Search

This chapter discusses how community-based narrative encounters can enhance medical students' narrative humility, the practice of recognizing the value of multiple narratives of health and reducing narrative privileging. The study in this chapter suggests that through exposure to individuals' lived experience of health, medical students are able to recognize both professional and personal narrative bias, leading to reflection on improved patient-centered care centered on testimonial justice and narrative respect.

Living and working through the challenges of a pandemic offered a unique research opportunity to engage with some core questions about what really matters in Religious Education (RE) in countries across Europe. The "What COVID Reveals to Religious Education Specialists" research project sought to provide a reflective space for RE specialists, drawn from the board members of the European Forum for Teachers of Religious Education (EFTRE), to consider their experiences of RE during the COVID-19 pandemic and to begin to articulate what they might want in the future for RE in light of their experiences. Areas explored in the online qualitative survey included: challenging questions and issues, social unrest, student-teacher relationships, learning scenarios, valued dimensions in RE, opportunities for the future, and 'ideal' RE. Respondents were from sixteen of the twenty-two countries present on the EFTRE Board, offering their individual perspectives from Western, Northern, Central and Southern Europe. Using the tool ATLAS.ti, an inductive analytical approach was employed; a number of key group 'themes' emerged from the responses, which provided a basis for further analysis. This paper will present some of the main findings in dialogue with the focusing research stimulus question: "What does COVID-19 reveal to RE specialists about their subject?" The project is a European collaboration involving researchers from Austria, Germany, Hungary, Ireland and Wales.

Teaching preparation is critical to success in graduate school, as many doctoral students across disciplines are expected to teach or assist in teaching undergraduate classes as part of a graduate assistantship or in the capacity of adjunct faculty. Many go on to enter their chosen fields in the academy with the expectation that they are fully prepared to develop and teach their own courses at the undergraduate and even graduate level. This paper explores the frequency and type of teaching preparation and professional development coursework in 40 criminology and criminal justice doctoral programs. Findings reveal that nearly half of these programs offered none of these courses whatsoever. Required coursework formalizes the knowledge and skills that are key to success in teaching during graduate school and beyond.

Abstract: For large, regulated rivers, operators can impact abiotic conditions for the benefit of the ecosystem, primarily by controlling the volume of discharge from upstream reservoirs. Understanding the decision space around discharge is necessary for evaluating tradeoffs between environmental and other objectives. As a result of climate change, warming water temperatures are increasingly becoming a concern for thermally‐sensitive fauna. In California's largest river, the Sacramento, extinction risk of salmon populations is linked to high water temperatures. Yet, little is known about how much water temperature in lower reaches can be affected by reservoir discharge operations, and the potential benefits to salmon. We used a process‐based water temperature model to estimate the ability of reservoir discharge to mediate river temperature heating processes impacting downstream locations (discharge‐mediated temperature management). To bound this analysis, we used historical forcings over a recent 29‐year span. Results indicate reservoir discharge increases of up to 340 cms over the historical record could have decreased water temperature in the lower reaches by up to 3.6°C. Salmon require water below 20°C during most stages of their lifecycle, and we found that normative water operations could ensure 20°C was rarely exceeded for two potential management seasons, in late‐spring and early‐fall. These periods coincide with important rearing and migratory periods for salmon, during which they frequently experience excessive temperatures under the management status‐quo. This analysis provides stakeholders tools to manage conditions for native fauna in the face of a warming climate, and a framework for developing similar tools in other large, regulated rivers.

One of the most underdiagnosed medical conditions worldwide is depression. It has been demonstrated that the current classical procedures for early detection of depression are insufficient, which emphasizes the importance of seeking a more efficient approach to overcome this challenge. One of the most promising opportunities is arising in the field of Artificial Intelligence as AI-based models could have the capacity to offer a fast, widely accessible, unbiased and efficient method to address this problem. In this paper, we compared three natural language processing models, namely, BERT, GPT-3.5 and GPT-4 on three different datasets. Our findings show that different levels of efficacy are shown by fine-tuned BERT, GPT-3.5, and GPT-4 in identifying depression from textual data. By comparing the models on the metrics such as accuracy, precision, and recall, our results have shown that GPT-4 outperforms both BERT and GPT-3.5 models, even without previous fine-tuning, showcasing its enormous potential to be utilized for automated depression detection on textual data. In the paper, we present newly introduced datasets, fine-tuning and model testing processes, while also addressing limitations and discussing further considerations for future research.

Background: A grading system was developed for computerized tomography (CT) scans evaluating patients with suspected small bowel obstruction (SBO). We hypothesized that patients with a higher grade of suspected SBO on CT scan would be more likely to require surgical intervention. Methods: Retrospective chart review of patients who presented to the Emergency Room (ER) who had a CT of the abdomen and pelvis for suspected SBO. Patients were divided into 5 groups: Grade 1 (SBO unlikely), Grade 2 (probable partial or early SBO), Grade 3 (probable high grade SBO), Grade 4 (SBO with changes concerning for ischemia) and Not Graded. Results: The CT scans of 655 patients were graded. Of the 22 patients with a grade 1 SBO, only 1 went for surgery (4.5 %). For grade 2 patients, 23 out of 299 had an operation (7.7 %), for grade 3 it was 84 out of 299 (28.1 %) and for grade 4 SBO, 25 out of 35 patients (71.4 %) had surgery. The p value is

The impact of novel supplementary cementitious materials (SCMs) on the phase assemblage and the pore structure in cement pastes was studied and linked to their impact on the compressive strength in mortar. The composite cements analysed had a composition of 78 wt.% Portland cement, 18 wt.% SCM and 4 wt.% limestone filler, and the samples were cured sealed for 91 days at 20°C. The investigated SCMs comprise natural materials such as clays and volcanic rocks (rhyolite and hyaloclastite), and industrial products such as fly ash, slag, oil shale ash, bio-fuel ash or bio-coal fly ash. The results revealed that all the SCMs except oil shale ash contribute to the phase assemblage in a similar way, when clinker is replaced with 18 wt.% SCM. The pore structure of the different cement pastes was similar. Even when the composite cement pastes showed a higher total intruded pore volume compared to the Portland cement paste sample, these samples showed higher compressive strength. This indicates that total intruded porosity is not the only contribution to strength.

Juvenile salmonids migrate hundreds of kilometers from their natal streams to mature in the ocean. Throughout this migration, they respond to environmental cues such as local water velocities and other stimuli to direct and modulate their movements, often through heavily modified riverine and estuarine habitats. Management strategies in an uncertain future of climate change and altered land use regimes depend heavily on being able to reliably predict their ocean entry timings, route use, and survival rates through rivers and estuaries. We developed a spatially-explicit agent-based model of fish movement in response to hydrodynamic flows that uses movement dynamics gleaned from multi-dimensional tracking datasets of acoustically tagged juveniles moving through an urbanized, branched tidal estuary. We demonstrate how such models can be calibrated, and we apply it to the Sacramento-San Joaquin Delta in Central California. The quality of the out-of-sample validation of the model to predict juvenile salmon survival and route selection indicates that the model is versatile and flexible enough to be used in novel hydroclimatological conditions

BackgroundTreatment patterns for intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC) differ, but limited studies exist comparing them. This study examines differences in molecular profiling rates and treatment patterns in these populations, focusing on use of adjuvant, liver-directed, targeted, and investigational therapies.MethodsThis multicenter collaboration included patients with ICC or ECC treated at 1 of 8 participating institutions. Retrospective data were collected on risk factors, pathology, treatments, and survival. Comparative statistical tests were 2-sided.ResultsAmong 1039 patients screened, 847 patients met eligibility (ICC = 611, ECC = 236). Patients with ECC were more likely than those with ICC to present with early stage disease (53.8% vs 28.0%), undergo surgical resection (55.1% vs 29.8%), and receive adjuvant chemoradiation (36.5% vs 4.2%) (all P

PurposeFollowing treatment for localized prostate cancer, a subset of men will develop recurrent disease in the abdominopelvic nodes. For radiation therapy (RT), the optimal treatment volume, fractionation schedule, and dose remain unanswered questions. We report early outcomes for patients treated with involved-field stereotactic body radiation therapy (SBRT) (IF-SBRT) for nodal oligo-recurrent (NOR) prostate cancer.MethodsBetween January 2018 and October 2023, 67 patients with a median age of 75 with NOR prostate cancer treated with 74 courses of IF-SBRT at Georgetown were eligible for this analysis. NOR was defined as any volume of disease that could be safely treated within an IF. All patients were treated with five-fraction IF-SBRT (27.5–35 Gy). The IF treatment volume was defined as the nodal basin containing the gross disease as well as the immediately adjacent basins. Disease progression was defined as a prostate-specific antigen (PSA) rise above the pretreatment baseline or initiation of a second treatment. Local control and progression-free survival were calculated using the Kaplan–Meier method.ResultsDetection of pre-SBRT NOR was ascertained by prostate-specific membrane antigen (PSMA) (38%), fluciclovine (50%), or MRI/CT (12%). Median follow-up was 50 months (1–262). The median pre-salvage PSA was 6.5 ng/mL (range, 0.1–335). The median number of involved nodes was 3 (range, 1–16). The local control at 1 and 2 years was 98% and 93%, respectively. The 1- and 2-year progression-free survival was 78% and 50%, respectively. Twenty percent of treatment courses were followed by acute Grade 2 gastrointestinal (GI) toxicity: diarrhea (9%) and/or nausea (14%). Two patients (3%) experienced late Grade 2 nausea. On univariate analysis, measures of disease volume such as hormone sensitivity (p = 0.03), increasing involved node number (p = 0.008), and abdominal treatment (p = 0.03) were significantly associated with GI toxicity.ConclusionsWith the widespread adoption of PSMA agents, NORs are likely to increase. The optimal combination of local and systemic therapy in this population is unknown. With a favorable toxicity profile, IF-SBRT represents a safe and convenient local therapy treatment option for an elderly patient population. Patient- and treatment-related factors such as a large number of involved nodes and/or abdominal treatment may be associated with an increased risk of GI toxicity.

Abstract Yerba mate (Ilex paraguariensis St. Hil., Aquifoliaceae), a dioecious, subtropical, perennial tree found in South America, was hypothesized to exhibit secondary sexual dimorphism in relation to stomatal density (SD). The objective of this study was to examine the variability of SD in yerba mate leaves and its relationship to secondary sexual dimorphism as a first step towards identifying a genetic marker for gender determination in seedlings. Leaves from four male and four female plants were collected from two monoculture plantations, San Vicente and General Alvear, in the Misiones province, Argentina, during both flowering and vegetative latency periods. Results showed that SD was significantly higher in leaves from female than in male plants in both sites. Also, samples collected during the vegetative growth period have higher SD compared to flowering period. The findings indicate that the SD of yerba mate leaves varies based on gender and serves as a secondary marker for sexual determination in this species. We also discussed the impact of SD variability in photosynthesis rate between female and males.

Individuals utilizing Life Cycle Assessment within the emerging field of circular carbon might phrase and understand matters differently, causing ambiguity, due to different educational backgrounds and lacking definitions of central terms. Our research addresses the question, whether misleading or ambiguous terms exist, which impair transparency and scientific accuracy in carbon (dioxide) accounting in LCA. A structured literature research was performed to screen LCA standards, ISO standards, and the European legal database EUR-Lex. Nine terms with potential ambiguity in meaning or usage in LCA were identified: Avoided burden, avoided carbon, avoided CO2, carbon capture, carbon credit, circular carbon, circular CO2, negative emission, and net zero emission. A workflow was introduced to either obtain a consensus-based definition from standard literature or from peer-reviewed publications. For all terms, except avoided carbon, a recommended definition was found and showcased within case studies on the topic of mechanical recycling of plastics to produce a taxonomy suggestion for precise descriptions of different carbon dioxide (equivalent) accounting methods in LCA.

Introduction & Purpose Coaching is recognized as a complex socio-educational interaction (Jones, 2007), a view supported by the German Football Association (DFB). The DFB emphasizes reflection in the development of football coaches, seeing it as essential for the quality of coaching and the holistic development of youth players. Reflective competence (RC) is seen as a key component of professionalization (DFB, 2022), defined as the ability and willingness to comprehensively deal with one’s own knowledge and actions in breadth and to achieve a certain depth in the reflexive and transformative engagement with issues (Krieg & Kreis, 2014). Studies show that coaches learn primarily through observation and experience (Cushion, et al., 2012), which risks perpetuating outdated behaviors. Against this background, our study asks: What (breadth) and how (depth) do youth coaches reflect on their knowledge and coaching practice? Method Seven coaches from DFB selection centers in Bavaria participated in the study. Their training sessions were videotaped and used for reflection in stimulated recall interviews (Dempsey, 2010). Coaches were asked about their understanding of reflection using narrative prompts and to reflect independently on their training sessions using the video sequences. Analysis included categorizing the understanding and relevance of reflection, as well as the breadth and depth of reflection, taking into account individual differences. Result Coaches understood reflection as “thinking about oneself” or “looking back” to consciously justify or improve practices. They showed a high level of willingness to reflect, especially valuing peer feedback. In terms of breadth, coaches mostly reflected on corrective feedback behaviors, error patterns, or training alternatives. However, the depth of reflection was limited; coaches often moved to transformative reflection without deeply analyzing issues, lacking detailed descriptions against related assumptions, previous experiences, or theoretical explanations. Discussion Coaches focused primarily on optimizing practices rather than examining issues in depth. The breadth of reflection is consistent with the DFB's shift from coach-dominated to player-dominated training practices. Conclusion Our study highlights the critical role of reflection in the professional development of youth soccer coaches at DFB selection centers in Bavaria. While coaches show a significant willingness to engage in reflective practices, there is a notable deficiency in the depth of their reflection. This highlights the need for enhanced reflective training programs that encourage deeper, more comprehensive engagement with coaching practices and theoretical knowledge. By fostering such reflective competence, coaches can contribute to a more nuanced and effective coaching methodology, ultimately benefiting the holistic development of youth players. References Cushion, J., Ford, P., & Williams, M. (2012). Coach behaviours and practice structures in youth soccer: Implications for talent development. Journal of Sports Sciences, 30(15), 1631–1641. https://doi.org/10.1080/02640414.2012.721930 Dempsey, N. P. (2010). Stimulated recall interviews in ethnography. Qualitative Sociology, 33(3), 349-367. https://doi.org/10.1007/s11133-010-9157-x Deutscher Fußball Bund. (05.02.2022). DFB-Akademie startet mit neuem Ausbildungskonzept. https://www.dfb.de/news/detail/dfb-akademie-startet-mit-neuem-ausbildungskonzept-236675/ Jones, R. L. (2007). Coaching redefined: An everyday pedagogical endeavour. Sport, Education and Society, 12(2),159-173. https://doi.org/10.1080/13573320701287486 Krieg, M., & Kreis, A. (2014). Reflexion in Mentoringgesprächen – Ein Mythos? [Reflection in mentoring discussions - A myth?] Zeitschrift für Hochschulentwicklung, 9(1),103-117. https://doi.org/10.3217/zfhe-9-01/11

In the domain of precision livestock farming, the integration of diverse data sources is crucial for advancing sustainability and evaluating the implications of farm management practices on cow health. Addressing the challenge of data heterogeneity and management diversity, we propose a key-feature-based clustering method. This approach, merging knowledge-driven feature selection with unsupervised machine learning, enables the systematic investigation of management effects on cow health by forming distinct clusters for analysis. Utilizing data from 3,284 Austrian farms, including 80 features related to feeding, milking, housing, and technology systems, and health information for 56,000 cows, we show how this methodology can be applied to study the impact of technological systems on cow health resulting from the incidence of veterinary diagnoses. Our analysis successfully identified 14 distinct clusters, further divided into four main groups based on their level of technological integration in farm management: “SMART,” “TRADITIONAL,” “AMS (automatic milking system),” and “SENSOR.” We found that “SMART” farms, which integrate both AMS and sensor systems, exhibited a minimally higher disease risk for milk fever (OR 1.09) but lower risks for fertility disorders and udder diseases, indicating a general trend toward reduced disease risks. In contrast, farms with “TRADITIONAL” management, without AMS and sensor systems, showed the lowest risk for milk fever but the highest risk of udder disease (OR 1.12) and a minimally higher incidence of fertility disorders (OR 1.07). Furthermore, across all four groups, we observed that organic farming practices were associated with a reduced incidence of milk fever, udder issues, and particularly fertility diagnoses. However, the size of the effect varied by cluster, highlighting the complex and multifactorial nature of the relationship between farm management practices and disease risk. The study highlights the effectiveness of the key-feature-based clustering approach for high-dimensional data analyses aimed at comparing different management practices and exploring their complex relationships. The adaptable analytical framework of this approach makes it a promising tool for planning optimizing sustainable and efficient animal husbandry practices.

Abstract Quantitative assessment of cell migration in vitro is often required in fundamental and applied research from different biomedical areas including wound repair, tumor metastasis or developmental biology. A collection of assays has been established throughout the years like the most widely used scratch assay or the so-called barrier assay. It is the principle of these assays to introduce a lesion into an otherwise confluent monolayer in order to study the migration of cells from the periphery into this artificial wound and determine the migration rate from the time necessary for wound closure. A novel assay makes use of photosensitizers doped into a polystyrene matrix. A thin layer of this composite material is coated on the bottom of regular cell culture ware showing perfect biocompatibility. When adherent cells are grown on this coating, resonant excitation of the photosensitizer induces a very local generation of 1O2, which kills the cells residing at the site of illumination. Cells outside the site of illumination are not harmed. When excitation of the photosensitizer is conducted by microscopic illumination, high-precision wounding in any size and geometry is available even in microfluidic channels. Besides proof-of-concept experiments, this study gives further insight into the mechanism of photosensitizer-mediated cell wounding.

Abstract Objectives Peptidoglycan (PG) is an arthritogenic bacterial cell wall component whose role in human osteoarthritis is poorly understood. The purpose of this study was to determine if PG is present in synovial tissue of osteoarthritis patients at the time of primary total knee arthroplasty (TKA), and if its presence is associated with inflammation and patient reported outcomes. Methods Intraoperative synovial tissue and synovial fluid samples were obtained from 56 patients undergoing primary TKA, none of whom had history of infection. PG in synovial tissue was detected by immunohistochemistry (IHC) and immunofluorescence microscopy (IFM). Synovial tissue inflammation and fibrosis were assessed by histopathology and synovial fluid cytokine quantification. Primary human fibroblasts isolated from arthritis synovial tissue were stimulated with PG to determine inflammatory cytokine response. Results A total of 33/56 (59%) of primary TKA synovial tissue samples were positive for PG by IHC, and PG staining colocalized with markers of synovial macrophages and fibroblasts by IFM. Synovial tissue inflammation and elevated IL-6 in synovial fluid positively correlated with PG positivity. Primary human fibroblasts stimulated with PG secreted high levels of IL-6, consistent with ex vivo findings. Interestingly, we observed a significant inverse correlation between PG and age at time of TKA, indicating younger age at time of TKA was associated with higher PG levels. Conclusion Peptidoglycan is commonly found in synovial tissue from patients undergoing TKA. Our data indicate that PG may play an important role in inflammatory synovitis, particularly in patients who undergo TKA at a relatively younger age.