bluuebunny/crossref_metadata_2025 huggingface dataset:
Sudden life-threatening laryngeal edema in pregnancy: a case report
Authors: Chrisnata Vincent , Sugiarto Adhrie , Erniody Erniody , Sethiono Aldy
Published: April 2023

Background

Severe laryngeal edema during pregnancy is uncommon but can be encountered, particularly in patients with preeclampsia accompanied by other comorbidities. Careful consideration must be given to balance the urgency of securing the airway with the safety of the fetus and the patient’s long-term health consequences.

Case presentation

A 37-year-old Indonesian woman was brought to the emergency department at 36 weeks gestation due to severe dyspnea. Her condition worsened a few hours later during intensive care unit admission, with tachypnea, decreased oxygen saturation, and inability to communicate, necessitating intubation. Due to the edematous larynx, we could only use 6.0-sized endotracheal tube. The use of a small-sized endotracheal tube was expected to be short-lived, so she was considered for tracheostomy. Nevertheless, we decided to perform a cesarean section first after lung maturation because it would be safer for the fetus, and laryngeal edema usually improves after delivery. Cesarean section was performed under spinal anesthesia for the safety of the fetus, and 48 hours after delivery, she underwent a leakage test with a positive result, so extubation was performed. Stridor was no longer audible, breathing pattern was within normal limits, and vital signs were stable. The patient and her baby both recovered well with no long-term health consequences.

Conclusion

This case demonstrates that unexpected life-threatening laryngeal edema can occur during pregnancy, in which upper respiratory tract infections may trigger it. The decision between conservative and aggressive immediate airway management should be made with careful consideration of securing the patient’s airway, the safety of the fetus, and the patient’s long-term health consequences.
A cross-country comparison of health-related quality of life in the United States, Sweden, and Norway during the first year of the COVID-19 pandemic
Authors: Chen Jiahe , Gong Cynthia L. , Persson Ulf , Gu Ning Yan
Published: April 2023

Background

Limited studies have directly compared health-related quality of life (HRQoL) in different countries during the COVID-19 global pandemic. The objective of this study was to evaluate the HRQoL outcomes in the US, Sweden, and Norway during the first year under the pandemic.

Methods

In April 2020, during early phase of the pandemic, separately in the US, Sweden, and Norway, we surveyed 2,734, 1,003 and 1,020 respondents, then again in January 2021, we collected 2,252, 1,013 and 1,011 respondents. The survey was first developed in English and translated into Swedish and Norwegian. Selected variables were used for the current study. We collected respondents’ HRQoL using the EQ-5D-5L. Respondents’ background information included their sociodemographic data, medical history, and COVID-19 status. We reported the EQ-5D-5L utility, EQ-VAS, and the proportion of problems with each of the EQ-5D-5L health subdomains. Population quality-adjusted life year (QALY) changes based on EQ-5D-5L utility scores were also calculated. Outcomes were stratified by age. One-way ANOVA test was used to detect significant differences between countries and Student’s t-tests were used to assess the differences between waves.

Results

Respectively for the US, Sweden, and Norway, mean EQ-5D-5L utilities were 0.822, 0.768, and 0.808 in April 2020 (p < 0.001); 0.823, 0.783, and 0.777 in January 2021 (p < 0.001); mean EQ-VAS scores were 0.746, 0.687, and 0.692 in April 2020 (p < 0.001), 0.764, 0.682, and 0.678 in January 2021 (p < 0.001). For both waves, EQ-5D-5L utilities and EQ-VAS scores in the US remained higher than both Sweden and Norway (p < 0.001). Norwegians reported considerably lowered HRQoL over time (p < 0.01). Self-reported problems with anxiety/depression were highest for the US and Sweden, while Norwegians reported most problems with pain/discomfort, followed by anxiety/depression. The population QALYs increased in the US and Sweden, but decreased in Norway.

Conclusions

In the first year of the pandemic, a rebound in HRQoL was observed in the US, but not in Sweden or Norway. Mental health issues during the pandemic warrant a major public health concern across all 3 countries.
Kernel-based genetic association analysis for microbiome phenotypes identifies host genetic drivers of beta-diversity
Authors: Liu Hongjiao , Ling Wodan , Hua Xing , Moon Jee-Young , Williams-Nguyen Jessica S. , Zhan Xiang , Plantinga Anna M. , Zhao Ni , Zhang Angela , Knight Rob , Qi Qibin , Burk Robert D. , Kaplan Robert C. , Wu Michael C.
Published: April 2023

Background

Understanding human genetic influences on the gut microbiota helps elucidate the mechanisms by which genetics may influence health outcomes. Typical microbiome genome-wide association studies (GWAS) marginally assess the association between individual genetic variants and individual microbial taxa. We propose a novel approach, the covariate-adjusted kernel RV (KRV) framework, to map genetic variants associated with microbiome beta-diversity, which focuses on overall shifts in the microbiota. The KRV framework evaluates the association between genetics and microbes by comparing similarity in genetic profiles, based on groups of variants at the gene level, to similarity in microbiome profiles, based on the overall microbiome composition, across all pairs of individuals. By reducing the multiple-testing burden and capturing intrinsic structure within the genetic and microbiome data, the KRV framework has the potential of improving statistical power in microbiome GWAS.

Results

We apply the covariate-adjusted KRV to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) in a two-stage (first gene-level, then variant-level) genome-wide association analysis for gut microbiome beta-diversity. We have identified an immunity-related gene, IL23R, reported in a previous microbiome genetic association study and discovered 3 other novel genes, 2 of which are involved in immune functions or autoimmune disorders. In addition, simulation studies show that the covariate-adjusted KRV has a greater power than other microbiome GWAS methods that rely on univariate microbiome phenotypes across a range of scenarios.

Conclusions

Our findings highlight the value of the covariate-adjusted KRV as a powerful microbiome GWAS approach and support an important role of immunity-related genes in shaping the gut microbiome composition.
The associations between screen time and mental health in adolescents: a systematic review
Authors: Santos Renata Maria Silva , Mendes Camila Guimarães , Sen Bressani Guilherme Yanq , de Alcantara Ventura Samara , de Almeida Nogueira Yago Jean , de Miranda Débora Marques , Romano-Silva Marco Aurélio
Published: April 2023

Background

Adolescents have extensive use of screens and, they have common complains related to mental health. Here a systematic review was done to understand the association between screen time and adolescent’s mental health.

Method

This review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses – PRISMA. An update search was performed in January 2023 with the following keywords: “screen time,“ “adolescent,“ and “mental health” on PubMed, PsycINFO and Scopus databases.

Results

50 articles were included, most have found associations between screen exposure and mental health in adolescents. The most used device by adolescents was the smartphone and the use on weekdays was associated with diminished mental well-being. Social media use was negatively associated with mental well-being and, in girls, associated at higher risk for depression.

Conclusion

Excessive screen time in adolescents seems associated with mental health problems. Given the profusion and disparity of the results, additional studies are needed to clarify elements such as the screen content or the interaction of adolescents with different screen devices.

Systematic review registration:

PROSPERO CRD42022302817.
Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey
Authors: Lakhlifi Camille , Lejeune François-Xavier , Rouault Marion , Khamassi Mehdi , Rohaut Benjamin
Published: April 2023

Healthcare professionals’ statistical illiteracy can impair medical decision quality and compromise patient safety. Previous studies have documented clinicians’ insufficient proficiency in statistics and a tendency in overconfidence. However, an underexplored aspect is clinicians’ awareness of their lack of statistical knowledge that precludes any corrective intervention attempt. Here, we investigated physicians’, residents’ and medical students’ alignment between subjective confidence judgments and objective accuracy in basic medical statistics. We also examined how gender, profile of experience and practice of research activity affect this alignment, and the influence of problem framing (conditional probabilities, CP vs. natural frequencies, NF). Eight hundred ninety-eight clinicians completed an online survey assessing skill and confidence on three topics: vaccine efficacy, p value and diagnostic test results interpretation. Results evidenced an overall consistent poor proficiency in statistics often combined with high confidence, even in incorrect answers. We also demonstrate that despite overconfidence bias, clinicians show a degree of metacognitive sensitivity, as their confidence judgments discriminate between their correct and incorrect answers. Finally, we confirm the positive impact of the more intuitive NF framing on accuracy. Together, our results pave the way for the development of teaching recommendations and pedagogical interventions such as promoting metacognition on basic knowledge and statistical reasoning as well as the use of NF to tackle statistical illiteracy in the medical context.
Fracking compared to conventional balloon angioplasty alone for calcified common femoral artery lesions using intravascular ultrasound analysis: 12-month results
Authors: Haraguchi Takuya , Fujita Tsutomu , Kashima Yoshifumi , Tsujimoto Masanaga , Otake Ryo , Kasai Yuhei , Sato Katsuhiko
Published: April 2023

Background

Fracking is a novel technique to crack calcified lesions by hydraulic pressure. This study aimed to compare the performance of fracking and conventional balloon angioplasty without stenting for calcified common femoral artery (CFA) lesions using intravascular ultrasound (IVUS) analysis.

Methods

This retrospective, single-center, comparative observational study included 59 patients (67 limbs) with calcified CFA lesions treated with either fracking (n = 30) or balloon angioplasty (n = 29) between January 2018 and December 2020. The primary endpoint was 1-year primary patency. The secondary endpoints included procedure success, freedom from target lesion revascularization (TLR), procedure-related complications, and freedom from major adverse limb events (MALE). Predictors of restenosis were identified using multivariate Cox proportional hazards analysis.

Results

The mean follow-up duration was 403 ± 236 days. The fracking group had significantly higher incidence of 1-year primary patency (89.8% versus 49.2%, P < 0.001), procedure success (96.9% versus 74.3%, P = 0.009), and freedom from TLR (93.5% versus 74.2%, P = 0.038) than the balloon group. The rate of freedom from MALE was significantly higher in the fracking group than in the balloon group (76.9% versus 48.6%, P = 0.033). The groups had no significant difference in procedure-related complications (6.2% versus 5.7%, P = 0.928). A larger postprocedural IVUS-estimated minimum lumen area (MLA) was associated with a lower risk of restenosis (hazard ratio, 0.78; 95% confidence interval, 0.67–0.91; P < 0.001), with a cut-off value of 16.0 mm2 determined using receiver operating characteristics curve analysis. The incidence of 1-year primary patency in patients with a postprocedural MLA ≥16.0 mm2 (n = 37) was significantly higher than that in those with a postprocedural MLA < 16.0 mm2 (n = 30) (87.8% versus 44.6%, P < 0.001).

Conclusion

This study demonstrated the superior procedural efficacy of fracking compared to balloon angioplasty in treating calcified CFA lesions. The safety outcomes after fracking were comparable to those after balloon angioplasty. Large postprocedural MLA was an independent positive predictor of patency.
HLA-B27 positivity in a large miscegenated population of 5,389,143 healthy blood marrow donors in Brazil
Authors: Resende Gustavo Gomes , Saad Carla Gonçalves Schahin , de Oliveira Danielli Cristina Muniz , de Sousa Bueno Filho Julio Silvio , Sampaio-Barros Percival Degrava , de Medeiros Pinheiro Marcelo
Published: April 2023

Background

The prevalence of HLA-B27 gene positivity in healthy Caucasian communities varies between 8 and 14%. However, there is a lack of information in countries with a high rate of miscegenation, such as Brazil.

Aim

To estimate the frequency of HLA-B27 in the Brazilian general population using a large national registry database.

Methods

This is a cross-sectional ecological study using the Brazilian Registry of Volunteer Bone Marrow Donors (REDOME) database on HLA-B27 allelic frequency and proportion of positives of healthy donors (18–60 years old). Data were analyzed according to sex, age, race(by self-reported skin color recommended by the Brazilian Institute of Geography and Statistics-IBGE), and geographic region of residence.

Results

From 1994 to 2022, a total of 5,389,143 healthy bone marrow donors were included. The overall positivity for HLA-B27 was 4.35% (CI 95% 4.32–4.37%), regardless of sex and age (57.2% were women, mean age was 41.7yo). However, there was a difference between races: 4.85% in Whites; 2.92% in Blacks; 3.76% inPardos(Browns i.e. mixed races); 3.95% inAmarelos(Yellows i.e. Asian Brazilians); and 3.18% in Indigenous. There was also a difference regarding geographic region of residence (North: 3.62%; Northeast: 3.63%; Southeast: 4.29%; Midwest: 4.5% and 5.25% in South). The homozygosity rate for the HLA-B27 was 1.32% of all the positives and only 0.06% in the general population.

Conclusions

Our findings provide the first Brazilian national prevalence for HLA-B27 in 4.35%. There is a gradient gene positivity from North to South, suggesting that the genetic background related to the miscegenation due to colonization, slavery, and some later waves of immigration together with internal migratory flows, could explain our findings.
Guideline “Transient Global Amnesia (TGA)” of the German Society of Neurology (Deutsche Gesellschaft für Neurologie): S1-guideline
Authors: Sander Dirk , Bartsch Thorsten , Connolly Florian , Enzinger Christian , Fischer Urs , Nellessen Nils , Poppert Holger , Szabo Kristina , Topka Helge
Published: April 2023

Introduction

In 2022 the DGN (Deutsche Gesellschaft für Neurologie) published an updated Transient Global Amnesia (TGA) guideline. TGA is characterized by a sudden onset of retrograde and anterograde amnesia for a period of one to a maximum of 24 h (with an average of 6 to 8 h). The incidence is estimated between 3 and 8 per 100,000 population/year. TGA is a disorder that occurs predominantly between 50 and 70 years.

Recommendations

The diagnosis of TGA should be made clinically. In case of an atypical clinical presentation or suspicion of a possible differential diagnosis, further diagnostics should be performed immediately. The detection of typical unilateral or bilateral punctate DWI/T2 lesions in the hippocampus (especially the CA1 region) in a proportion of patients proves TGA. The sensitivity of MRI is considered higher when performed between 24 and 72 h after onset. If additional DWI changes occur outside the hippocampus, a vascular etiology should be considered, and prompt sonographic and cardiac diagnostics should be performed EEG may help to differentiate TGA from rare amnestic epileptic attacks, especially in recurrent amnestic attacks. TGA in patients < 50 years of age is a rarity, therefore it is mandatory to rapidly search for other causes in particular in younger patients. The cause of TGA is still unknown. Numerous findings in recent years point to a multifactorial genesis. Because the pathomechanism of TGA is not yet clearly known, no evidence-based therapeutic or prophylactic recommendations can be made.

Conclusions

There is no evidence for chronic sequelae of TGA with respect to cerebral ischemia, chronic memory impairment, or the onset of dementia-related syndromes.
Effusive-constrictive pericarditis as first manifestation of late-onset systemic lupus erythematosus: an atypical case with grave prognosis
Authors: Sumajaya I. Dewa Gde Dwi , Aryadi I. Putu Hendri , Eryana I. Made
Published: April 2023

Background

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that has a great diversity of clinical presentations and occurs mostly in young women. However, late-onset SLE does exist and seldom presents with an atypical case, including pericardial effusion (PE).

Case presentation

A 64 years old Asian woman presented with weakness all over the body and slight breathlessness for the past 2 days before the hospital admission. Her initial vital signs are 80/50 mmHg for blood pressure and a respiration rate of 24 breaths/min. Rhonchi were heard on the left lung and pitting edema on both legs. No evidence of any skin rash. Laboratory examination displayed anemia, hematocrit decrement, and azotemia. A 12-lead ECG demonstrated left-axis deviation with low voltage (Fig. 1). Chest X-ray showed left massive pleural effusion (Fig. 2). Transthoracic echocardiography revealed biatrial enlargement, normal EF 60%, diastolic dysfunction grade II, and thickening of the pericardium with mild circumferential PE corresponding with effusive-constrictive pericarditis (Fig. 3). The patient also brought CT angiography and cardiac MRI result, which confirmed pericarditis with PE. Treatment was initiated in ICU with fluid resuscitation of normal saline. The patient’s routine oral treatments, including furosemide, ramipril, colchicine, and bisoprolol, were carried on. An autoimmune workup was performed by a cardiologist and demonstrated an elevation in antinuclear antibody/ANA (IF) of 1:100, which finally unveiled a diagnosis of SLE. Pericardial effusion is one critical condition to consider, despite it being an uncommon presentation in late-onset SLE. Mild pericarditis in an SLE case can be treated with corticosteroid administration. Colchicine also has been found to reduce the risk of pericarditis recurrence. However, an atypical presentation from this case led to a slightly delayed treatment that escalated the morbidity and mortality risk. The patient had a sudden cardiac arrest and passed away 3 days after being treated.

Conclusions

Atypical presentation during late-onset SLE, mainly in the form of pericardial effusion even constrictive pericarditis, should be taken into a consideration since they are a scarce feature in SLE patients. Swift recognition and prompt treatment are important for the optimal outcome.
Exploring the life experiences of stroke survivors in Nigeria using the interpretive phenomenological analysis
Authors: Ogunlana Michael O. , Oyewole Olufemi O. , Nwosu Ifeoma Blessing , Govender Pragashnie
Published: April 2023

Background

The consequence of living as a stroke survivor has received significant attention in literature from different parts of the world. Enriching social relations and other factors are reported to influence the post-stroke experience. Differences in health systems, cultural factors and available resources have made it apt to explore the experience of life after a stroke in Nigerian stroke survivors. This study explored the lived experiences of Nigerian adult stroke survivors, with a focus on their concerns, hopes, dreams and daily routine experiences.

Methods

This qualitative study employed a phenomenological approach based on in-depth interviews with stroke survivors. Interpretative phenomenological analysis was used to analyse the in-depth exploration of the personal experiences of these stroke survivors and the meanings they attached to that experience.

Results

The participants in this study described their experiences, emphasising both the visible loss of mobility and emotional issues related to their condition. Three superordinate themes were identified: (1) stroke presentation; (2) affect, coping, and adaptation; and (3) social supports.

Conclusion

The study concluded that the experience of Nigerian stroke survivors is unique as it is a blend of supportive and non-supportive care scenarios, which is greatly associated with environmental and other intrinsic variables. Post-stroke mobility strongly influences the overall stroke experience.
Cooperative joint inversion of magnetotelluric and microseismic data for imaging The Geysers geothermal field, California, USA
Authors: Um Evan Schankee , Commer Michael , Gritto Roland , Peacock Jared R. , Alumbaugh David L. , Jarpe Steve P. , Hartline Craig
Published: April 2023

The Geysers geothermal field located in northern California, USA, is the world’s largest electricity-generating geothermal facility. To delineate the spatio-temporal distribution of reservoir steam and recharge water, we have collected microseismic and magnetotelluric (MT) data using a dense array of stations in 2021. The microseismic and MT data have been inverted together using a 3D cooperative joint inversion workflow. The joint inversion exploits a cross-gradient structural constraint because electrical conductivity structures observed in the geothermal field are strongly correlated with [Formula: see text]/[Formula: see text] structures. To mitigate convergence issues associated with 3D large-scale joint inversion, the scheme is split into small manageable inversion subsets. By systematically performing the three inversion subsets and exchanging the structural information between velocity and conductivity models, the cooperative joint inversion mimics the full joint inversion. The 3D joint inversion results agree well with previous 3D microseismic and MT inversion studies. We find that the cooperative joint inversion improves overall MT images in terms of resolution and consistency with respect to the [Formula: see text]/[Formula: see text] model. The joint inversion also further reduces the MT data misfit. In contrast, the joint inversion does not significantly improve microseismic images because MT inversion produces low-resolution conductivity images with respect to microseismic images in depth of investigation (i.e., 1–5 km) and thus does not provide sufficient structural details that are required for improving microseismic images.
Age as a moderating factor of treatment resistance in depression
Authors: Kautzky Alexander , Bartova Lucie , Fugger Gernot , Dold Markus , Souery Daniel , Montgomery Stuart , Zohar Joseph , Mendlewicz Julien , Fabbri Chiara , Serretti Alessandro , Rujescu Dan , Kasper Siegfried
Published: April 2023

Background

Treatment-resistant depression (TRD) is an important clinical challenge and may present differently between age groups.

Methods

A total of 893 depressed patients recruited within the framework of the European research consortium “Group for the Studies of Resistant Depression” were assessed by generalized linear models regarding age effects (both as numerical and factorial predictors) on treatment outcome, number of lifetime depressive episodes, hospitalization time, and duration of the current episode. Effects of age as numerical predictor on the severity of common depressive symptoms, measured with Montgomery–Åsberg Depression Rating Scale (MADRS) for two-time points, were assessed by linear mixed models, respectively, for patients showing TRD and treatment response. A corrected p threshold of 0.001 was applied.

Results

Overall symptom load reflected by MADRS (p < 0.0001) and lifetime hospitalization time (p < 0.0001) increased with age in TRD patients but not treatment responders. In TRD, higher age was predicting symptom severity of inner tension, reduced appetite, concentrations difficulties, and lassitude (all p ≤ 0.001). Regarding clinical significance, older TRD patients were more likely to report severe symptoms (item score > 4) for these items both before and after treatment (all p ≤ 0.001).

Conclusions

In this naturalistic sample of severely ill depressed patients, antidepressant treatment protocols were equally effective in addressing TRD in old age. However, specific symptoms such as sadness, appetite, and concentration showed an age-dependent presentation, impacting residual symptoms in severely affected TRD patients and calling for a precision approach by a better integration of age profiles in treatment recommendations.
Postoperative Adjuvant Anastrozole for 10 or 5 Years in Patients With Hormone Receptor–Positive Breast Cancer: AERAS, a Randomized Multicenter Open-Label Phase III Trial
Authors: Iwase Takuji , Saji Shigehira , Iijima Kotaro , Higaki Kenji , Ohtani Shoichiro , Sato Yasuyuki , Hozumi Yasuo , Hasegawa Yoshie , Yanagita Yasuhiro , Takei Hiroyuki , Tanaka Maki , Masuoka Hideji , Tanabe Masahiko , Egawa Chiyomi , Komoike Yoshifumi , Nakamura Toshitaka , Ohtsu Hiroshi , Mukai Hirofumi
Published: April 2023

PURPOSE

Treatment with an aromatase inhibitor for 5 years is the standard treatment for postmenopausal hormone receptor–positive breast cancer. We investigated the effects of extending this treatment to 10 years on disease-free survival (DFS).

PATIENTS AND METHODS

This prospective, randomized, multicenter open-label phase III study assessed the effect of extending anastrozole treatment for an additional 5 years in postmenopausal patients who were disease-free after treatment with either 5 years of anastrozole alone or 2-3 years of tamoxifen followed by 2-3 years of anastrozole. Patients were allocated randomly (1:1) to continue anastrozole for an additional 5 years or stop anastrozole. The primary end point was DFS, including breast cancer recurrence, second primary cancers, and death from any cause. This study is registered with University Hospital Medical Information Network, Japan (UMIN) clinical trials registry (UMIN000000818).

RESULTS

We enrolled 1,697 patients from 117 facilities between November 2007 and November 2012. Follow-up information was available for 1,593 patients (n = 787 in the continue group, n = 806 in the stop group), who were defined as the full analysis set, including 144 patients previously treated with tamoxifen and 259 patients who underwent breast-conserving surgery without irradiation. The 5-year DFS rates were 91% (95% CI, 89 to 93) in the continue group and 86% (95% CI, 83 to 88) in the stop group (hazard ratio, 0.61; 95% CI, 0.46 to 0.82; P < .0010). Notably, extended anastrozole treatment reduced the incidence of local recurrence (continue group, n = 10; stop group, n = 27) and second primary cancers (continue group, n = 27; stop group, n = 52). There was no significant difference in overall or distant DFS. Menopausal or bone-related all-grade adverse events were more frequent among patients in the continue group than those in the stop group, but the incidence of grade ≥3 adverse events was <1% in both groups.

CONCLUSION

Continuing adjuvant anastrozole for an additional 5 years after 5 years of initial treatment with anastrozole or tamoxifen followed by anastrozole was well tolerated and improved DFS. Although no difference in overall survival was observed as in other trials, extended anastrozole therapy could be one treatment choice in postmenopausal patients with hormone receptor–positive breast cancer.
Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes
Authors: Haines Melanie S , Kaur Snimarjot , Scarff Geetanjali , Lauze Meghan , Gerweck Anu , Slattery Meghan , Oreskovic Nicolas M , Ackerman Kathryn E , Tenforde Adam S , Popp Kristin L , Bouxsein Mary L , Miller Karen K , Misra Madhusmita
Published: April 2023

Context

Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners.

Objective

To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength.

Design

Cross-sectional.

Setting

Clinical research center.

Participants

39 men (20 runners, 19 controls), ages 16–30 years.

Main Outcome Measures

Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability.

Results

Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (−1.4 ± 0.8 vs −0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA <median had lower lumbar spine (−1.5 ± 0.7, P = .028), while runners with EA ≥median had higher hip (0.3 ± 0.7 vs −0.4 ± 0.5, P = .002), BMD Z-scores vs controls. After adjusting for calcium intake and running mileage, runners with EA <median had lower mean tibial total and trabecular volumetric BMD, trabecular bone volume fraction, cortical porosity, and apparent modulus vs controls (P < .05). Appendicular lean mass and serum estradiol (R ≥ 0.45, P ≤ .046), but not testosterone, were positively associated with tibial failure load among runners.

Conclusions

Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.
Short-term Intensive Lifestyle Therapy in a Worksite Setting Improves Cardiometabolic Health in People With Obesity
Authors: Schweitzer George G , Beckner David C , Smith Gordon I , Klein Samuel
Published: April 2023

Context

The Pritikin Program, which provides intensive lifestyle therapy, has been shown to improve cardiometabolic outcomes when provided as a residential program.

Objective

The purpose of the present study was to conduct a short-term, randomized, controlled trial to evaluate the feasibility and clinical efficacy of treatment with the Pritikin Program in an outpatient worksite setting.

Methods

Cardiometabolic outcomes were evaluated in people with overweight/obesity and ≥2 metabolic abnormalities (high triglycerides, low high-density lipoprotein (HDL) cholesterol, high blood pressure, HbA1c > 5.7%), before and after they were randomized to 6 weeks of standard care (n = 26) or intensive lifestyle therapy, based on the Pritikin Program (n = 28). Participants in the lifestyle intervention group were provided all food as packed-out meals and participated in group nutrition, behavioral education, cooking classes, and exercise sessions 3 times per week at a worksite location.

Results

Compared with standard care, intensive lifestyle therapy decreased body weight (−5.0% vs −0.5%), HbA1c (−15.5% vs +2.3%), plasma total cholesterol (−9.8% vs +7.7%), low-density lipoprotein cholesterol (−10.3% vs +9.3%) and triglyceride (−21.7% vs +3.0%) concentrations, and systolic blood pressure (−7.0% vs 0%) (all P values < .02), and increased exercise tolerance (time to exhaustion walking on a treadmill by +23.7% vs +4.5%; P < .001).

Conclusion

This study demonstrates the feasibility and clinical effectiveness of short-term, intensive outpatient lifestyle therapy in people with overweight/obesity and increased risk of coronary heart disease when all food is provided and the intervention is conducted at a convenient worksite setting.
« Οι σχολικές εκδηλώσεις στο Δευτεροβάθμιο Σχολείο ως μέσο ιδεολογικής χειραγώγησης κατά τη δικτατορία(1967-1974) Το παράδειγμα του Γυμνασίου Φερών»
Authors: ΚΑΡΑΚΥΡΓΙΟΥ ΚΩΝΣΤΑΝΤΙΝΑ
Published: April 2023

Η παρούσα μελέτη επιχειρεί να δώσει απαντήσεις στο ερώτημα, εάν η δικτατορία του 1967 προώθησε την ιδεολογική χειραγώγηση των μαθητών στο Δευτεροβάθμιο Σχολείο, μέσω των σχολικών εκδηλώσεων, κατά την περίοδο 1967-1974. Μετά τη διερεύνηση του ιστορικού πλαισίου της περιόδου, η έρευνα εστίασε στην προέλευση και το περιεχόμενο της ιδεολογίας του καθεστώτος και στην εκπαιδευτική πολιτική που αυτό εφάρμοσε, ενώ μέσα από τη μελέτη πρωτογενούς αρχειακού υλικού, των Πρακτικών Συνεδριάσεων του Συλλόγου Καθηγητών του Εξατάξιου Γυμνασίου Φερών, ανέδειξε τους τρόπους με τους οποίους η διοργάνωση των σχολικών εορτών, των εκδρομών, των γυμναστικών επιδείξεων και των άλλων εκδηλώσεων επιχειρούσε τον ιδεολογικό προσανατολισμό των μαθητών της Μέσης Εκπαίδευσης στα ιδεώδη του ελληνοχριστιανικού πολιτισμού.Λέξεις Κλειδιά: Δικτατορία 21ης Απριλίου, Αναγκαστικός Νόμος, Μεταρρύθμιση 1964, Εθνικοφροσύνη, Ελληνοχριστιανικός πολιτισμός
Ευρωπαϊκή εκπαιδευτική πολιτική και η προσπάθεια ένταξης της Ελλάδας σε αυτή
Authors: ΑΘΑΝΑΣΑΚΟΥ ΠΗΝΕΛΟΠΗ
Published: April 2023

Ευρωπαϊκή εκπαιδευτική πολιτική και η προσπάθεια ένταξης της Ελλάδας σε αυτή
Η πολιτική ταυτότητα, η φιλοσοφία και οι εκπαιδευτικές μεταρρυθμίσεις του Ελευθερίου Βενιζέλου
Authors: Μεταξούδης Ελευθέριος Θεόδωρος
Published: April 2023

Μέσα από το μεγάλο και συνεχές μεταρρυθμιστικό έργο, που διαπέρασε και μεταμόρφωσε την Ελληνική κοινωνία, μπορεί και πρέπει, να ερευνηθεί και να σκιαγραφηθεί το ιδεολογικό και πολιτικό πορτρέτο του Ελευθερίου Βενιζέλου. Το πορτρέτο ενός βαθιά φιλελεύθερου ηγέτη, ο οποίος όμως, υπερβαίνοντας το φιλελευθερισμό, εγκολπώνει στοιχεία πολιτικού ριζοσπαστισμού. Το φιλελεύθερο και ριζοσπαστικό αυτό πνεύμα, το οποίο εφαρμόστηκε στο σύνολο των εκπαιδευτικών πεδίων της χώρας, υπεράνω όλων των κομματικών ανταγωνισμών και των φορέων εκπροσώπησής τους, σε θέματα όπως, της γλώσσας για τη διδασκαλική διαδικασία, στο ζήτημα της διάρθρωσης της εκπαίδευσης, στην ανύψωση του μορφωτικού επιπέδου για την επίτευξη της επιζητούμενης πολιτικής κοινωνικοποίησης των μαθητών (και κυρίως των γυναικών), αλλά και στην επιβολή μιας  αναγκαίας συνθήκης για τη στροφή της εκπαίδευσης στα ζωντανά στοιχεία του πολιτισμού, είναι ζητήματα τα οποία αυτή η εργασία πραγματεύεται.
Η θεσμοθέτηση της Εκπαίδευσης στα Προεπαναστατικά και Επαναστατικά Συνταγματικά Κείμενα.
Authors: ΤΑΤΣΙΟΥ ΕΛΕΝΑ Δ
Published: April 2023

Ο Νεοελληνικός Διαφωτισμός πέρα από την προφανή επίδραση που άσκησε στη γιγάντωση του αιτήματος της μόρφωσης των Ελλήνων, επηρέασε καταλυτικά την κήρυξη της Ελληνικής Επανάστασης και τη συνακόλουθη διαμόρφωση του Καταστατικού Χάρτη της Ελληνικής Πολιτείας. Ο θεσμός της εκπαίδευσης κατοχυρώνεται ως θεμελιώδες ατομικό και κοινωνικό δικαίωμα για άνδρες και γυναίκες ήδη από το προεπαναστατικό Σχέδιο Συντάγματος του Ρήγα Βελεστινλή με διατύπωση αξεπέραστη ακόμα και για το σύγχρονο συνταγματικό δίκαιο. Αργότερα η εκπαίδευση ως υπέρτατο θεσμικό δικαίωμα εντοπίζεται στα Συντάγματα της Επτανήσου Πολιτείας με τη ρητή απαίτηση ίδρυσης εκπαιδευτικών ιδρυμάτων όλων των βαθμίδων και κορυφαίο την Ιόνιο Ακαδημία. Στην ελληνική συνταγματική ιστορία η εκπαίδευση τελεί υπό την προστασία της εκτελεστικής εξουσίας ήδη από τις πρώιμες επαναστατικές διακηρύξεις όπως η Νομικὴ Διάταξις τῆς Ανατολικής Χέρσου. Αν και παραδόξως απουσιάζει από το πρώτο Σύνταγμα της Εθνεγερσίας το δικαίωμα στην εκπαίδευση έλαβε, με λιτή διατύπωση, τη θέση του ανάμεσα στα βασικά ατομικά δικαιώματα τόσο στο Σύνταγμα του Άστρους (1823), όσο πολύ περισσότερο στο Σύνταγμα της Τροιζήνας (1827). Με τα Συντάγματα του Αγώνα η Δημόσια Παιδεία τελεί υπό την φροντίδα του Κράτους, οι δε έλληνες αποκτούν το δικαίωμα της μόρφωσης, της ίδρυσης σχολείων και της επιλογής των διδασκάλων τους.
Το μοντέλο των τριών διαστάσεων της μάθησης του Illeris μέσω ενός ποιήματος και της τεχνικής «Συνέντευξη από ειδικό»
Authors: Χρήστου Μαρία
Published: April 2023

Στο παρόν άρθρο παρουσιάζεται μια πρόταση εμβάθυνσης στις τρεις διαστάσεις της μάθησης, σύμφωνα με το μοντέλο του Illeris (περιεχόμενο, υποκίνηση, αλληλεπίδραση με το περιβάλλον μάθησης), μέσω της κριτικής επεξεργασίας του ποιήματος του Νικηφόρου Βρεττάκου «Τα δεκατέσσερα παιδιά», σε συνδυασμό με την εκπαιδευτική τεχνική «Συνέντευξη από ειδικό». Έναυσμα υπήρξε ο τρόπος που προσεγγίστηκε κριτικά το ποίημα του Βρεττάκου από την Ομάδα Αυτομόρφωσης της Επιστημονικής Ένωσης Εκπαίδευσης Ενηλίκων (E.E.E.E.) σε μια από τις διαδικτυακές συναντήσεις της κατά το έτος 2020 – 2021, με στόχο την εμβάθυνση σε θέματα που σχετίζονται με τον τρόπο που μαθαίνουμε. Αρχικά γίνεται αναφορά στις τρεις διαστάσεις της μάθησης, σύμφωνα με το μοντέλο του Illeris, αλλά και στον τρόπο αντιμετώπισής τους από τη μεριά των εκπαιδευτικών, λαμβάνοντας υπόψη τις αντιστάσεις που μπορεί να προβάλουν στην περίπτωση που έρθουν αντιμέτωποι με δύσκολες εκπαιδευτικές συνθήκες στα σχολεία που εργάζονται. Κατόπιν, γίνεται αναφορά στη συμβολή της τέχνης ως μέσο προσέγγισης θεωρητικών ζητημάτων, αλλά και ως μέσο αναστοχασμού των προσωπικών πεποιθήσεων των αποδεκτών. Στη συνέχεια, παρουσιάζονται συγκεκριμένα θέματα που αναδείχθηκαν από τα μέλη της Ομάδας Αυτομόρφωσης της Ε.Ε.Ε.Ε. σχετικά με τις τρεις διαστάσεις της μάθησης, μέσω της κριτικής επεξεργασίας του ποιήματος του Νικηφόρου Βρεττάκου, αξιοποιώντας την τεχνική ανάλυσης λογοτεχνικών έργων τέχνης της Αντιγόνης Βλαβιανού. Κατόπιν, αξιοποιώντας την εκπαιδευτική τεχνική «Συνέντευξη από ειδικό» επιχειρείται η εμβάθυνση στα προαναφερθέντα θέματα που αναδείχθηκαν από την επεξεργασία του ποιήματος, μέσα από το προσωπικό βίωμα ενός συνταξιούχου εκπαιδευτικού, ο οποίος στις αρχές της δεκαετίας του 1960 βίωσε ανάλογες εκπαιδευτικές συνθήκες με αυτές που περιγράφονται στο ποίημα, όπως μας τα διηγήθηκε σε συνέντευξη που μας παραχώρησε. Ακολουθεί συζήτηση και σύνοψη συμπερασμάτων.

Το κείμενο θα μπορούσε να αποτελέσει μια πρόταση προσέγγισης θεωρητικών ζητημάτων για όλες τις βαθμίδες εκπαίδευσης, με τις ανάλογες προσαρμογές και την κατάλληλη καθοδήγηση από τον διδάσκοντα, λαμβάνοντας υπόψη την ηλικία, τις εμπειρίες και τα βιώματα των εκπαιδευομένων.  Χωρίς να παραβλέπουμε τη σημασία απόδοσης ενός θεωρητικού ζητήματος με τη χρήση του επιστημονικού λόγου, σε όλες τις βαθμίδες εκπαίδευσης και στην εκπαίδευση ενηλίκων, προτείνουμε παράλληλα την προσέγγιση του ίδιου θεωρητικού ζητήματος μέσω της κριτικής επεξεργασίας σημαντικών έργων τέχνης, με κατάλληλη τεχνική, όπως επίσης και μέσω της αξιοποίησης της εκπαιδευτικής τεχνικής «Συνέντευξη από ειδικό», η οποία ενισχύει την εμπέδωση της θεωρίας και την εμβάθυνση σε αυτήν. Σε όλο το άρθρο χρησιμοποιείται ένα γένος, χάριν οικονομίας του λόγου, χωρίς αυτό να παραπέμπει σε οποιαδήποτε διάκριση με βάση το φύλο.
Current and future opportunities of autodissemination of pyriproxyfen approach for malaria vector control in urban and rural Africa
Authors: Mmbaga Augustino Thabiti , Lwetoijera Dickson Wilson
Published: April 2023

Despite the progress made in reducing malaria burden, new ways to address the increasing challenges of insecticide resistance and the invasion and spread of exotic malaria vectors such as Anopheles stephensi in Africa are urgently needed. While African countries are adopting larviciding as a complementary intervention for malaria vector control, the autodissemination technology has the potential to overcome barriers associated with the identification and treatment of prolific habitats that impede conventional larviciding approaches in rural settings. The autodissemination technology as a “lure and release” strategy works by exploiting the resting behavior of gravid mosquitoes to transfer lethal concentration of biological or chemical insecticide such as pyriproxyfen (PPF), an insect growth regulator (IGRs) to their oviposition sites and result in adult emergence.

Despite the evidence of the autodissemination approach to control other mosquito-borne diseases, there is growing and promising evidence for its use in controlling malaria vectors in Africa, which highlights the momentous research that needs to be sustained. This article reviews the evidence for efficacy of the autodissemination approach using PPF and discusses its potential as efficient and affordable complementary malaria vector control intervention in Africa. In the previous studies that were done in controlled semi-field environments, autodissemination with PPF demonstrated its potential in reducing densities of captive population of malaria vectors such as Anopheles gambiae and Anopheles arabiensis. Of importance, empirical evidence and biology-informed mathematical models to demonstrate the utility of the autodissemination approach to control wild populations of malaria vectors under field environment either alone or in combination with other tools are underway. Among others, the key determining factors for future introduction of this approach at scale is having scalable autodissemination devices, optimized PPF formulations, assess its integration/complementarity to existing conventional larviciding, and community perception and acceptance of the autodissemination approach.
Puzzle—An OR Approach for WORdle
Authors: Lakhani Simran , Vora Mustafa , Mahajan Ashutosh
Published: April 2023

Modeling exercises are designed around the popular game Wordle. These exercises can possibly be used in a computational or modeling laboratory course or in a course on modeling operations research (OR) problems. They assume some familiarity with modeling integer programs, a programming language like Python for basic text processing, and optimization software like AMPL or PYOMO. These exercises were tried in a master’s-level course on modeling OR problems. Two sessions of three hours each are ideal for the whole exercise.
A energia do gesto: a “arte fotográfica” de José Oiticica Filho
Authors: Avelar Ana Candida
Published: April 2023

As séries Recriações e Ouropretenses, de José Oiticica Filho, são analisadas à luz de aproximações com obras e ideias de fotógrafos e da crítica estadunidense em torno do Expressionismo Abstrato. Nessa direção, trazemos a fortuna crítica relativa ao fotógrafo Aaron Siskind como caso significativo se comparada àquela produzida sobre a obra de Oiticica Filho.
Ela, a Mário de Andrade: Revisitando a consciência nacional modernista
Authors: Lustosa Tertuliana
Published: April 2023

Neste artigo, através da compreensão da perspectiva da obra ensaística de Mario deAndrade, pretende-se encorajar uma abordagem crítica da modernidade, revisitando a ideia deconsciência do nacional e apontando o aspecto de que essa consciência é ao mesmo tempo também pessoal e traz perspectivas dos lugares de fala de cada artista. Mário, em sua crítica, buscaum passado onde pudesse se assentar a prática artística contemporânea, o que resulta muitoforte no aspecto literário desses escritos e sua contextualização é bastante psicológica sobre osartistas e as obras criticadas, e é justamente esse viés que aponta para perspectivas contemporâneas, dos estudos culturais e de outras possibilidades de se observar a arte modernista.
Nurses' effort for providing end-of-life care in paediatric oncology: a phenomenological study
Authors: Ghaljeh Mahnaz , Rezaee Nasrin , Mardani-Hamooleh Marjan
Published: April 2023

Background:

Many children with cancer are hospitalised before the end of life and need special care. To improve the delivery of care for children, it is necessary to understand the insights, emotions and feelings of nurses.

Aim:

This study aimed to explore the lived experiences of nurses providing end-of-life care for children with cancer.

Methods:

A phenomenological hermeneutic approach was used to analyse the experience of 14 oncology nurses working in a children's hospital who were caring for children with cancer.

Findings:

Three themes and seven subthemes emerged from the analysis. The three main themes were: pain management (relieving physical pain and reducing the mental pain of the child and family); respect-based care (for the values and beliefs of the child and family and honesty in providing information to them); and negative reflections of care (psychological trauma, cultural challenges and futile care).

Conclusion:

The results of the present study showed that, despite the problems experienced by the nurses, they were still trying to provide life-sustaining care for children with cancer.
March 2023 Critical Care Case of the Month: A Bad Egg
Authors:   Phoenix Pulmonary and Critical Care Research and Education Foundation, Gilbert, AZ USA, Robbins Richard
Published: April 2023

No abstract available. Article truncated after 150 words. History of Present Illness: You are asked to see a 35-year-old man who was admitted to the ICU from the ER the previous night with an exacerbation of his chronic obstructive pulmonary disease (COPD). He has a long history of COPD and came to the ER for COVID-19 testing because he was at a party where a friend was later found to COVID-19. He denies any change in his chronic respiratory symptoms but his spirometry was significantly worse than his baseline in the ER and despite his protests he was admitted. He was treated with empiric antibiotics (amoxicillin and clavulanic acid), corticosteroids (methylprednisolone 125 mg every 6 hours), bronchodilators (albuterol/ipratropium every 4 hours) and oxygen. He says his breathing has not improved and he wants to go home. He has had gradually increasing shortness of breath for the past 8-10 years. He has minimal cough but denied any fevers, systemic …
Análisis de imágenes para la enseñanza de la producción oral de ELE en dos colecciones de manuales marfileños
Authors: Koffi Konan Hervé
Published: April 2023

Las imágenes, además de formar parte de la vida diaria de la nueva generación de jóvenes, poseen un enorme potencial para el desarrollo de las destrezas en el marco de la enseñanza de lenguas. En este contexto, el autor ha querido analizar los nuevos manuales de ELE marfileños, ¡Ya estamos! y ¡Más allá!, para sopesar no solo su grado de integración a los contenidos, sino también su utilización como soporte para fomentar la producción oral. Se llega a la conclusión de que ha habido una evolución positiva en cuanto a su estudio. Sin embargo, se espera una valoración más justa de las imágenes en los procesos de enseñanza, y sobre todo una metodología más adecuada a su explotación.
BP-based supervised learning algorithm for multilayer photonic spiking neural network and hardware implementation
Authors: Zhang Yahui , Xiang Shuiying , Han Yanan , Guo Xingxing , Zhang Wu , Tan Qinggui , Han Genquan , Hao Yue
Published: April 2023

We introduce a supervised learning algorithm for photonic spiking neural network (SNN) based on back propagation. For the supervised learning algorithm, the information is encoded into spike trains with different strength, and the SNN is trained according to different patterns composed of different spike numbers of the output neurons. Furthermore, the classification task is performed numerically and experimentally based on the supervised learning algorithm in the SNN. The SNN is composed of photonic spiking neuron based on vertical-cavity surface-emitting laser which is functionally similar to leaky-integrate and fire neuron. The results prove the demonstration of the algorithm implementation on hardware. To seek ultra-low power consumption and ultra-low delay, it is great significance to design and implement a hardware-friendly learning algorithm of photonic neural networks and realize hardware-algorithm collaborative computing.