Assessment of Clinical Scales for Detection of Large Vessel Occlusion in Ischemic Stroke Patients from The Dijon Stroke Registry

(1) Background: The limited availability of thrombectomy-capable stroke centres raises questions about pre-hospital triage of patients with suspected stroke (IS) due to large vessel occlusion (LVO). Aims: This study aimed to evaluate the diagnostic accuracy of clinical stroke severity scales available for LVO detection. (2) Methods: Patients with IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). Clinical signs and arterial imaging data were collected. LVO was defined as an occlusion site affecting the terminal intracranial internal carotid artery, the M1 segment of the middle cerebral artery (MCA), or the basilar artery (restricted definition). A wide definition of LVO also included the M2 segment of the MCA. For each of the 16 evaluated scales, a receiver operator characteristic (ROC) analysis was performed, and the c-statistic representing the area under the ROC curve was evaluated to assess discrimination for predicting LVO. (3) Results: 971 patients were registered, including 123 patients (12.7%) with an LVO according to the restricted definition. The c-statistic for LVO detection ranged between 0.66 and 0.80 according to the different scales, with a sensibility varying from 70% to 98% and a specificity from 33% to 86%. According to the wide definition of LVO (174 patients, 17.9%), the c-statistic was slightly lower, ranging between 0.64 and 0.79. The sensitivity was 59% to 93%, and the specificity was 34% to 89%. (4) Conclusion: The clinical scales failed to combine a high sensitivity and a high specificity to detect LVO. Further studies are needed to determine the best strategy for pre-hospital triage of IS patients.

Indigenous Peoples and Traditional Local Communities’ Mobilisation to Regain Control: The Role of Human Rights

The article reviews trends in international non-binding standards: 1) the equalisation of indigenous peoples and local communities as rights-holders; 2) the strength and weakness of the safeguards approach in the context of redd+; 3) the wide definition of who constitutes stakeholders; and 4) the scope of a due diligence requirement. The article identifies and discusses two approaches: 1) mobilisation, understood as political or legal pressure exerted upon endogenous actors by other endogenous actors, and where international human rights serve as the norm basis for this pressure. 2) control, implying that power asymmetries in relation to external actors are challenged by alliances with human rights organisations and environmental organisations. Both benefit from being embedded in human rights principles: dignity, non-discrimination, rule of law, accountability, transparency, participation and empowerment. Human rights might, however, lead to tensions internally, as these principles can conflict with customary and exclusionary decision-making procedures.

Measures of Decision Aid Quality Are Preference-Sensitive and Interest-Conflicted – 1: Normative Measures

The belief that following rigorous inclusive methods will eliminate bias from ‘quality’ measures ignores the preferences necessarily embedded in any formative instrument. These preferences almost always reflect the interests of its developers when one uses the wide definition of ‘interest’ appropriate in healthcare research and provision. We focus on the International Patient Decision Aid Standards instrument, a popular normative measure of decision aid quality. Drawing on its application to a set of 23 breast cancer screening decision aids, we show the effects of modifications that reflect our own different interest-conflicted preferences. It is emphasised that the only objection is to the implication that any formative instrument should be promoted or treated as the ‘the gold standard’, without a conflict of interests disclaimer, and to the implication that other instruments cannot provide equally valid, high-quality measures.

Realising supply chain resilience: an exploratory study of Irish firms' priorities in the wake of Brexit

PurposeThe purpose of this research is to validate an industry-wide definition of supply chain resilience (SCRES) within the Irish supply chain sector and measure the key elements of SCRES and their relative importance for Irish firms in light of Brexit.Design/methodology/approachSurvey method is used in this research. Data were collected from supply chain managers in Irish firms. Findings were analysed in accordance with industry sector and exposure to Brexit.FindingsThe results from the respondents confirm a willingness to define and utilise SCRES under a four-phase cycle; ready, respond, recover and grow. Focus on SCRES enablers shifts in accordance with cycle position. Understanding cycle position is paramount for successful execution of a SCRES strategy. Findings can be used as a basis for the development, implementation and management of a SCRES strategy.Research limitations/implicationsResearch was conducted at one specific point during Brexit negotiations. Sector specific and longitudinal studies are required to build upon this exploratory study.Practical implicationsSupply chain managers must ensure that phase position and enabler implementation are aligned to maximise the investment in a SCRES strategy. As a disruption event and its associated response evolve, management must demonstrate an ability to deploy and focus efforts on different SCRES enablers throughout the four-phase cycle.Originality/valueThis is the first research focussing on an industry-wide accepted definition of SCRES and its key enablers within Irish supply chains.

The role of endoscopic ultrasound guidance for biliary and pancreatic duct access and drainage to overcome the limitations of ERCP: a retrospective evaluation

Background Endoscopic ultrasound (EUS)-guided ductal access and drainage (EUS-DAD) of biliary/pancreatic ducts after failed endoscopic retrograde cholangiopancreatography (ERCP) is less invasive than percutaneous transhepatic biliary drainage (PTBD). The actual need for EUS-DAD remains unknown. We aimed to determine how often EUS-DAD is needed to overcome ERCP failure. Methods Consecutive duct access procedures (n = 2205; 95 % biliary) performed between June 2013 and November 2015 at a tertiary-care center were reviewed. ERCP was used first line, EUS-DAD as salvage after ERCP, and PTBD when both had failed. Procedures were defined as “index” in patients without prior endoscopic duct access and “combined” when EUS-DAD followed successful ERCP. The main outcomes were the EUS-DAD and PTBD rates. Results EUS-DAD was performed in 7.7 % (170/2205) of overall procedures: 9.1 % (116/1274) index and 5.8 % (54/931) follow-up. Most index EUS-DADs were performed following (46 %) or anticipating (39 %) ERCP failure, whereas 15 % followed successful ERCP (combined procedures). Among index procedures, the EUS-DAD rate was higher in surgically altered anatomy (58.2 % [39 /67)] vs. 6.4 % [77/1207]); PTBD was required in 0.2 % (3/1274). Among follow-up procedures, ERCP represented 85.7 %, cholangiopancreatography through mature transmural fistulas 8.5 %, and EUS-DAD 5.8 %; no patient required PTBD. The secondary PTBD rate was 0.1 % (3/2205). Six primary PTBDs were performed (overall PTBD rate 0.4 % [9/2205]). Conclusions EUS-DAD was required in 7.7 % of ERCPs for benign and malignant biliary/pancreatic duct indications. Salvage PTBD was required in 0.1 %. This high EUS-DAD rate reflects disease complexity, a wide definition of ERCP failure, and restrictive PTBD use, not poor ERCP skills. EUS-DAD effectively overcomes the limitations of ERCP eliminating the need for primary and salvage PTBD in most cases.

Analisis Kritis Terhadap Pandangan Sarjana Dalam Mendefinisikan Manhaj, Uslub Dan Wasilah Dakwah

Terdapat tiga istilah yang sering kali disebut oleh para sarjana dalam membincangkan metode dakwah iaitu manhaj, uslub, dan wasilah. Mereka berbeza pandangan dalam mendefinisikan setiap satu terma berkenaan. Ada yang memberikan definisi yang luas dan ada pula yang memberikan definisi yang agak sempit. Ada yang mendefinisikan metode dalam dakwah sebagai manhaj, tetapi ada pula yang mendefinisikannya sebagai uslub. Perbezaan dalam mendefinisikan perkara ini menyebabkan perbezaan terma tetapi pada hakikatnya merujuk kepada aspek yang sama sahaja. Metode kepustakaan digunakan bagi membincangkan perbezaan pandangan berkenaan. Hasil utama perbincangan mendapati metode dakwah terbahagi kepada tiga tingkatan yang mewakili 3 istilah tersebut; pertama, manhaj bagi menentukan tujuan dari sesuatu usaha dakwah, kedua, uslub iaitu pendekatan yang dijalankan, dan ketiga, wasilah iaitu merujuk kepada medium atau saluran yang digunakan. Abstract There are three terms that usually used by scholars in discussion on method of da’wah namely, manhaj, uslūb and wasīlah. They have different views in defining each of these terms. Some scholars provide a wide definition while others provide a narrow definition. Some define method as manhaj, but some define the same method as the uslūb. Difference perspective in defining this matter led to the different terms but the essence of the subject is same. Library research method is used to discuss different view among scholars on this matter. The result found that the method of da’wah could be divided into three levels; the first is manhaj to determine the direction of a da’wah that is called manhaj, the approach used that is called uslūb and the medium used is that called wasīlah. The difference among scholars in expressing method da'wah is only in terminology chosen, not in the essence because they agree that da'wah should be done with the appropriate methods and approaches that may differ according to nature of target groups. Different approaches are inevitable because da’wah could be seen from many perspectives.

School Principals Putting Bullying Policy to Practice

School principals must rely on state statutes and district policies to navigate reports of school bullying. Investigating reports to determine the outcomes may vary depending upon the districts definition of bullying, the investigation process, and follow through to reporting the findings of the investigation to the involved children and youth’s parents. However, investigating reports can be challenging due to the confusion of what constitutes bullying. This confusion can be especially troubling for parents who believe their child is being bullied. In order to understand principals' perspectives on bullying, two focus groups were conducted with nine urban school principals. Researchers examined principals’ perceptions of how state- and district-level policies were used within their bully investigation practices. These principals suggest that a clear, specific district wide definition of bullying and step by step procedures to investigate reports, along with the state anti-bullying statute, provide a valuable guide for follow-through and back up in determining cases of school bullying. In addition, they identified how policies and district mandates affected parents, particularly when reporting their investigation findings. Implications for bully prevention policies are discussed.

‘Our dream is simple: Peace, safe and freedom’: Regime-critical activism and artistic expression by Syrians in Denmark and Sweden

This article seeks to understand mediatized dynamics of regime-critical activism and cultural performances by Syrians in Europe. The focus of this research is on the Öresund-region between Denmark and Sweden. Sweden was the first country in Europe to give immediate permanent residence to Syrian refugees. It initially received most of the Syrian refugees in 2015. After the arrival of large groups of Syrians at Malmö station in that year, a growing network of volunteers responded to the influx of refugees. Syrians started to build relationships with local activists and have since joined in organizing publicly mediated events, creating a new landscape for creative industries and performance arts in the region. Applying a protest communication ecology approach, I use a wide definition of media which includes the aesthetics of street demonstrations, performance arts and music, mediated and communicated through digital online platforms. I apply an adjusted concept of communitas, including digital media and online communication as analytical concept to observe and describe not only how communitas is re-formed between Syrian refugees after arrival but also how it emerges between Syrians and local hosts.

Civil society and the European Union. From enthusiasm to disenchantment

This paper adopts the wide definition of civil society, namely the one suggested by the EU. It includes all sorts of private collectives from producer groups, trade unions, care and common cause organizations, NGOs, to social and protest movements. Distinguishing between a structural (governance) and an actor-centred perspective (collective action) and, orthogonally, two levels of territorial complexity (the sub-, and the supranational), the history of the relationship between the EU and civil society is presented for the period of the past 35 years. It turns out that despite enormous efforts invested in the relationship from the part of both sides, and of many heroic declamations aimed at pathbreaking reform, the outcome tends to be relatively meagre and disenchanting both in institutional and organizational terms.

An evidence-based framework for identifying technologies of no or low-added value (NLVT)

ObjectiveTo synthetize the state of the art of methods for identifying candidate technologies for disinvestment and propose an evidence-based framework for executing this task.MethodsAn interpretative review was conducted. A systematic literature search was performed to identify secondary or tertiary research related to disinvestment initiatives and/or any type of research that specifically described one or more methods for identifying potential candidates technologies, services, or practices for disinvestment. An iterative and critical analysis of the methods described alongside the disinvestment initiatives was performed.ResultsSeventeen systematic reviews on disinvestment or related terms (health technology reassessment or medical reversal) were retrieved and methods of 45 disinvestment initiatives were compared. On the basis of this evidence, we proposed a new framework for identifying these technologies based on the wide definition of evidence provided by Lomas et al. The framework comprises seven basic approaches, eleven triggers and thirteen methods for applying these triggers, which were grouped in embedded and ad hoc methods.ConclusionsAlthough identification methods have been described in the literature and tested in different contexts, the proliferation of terms and concepts used to describe this process creates considerable confusion. The proposed framework is a rigorous and flexible tool that could guide the implementation of strategies for identifying potential candidates for disinvestment.