.49, 95% CI [1.138, 1.949]). IOL was no longer significant when adjusting for confounding variables and known risk factors. Conclusion: IOL was not associated with OASI when accounting for known antepartum and intrapartum risk factors. Further investigation of modifiable and non-modifiable risks during labor is imperative to decrease the risk of OASI and associated pelvic floor disorders. [ABSTRACT FROM AUTHOR]

Background: One of the problems currently faced by Indonesia is nutritional problems in the form of stunting. Stunting is a disruption in the growth and development of children due to chronic malnutrition and recurrent infections, characterized by their length or height being below the standard. Methods: This descriptive research aimed to describe the condition of stunting in Tegal City and the efforts of the Tegal City government in contributing to the reduction of the stunting rate. Results: This activity has shown good results, this can be seen from the reduction in the stunting rate in Tegal City from 9.94% in 2022 to 8.21% in 2023. The program to reduce stunting rates in Tegal City was established through the formation of the stunting reduction acceleration team (SRAT). Some of the activities carried out by SRAT include sensitive services linked to poverty management program activities, such as providing integrated healthy livable houses, interventions in the use of yard land, expanding family planning acceptors, refining social assistance recipients, and providing access to drinking water and sanitation management. Specific services are carried out by strengthening specific interventions on a provincial scale, enhancing communication and behavior change by strengthening communication and behavior change and planning and monitoring the evaluation of regional apparatus organizations’ program integration. Collaboration with potential partners is also key in accelerating stunting reduction, along with ongoing monitoring and evaluation of performance. This activity has shown positive outcomes, as evidenced by the reduction in the stunting rate in Tegal City from 9.94% in 2022 to 8.21% in 2023. Conclusion: The prevalence of stunted children in Tegal City has decreased. Effective leadership, a strong civil society, and targeting vulnerable communities during the implementation of specific and sensitive nutrition interventions are the main factors that support the achievement of these targets. [ABSTRACT FROM AUTHOR]

In this work, we systematically analyse the population projections used in the emissions scenario ensembles reviewed by the Working Group III in the latest three reports of the Intergovernmental Panel on Climate Change (IPCC). We show that emissions scenarios span smaller demographic uncertainties than alternative estimates both for the world and for critical regions, such as South-East Asia, Sub-Saharan Africa, and China. Furthermore, the range of demographic projections has consistently shrunk over subsequent reports, exposing a problematic convergence towards a single socio-economic pathway: the "middle path" or SSP2. We argue that the undersampling of population uncertainties limits the range of future emission trajectories and has implications for climate transition scenarios. Emissions scenarios with a wider set of assumptions about future population should be submitted to the IPCC. The methods utilised in this study inform the development of independent audit methods for the assessment of relevant uncertainty sources in IPCC databases. [ABSTRACT FROM AUTHOR]

The photoionization (PI) spectra of small gas-phase yttrium monoxide clusters, YnO (n = 1–8), are investigated, and the adiabatic ionization energies are determined. The stable structures are obtained from density functional theory (DFT) calculations. The ground state structures are further confirmed by the CCSD(T) method. The PI spectra are calculated for these stable structures and are compared with the experimental PI spectra. The ground-state structures of the neutral and cation clusters are experimentally assigned with confidence on the basis of a favourable agreement between the experimental and calculated PI spectra. New structures are proposed for Y2O, Y6O, and Y8O compared to the previous literature. Y2O is a linear molecule in the ground state that was previously proposed as a C2v bent molecule. The YnO clusters become 3-dimensional from n ≥ 3. The O atom stays outside, bridging a triangular face of yttrium clusters. Chemical bonding between the yttrium and oxygen atoms is mostly ionic. The excess charge on the oxygen atom is around 1.4e−, transferred from the yttrium atoms bonded with it. Yttrium atoms are mostly covalently bonded. However, for the bigger clusters, free charges of both polarities appear on yttrium atoms that are not bonded with oxygen, indicating ionic interactions. Frontier orbitals consist of mainly delocalized 4d electrons with some 5s contributions, forming Y–Y bonding interactions, but with little contribution and zero contribution from the oxygen orbitals, regardless of the cluster size. The lost electron of YnO+ mostly comes from the 5s orbitals of all Y atoms in the cluster up to size n = 4, and then from 4d–5s hybrid orbitals from n ≥ 5, with the d contribution increasing with size. This is contrary to the previous view in the literature that photoionization occurs from a localized 4d orbital. [ABSTRACT FROM AUTHOR]

Reverse remodeling, the overarching concept behind myocardial recovery, describes the process in which the maladaptive cardiac structural and functional alterations are reversed by removing the underlying etiology or by therapy. This review addresses different imaging modalities and biomarkers as possible predictors for reverse remodeling in patients with chronic heart failure. Although echocardiography remains the imaging modality of choice in daily practice, the presence and amount of fibrosis on cardiac magnetic resonance is a better predictor and inversely correlated with the likelihood for reverse remodeling. A decrease in NT-proBNP levels and serum soluble ST3 during follow-up is associated with better clinical and structural outcomes. The role of troponins and galectine-3 is less clear. There is a promising role for microRNAs in the future, although more research is necessary. Accurate predictors of reverse remodeling could help identify patients with an increased likelihood for reverse remodeling and, in turn, improve patient-tailored medicine. [ABSTRACT FROM AUTHOR]

Background: Polymyxin B (PMB)-based combination therapies are used to treat severe carbapenem-resistant gram-negative bacterial (CR-GNB) infections. This observational study investigated the relationship between clinical factors, including PMB concentration, and clinical efficacy and safety. Patients and Methods: Polymyxin B regimens were optimized through therapeutic drug monitoring (TDM) and area under the concentration-time curve (AUC). In all, 382 samples were tested from 130 patients. Logistic regression was used to analyze the relationships between variables with clinical efficacy and 30-day mortality factors were analyzed by Cox regression. The sensitivity and specificity of Cmin and AUC for the occurrence of acute kidney injury (AKI) were determined by ROC curve analysis. Results: The clinical effectiveness of PMB was 65.4%. Multivariate logistic regression analysis revealed that lung infection, continuous renal replacement therapy, and C-reactive protein were independent factors significantly associated with efficacy. AKI occurred in 14.6% of the patients during treatment; age > 73 years (OR: 3.63; 95% CI: 1.035– 12.727; P = 0.044), Cmin greater than 2.3 μg/mL (OR: 7.37; 95% CI: 1.571– 34.580; P = 0.011), combined vancomycin (OR: 9.47; 95% CI: 1.732– 51.731; P = 0.009), and combined piperacillin-tazobactam (OR: 21.87; 95% CI: 3.139– 152.324; P = 0.002) were independent risk factors. The identified PMB cut-offs for predicting AKI were Cmin = 2.3 μg/mL and AUC = 82.0 mg h/L. Conclusion: Polymyxin B-based combination regimens are effective in treating CR-GNB infections, particularly bloodstream infections, but have shown unsatisfactory for lung infections. Cmin ≥ 2.3 μg /mL and AUC ≥ 82.0 mg h/L may increase PMB-associated AKI incidence. PMB dose should be adjusted based on TDM to ensure efficacy. [ABSTRACT FROM AUTHOR]

This study investigates the mechanical and tribological properties of Kevlar-based composites filled with varying weight percentages (5%, 10%, and 15%) of nano fillers, specifically nanographene oxide (GnO) and silicon dioxide (SiO2), intended for automotive applications. The composites were fabricated using the conventional hand layup method. To assess the mechanical performance, including tensile, flexural, interlaminar shear strength (ILSS), and hardness, tests were conducted to evaluate material strength. Tribological characteristics were examined through wear and frictional tests carried out under different temperature conditions, ranging from 50 °C to 250 °C, with a sliding speed of 0.261 m/s, loads varying from 156 N to 315 N, and a test duration of 120 min. Comparative results revealed that the composite containing 10 wt% SiO2 exhibited superior mechanical properties, with a tensile strength of 372.45 MPa, flexural strength of 339.92 MPa, ILSS of 56.38 MPa, and a hardness rating of 92 HRB. These improvements were attributed to the inherent hardness and effective dispersion of SiO2, enhancing matrix-fiber bonding. In comparison to nano GnO, the Kevlar fibers loaded with 10 wt% nano SiO2 demonstrated the highest capacity for reducing wear (0.554 × 10−3m3/Nm) and frictional coefficients (0.083). Because SiO2's stiff and strong structure offers a firm surface against the opposing material, it lowers friction and resists wear. The friction rate of the nano-fillers-loaded materials gradually increased with rising temperatures up to 200 °C and exhibited a significant increase from 200 to 250 °C. Conversely, Kevlar composites with 15 wt% SiO2 and 15 wt% GnO displayed higher wear rates, accompanied by pronounced fiber breakage and surface degradation, attributed to intense frictional forces generating thermal effects during sliding. Microstructural and structural characteristics of the hybrid composites were analyzed using high-resolution transmission electron microscopy (HRTEM), scanning electron microscopy (SEM), electron diffraction (ED), and X-ray diffraction (XRD). In summary, Kevlar composites with 10 wt% SiO2 filler demonstrated exceptional wear resistance, positioning them as promising candidates for automotive components prone to wear and friction, such as clutch systems, brakes, and engine parts. [ABSTRACT FROM AUTHOR]

AI enhances customer engagement and brand loyalty by delivering tailored, efficient, and smooth interactions. Through the power of AI, brands are empowered to provide personalized, efficient, and timely experiences to customers, fostering lasting engagement and loyalty. By leveraging AI technologies effectively, companies can cultivate strong and enduring relationships with their customers, leading to heightened retention and advocacy. The study utilizes a comprehensive research approach, incorporating both qualitative and quantitative data collection analysis. Participants from diverse industries are chosen and data is gathered through surveys, interviews, and observations. The survey includes inquiries concerning customer engagement, brand loyalty, and perceptions of AI. Consumers perceive companies utilizing AI technologies as more innovative, efficient, and responsive to their needs. Moreover, AI's ability to provide personalized and customized experiences enhances customer satisfaction and increases their intention to remain loyal to the brand. The study also reveals that the level of trust in AI technologies plays a crucial role in its impact on customer loyalty. The findings provide empirical evidence on the significant effect of AI on consumer long-term engagement and brand loyalty. Businesses can leverage these insights to design effective AI-based strategies that enhance customer experiences and foster brand loyalty. Additionally, the work points out the significance of building customer trust in AI technologies, emphasizing the need for transparent and ethical AI practices. The findings shows that recommendation systems do have an impact over long term customer engagement, whereas perceived personalization doesn't have an impact over long term customer engagement. Predictive personalization and personalized algorithms, AI based brand loyalty programs, product innovation, self learning, AI-based service quality and customer engagement have a significant impact over brand loyalty. [ABSTRACT FROM AUTHOR]

Background: In the UK, tens of millions of working days are lost due to work‐related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH‐trained doctors and nurses in the UK. Multi‐disciplinary models of OH delivery, including a more varied range of healthcare and non‐healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return‐to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi‐disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work‐related outcomes. Objectives: The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost‐effectiveness of multi‐disciplinary OH interventions intending to improve work‐related outcomes. Search Methods: In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023. Selection Criteria: Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi‐disciplinary (including professionals from different backgrounds in clinical and non‐clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level. Data Collection and Analysis: Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR‐2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI‐Mapper software to create an EGM. Stakeholder Involvement: We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it. Main Results: We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically‐Low quality ratings. We did not identify any relevant systematic review evidence on any other work‐related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost‐effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review. Authors' Conclusions: This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost‐effectiveness of multi‐disciplinary, workplace‐based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews. [ABSTRACT FROM AUTHOR]

Traumatic brain injuries (TBIs) represent a significant public health concern, with mild-to-moderate cases comprising a substantial portion of incidents. Understanding the predictors of mortality among adult patients with mild-to-moderate TBIs is crucial for optimizing clinical management and improving outcomes. This literature review examines the existing research to identify and analyze the mortality predictors in this patient population. Through a comprehensive review of peer-reviewed articles and clinical studies, key prognostic factors, such as age, Glasgow Coma Scale (GCS) score, the presence of intracranial hemorrhage, pupillary reactivity, and coexisting medical conditions, are explored. Additionally, this review investigates the role of advanced imaging modalities, biomarkers, and scoring systems in predicting mortality following a mild-to-moderate TBI. By synthesizing the findings from diverse studies, this review aims to provide clinicians and researchers with valuable insights into the factors influencing mortality outcomes in adult patients with a mild-to-moderate TBI, thus facilitating more informed decision making and targeted interventions in clinical practice. [ABSTRACT FROM AUTHOR]

Key Points: Question: Among patients with large-vessel occlusion acute ischemic stroke, does adjunctive intravenous methylprednisolone added to endovascular thrombectomy improve clinical outcomes? Findings: In this randomized clinical trial that included 1680 patients, intravenous methylprednisolone, compared with placebo, as adjunct to endovascular thrombectomy resulted in no significant difference in disability severity between groups as measured by the overall distribution of the modified Rankin Scale score at 90 days (adjusted generalized odds ratio for a lower level of disability, 1.10). Meaning: Adjunctive methylprednisolone therapy added to endovascular treatment for acute ischemic stroke did not significantly improve the degree of overall disability. Importance: It is uncertain whether intravenous methylprednisolone improves outcomes for patients with acute ischemic stroke due to large-vessel occlusion (LVO) undergoing endovascular thrombectomy. Objective: To assess the efficacy and adverse events of adjunctive intravenous low-dose methylprednisolone to endovascular thrombectomy for acute ischemic stroke secondary to LVO. Design, Setting, and Participants: This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 82 hospitals in China, enrolling 1680 patients with stroke and proximal intracranial LVO presenting within 24 hours of time last known to be well. Recruitment took place between February 9, 2022, and June 30, 2023, with a final follow-up on September 30, 2023. Interventions: Eligible patients were randomly assigned to intravenous methylprednisolone (n = 839) at 2 mg/kg/d or placebo (n = 841) for 3 days adjunctive to endovascular thrombectomy. Main Outcomes and Measures: The primary efficacy outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores (range, 0 [no symptoms] to 6 [death]). The primary safety outcomes included mortality at 90 days and the incidence of symptomatic intracranial hemorrhage within 48 hours. Results: Among 1680 patients randomized (median age, 69 years; 727 female [43.3%]), 1673 (99.6%) completed the trial. The median 90-day modified Rankin Scale score was 3 (IQR, 1-5) in the methylprednisolone group vs 3 (IQR, 1-6) in the placebo group (adjusted generalized odds ratio for a lower level of disability, 1.10 [95% CI, 0.96-1.25]; P =.17). In the methylprednisolone group, there was a lower mortality rate (23.2% vs 28.5%; adjusted risk ratio, 0.84 [95% CI, 0.71-0.98]; P =.03) and a lower rate of symptomatic intracranial hemorrhage (8.6% vs 11.7%; adjusted risk ratio, 0.74 [95% CI, 0.55-0.99]; P =.04) compared with placebo. Conclusions and Relevance: Among patients with acute ischemic stroke due to LVO undergoing endovascular thrombectomy, adjunctive methylprednisolone added to endovascular thrombectomy did not significantly improve the degree of overall disability. Trial Registration: ChiCTR.org.cn Identifier: ChiCTR2100051729 This clinical trial assesses the efficacy and adverse events of adjunctive intravenous low-dose methylprednisolone to endovascular thrombectomy for patients with acute ischemic stroke secondary to large-vessel occlusion. [ABSTRACT FROM AUTHOR]

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Consumers in the United States (n = 290) and Japan (n = 221) participated in 2 × 2 experiments designed to test effects of agent type (online human or chatbot) and communication strategy (targeted or tailored) on attitudes toward messages and agents. In both national samples, tailored messages were more effective in positively affecting attitudes. In addition, perceived humanness was found to mediate the relationships between agent type and attitudes such that when human or artificial agents are perceived as more human in text exchanges, perceived humanness in turn increases attitudes toward both the agents and messages. Hypothesized effects based on individualism-collectivism were not found. Theoretical and practical implications for designing interactive message strategy via conversational chatbots in an era of artificial intelligence (AI) and global communication are discussed. [ABSTRACT FROM AUTHOR]

The cloud-computing paradigm based on containers has progressively grown in recent years as a flexible strategy that has proven to be energy efficient. The increasing usage of the container as a service technology in data centers (DCs) among cloud providers highlights the necessity of the container installation design phase in cloud environments. Cloud providers attempt to enhance resource utilization and reduce energy consumption by employing various VM selection and placement policies. This procedure for placement acquires a new aspect, with containers now being deployed on virtual machines (VMs) and those guest VMs being installed on physical machines (PMs). The intricacy of this issue increases when the variety of the containers, VMs, and PMs is taken into account. In this paper, an optimal placement strategy for containers is proposed based on the bio-inspired algorithms. The firefly algorithm has been modified to use discretization strategy (Discrete Firefly Algorithm, DFF) and has also used local search mechanism (Discrete Firefly with Local Search Mechanism, DFFLSM). The proposed versions of firefly algorithm are compared with first fit, first fit decreasing, random algorithm and ant colony algorithm. The comparison is done based on average energy consumption, average active VM, average active PM and average overall service-level agreement violations in the DC. The results show that DFFLSM performs better than all pre-existing container placement algorithms in terms of energy efficiency. It reduces average energy consumption of DC by 9.32% and 40.85% and average active PM by 18.30% and 21.89% in homogenous and heterogeneous environment, respectively. [ABSTRACT FROM AUTHOR]

Aim: To identify and explore tools that measured and detected complexity of care among community dwelling people aged 65 years and older. Data Sources: Databases were searched for articles published up to 23 September 2022 including CINAHL, EMBASE and MEDLINE, Cochrane database for trials and grey literature. Methods: A scoping review was conducted and reported in accordance with the PRISMA guidelines. Eligible articles included those with participants aged over 65 years, living in the community and studies that included care complexity detection or assessment and how this related to care delivered. Covidence was used to screen titles, abstracts and full‐text articles. Results: Eighteen full texts were reviewed; four studies were included in the final review. All selected studies included people aged over 65 years living in the community. A high level of reliability for the items included in the interventions was found. The selected studies included tools for assessing older person's needs with nurses involved in the assessment. Conclusion: The review identified four tools for measuring complexity in community dwelling older people. Two tools have the capacity to objectively measure complexity due to the holistic nature of items included and appear easy to use to support clinical judgement decisions. Impact: The review places a spotlight on the concept of complexity and highlights the lack of definition of care complexity. The synthesized result highlights the need to explore detection of care complexity of older people further and consider ways of supporting clinical judgement and decision making of community nurses. The use of a validated tool may enhance clinical judgement regarding care complexity and may lead to a more consistent and timely approach to care. Patient or Public Contribution: During the development phase, the study was presented to a consumer group from the researcher's workplace. Prospero Registration: CRD42022299336. [ABSTRACT FROM AUTHOR]