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Abstract Background Driving after cannabis use (DACU) is associated with increased risk of motor vehicle collisions. As cannabis legalization expands, DACU is emerging as a major public safety concern. Attitudes have a significant impact on behavioural decision making. As such, understanding the degree to which people have favorable or unfavorable evaluations of DACU is an important first step for informing prevention efforts. This systematic review summarizes existing evidence on attitudes toward DACU, their association with actual or intended DACU, and changes in attitudes following legalization of recreational cannabis. Methods Four electronic databases (MEDLINE, EMBASE, PsycINFO, and TRID) were searched for studies that reported attitudes or changes in attitudes toward DACU published between their inception dates and February 26 2024. A total of 1,099 records were retrieved. Studies were analyzed using an inductive thematic synthesis approach. Results Seventy studies from seven countries originating predominantly from the United States and Canada met inclusion criteria. Thematic analysis identified six themes. (I) Attitudes toward the safety and acceptability of DACU are mixed; participants in 35 studies predominantly expressed negative attitudes toward DACU (e.g., DACU is dangerous, affects driving ability, and increases crash risk). However, 20 studies reported opposing views. (II) Attitudes toward DACU vary by age, sex/gender, and cannabis use frequency; youth, men, and frequent cannabis users tended to view DACU more favorably than older participants, women, and occasional or non-users. (III) Attitudes toward DACU are associated with past DACU and intention to DACU. (IV) DACU is viewed more favorably than driving after drinking alcohol. (V) The relationship between legal status of recreational cannabis and attitudes toward DACU is unclear. (VI) Perceived risk of apprehension for DACU is low to moderate. Conclusions This review found that perceptions of DACU are primarily negative but mixed. Findings suggest that attitudes toward DACU are important targets for interventions to reduce this behaviour.

This paper explores the school culture and sense of community of a Midwestern middle school after seven years of personalized learning reform. This mixed method study identified a strong school culture based on the School Culture Triage Survey. Focus group interviews supported the survey findings and attributed the successful implementation and expansion of the personalized learning program to affiliative collegiality, autonomy/innovation, being student-centered, and intentional. These findings can be powerful for any school in instituting personalized or customized learning models.

BACKGROUND: The Scale for Assessment and Rating of Ataxia (SARA) is a widely used clinical scale to assess cerebellar ataxia but faces some criticisms about the relevancy of all its items. OBJECTIVES: To prepare for future clinical trials, we analyzed the progression of SARA and its items in several polyQ spinocerebellar ataxias (SCA) from various cohorts. METHODS: We included data from patients with SCA1, SCA2, SCA3, and SCA6 from four cohorts (EUROSCA, RISCA, CRC-SCA, and SPATAX) for a total of 850 carriers and 3431 observations. Longitudinal progression of the SARA and its items was measured. Cohort, stage and genetic effects were tested. We looked at the respective contribution of each item to the total scale. Sensitivity to change of the scale and the impact of item removal was evaluated by calculating sample sizes needed in various scenarios. RESULTS: Longitudinal progression was significantly different between cohorts in SCA1, SCA2 and SCA3, the EUROSCA cohort having the fastest progression. Advanced-stage patients were progressing slower in SCA2 and SCA6. Items were not contributing equally to the full scale through ataxia severity: gait, stance, hand movement, and heel-shin contributed the most in the early stage, and finger-chase, nose-finger, and sitting in later stages. Few items drove the sensitivity to the change of SARA, but changes in the scale structure could not improve its sensitivity in all populations. CONCLUSION: SARA and its items progression pace showed high heterogeneity across cohorts and SCAs. However, no combinations of items improved the responsiveness in all SCAs or populations taken separately.

Purpose: Eulerian video magnification (EVM)+waveform is a novel video processing software that enhances visualization of tissue perfusion and has been shown to improve hand surgeon identification of ischemia via video alone. The purpose of this study is to determine whether EVM+waveform technology will support improved accuracy in identifying hand ischemia for less experienced persons, regardless of the evaluator’s health care experience or the melanin content of the hand in the video. Methods: Healthy volunteers were recruited for us to record videos of their hands both perfused and under tourniquet-induced ischemia. Videos were processed with EVM+waveform and inserted into a 26-question survey. There were two types of questions presented in each survey. One format showed a video processed with EVM+waveform, and the respondent was asked if the hand was ischemic, perfused, or if they were unsure. The second format presented two side-by-side videos, one ischemic and one perfused. Both were processed with EVM+waveform, and the respondent had to choose which was ischemic. Respondents included both medical and non-medical professionals none of whom had experience with hand surgery. Results: A total of 64 survey responses were recorded. The EVM+waveform technology significantly improved accuracy in determining ischemia regardless of the respondent’s health care experience. Respondents were divided into medical doctorate (MD; n = 15) and non-MD (n = 49) groups. Both groups demonstrated significant improvement in determining ischemia when using EVM+waveform. Within the non-MD cohort, accuracy percentages significantly improved across Fitzpatrick types IV, V, and VI. Within the MD cohort, accuracy percentages significantly improved across Fitzpatrick types III, V, and VI. Conclusions: These findings further establish EVM+waveform as an effective modality for identifying ischemia via video alone, as it enhanced performance for inexperienced evaluators. EVM+waveform is effective for assessing various skin types, especially those with higher skin melanin content. Type of study/level of evidence: Diagnostic, IV.

OBJECTIVE: Obstructive sleep apnea (OSA) has many treatment options and the Internet is an important resource for patients. The quality of information reviewed by patients about sleep surgery is unknown. We assessed readability, accessibility, actionability, and quality of online content for OSA surgeries. STUDY DESIGN: Review of webpages by 2 independent reviewers. SETTING: Internet-based search. METHODS: We queried Google for sleep apnea surgery and included top 100 English language webpages. Content was scored by 2 reviewers using the Flesch-Kincaid (FK), Simple Measure of Gobbledygook (SMOG), JAMA benchmarks, CDC Clear Communication Index (CCI), and Patient Education Materials Assessment Tool (PEMAT) understandability and actionability scores. RESULTS: Eighty-seven webpages were evaluated including 40 hosted by academic hospitals, 23 private practices, 10 general knowledge, 4 national organizations, 3 industry, 3 non-profit hospitals, and 2 government-sponsored. Mean CCI ranged from 22.7% to 84.9%. No sources met the 90% CCI cutoff. Average PEMAT understandability score was 80.4% (±7.8; 62.5%-93.3%), with 91% meeting the 70% standard score. Average PEMAT-actionability score was 38.4% (±16.5; 0%-70%), with 5% meeting the standard score. The average readability of webpages was the 10th grade reading level. Only 5% of pages met the recommended 6th grade reading level or lower. Only 21% of pages addressed surgical risks. CONCLUSION: Most online resources regarding OSA surgery do not meet recommended standards for communication. Providers should be aware of limitations of materials when counseling patients on sleep surgery treatments. Future patient education resources should meet health communication and readability standards.

Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilitate a future consensus-based statement (e.g. via a modified Delphi) and series of recommendations. The panel convened weekly online meetings from October 2021 to December 2022. Research considerations addressed the nosographic status of disorders of consciousness, case ascertainment and verification, selection of dependent variables, choice of covariates and measurement and analysis of outcomes and covariates, aiming to promote more homogeneous designs and practices in future observational studies. The goal of this review is to inform a broad community of professionals with different backgrounds and clinical interests to address the methodological challenges imposed by the transition of care from acute to chronic stages and to streamline data gathering for patients with disorders of consciousness. A coordinated effort will be a key to allow reliable observational data synthesis and epidemiological estimates and ultimately inform condition-modifying clinical trials.

Teacher education programs help preservice teachers develop their identities through various curricular practices, including field experiences. The COVID-19 pandemic impacted teacher education programs as they were pressed to coordinate virtual field experiences. This intrinsic case study explored how virtual field experiences coupled with structured reflection practices shaped teacher identity development of preservice Career and Technical Education (CTE) students at the sophomore and senior levels. CTE preservice teachers were selected for this study due to the inherent nature of CTE teachers to include technical and hands-on learning. Qualitative analysis of student check-in meeting reflections revealed four themes: (1) Prior field experiences shaped attitude and approach to the virtual environment; (2) Initial reluctance gave way to envisioned success; (3) The virtual environment changes relationships; (4) Additional opportunities for critical reflection contributed to building CTE teacher identity. Quantitative data from post-experience surveys indicated the impact of virtual field experiences on certain components of teacher identity and efficacy. Recommendations for practice include helping preservice teachers develop skills and confidence regarding the development of student-to-teacher relationships and providing future preservice teachers with brief, high-quality virtual field experiences to better prepare them for the changing landscape of education.

Sustainable Development Goal 5 challenges governments to address child marriage, which may inhibit girls from developing an agentic self. This paper assesses the direct influence of community gender norms on adolescent agency, and the normative contexts in which gender gaps in adolescent agency are larger or smaller in Nepal. Using baseline data for adolescent girls, adolescent boys, and adults in 54 clusters participating in the CARE Tipping Point Trial, multilevel analysis tested whether: adolescent boys had higher agency than girls; and community gender norms among adults "partly accounted for or modified" gender gaps in adolescent agency. Gender gaps in agency disfavoring girls were common. Community gender norms were more positively associated with intrinsic agency among girls than boys, and more negatively associated with instrumental and collective agency among girls than boys. Enhancing girls' agency while promoting gender-equitable community norms may empower girls' transition to adulthood.

This article examines the growing influence of Chinese investments in Latin America, focusing on Venezuela and Argentina. It explores how these countries benefit from Chinese capital and how this investment impacts their economies. Venezuela has relied on oil-backed loans to sustain its political system, worsening its economic challenges. In contrast, Argentina has channeled Chinese investment into infrastructure, including hydroelectric dams, nuclear plants, railway modernization, and energy diversification projects. The study highlights that while infrastructure investment can enhance economic stability and reduce reliance on further loans, both countries remain vulnerable due to their dependence on raw material exports. Despite these challenges, the study underscores that with institutional improvements and a shift toward diversification, such investments can contribute to sustainable growth in both nations. A qualitative research approach using secondary sources was employed to analyze the long-term implications of Chinese investments in these two economies.

IntroductionIntravenous non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in healthcare settings, but their comparative safety and resource utilization impacts remain understudied. This study aimed to compare adverse drug reactions (ADRs) and healthcare resource utilization (HCRU) between patients receiving IV-ibuprofen versus IV/IM ketorolac.MethodsA retrospective, longitudinal analysis was conducted using an all-payer database, examining records from January 1, 2014, to June 3, 2023. The study included both adult (≥18 years) and pediatric (

BackgroundEvaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).MethodsUsing previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.ResultsThe ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.ConclusionThis review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

BACKGROUND AND OBJECTIVES: In spinocerebellar ataxia, ataxia onset can be preceded by mild clinical manifestation, cerebellar and/or brainstem alterations, or biomarker modifications. READISCA is a prospective, longitudinal observational study of patients with spinocerebellar ataxia type 1 (SCA1) and 3 (SCA3) to provide essential markers for therapeutic interventions. We looked for clinical, imaging, or biological markers that are present at an early stage of the disease. METHODS: We enrolled carriers of a pathologic ATXN1 or ATXN3 expansion and controls from 18 US and 2 European ataxia referral centers. Clinical, cognitive, quantitative motor, neuropsychological measures and plasma neurofilament light chain (NfL) measurements were compared between expansion carriers with and without ataxia and controls. RESULTS: We enrolled 200 participants: 45 carriers of a pathologic ATXN1 expansion (31 patients with ataxia [median Scale for the Assessment and Rating of Ataxia: 9; 7-10] and 14 expansion carriers without ataxia [1; 0-2]) and 116 carriers of a pathologic ATXN3 expansion (80 patients with ataxia [7; 6-9] and 36 expansion carriers without ataxia [1; 0-2]). In addition, we enrolled 39 controls who did not carry a pathologic expansion in ATXN1 or ATXN3. Plasma NfL levels were significantly higher in expansion carriers without ataxia than controls, despite similar mean age (controls: 5.7 pg/mL, SCA1: 18.0 pg/mL [p < 0.0001], SCA3: 19.8 pg/mL [p < 0.0001]). Expansion carriers without ataxia differed from controls by significantly more upper motor signs (SCA1 p = 0.0003, SCA3 p = 0.003) and by the presence of sensor impairment and diplopia in SCA3 (p = 0.0448 and 0.0445, respectively). Functional scales, fatigue and depression scores, swallowing difficulties, and cognitive impairment were worse in expansion carriers with ataxia than those without ataxia. Ataxic SCA3 participants showed extrapyramidal signs, urinary dysfunction, and lower motor neuron signs significantly more often than expansion carriers without ataxia. DISCUSSION: READISCA showed the feasibility of harmonized data acquisition in a multinational network. NfL alterations, early sensory ataxia, and corticospinal signs were quantifiable between preataxic participants and controls. Patients with ataxia differed in many parameters from controls and expansion carriers without ataxia, with a graded increase of abnormal measures from control to preataxic to ataxic cohorts. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov NCT03487367.

OBJECTIVE: This study was undertaken to identify magnetic resonance (MR) metrics that are most sensitive to early changes in the brain in spinocerebellar ataxia type 1 (SCA1) and type 3 (SCA3) using an advanced multimodal MR imaging (MRI) protocol in the multisite trial setting. METHODS: SCA1 or SCA3 mutation carriers and controls (n = 107) underwent MR scanning in the US-European READISCA study to obtain structural, diffusion MRI, and MR spectroscopy data using an advanced protocol at 3T. Morphometric, microstructural, and neurochemical metrics were analyzed blinded to diagnosis and compared between preataxic SCA (n = 11 SCA1, n = 28 SCA3), ataxic SCA (n = 14 SCA1, n = 37 SCA3), and control (n = 17) groups using nonparametric testing accounting for multiple comparisons. MR metrics that were most sensitive to preataxic abnormalities were identified using receiver operating characteristic (ROC) analyses. RESULTS: Atrophy and microstructural damage in the brainstem and cerebellar peduncles and neurochemical abnormalities in the pons were prominent in both preataxic groups, when patients did not differ from controls clinically. MR metrics were strongly associated with ataxia symptoms, activities of daily living, and estimated ataxia duration. A neurochemical measure was the most sensitive metric to preataxic changes in SCA1 (ROC area under the curve [AUC] = 0.95), and a microstructural metric was the most sensitive metric to preataxic changes in SCA3 (AUC = 0.92). INTERPRETATION: Changes in cerebellar afferent and efferent pathways underlie the earliest symptoms of both SCAs. MR metrics collected with a harmonized advanced protocol in the multisite trial setting allow detection of disease effects in individuals before ataxia onset with potential clinical trial utility for subject stratification. ANN NEUROL 2023;93:686-701.

The bombardment of information on students in higher education has created a need for not only information processing skills but improved communicative competence and interpersonal relationship skills. In an attempt to address this, we have implemented book clubs in our undergraduate teacher education courses. In these book clubs, we facilitate students in both critique and analysis of perspectives at difference with one another as well as the process of communicating on a professional level. The results have been students who feel more confident in evaluating literature and hosting conversations with critical elements.