Explore the vast range of titles available.

Evidence regarding whether imaging can be used effectively to select patients for endovascular thrombectomy (EVT) is scarce. We aimed to investigate the association between baseline imaging features and safety and efficacy of EVT in acute ischaemic stroke caused by anterior large-vessel occlusion. In this meta-analysis of individual patient-level data, the HERMES collaboration identified in PubMed seven randomised trials in endovascular stroke that compared EVT with standard medical therapy, published between Jan 1, 2010, and Oct 31, 2017. Only trials that required vessel imaging to identify patients with proximal anterior circulation ischaemic stroke and that used predominantly stent retrievers or second-generation neurothrombectomy devices in the EVT group were included. Risk of bias was assessed with the Cochrane handbook methodology. Central investigators, masked to clinical information other than stroke side, categorised baseline imaging features of ischaemic change with the Alberta Stroke Program Early CT Score (ASPECTS) or according to involvement of more than 33% of middle cerebral artery territory, and by thrombus volume, hyperdensity, and collateral status. The primary endpoint was neurological functional disability scored on the modified Rankin Scale (mRS) score at 90 days after randomisation. Safety outcomes included symptomatic intracranial haemorrhage, parenchymal haematoma type 2 within 5 days of randomisation, and mortality within 90 days. For the primary analysis, we used mixed-methods ordinal logistic regression adjusted for age, sex, National Institutes of Health Stroke Scale score at admission, intravenous alteplase, and time from onset to randomisation, and we used interaction terms to test whether imaging categorisation at baseline modifies the association between treatment and outcome. This meta-analysis was prospectively designed by the HERMES executive committee but has not been registered. Among 1764 pooled patients, 871 were allocated to the EVT group and 893 to the control group. Risk of bias was low except in the THRACE study, which used unblinded assessment of outcomes 90 days after randomisation and MRI predominantly as the primary baseline imaging tool. The overall treatment effect favoured EVT (adjusted common odds ratio [cOR] for a shift towards better outcome on the mRS 2·00, 95% CI 1·69–2·38; p<0·0001). EVT achieved better outcomes at 90 days than standard medical therapy alone across a broad range of baseline imaging categories. Mortality at 90 days (14·7% vs 17·3%, p=0·15), symptomatic intracranial haemorrhage (3·8% vs 3·5%, p=0·90), and parenchymal haematoma type 2 (5·6% vs 4·8%, p=0·52) did not differ between the EVT and control groups. No treatment effect modification by baseline imaging features was noted for mortality at 90 days and parenchymal haematoma type 2. Among patients with ASPECTS 0–4, symptomatic intracranial haemorrhage was seen in ten (19%) of 52 patients in the EVT group versus three (5%) of 66 patients in the control group (adjusted cOR 3·94, 95% CI 0·94–16·49; pinteraction=0·025), and among patients with more than 33% involvement of middle cerebral artery territory, symptomatic intracranial haemorrhage was observed in 15 (14%) of 108 patients in the EVT group versus four (4%) of 113 patients in the control group (4·17, 1·30–13·44, pinteraction=0·012). EVT achieves better outcomes at 90 days than standard medical therapy across a broad range of baseline imaging categories, including infarcts affecting more than 33% of middle cerebral artery territory or ASPECTS less than 6, although in these patients the risk of symptomatic intracranial haemorrhage was higher in the EVT group than the control group. This analysis provides preliminary evidence for potential use of EVT in patients with large infarcts at baseline. Medtronic.

Control systems have come to play an important role in the performance of modern vehicles with regards to meeting goals on low emissions and low fuel consumption. To achieve these goals, modeling, simulation, and analysis have become standard tools for the development of control systems in the automotive industry.

To explore the quality, reliability, and practical effect of the Simodont virtual simulation training system in preclinical teaching of access and coronal cavity preparation for dental undergraduate students. Twenty dental undergraduate students from Guanghua School of Stomatology, Sun Yat-sen University, were recruited and randomly divided into two groups after theory training. The groups were allocated using the random number method and assessed for access and coronal cavity preparation skills using a standardized assessment form and the Simodont virtual simulation system operation manual. Baseline scores were recorded for each student. One group received training with the Simodont virtual simulation system, while the other used a conventional phantom simulator system. After training, skills were reassessed, and scores were recorded. The groups then switched training systems and were assessed again. All students completed a Teaching Questionnaire at the end of the training. Data was collected and analyzed. The mean score of students in the virtual simulation priority group (15.9 ± 0.56 points) and the phantom-simulator priority group (15.3 ± 0.40 points) was significantly higher than the baseline score (13.3 ± 0.63 points) and (13.1 ± 0.30 points) ( P < 0.05), respectively. Furthermore, the mean score of students in the virtual simulation priority group after training with both systems (15.9 ± 0.56 points) was significantly higher than that of the students in the virtual simulation priority group alone (14.2 ± 0.62 points) ( P < 0.05). The mean score was also significantly higher in the virtual simulation priority group of students (15.9 ± 0.56 points) trained with both systems than in the phantom-simulator priority group of students (15.3 ± 0.40 points) trained with both systems for the assessment (p < 0.05). The mean score of students in the phantom-simulator priority group (15.3 ± 0.40 points) after training with both systems was significantly higher than that of the students in the phantom-simulator priority group alone (14.3 ± 0.28 points) ( P < 0.05). The questionnaire results showed that the students fully agreed that \"the Simodont virtual simulation system has the characteristics of repeatability, multi-dimensionality, and multiple practices, and gives me more attention to details. However, they also noted that \"it needs to be improved and upgraded to be closer to the conventional phantom-simulator system. Compared with the conventional phantom-simulator system alone, the preclinical teaching effectiveness of access and coronal cavity preparation could be significantly enhanced by incorporating the Simodont virtual simulation system alongside the phantom-simulator training system. The training sequence might influence this improvement.

This study evaluates the impact of high-fidelity simulation on the acquisition and retention of competencies in nursing students. High-fidelity simulation provides a realistic and risk-free environment allowing students to practice, which potentially enhances the acquisition and retention of required competencies. A blinded, randomised clinical trial with three arms was conducted with a pretest and a follow-up at 6 months (post-test 1) and 12 months (post-test 2). This study was conducted with 105 s-year nursing students, divided into three groups: control (6 low-fidelity simulations), intervention 1 (3 high-fidelity and 3 low-fidelity) and intervention 2 (6 high-fidelity simulations). Competencies were assessed using the Objective Structured Clinical Examination at baseline, 6 and 12 months. Student satisfaction was measured with the Simulated Clinical Experiences Scale. Initial competency scores were similar across groups. At 6 months, both intervention groups showed significant improvements in critical thinking (6.2 and 6.0, p < 0.05), clinical skills (6.8 and 6.6, p < 0.05), communication (8.0 and 8.3, p < 0.05) and ethics (7.6 and 7.5, p < 0.05) compared with the control group. Intervention group 1 demonstrated better competency retention at 12 months. Overall satisfaction with highfidelity simulation was high (9.13/10), with particular praise for the practical dimension (8.95/10), realism (8.02/10) and the cognitive dimension (9.43/10). High-fidelity simulation has the potential to enhance nursing competencies effectively. This approach supports long-term skill retention, highlighting the importance of a well-structured curriculum that integrates different simulation levels for optimal student preparation for clinical practice.

How do you get students to engage in a historical episode or era? How do you bring the immediacy and contingency of history to life? Michael A. Barnhart shares the secret to his award-winning success in the classroom with Can You Beat Churchill?, which encourages role-playing for immersive teaching and learning. Combating the declining enrollment in humanities classes, this innovative approach reminds us how critical learning skills are transmitted to students: by reactivating their curiosity and problem-solving abilities. Barnhart provides advice and procedures, both for the use of off-the-shelf commercial simulations and for the instructor who wishes to custom design a simulation from scratch. These reenactments allow students to step into the past, requiring them to think and act in ways historical figures might have. Students must make crucial or dramatic decisions, though these decisions need not align with the historical record. In doing so, they learn, through action and strategic consideration, the impact of real individuals and groups of people on the course of history. There is a quiet revolution underway in how history is taught to undergraduates. Can You Beat Churchill? hopes to make it a noisy one.