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Despite years of investigation on international students' adjustment, cultural distance and cultural intelligence, the definitions of and the relationship between these concepts are not yet sufficiently well established. This article further explores the three concepts and their possible interrelations. We propose a hypothesized model that considers subjectively perceived cultural distance (PCD) a variable of specific importance, and wherein we assume that the relationship between PCD and international students' adjustment is moderated by students' cultural intelligence (CQ). Our model aims to better explain the dynamics between these variables; it posits that students' CQ level will affect whether and how PCD may influence international students' psychological, sociocultural and academic adjustment in the host country. Consequently, the model offers several implications for future research and possible interventions to support international students' adjustment in higher education.

Background: It is unclear whether the limitations of young persons with a mild intellectual disability or borderline intellectual functioning preclude feasibility of the daily diary method. Method: For 60 consecutive days, 50 participants (M[subscript age] = 21.4, 56% male) who receive care in an ambulatory, residential, or juvenile detention setting, self-rated both standardised and personalised diary questions through an app. Diary entries were used for feedback in treatment. Interviews were used to explore acceptability. Results: Average compliance was 70.4%, while 26% of participants dropped out. Compliance was good in ambulatory (88.9%) and residential care (75.6%), but not in the juvenile detention setting (19.4%). The content of self-selected diary items varied widely. Participants deemed the method acceptable. Conclusions: Daily monitoring is feasible for individuals with a mild intellectual disability or borderline intellectual functioning receiving ambulatory or residential care, and can provide scientists and practitioners with important insights into day-to-day behavioural patterns.

Category: Midfoot/Forefoot; Diabetes Introduction/Purpose: Charcot arthropathy is a debilitating and challenging clinical problem for patients and providers. Patient reported outcome measures (PROMs) are an effective tool for gauging a patient’s quality of life and daily functioning but they have not been reported in the setting of midfoot Charcot arthropathy. Our goal is to assess PROMs severity in midfoot Charcot arthropathy (Brodsky Type 1), alongside linked demographics and comorbidities. We will compare these values with PROMs from conditions like ESRD, knee and hip arthritis, highlighting Charcot arthropathy's comparable debilitation. Methods: A retrospective chart review identified 67 patients with Brodsky Type 1 Charcot arthropathy by one of two fellowship-trained foot and ankle surgeons at a single academic medical center between years 2015 and 2023. ICD-10 CM codes E11.610, M14.671, and M14.672 were used to identify diagnosis of Charcot arthropathy and radiological interpretation determined Brodsky type. Data collected from patient charts included demographics, medical history, presence of ulcers, and preoperative Visual Analog Scale (VAS), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), SSS-8, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores and postoperative FAOS and FAAM scores. A One-Way ANOVA was performed to evaluate statistical significance. Averages of preoperative PROM scores were compared to literature values for other diseases. Results: Our cohort was mostly male (58.2%), with mean age 61.73 years, BMI 32.9, and A1C 6.9. Initial presentation revealed 50.7% had ulcers. Brodsky type 1 (midfoot) had notably the lowest pre-op PROM scores when compared to other Brodsky types: PDI Recreation (p=.033), FAOS Symptoms and Stiffness (p=.044), and FAOS Recreation (p=.027). Ulcer presence yielded significantly lower FAAM-ADL scores (p=.038), while other PROMs showed no statistical difference. Our mean VAS score was 53.34 which was higher than hip arthritis VAS (43.0) but lower than ESRD VAS (60.0) and knee arthritis VAS (64.2). Our SF-12 PCS scores (29.4) exceeded prior reports (hip 28.5, knee 28.6), while SF-12 MCS scores were higher in earlier studies (hip 49.6, knee 51.5) than our 43.8. Conclusion: Patients with Charcot arthropathy struggle in daily tasks, reflected in lowered FAOS ADL scores. Brodsky type 1 patients also face challenges in higher-level activities, evident in reduced PDI recreation and FAOS recreation scores. Those with ulcers similarly encounter issues in daily tasks, seen in lower FAAM ADL scores. Brodsky type 1 patients also experience debilitating pain as noted by higher VAS scores when compared to known debilitating conditions such as hip and knee arthritis. Comparatively minor differences in knee and hip arthritis SF-12 PCS scores indicate significant physical limitations for these patients.

IntroductionDuring the COVID-19 pandemic, major events with immune-modulating effects at population-level included COVID-19 infection, lockdowns, and mass vaccinations campaigns. As immune responses influence many immune-mediated diseases, population scale immunological changes may have broad consequences.MethodsWe investigated the impact of lockdowns, COVID-19 infection and vaccinations on immune responses in the 2000HIV study including 1895 asymptomatic virally-suppressed people living with HIV recruited between October 2019 and October 2021. Their inflammatory profile was assessed by targeted plasma proteomics, immune responsiveness by cytokine production capacity of circulating immune cells, and epigenetic profile by genome-wide DNA methylation of immune cells.ResultsPast mild COVID-19 infection had limited long-term immune effects. In contrast, COVID-19 vaccines and especially lockdowns significantly altered both the epigenetic profile in immune cells at DNA methylation level and immune responses. Lockdowns resulted in a strong overall exaggerated immune responsiveness, while COVID-19 vaccines moderately dampened immune responses. Lockdown-associated immune responsiveness alterations were confirmed in 30 healthy volunteers from the 200FG cohort that, like the 2000HIV study, is part of the Human Functional Genomics Project.DiscussionOur data suggest that lockdowns have unforeseen immunological effects. Furthermore, COVID-19 vaccines have immunological effects beyond anti-SARS-CoV-2 activity, and studies of their impact on non-COVID-19 immune-mediated pathology are warranted.

BackgroundGiven the multifactorial nature of type 2 diabetes (T2D), health care for this condition would benefit from a holistic approach and multidisciplinary consultation. To address this, we developed the web-based 360-degree (360°) diagnostic tool, which assesses 4 key domains: “body” (physical health parameters), “thinking and feeling” (eg, mental health and stress), “behavior” (lifestyle factors), and “environment” (eg, work and housing conditions). ObjectiveThis work examines the acceptability, implementation, and potential effects of the 360° diagnostic tool and subsequent tailored treatment (360° approach) in a 6-month intervention and feasibility study conducted in standard primary health care settings in the Netherlands. MethodsA single-group design with baseline, 3-month, and 6-month follow-ups was used. A total of 15 people with T2D and their health care providers from 2 practices participated in a 6-month intervention, which included the 360° diagnosis, tailored treatment, and both individual and group consultations. The 360° diagnosis involved clinical measurements for the “body” domain and self-reports for the “thinking and feeling,” “behavior,” and “environment” domains. After multidisciplinary consultations involving the general practitioner, pharmacist, nurse practitioner (NP), and dietitian, the NP and dietitian provided tailored advice, lifestyle treatment, and ongoing support. At the end of the intervention, face-to-face semistructured interviews were conducted with health care professionals (n=6) and participants (n=13) to assess the acceptability and implementation of the 360° approach in primary health care. Additionally, data from 14 participants on the “thinking and feeling” and “behavior” domains at baseline, 3 months, and 6 months were analyzed to assess changes over time. ResultsThe semistructured interviews revealed that both participants with T2D and health care professionals were generally positive about various aspects of the 360° approach, including onboarding, data collection with the 360° diagnosis, consultations and advice from the NP and dietitian, the visual representation of parameters in the profile wheel, counseling during the intervention (including professional collaboration), and the group meetings. The interviews also identified factors that promoted or hindered the implementation of the 360° approach. Promoting factors included (1) the care, attention, support, and experience of professionals; (2) the multidisciplinary team; (3) social support; and (4) the experience of positive health effects. Hindering factors included (1) too much information, (2) survey-related issues, and (3) time-consuming counseling. In terms of effects over time, improvements were observed at 3 months in mental health, diabetes-related problems, and fast-food consumption. At 6 months, there was a reduction in perceived stress and fast-food consumption. Additionally, fruit intake decreased at both 3 and 6 months. ConclusionsOur findings suggest that the 360° approach is acceptable to both people with T2D and health care professionals, implementable, and potentially effective in fostering positive health changes. Overall, it appears feasible to implement the 360° approach in standard primary health care. Trial RegistrationNetherlands Trial Register NL-7509/NL-OMON45788; https://onderzoekmetmensen.nl/nl/trial/45788

Background: The clinical frailty scale (CFS) was used as a triage tool for medical decision making during the COVID-19 pandemic. The CFS has been posed as a suitable risk marker for in-hospital mortality in COVID-19 patients. We evaluated whether the CFS is associated with mortality 24 months after hospitalisation for COVID-19. Methods: The COvid MEdicaTion (COMET) study is an international, multicentre, observational cohort study, including adult patients hospitalised for COVID-19 between March 2020–July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected at admission, survival data were collected 24 months after hospitalisation. Multivariable cox proportional hazard models stratified by age (

Purpose To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D). Method A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory. Result The analysis identified the core category “Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it.” Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management. Conclusion Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.

Objective: To improve sustainability of a patient decision aid for systemic treatment of metastatic colorectal cancer, we evaluated real-world experiences and identified ways to optimize decision aid content and future implementation. Methods: Semi-structured interviews with patients and medical oncologists addressed two main subjects: user experience and decision aid content. Content analysis was applied. Fifteen experts discussed the results and devised improvements based on experience and literature review. Results: Thirteen users were interviewed. They confirmed the relevance of the decision aid for shared decision making. Areas for improvement of content concerned; 1) outdated and missing information, 2) an imbalance in presentation of treatment benefits and harms, and 3) medical oncologists' expressed preference for a more center-specific or patient individualized decision aid, presenting a selection of the guideline recommended treatment options. Key points for improvement of implementation were better alignment within the care pathway, and clear instruction to users. Conclusion: We identified relevant opportunities for improvement of an existing decision aid and developed an updated version and accompanying implementation strategy accordingly. Innovation: This paper outlines an approach for continued decision aid and implementation strategy development which will add to sustainability. Implementation success of the improved decision aid is currently being studied in a multi-center mixed-methods implementation study.

Objective: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by a variety of disease symptoms and an unpredictable clinical course. To improve treatment outcome, stratification based on immunological manifestations commonly seen in patients with SLE such as autoantibodies, type I interferon (IFN) signature and neutrophil extracellular trap (NET) release may help. It is assumed that there is an association between these immunological phenomena, since NET release induces IFN production and IFN induces autoantibody formation via B-cell activation. Here we studied the association between autoantibodies, the IFN signature, NET release, and clinical manifestations in patients with SLE. Methods: We performed principal component analysis (PCA) and hierarchical clustering of 57 SLE-related autoantibodies in 25 patients with SLE. We correlated each autoantibody to the IFN signature and NET inducing capacity. Results: We observed two distinct clusters: one cluster contained mostly patients with a high IFN signature. Patients in this cluster often present with cutaneous lupus, and have higher anti-dsDNA concentrations. Another cluster contained a mix of patients with a high and low IFN signature. Patients with high and low NET inducing capacity were equally distributed between the clusters. Variance between the clusters is mainly driven by antibodies against histones, RibP2, RibP0, EphB2, RibP1, PCNA, dsDNA, and nucleosome. In addition, we found a trend towards increased concentrations of autoantibodies against EphB2, RibP1, and RNP70 in patients with an IFN signature. We found a negative correlation of NET inducing capacity with anti-FcER (r = −0.530; p = 0.007) and anti-PmScl100 (r = −0.445; p = 0.03). Conclusion: We identified a subgroup of patients with an IFN signature that express increased concentrations of antibodies against DNA and RNA-binding proteins, which can be useful for further patient stratification and a more targeted therapy. We did not find positive associations between autoantibodies and NET inducing capacity. Our study further strengthens the evidence of a correlation between RNA-binding autoantibodies and the IFN signature.

Abstract Growing interest in Earth Orientation Parameters (EOP) resulted in various approaches to the EOP prediction algorithms, as well as in the exploitation of distinct input data, including the observed EOP values from various operational data centers and modeled effective angular momentum functions. Considering these developments and recently emerged new methodologies, the Second Earth Orientation Parameters Prediction Comparison Campaign (2nd EOP PCC) was pursued in 2021–2022. The campaign was led by Centrum Badań Kosmicznych Polskiej Akademii Nauk in cooperation with Deutsches GeoForschungsZentrum and under the auspices of the International Earth Rotation and Reference Systems Service. This paper provides the analysis and evaluation of the polar motion predictions submitted during the 2nd EOP PCC with the prediction horizons between 10 and 30 days. Our analysis shows that predictions are highly reliable with only a few occasional discrepancies identified in the submitted files. We demonstrate the accuracy of EOP predictions by (a) calculating the mean absolute error relative to polar motion observations from September 2021 through December 2022 and (b) assessing the stability of the predictions in time. The analysis shows unequal results for the x and y components of polar motion (PMx and PMy, respectively). Predictions of PMy are usually more accurate and have a smaller spread across all submitted files when compared to PMx. We present an analysis of similarity between the participants to indicate what methods and input data give comparable output. We also prepared the ranking of prediction methods for polar motion summarizing the achievements of the campaign.

Colorectal cancer patients with ≤10 unresectable metastases were treated with single-fraction sub-ablative radiotherapy in addition to standard of care systemic therapy in a single-arm, open-label, multicenter, pilot study (SIRIUS) to assess feasibility and safety. Results indicate that radiotherapy combined with systemic therapy is feasible and safe in this population.

Abstract Purpose Total knee arthroplasty (TKA) is the standard treatment of end‐stage osteoarthritis. TKA is often used and, therefore, poses a healthcare and societal burden, which is likely to increase further. Headroom analyses evaluate a technology under development by making assumptions about its effectiveness. This article applies a headroom approach to forecast the potential value of innovations that improve TKA‐related care in the Netherlands in terms of cost‐effectiveness and surgeries avoided. Methods A state‐transition model estimating lifetime direct health effects, healthcare‐ and societal costs and percentage of avoide d surgeries was developed. The model compared care as usual to five hypothetical interventions to calculate the headroom associated with (1) preventing the need for TKAs, (2) preventing the need for all TKA revisions, (3) postponing TKAs without quality‐of‐life loss, (4) preventing periprosthetic joint infections (PJIs) and (5) improving patient satisfaction. Results Preventing the need for all TKAs amounted to €43,076 of headroom. Preventing the need for TKA revisions amounted to €2276 (5.8% of surgeries avoided), postponing TKAs by 5 years amounted to €7634 (32.4% of surgeries avoided), preventing PJIs amounted to €1187 (1.4% of surgeries avoided) and improving patient satisfaction amounted to €16,622 (0% of surgeries avoided). The headroom of each hypothetical intervention was highest in younger populations (

Recently, several quantum benchmarking algorithms have been developed to characterize noisy quantum gates on today's quantum devices. A fundamental issue in benchmarking is that not everything about quantum noise is learnable due to the existence of gauge freedom, leaving open the question what information is learnable and what is not, which is unclear even for a single CNOT gate. Here we give a precise characterization of the learnability of Pauli noise channels attached to Clifford gates using graph theoretical tools. Our results reveal the optimality of cycle benchmarking in the sense that it can extract all learnable information about Pauli noise. We experimentally demonstrate noise characterization of IBM's CNOT gate up to 2 unlearnable degrees of freedom, for which we obtain bounds using physical constraints. In addition, we show that an attempt to extract unlearnable information by ignoring state preparation noise yields unphysical estimates, which is used to lower bound the state preparation noise.

Reasoning-and-proving is a crucial part of students' mathematical experiences in secondary school. There is scholarly debate, however, on the extent to which proving at the secondary level needs to be formal and whether all students should be held to disciplinary standards of rigor. In this study, we investigated the notion of "proof for all" from the perspective of secondary mathematics teachers. We analyzed, using the framework of practical rationality, the justifications teachers gave for whether or not all students should learn proof. Based on interviews with twenty-one secondary teachers from a socioeconomically-diverse set of schools, we found that teachers differ in their opinions of who should learn proving but they were similar in their feelings of obligation toward individual student learning; some teachers cited obligations to individual students as a justification for teaching proving to all students and others cited those obligations as a justification for not teaching proving to some students. We also share teachers' perspective with regard to their obligations to the discipline, educational institutions, interpersonal dynamics among students, and the worldly relevance of mathematics education.

Proofs are attempts to conclusively demonstrate the validity of the claim for all cases indicated within its domain, which implies that proving should involve thoughtful consideration of the domain. This study analyzed the enactment of three general claim tasks, or tasks where the domain of the claim referred to an infinite number of cases, that were used during an introduction-to-proof teaching experiment with 10 ninth grade students. We analyzed the tasks in terms of the opportunities students experienced to engage in reasoning-and-proving and attend to the domain of the claims. The use of general claim tasks provided students with opportunities to engage in varied reasoning-and-proving activities, including forms not typically found in textbooks. Students' attention to the domain of the claims increased over the course of study as a result of the teacher-researcher's continued focus on this aspect of the tasks, although their attention did not always encompass all cases within the domain. By making the domain of mathematical claims a central focus, we emphasize its important role in the reasoning-and-proving opportunities afforded to students and contribute to an understanding of students' early interpretations of this aspect of proof tasks.