The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians

Background Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews. Results Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands. Conclusions Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes.

The Implementation of TNFRSF Co-Stimulatory Domains in CAR-T Cells for Optimal Functional Activity

The Tumor Necrosis Factor Receptor Superfamily (TNFRSF) is a large and important immunoregulatory family that provides crucial co-stimulatory signals to many if not all immune effector cells. Each co-stimulatory TNFRSF member has a distinct expression profile and a unique functional impact on various types of cells and at different stages of the immune response. Correspondingly, exploiting TNFRSF-mediated signaling for cancer immunotherapy has been a major field of interest, with various therapeutic TNFRSF-exploiting anti-cancer approaches such as 4-1BB and CD27 agonistic antibodies being evaluated (pre)clinically. A further application of TNFRSF signaling is the incorporation of the intracellular co-stimulatory domain of a TNFRSF into so-called Chimeric Antigen Receptor (CAR) constructs for CAR-T cell therapy, the most prominent example of which is the 4-1BB co-stimulatory domain included in the clinically approved product Kymriah. In fact, CAR-T cell function can be clearly influenced by the unique co-stimulatory features of members of the TNFRSF. Here, we review a select group of TNFRSF members (4-1BB, OX40, CD27, CD40, HVEM, and GITR) that have gained prominence as co-stimulatory domains in CAR-T cell therapy and illustrate the unique features that each confers to CAR-T cells.

Non-surgical management of thyroid nodules – the role of ablative therapies

Context After a thorough evaluation most thyroid nodules are deemed of no clinical consequence and can be observed. However, when they are compressive, toxic, or involved by papillary thyroid carcinoma (PTC) surgery or RAI (if toxic) are the treatments of choice. Both interventions can lead to hypothyroidism and other adverse outcomes (e.g. scar, dysphonia, logistical limitation with RAI). Active surveillance might be used for papillary thyroid microcarcinoma (PTMC) initially, but anxiety leads many cases to surgery later. Several ablative therapies have thus evolved over the last few years aimed at treating these nodules while avoiding described risks. Cases We present 4 cases of thyroid lesions causing concerns (compressive symptoms, thyrotoxicosis, anxiety with active surveillance of PTMC). The common denominator is patients’ attempt to preserve thyroid function, bringing into focus percutaneous ethanol injection (PEI) and thermal ablation techniques (radiofrequency ablation – RFA – being the most common). We discuss the evidence supporting these approaches and compare them with standard therapy, where evidence exists. We discuss additional considerations for the utilization of these therapies, their side-effects and conclude with a simplified description of how these procedures are performed. Conclusions Thermal ablation, particularly RFA, is becoming an attractive option for managing a subgroup of solid thyroid nodules while PEI has a role in managing thyroid cysts and a select group of PTMC. Their role in the algorithm of thyroid nodule management is still being refined and technical expertise will be essential to reproduce the reported results into everyday practice.

Evaluating Technological Innovation Impact. An Empirical Analysis of The Offshore Wind Sector.

This study analyses the drivers that impact innovation on offshore wind energy for a select group of countries, applying the quantile and GMM approaches for a period between 2010-2019. The OLS results from the quantile analysis say the log of trademark, Carbon emissions, offshore wind capacity, and electricity from renewable energy are significant and impact on innovation regarding offshore wind energy. Generally, the Breusch-Pagan / Cook-Weisberg test for heteroskedasticity test reveals the variables have a constant variance, confirming the robustness of the findings. The quantile regression depicts that at 25th and 75th quantiles levels, the log of trademark, the log of trade flows, the log of scientific and technical journals quantile coefficients is significantly different from zero and exhibit varied effects on the explained variable patent.Similarly, the analysis applied the IV-GMM estimation in ivreg2 to identify the over restrictions, the Hansen J statistic, and give the robust moment of conditions analysis. The findings are consistent with prior analysis with the log of trademark, the log of offshore wind capacity, the log of carbon emissions, Scientific and technology journals, the log of patent, electricity from renewables to be significant and impact on innovation.The robustness was done on the GMM models, by applying the Huber-White-Sandwich estimator of the variance of the GMM linear models approximators. The ivreg2 robust analysis revealed that the estimates are efficient for homoskedasticity and Statistics robust to heteroskedasticity.Ultimately, the interaction term ‘’cross’’ came out significant in the analysis. Signifying the importance of the interaction variables in scaling innovation.This study will sever as a reference document for policy formulators regarding scaling up innovation for offshore wind energy.

Discursive Marketisation Through Positive Evaluation: A Diachronic Analysis of About Us Texts of Top-Tier Chinese Universities Over the Past Two Decades

This study explored the marketisation process of top-tier Chinese universities by scrutinising their self-promotional strategies over the past two decades. Drawing on Martin and White’s (2005) Appraisal framework, we identified all attitudinal markers in the About Us texts posted by 35 top-tier Chinese universities on their official websites at two time-points: the turn of the century and the year of 2021. The 35 universities were drawn from China’s “Double First Class” Initiative that prioritises the development of a select group of elite universities in China. Close textual analyses focussing on the attitudinal markers with reference to their contexts were conducted to identify the themes evaluated in the About Us texts; Wilcoxon signed-rank tests were run to quantitatively compare the relative frequencies of the attitudinal markers between the two phases, which was then supplemented by diachronic qualitative comparisons on the fine-grained linguistic features surrounding the markers. The study identified seven major themes positively appraised by the universities at both time-points. It also revealed diachronic differences in the use of attitudinal markers, reflecting a mediated change of promotional strategies over the past 20 years or so in the Chinese higher education context. These findings point to the influence of market, government, and tradition on Chinese top-tier universities’ promoting strategies and the role of social cognition in shaping student choice. They also suggest the emergence of a higher education system with Chinese characteristics that features a reconciliation of market and government forces.

Multimodality durable salvage of recurrent brain metastases refractory to LITT, SRS and immunotherapy with resection and cesium-131 brachytherapy: case report and literature review

Brain metastases (BrM) are treated with multimodality therapy, however the optimal combination and timing of modalities in the setting of recurrent tumours that have failed prior treatments remain poorly defined. We present a case of a patient with biopsy-confirmed renal cell carcinoma BrM with good performance status initially treated with laser interstitial thermal ablation therapy (LITT) followed by stereotactic radiosurgery and dual checkpoint inhibitor immunotherapy. He subsequently developed rapid in-field recurrence which was treated with salvage surgical resection and implantation of intracavitary cesium-131 brachytherapy. The patient’s disease remained stable through 18 months postoperatively. This case illustrates the range of options available and provides a combination salvage therapy strategy in a select group of locally recurrent patients who have exhausted conventional treatment options.

A Carefare Regime

Hungary’s anti-liberal government has invented a novel solution to the care crisis, which I call a “carefare regime”. This chapter describes four key features of the policies, policy practice and discourse that make up Hungary’s carefare regime. I argue that in contrast to welfare state models familiar from developed democracies, in post-2010 Hungary, women’s claims to social citizenship are most successfully made on the basis of doing care work. The state is re-engineered rather retrenched: services are not commodified but “churchified” in an effort to redistribute resources and build political loyalty. Women are constructed as “naturally” responsible for reproduction and care and this responsibility is tied to sentimentalized notions about femininity and true womanhood. In addition to providing care in the household, women are increasingly engaged in the paid labor market too, where the tolerance for gender inequality is officially mandated. A carefare regime provides limited financial advantages for a select group of women, while simultaneously increasing their devalued work burden both in and outside the household: it feeds a growing underclass of women workers.

Development of the Prevent for Work Questionnaire (P4Wq) for the assessment of musculoskeletal risk factors in the workplace: part 2—pilot study for questionnaire development and validation

ObjectiveThe aim of this study was to develop a multifactorial, self-report questionnaire: Prevent for Work Questionnaire (P4Wq). The questionnaire is intended for screening for risk factors in work-related musculoskeletal disorders (WMSDs).DesignData were collected from otherwise healthy workers employed in three service areas at a specialist hospital in Italy: healthcare, administration and ancillary services.Setting and participantsIn all, 115 participants were enrolled (67% women; average age 41.5±9.94 years). The content of the tool for WMSDs was derived from three participation rounds of analysis involving a select group of experts who identified the questionnaire domains and items. Participants responded to 89 items in addition to the EuroQol 5 Dimensions Questionnaire (EQ-5D-5L), Fear-Avoidance Beliefs Questionnaire (FABq) and Oswestry Disability Index (ODI). The proportion of missing data and the distribution of responses were analysed for each item. Items with a discrimination index >0.40 and an interitem correlation <0.80 were retained. Factor analysis was performed using the VARIMAX rotation method, factor extraction, and identification, assignment of items to subscales, and assignment of scores to items. Internal consistency, reliability, construct validity and face validity were also assessed.ResultsA total of 52 items were included in the factor analysis and four subscales identified: Physical Stress Subscore (six items); Mental Stress Subscore (six items); Job Satisfaction Subscore (four items) and Kinesiophobia/Catastrophizing Subscore (four items). The items in the final questionnaire version had a factor loading >0.7. The questionnaire consisted of 20 items with good internal consistency (Cronbach’s alpha 0.81–0.91), reliability (weighted kappa coefficient 0.617–1.00), good construct validity (EQ-5D-5L, r=−0.549, p<0.001; ODI, r=0.549, p<0.001; FABq work, r=0.688, p<0.001) and satisfactory face validity (universal validity index 96.04%).ConclusionThe P4Wq is a 20-item, multifactorial self-report risk assessment questionnaire. It may provide a useful tool for screening for WMSDs by specifically addressing back disorders. It investigates risks for individual workers and may inform educational programmes and preventive strategies tailored to a worker’s needs.Trial registration numberNCT04192604

Down-Regulation of Yeast Helicase Ded1 by Glucose Starvation or Heat-Shock Differentially Impairs Translation of Ded1-Dependent mRNAs

Ded1 is an essential DEAD-box helicase in yeast that broadly stimulates translation initiation and is critical for mRNAs with structured 5′UTRs. Recent evidence suggests that the condensation of Ded1 in mRNA granules down-regulates Ded1 function during heat-shock and glucose starvation. We examined this hypothesis by determining the overlap between mRNAs whose relative translational efficiencies (TEs), as determined by ribosomal profiling, were diminished in either stressed WT cells or in ded1 mutants examined in non-stress conditions. Only subsets of the Ded1-hyperdependent mRNAs identified in ded1 mutant cells exhibited strong TE reductions in glucose-starved or heat-shocked WT cells, and those down-regulated by glucose starvation also exhibited hyper-dependence on initiation factor eIF4B, and to a lesser extent eIF4A, for efficient translation in non-stressed cells. These findings are consistent with recent proposals that the dissociation of Ded1 from mRNA 5′UTRs and the condensation of Ded1 contribute to reduced Ded1 function during stress, and they further suggest that the down-regulation of eIF4B and eIF4A functions also contributes to the translational impairment of a select group of Ded1 mRNA targets with heightened dependence on all three factors during glucose starvation.

Group-wise context selection network for choroid segmentation in optical coherence tomography

Choroid thickness measured from optical coherence tomography (OCT) images has emerged as a vital metric in the management of retinal diseases such as high myopia. In this paper, we propose a novel group-wise context selection network (referred to as GCS-Net) to segment the choroid of either normal or high myopia eyes. To deal with the diverse choroid thickness and the variable shape of the pathological retina, GCS-Net adopts the group-wise channel dilation (GCD) module and the group-wise spatial dilation (GSD) module, which can automatically select group-wise multi-scale information under the guidance of channel attention or spatial attention, and enhance the consistency between the receptive field and the target area. Furthermore, a boundary optimization network with a new edge loss is incorporated to improve the resulting choroid boundary by deep supervision. Experimental results evaluated on a dataset composed of 1650 clinically obtained OCT B-scans show that the proposed GCS-Net can achieve a Dice similarity coefficient of 95.97±0.54%, which outperforms some state-of-the-art segmentation networks.