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Tenecteplase has been shown to be non-inferior to alteplase for the treatment of acute ischemic stroke within 4.5 hours of stroke onset. While not formally approved by regulatory authorities, many jurisdictions have transitioned to using tenecteplase for routine stroke treatment because it is simpler to use and has cost advantages.
Methods:
We report a three-phase time-series analysis over 2.5 years and the process for transition from use of alteplase to tenecteplase for the routine treatment of acute ischemic stroke from a system-wide perspective involving an entire province. The transition was planned and implemented centrally. Data were collected in clinical routine, arising from both administrative sources and a prospective stroke registry, and represent real-world outcome data. Data are reported using standard descriptive statistics.
Results:
A total of 1211 patients were treated with intravenous thrombolysis (477 pre-transition using alteplase, 180 transition period using both drugs, 554 post-transition using tenecteplase). Baseline characteristics, adverse events and outcomes were similar between epochs. There were four dosing errors with tenecteplase, including providing the cardiac dose to two patients. There were no instances of major hemorrhage associated with dosing errors.
Discussion:
The transition to using intravenous tenecteplase for stroke treatment was seamless and resulted in identical outcomes to intravenous alteplase.
In this article, I argue that the musical landscape in Panama during the nineteenth century was much more active, diverse and globally connected than previously observed by authors of traditionally accepted music historiography of the country. Particularly, I discuss the heightened activity in the second half of the century through primary sources concerning violinist Miguel Iturrado (d. 1879). I further argue that the violin culture fostered by Iturrado and his contemporaries became a solid platform for cultural exchange which allowed for the development of early-twentieth-century music production in Panama. I conclude that the flourishing of numerous fin-de-siècle concert violinists, as well as the advent of the violinist-composers of dance music now known as the Azuero School in the first third of twentieth-century Panama, are directly related to Iturrado’s –and his colleagues’– musical and cultural achievements.
Discourse on the existence of Ghanaian English (GhE) has provided several works leading to the descriptions of GhE pronunciations, especially vowels. However, the major challenge is that most of these studies, impressionistically, have provided different numbers of the English monophthongal vowels used in the Ghanaian context and often discount the existence of certain vowels used in GhE. Consequently, the present study employed the acoustic approach to investigate the English monophthongs produced by 40 educated Ghanaian speakers of English. The purposive sampling was used to select those with first degree to study. The descriptive research design was used to study the formant one and two of the vowels. The vowels were studied within three different contextual realisations: in citation, in sentences and in spontaneous speech. The results revealed that the Ghanaian speakers of English employed in this study realised the English vowels /iː, ɪ, e, a, ɑː, ɒ, ɔː, ʊ, uː ʌ, ə/. The /ɜː/ vowel was shortened while the /æ/ was replaced with the /a/ vowel. This suggests that most of the Ghanaian speakers of English in this study could produce more RP vowels, contrary to earlier studies.
Barricaded incidents, hostage-taking and sieges occur in the community, where police negotiators are usually called on to bring about a peaceful resolution. They occur also in prisons and psychiatric hospitals, where they will be managed by the institution’s staff, with police support if needed. Psychiatrists and other mental health professionals have been involved in providing training and on-call support for negotiators and decision makers in these crisis situations. This article describes definitions and goals in relation to such incidents, and outlines a five-phase framework for their management (training; first responders, preliminary interventions and inquiries; negotiations; resolution; aftercare), indicating the psychiatrist’s role during each phase. Ethical issues are also discussed.
Ensemble pour le plaisir ! (EPLP) est un programme ayant pour objectif d’amener les personnes vivant avec un trouble neurocognitif et leur proche aidant à retrouver des moments de plaisir au sein de leur relation. Appuyé par la théorie du comportement planifié d’Ajzen, le présent article vise à analyser la démarche d’implantation du programme EPLP au sein de milieux communautaires et de soulever les facteurs d’influence menant au changement de comportement des parties prenantes. Les résultats montrent que bien que les attitudes, les normes et la notion de contrôle soient favorables à l’intention de changer le comportement, des ressources médiatrices telles que le financement et le mentorat par l’équipe de recherche sont essentielles à l’implantation pérenne du programme.
We aimed to reveal the psychological effects of old and young individuals after the earthquake by looking at their post-traumatic stress disorder (PTSD) and depression situations.
Methods
Data collected by face-to-face survey method were analyzed. The 4 provinces (Hatay, Kahramanmaraş, Adıyaman, and Gaziantep) most affected by the 7.7 and 7.6 magnitude earthquakes centered in Kahramanmaraş, Turkey on February 6, 2023 were included in the study. Peritraumatic distress inventory, impact of events scale, and Beck depression inventory were applied to 300 people (150 old, 150 young).
Results
The presence of peritraumatic stress was observed in 94% (282 people), PTSD symptoms in 90% (270 people) and moderate to severe depression in 36.7% (110 people). When younger were compared with those elders, it was concluded that there was no significant difference in terms of presence of peritraumatic distress (49.6% vs. 50.4%, P=0.627), PTSD (49.6% vs. 50.4%, P=0.620) and moderate to severe depression (45.5% vs. 54.5%, P=0.258).
Conclusions
We found similar rates of PTSD and depression symptoms in older and younger adults exposed to earthquakes. Policies need to be developed to ensure psychological well-being after an earthquake disaster in the adult population regardless of age group.
Disasters, both natural and human-made, pose significant challenges to public health systems worldwide. This Research Letter examines the latest strategies and interventions in disaster preparedness and response. Our study highlights key practices that enhance the readiness and resilience of healthcare professionals and communities against disasters. The strategies reviewed include comprehensive emergency planning, simulation exercises, continuous education, interagency coordination, community engagement, and technological advancements. Our findings underscore the importance of multifaceted approaches that significantly improve disaster preparedness and response outcomes. This research provides valuable insights into effective disaster management practices and establishes an important foundation for future studies.
To understand the scenarios where health care worker (HCW) masking is most impactful for preventing nosocomial transmission.
Methods:
A mathematical agent-based model of nosocomial spread with masking interventions. Masking adherence, community prevalence, disease transmissibility, masking effectiveness, and proportion of breakroom (unmasked) interactions were varied. The main outcome measure is the total number of nosocomial infections in patients and HCW populations over a simulated three-month period.
Results:
HCW masking around patients and universal HCW masking reduces median patient nosocomial infections by 15% and 18%, respectively. HCW-HCW interactions are the dominant source of HCW infections and universal HCW masking reduces HCW nosocomial infections by 55%. Increasing adherence shows a roughly linear reduction in infections. Even in scenarios where a high proportion of interactions are unmasked “breakroom” interactions, masking is still an effective tool assuming adherence is high outside of these areas. The optimal scenarios where masking is most impactful are those where community prevalence is at a medium level (around 2%) and transmissibility is high.
Conclusions:
Masking by HCWs is an effective way to reduce nosocomial transmission at all levels of mask effectiveness and adherence. Increases in adherence to a masking policy can provide a small but important impact. Universal HCW masking policies are most impactful should policymakers wish to target HCW infections. The more transmissible a variant in circulation is, the more impactful HCW masking is for reducing infections. Policymakers should consider implementing masking at the point when community prevalence is optimum for maximum impact.
This paper draws attention to the untapped potential of international law (IL) in understanding how security communities develop. It focuses, among others, on ‘transnational legal processes’ – a key overlooked variable – by highlighting what international relations (IR) theory can learn from IL. In so doing, the paper contributes to the literature in three ways. First, it proposes a definition and conceptualisation of regional norms in the study of security communities. Second, by pointing out legal and judicial factors that facilitate or hinder the legal internalisation of regional norms, and consequently affect the development of a security community, it suggests new important research questions that can help broaden the ontology of security communities and bring theoretical heft to the fundamental concept of peaceful change. Third, the paper discusses how and under what conditions regional norms contribute to maintaining reasonable expectations of peaceful change not only at the systemic or state elite level, but equally at the domestic societal level.
Indoor positioning systems (IPS) are essential for mobile robot navigation in environments where global positioning systems (GPS) are unavailable, such as hospitals, warehouses, and intelligent infrastructure. While current surveys may limit themselves to specific technologies or fail to provide practical application-specific details, this review summarizes IPS developments directed specifically towards mobile robotics. It examines and compares a breadth of approaches that vary across non-radio frequency, radio frequency, and hybrid sensor fusion systems, through the lens of performance metrics that include accuracy, delay, scalability, and cost. Distinctively, this work explores emerging innovations, including synthetic aperture radar (SAR), federated learning, and privacy-aware AI, which are reshaping the IPS landscape. The motivation stems from the’ increasing complexity and dynamic nature of indoor environments, where high-precision, real-time localization is essential for safety and efficiency. This literature review provides a new conceptual, cross-border pathway for research and implementation of IPS in mobile robotics, addressing both technical and application-related challenges in sectors related to healthcare, industry, and smart cities. The findings from the literature review allow early career researchers, industry knowledge workers, and stakeholders to provide secure societal, human, and economic integration of IPS with AI and IoT in safe expansions and scale-ups.
Some trials have evaluated peer support for people with mental ill health in high-income, mainly English-speaking countries, but the quality of the evidence is weak.
Aims
To investigate the effectiveness of UPSIDES peer support in high-, middle- and low-income countries.
Method
This pragmatic multicentre parallel-group wait-list randomised controlled trial (registration: ISRCTN26008944) with three measurement points (baseline and 4 and 8 months) took place at six study sites: two in Germany, and one each in Uganda, Tanzania, Israel and India. Participants were adults with long-standing severe mental health conditions. Outcomes were improvements in social inclusion (primary) and empowerment, hope, recovery, health and social functioning (secondary). Participants allocated to the intervention group were offered UPSIDES peer support.
Results
Of the 615 participants (305 intervention group), 337 (54.8%) identified as women. The average age was 38.3 (s.d. = 11.2) years, and the mean illness duration was 14.9 (s.d. = 38.4) years. Those allocated to the intervention group received 6.9 (s.d. = 4.2) peer support sessions on average. Intention-to-treat analysis showed effects on two of the three subscales of the Social Inclusion Scale, Empowerment Scale and HOPE Scale. Per-protocol analysis with participants who had received three or more intervention sessions also showed an effect on the Social Inclusion Scale total score (β = 0.18, P = 0.031, 95% CI: 0.02–0.34).
Conclusions
Peer support has beneficial impacts on social inclusion, empowerment and hope among people with severe mental health conditions across diverse settings. As social isolation is a key driver of mental ill health, and empowerment and hope are both crucial for recovery, peer support can be recommended as an effective component of mental healthcare. Peer support has the potential to move global mental health closer towards a recovery- and rights-based orientation.
The COVID-19 pandemic caused widespread disruption to early childhood education and care services worldwide, affecting children’s well-being and placing unprecedented caregiving burdens on families. This paper compares the childcare-related social policy responses in three countries representing distinct welfare regimes: South Korea (Productivist/East Asian), France (Conservative-Corporatist), and the UK (Liberal). Focusing on four key domains – ECEC services, family leave, work environment, and financial support – it examines how each country addressed childcare challenges during the pandemic. The findings show that, while some similarities emerged in responding to shared challenges, the policy responses diverged considerably. These differences were shaped not only by pandemic-specific health strategies but also by pre-existing welfare structures and childcare systems. France utilised its strong public infrastructure and introduced special childcare leave; Korea expanded temporary family leave and financial aid while relying heavily on informal care; and the UK prioritised employment protection with limited direct caregiving support. The study underscores the importance of institutional flexibility and multi-layered care systems in building crisis-resilient childcare policies.
The production and circulation of common wares during the late antique period in North Africa has been largely overlooked by past scholarship, despite their potential to shed light on late antique production, workshop organisation and regional ceramic economies. This paper provides the first detailed study of a distinctive type of late antique, wheelmade common ware, the so-called African ‘painted ware’ (APW). It first presents a critical overview of the distribution of painted wares and their typology, decoration and chronology based on existing publications. It then develops a typology of vessel shapes, but also decoration patterns based on a large, well-preserved assemblage of painted ceramics recently excavated by the DAI, INP and UCL at the archaeological sites of Bulla Regia and Chimtou in the Medjerda valley, Tunisia. To understand the composition, technology and provenance of the wares, petrographic and chemical analysis was conducted on 57 painted sherds from the two sites. The results suggest the existence of a production centre in the Medjerda Valley, with potters using local calcareous clay tempered with sand, while the decoration was obtained using iron-based pigments. Comparison with published painted wares at other sites contributes to an initial insight into regional distribution patterns of the painted ware.
Water hyacinth is an invasive aquatic plant that has been associated with major negative economic and ecological impacts in water systems worldwide, including Rwanda, since its establishment in the country in the 1960s. While biological control is considered the most sustainable management method, the success of biocontrol agents depends on various abiotic factors, with temperature being critical. This study assessed the suitability of potential water hyacinth biocontrol agents such as: Neochetina weevils, Megamelus scutellaris Berg (Hemiptera: Delphacidae), and Cornops aquaticum Bruner (Orthoptera: Acrididae) for regions with a temperate climate by testing their thermal boundaries. Using thermal physiology limits and CLIMEX modelling, we found that Neochetina eichhorniae Warner and N. bruchi Hustache (Coleoptera: Curculionidae) had lower thermal minimums (CTmin) of 2.4°C and 2.6°C, respectively, compared to Megamelus scutellaris (4.7°C) and Cornops aquaticum (6.2°C). CLIMEX modelling predicted the suitability of Neochetina weevils and C. aquaticum across Rwanda, while M. scutellaris appeared unsuitable for the colder northern regions of the country but appropriate for the central and eastern regions. These findings suggests that the historical failure of Neochetina weevils introduced to Rwandan water bodies in 2000 was not due to temperature extremes. Rather, other factors such as release numbers or water quality may have played a role. This study provides crucial information for future biocontrol efforts in Rwanda and similar temperate regions, highlighting the importance of pre-release thermal tolerance assessments and climate modelling to predict biocontrol agent establishment and efficacy.
I discuss and clarify the relationship between the recent wave of “intrinsic” coordinate-free approaches to Maxwell gravitation and the coordinate-based discussions of Saunders (2013) and Wallace (2020).
This study presents an innovative framework to improve the accessibility and usability of collaborative robot programming. Building on previous research that evaluated the feasibility of using a domain-specific language based on behaviour-driven development, this paper addresses the limitations of earlier work by integrating additional features like a drag-and-drop Blockly web interface. The system enables end users to define and execute robot actions with minimal technical knowledge, making it more adaptable and intuitive. Additionally, a gesture-recognition module facilitates multimodal interaction, allowing users to control robots through natural gestures. The system was evaluated through a user study involving participants with varying levels of professional experience and little to no programming background. Results indicate significant improvements in user satisfaction, with the system usability scale overall score increasing from 7.50 to 8.67 out of a maximum of 10 and integration ratings rising from 4.42 to 4.58 out of 5. Participants completed tasks using a manageable number of blocks (5 to 8) and reported low frustration levels (mean: 8.75 out of 100) alongside moderate mental demand (mean: 38.33 out of 100). These findings demonstrate the tool’s effectiveness in reducing cognitive load, enhancing user engagement and supporting intuitive, efficient programming of collaborative robots for industrial applications.