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Abstract Government-based policy labs have established themselves across the Canadian policy landscape. This article argues these labs contribute to public value management. We begin by reviewing the public value management [...]

Background:. Facial skin cancer and its surgical treatment can affect health-related quality of life. The FACE-Q Skin Cancer Module is a patient-reported outcome measure that measures different aspects of health-related quality of life and has recently been translated into Dutch. This study aimed to evaluate the performance of the translated version in a Dutch cohort using modern psychometric measurement theory (Rasch). Methods:. Dutch participants with facial skin cancer were prospectively recruited and asked to complete the translated FACE-Q Skin Cancer Module. The following assumptions of the Rasch model were tested: unidimensionality, local independence, and monotonicity. Response thresholds, fit statistics, internal consistency, floor and ceiling effects, and targeting were assessed for all scales and items within the scales. Responsiveness was tested for the “cancer worry” scale. Results:. In total, 259 patients completed the preoperative questionnaire and were included in the analysis. All five scales assessed showed a good or sufficient fit to the Rasch model. Unidimensionality and monotonicity were present for all scales. Some items showed a local dependency. Most of the scales demonstrate ordered item thresholds and appropriate fit statistics. Conclusions:. The FACE-Q Skin Cancer Module is a well-designed patient-reported outcome measure that shows psychometric validity for the translated version in a Dutch cohort, using classical and modern test theory.

Out of all the complex systems in science education curricula, cellular respiration is considered to be one of the most complex and abstract processes. Students are known to have low interest and difficulties in conceptual understanding of cellular respiration which provides a challenge for teaching and learning. In this study, we took literature about modelling and teaching and learning cellular respiration as a starting point for the design of a concrete dynamic model in which students (n = 126) use Lego® to simulate the process of cellular respiration. Students used the simulation embedded in the context of finding the efficiency of a sediment battery as a future source of green energy and we tested the effects on conceptual learning and situational interest in an experimental study. Results on conceptual learning show that both experimental and control groups had comparable results in the test. The questions that students in the experimental group asked during enactment, however, gave notice of a focus on both isolated component parts as well as modes of organization at higher organizational levels which is linked to how biologists mechanistically understand complex systems. Both groups report a similar high measure to which the topic is meaningful in real life (situational interest value), whereas the enjoyment (situational interest feeling) was significantly increased in the experimental group. Furthermore, students report specific advantages (e.g., I now understand that one acid chemically changes into another and they do not just transfer atoms) and disadvantages (e.g., time issues).

Promoting problem-solving in students is an important aim of secondary science education. There is a mismatch, however, between the complex, ill-structured nature of realistic scientific problems, versus the well-structured problems students are generally confronted with. The current study investigates a teaching-learning strategy that resolves this mismatch by combining a focus on "hierarchical problem-solving strategies" for complex, authentic problems with the use of domain-specific question agendas that represent "scientific perspectives." Three design principles were applied to develop an exemplary lesson series that was implemented in two Dutch pre-university classes. A pre-/post-test research design was followed in which data was collected in the form of sets of student-generated research questions. Additionally, audio recordings of lessons and student interviews were collected and analysed. Results indicate that participating students became more proficient at applying "hierarchical problem-solving strategies" like (1) reducing complex ecological problems to more manageable subproblems by formulating productive research questions and (2) identifying types of ecological problems by connecting them to domain-specific question agendas (problem-abstraction). A qualitative analysis of the teaching-learning process and student interviews informed potential refinements of the design principles, namely the use of more diverse contexts and a greater focus on collaborative learning.

Background: Guidelines recommend operative treatment followed by cast immobilization for acute complete ulnar collateral ligament (UCL) ruptures, including Stener lesions. This recommendation is based on expert opinion, anatomic theories, and low-quality observational case series. High-quality studies comparing non-operative treatment to operative treatment are lacking. We hypothesize that primarily non-operative treatment with cast immobilization (cast immobilization) is non-inferior regarding functional outcome and carries concomitant lower costs compared with immediate operative treatment followed by cast immobilization (operative treatment) for complete UCL ruptures, including Stener lesions. Methods: This is a multicenter randomized controlled non-inferiority trial (RCT) including patients of 18 years and above, requiring treatment for an acute complete UCL rupture, including Stener lesions. Patients are randomized to cast immobilization or operative treatment followed by cast immobilization. Immobilization consists of 4 weeks of a non-removable cast around the metacarpophalangeal (MCP) and carpometacarpal (CMC) joint of the thumb in a neutral position, followed by a removable cast for 4 weeks for both groups. Patients in the cast immobilization group are re-evaluated 2 to 3 weeks after the start of cast immobilization to examine thumb stability and determine if secondary surgery is required. In case of persistent laxity, secondary surgery is required. The primary outcome is hand function expressed as the Michigan Hand outcome Questionnaire (MHQ) at 6 months (from injury to 6 months after). Discussion: If cast immobilization is non-inferior to operative treatment, the proposed treatment strategy will reduce patient burden by preventing surgery. It is expected that about one in ten patients who started with cast immobilization will need secondary surgery during re-evaluation. As a result, completion of the treatment will take longer for these patients compared to patients who received immediate operative treatment. Trial registration: Central Committee on Research Involving Human Subjects (CCMO), NL78886.100.21; registered on 4 October 2021. Medical Research Ethics Committees United (MEC-U), R21.006; registered on 09 December 2021. Clinical Trial register, identifier: NCT05291260; retrospectively registered on 22 March 2022. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal disease with a dismal prognosis. However, while most patients die within the first year of diagnosis, very rarely, a few patients can survive for >10 years. Better understanding the molecular characteristics of the pancreatic adenocarcinomas from these very-long-term survivors (VLTS) may provide clues for personalized medicine and improve current pancreatic cancer treatment. To extend our previous investigation, we examined the proteomes of individual pancreas tumor tissues from a group of VLTS patients (survival ≥10 years) and short-term survival patients (STS, survival

Comprehensive analysis of tumor infiltrating myeloid cells in the tumor microenvironment of penile squamous cell carcinoma (PSCC) is lacking. In this retrospective study, for the first time, PSCC resection specimens (N = 103) were annotated into the following compartments: intratumoral tumor (IT Tumor), intratumoral stroma (IT Stroma), peritumoral tumor (PT Tumor) and peritumoral stroma (PT Stroma) compartments. We then quantified CD14+, CD68+ and CD163+ myeloid cells within these compartments using an image analysis software and assessed their association with various clinical parameters, including high-risk human papillomavirus (hrHPV) status. In the total cohort, hrHPV status, grade of differentiation, age and tumor size were associated with myeloid cell densities. hrHPV+ tumors had higher infiltration rates of CD14+, CD68+ and CD163+ myeloid cells in the IT tumor compartment (p < 0.001, for all) compared to hrHPV− tumors. Furthermore, when examining the association between compartment-specific infiltration and differentiation grade, increased myeloid cell densities in the IT tumor compartment were associated with a more advanced histological grade (p < 0.001, for all). This association remained significant when the hrHPV− cohort (N = 60) was analyzed (CD14+ p = 0.001; CD68+ p < 0.001; CD163+ p = 0.004). Subgroup analysis in the hrHPV+ group (N = 43) showed that high infiltration rates of CD68+ and CD163+ cells in the PT tumor compartment were associated with lymph node (LN) metastasis (p = 0.031 and p = 0.026, respectively). Regarding the association between myeloid cell densities and disease-specific survival, the risk of death was found to decrease slightly as the number of myeloid cells in the IT tumor compartment increased (CD14+ p = 0.04; CD68+ p = 0.05; CD163+ p = 0.02). However, after adjusting for hrHPV, no independent association between myeloid densities and disease-specific survival were found. Altogether, these findings demonstrate the importance of assessing myeloid cell densities within the spatial context of the tumor. Further studies are needed to unravel the specific phenotype of myeloid cells residing in the different compartments, their effect on clinical parameters and the impact of hrHPV on the recruitment of myeloid cell populations in PSCC.

This study explores Jesus' ideas about peacebuilding in their historical context. The study considers Jesus' teaching within the context of the conflict of first-century Palestine at its center. Jesus conceptualizes peace in the context of the kingdom of God and prioritizes peace over justice. The principles for Jesus' strategy for peacebuilding are motivated by compassion, love, identity, forgiveness, and peace itself as a superior reality. The practical implications of these include reset of conflict realities, recognition of ambivalence of conflict and peace, building a culture of peace in the presence of conflict, reconciliation, repentance, and forgiveness, and human free will. The study identifies four conflict barriers that contribute to present-day conflict perpetuation: a destructive emotional orientation, a compromised vision for peace, compromised pragmatic ethics, and an ethnocentric view of peace. [ABSTRACT FROM AUTHOR]