bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors influencing caregivers' uncertainty of children undergoing cardiac surgery in Bangkok, Thailand
Authors: Maneekunwong Kunnara , Srichantaranit Arunrat , Thampanichawat Wanlaya
Published: May 2021

Purpose

This study aims to determine the factors influencing caregivers' uncertainty about children undergoing cardiac surgery in a tertiary hospital in Bangkok, Thailand.

Design/methodology/approach

A correlational predictive study was conducted among 75 caregivers of children from infancy to fifteen years old who were undergoing first time cardiac surgery in a tertiary hospital in Bangkok, Thailand. Four questionnaires were inquired to evaluate caregivers' uncertainty about the illness, and influential factors included (1) perception of the severity of the illness, (2) credible authority of health-care providers and (3) information and emotional support. The descriptive statistics, Pearson correlation coefficient and multiple regression analysis were used to analyze the data and influential factors.

Findings

The significant influential factors affecting caregivers' uncertainty were (1) perception of the severity of the illness (β = 0.413, p < 0.001), (2) credible authority of health-care providers (β = −0.287, p = 0.004) and (3) information and emotional support (β = −0.223, p = 0.026), and their explanation power was about 33.9 % (R2 = 0.339, F = 13.630, p < 0.001).

Research limitations/implications

A limitation of this study was that the researcher selected the sample group by convenient sampling and only caregivers of children who underwent cardiac surgery in Siriraj hospital were selected. Therefore, the sample group might have lacked variety and was not a good representative of the population. Future studies should be conducted by varying the setting and using randomized sampling.

Practical implications

This study provides clear recommendations to assess the perception of the severity of the illness by caregivers, build credibility and trust by providing quality care and should develop information and emotional support interventions for reducing the levels of caregivers' uncertainty of children undergoing cardiac surgery.

Originality/value

Health-care providers should develop the appropriate intervention for reducing caregivers' uncertainty by assessing the perception of the severity of the illness, providing information and emotional support and building trust for the caregivers of the children who are undergoing cardiac surgery.
Huawei in Venezuela: a review of 2006–2019
Authors: Baldo Carlos M. , Vail Richard , Seidel Julie
Published: May 2021

Purpose

The aim of this article is to describe Huawei's internationalization process in Venezuela and show how socio-political and economic conditions helped to expedite the company's development in this Latin American nation between 2006 and 2019. Through this internationalization process, Huawei participated in a large technological transition in Venezuelan telecommunications.

Design/methodology/approach

This research uses an integrative approach, developing a quasi-case study from a review of the academic literature, contemporary news stories and institutional and practitioner documents.

Findings

The review indicates that Huawei was engaged in business with the Venezuelan phone company before its renationalization. Secondly, Huawei's internationalization was a beneficiary of the increased relations between the Venezuelan and Chinese governments, mainly through “oil for loans/goods” agreements. Lastly, this internationalization process includes wholly owned subsidiaries, direct export, greenfield and government joint ventures.

Practical implications

This research provides an understanding to other firms and strategists about the benefits of strong bilateral economic relationships between home and host countries.

Originality/value

This paper is among the first academic articles that describe the internationalization process of Huawei in Venezuela. Considering the host country's changing political and economic conditions during the last 20 years, such research may provide a perspective for considering other Chinese business expansions in Venezuela and Latin America.
Dexmedetomidine attenuates one‐lung ventilation associated lung injury by suppressing inflammatory responses: A systematic review and meta‐analysis
Authors: Bai Yun‐Xiao , Zhang Jie‐Han , Zhao Bing‐Cheng , Liu Ke‐Xuan , Bai Yao‐Wu
Published: May 2021

One‐lung ventilation (OLV), a common ventilation technique, is associated with perioperative lung injury, tightly connected with inflammatory responses. Dexmedetomidine has shown positive anti‐inflammatory effects in lung tissues in pre‐clinical models. This study investigated the efficacy of dexmedetomidine for suppressing inflammatory responses in patients requiring OLV. We searched PubMed, MEDLINE, Embase, Scopus, Ovid, and Cochrane Library for randomized controlled trials focusing on dexmedetomidine’s anti‐inflammatory effects on patients requiring OLV without any limitation on the year of publication or languages. 20 clinical trials were assessed with 870 patients in the dexmedetomidine group and 844 in the control group. Our meta‐analysis investigated the anti‐inflammatory property of dexmedetomidine perioperatively [T1 (30‐min OLV), T2 (90‐min OLV), T3 (end of surgery) and T4 (postoperative day 1)], demonstrating that dexmedetomidine’s intraoperative administration resulted in a significant reduction in serum concentration of interleukin‐6, tumor necrosis factor‐α and other inflammatory cytokines perioperatively. By calculating specific I2 index, significant heterogeneity was observed on all occasions, with I2 index ranging from 95% to 99%. For IL‐6 changes, sensitivity analysis showed that the exclusion of a single study led to a significant decrease of heterogeneity (96%–0%; p < 0.00001). Besides, pulmonary oxygenation was ameliorated in the dexmedetomidine group comparing with the control group. In conclusion, perioperative administration of dexmedetomidine can attenuate OLV induced inflammation, ameliorate pulmonary oxygenation, and may be conducive to a decreased occurrence of postoperative complications and better prognosis. However, the results should be prudently interpreted due to the evidence of heterogeneity and the limited number of studies.
Practising legal geography
Authors: Brickell Katherine , Jeffrey Alex , McConnell Fiona
Published: May 2021

Legal geography is experiencing a “practice turn.” Understanding the material, spatial, and embodied characteristics of law is illuminating hitherto obscured experiences of justice, injustice, and political practice. It is contributions from scholars at the forefront of these concerns, from geography and cognate disciplines, that comprise the papers in the Practising legal geography special section. Across seven papers we are seeking to explore the ways in which a focus on practice can deepen our understanding of the methods and praxis of legal geography. Following an outline of its conceptual underpinnings and origins of the research, we give a short account of each of the papers and point to areas of future research for which they provide provocation. Practice emerges as much more than empirical detail – it is a perspective through which we can trace the operation of power and struggle in the making of law.
Does learning to code influence cognitive skills of elementary school children? Findings from a randomized experiment
Authors: Özcan Meryem Şeyda , Çetinkaya Esra , Göksun Tilbe , Kisbu‐Sakarya Yasemin
Published: May 2021

Background

Coding has been added to school curricula in several countries, being one of the necessary competencies of the 21st century. Although it has also been suggested to foster the development of several cognitive skills such as computational thinking and problem‐solving, studies on the effects of coding are very limited, provide mixed results, and lack causal evidence.

Aim

This study aims to evaluate the impact of a learn‐to‐code programme on three cognitive skills in children: computational thinking, fluid intelligence, and spatial orientation, using a randomized trial.

Sample

One hundred seventy‐four (n = 81 girls) 4th‐grade children participated in the study.

Methods

Children were randomly assigned to one of the three 10‐week learning programmes: learn‐to‐code (treatment of interest), mathematics (another STEM‐related comparison treatment), and reading (control). Children responded to paper–pencil computational thinking, and spatial orientation measurements, and face‐to‐face matrix reasoning task at pre‐ and post‐tests.

Results

Results showed that children’s computational thinking scores increased significantly only in the learn‐to‐code condition. Fluid intelligence significantly increased in all conditions, possibly due to a practice effect. The spatial orientation did not improve in any of the conditions.

Conclusion

These findings suggested that learning to code can be selectively beneficial for the development of computational thinking skills while not effective for spatial reasoning and fluid intelligence.
The role of interferons type I, II and III in myositis: A review
Authors: Bolko Loïs , Jiang Wei , Tawara Nozomu , Landon‐Cardinal Océane , Anquetil Céline , Benveniste Olivier , Allenbach Yves
Published: May 2021

The classification of idiopathic inflammatory myopathies (IIM) is based on clinical, serological and histological criteria. The identification of myositis‐specific antibodies has helped to define more homogeneous groups of myositis into four dominant subsets: dermatomyositis (DM), antisynthetase syndrome (ASyS), sporadic inclusion body myositis (sIBM) and immune‐mediated necrotising myopathy (IMNM). sIBM and IMNM patients present predominantly with muscle involvement, whereas DM and ASyS patients present additionally with other extramuscular features, such as skin, lung and joints manifestations. Moreover, the pathophysiological mechanisms are distinct between each myositis subsets. Recently, interferon (IFN) pathways have been identified as key players implicated in the pathophysiology of myositis. In DM, the key role of IFN, especially type I IFN, has been supported by the identification of an IFN signature in muscle, blood and skin of DM patients. In addition, DM‐specific antibodies are targeting antigens involved in the IFN signalling pathways. The pathogenicity of type I IFN has been demonstrated by the identification of mutations in the IFN pathways leading to genetic diseases, the monogenic interferonopathies. This constitutive activation of IFN signalling pathways induces systemic manifestations such as interstitial lung disease, myositis and skin rashes. Since DM patients share similar features in the context of an acquired activation of the IFN signalling pathways, we may extend underlying concepts of monogenic diseases to acquired interferonopathy such as DM. Conversely, in ASyS, available data suggest a role of type II IFN in blood, muscle and lung. Indeed, transcriptomic analyses highlighted a type II IFN gene expression in ASyS muscle tissue. In sIBM, type II IFN appears to be an important cytokine involved in muscle inflammation mechanisms and potentially linked to myodegenerative features. For IMNM, currently published data are scarce, suggesting a minor implication of type II IFN. This review highlights the involvement of different IFN subtypes and their specific molecular mechanisms in each myositis subset.
Life‐history strategies in salmonids: the role of physiology and its consequences
Authors: Birnie‐Gauvin Kim , Bordeleau Xavier , Cooke Steven J. , Davidsen Jan G. , Eldøy Sindre H. , Eliason Erika J. , Moore Andy , Aarestrup Kim
Published: May 2021

Salmonids are some of the most widely studied species of fish worldwide. They span freshwater rivers and lakes to fjords and oceans; they include short‐ and long‐distance anadromous migrants, as well as partially migratory and non‐migratory populations; and exhibit both semelparous and iteroparous reproduction. Salmonid life‐history strategies represent some of the most diverse on the planet. For this reason, salmonids provide an especially interesting model to study the drivers of these different life‐history pathways. Over the past few decades, numerous studies and reviews have been published, although most have focused on ultimate considerations where expected reproductive success of different developmental or life‐history strategies are compared. Those that considered proximate causes generally focused on genetics or the environment, with less consideration of physiology. Our objective was therefore to review the existing literature on the role of physiology as a proximate driver for life‐history strategies in salmonids. This link is necessary to explore since physiology is at the core of biological processes influencing energy acquisition and allocation. Energy acquisition and allocation processes, in turn, can affect life histories. We find that life‐history strategies are driven by a range of physiological processes, ranging from metabolism and nutritional status to endocrinology. Our review revealed that the role of these physiological processes can vary across species and individuals depending on the life‐history decision(s) to be made. In addition, while findings sometimes vary by species, results appear to be consistent in species with similar life cycles. We conclude that despite much work having been conducted on the topic, the study of physiology and its role in determining life‐history strategies in salmonids remains somewhat unexplored, particularly for char and trout (excluding brown trout) species. Understanding these mechanistic links is necessary if we are to understand adequately how changing environments will impact salmonid populations.
Prevalence and distribution of maxillofacial trauma in tertiary care centers before/ after motorcycle helmet use law in Sullia, India—A retrospective study
Authors: Chalathadka Mahabaleshwara , Ram Bhargav , Amudhan CR Thamil , PB Rachana , Pasha Aysha Kaleem , Kulkarni Sneha
Published: May 2021

Background/aims

In India, motorcycles are commonly involved in accidents and traffic rules negligence, most of which include some type of maxillofacial trauma. In September 2019, the rules for motorcycle and helmet use were modified to compulsory use in the state of Karnataka. The aim of this study was to assess the impact of mandatory helmet use on maxillofacial fractures and injuries in Sullia Taluk, Karnataka.

Materials and methods

The study was based on the information obtained from clinical records in the K.V.G Dental College and the K.V.G Medical College from February 2019 to February 2020. The inclusion criteria were subjects who met with two‐wheeler accidents with complete case records and radiological investigations.

Results

A total of 78 individuals reported with maxillofacial trauma from February 2019 to February 2020. The mean age was 31 ± 14 years. There were 74 (94%) males and 4 (6%) females. Forty‐nine cases reported before the mandatory helmet use rule and 29 cases reported after the helmet use rule. There was a 36.3% decrease in the incidence of maxillofacial trauma, 23.5% decrease in fractures, and an 89% reduction in the number of victims who underwent open reduction and internal fixation during the post‐law period.

Conclusion

There was a significant reduction in the incidence and severity of maxillofacial trauma after the implementation of the helmet rule.
Saving energy at home: Exploring the role of behavior regulation and habit
Authors: Webb Dave , Soutar Geoffrey N. , Gagné Marylène , Mazzarol Tim , Boeing Alexandra
Published: May 2021

Global demand for energy, environmental concerns over power generation emissions, and rising household energy costs have heightened interest in exploring ways to reduce energy consumption. Numerous approaches have been adopted, including those that build on the important recognition of consumer intentions as a predictor of behavior. However, the literature suggests intentions only moderately explain behavior. Thus, there is a case for further research to explore how the intention to behavior relationship can be strengthened. In response, this study contributes to a better understanding of how to reduce household energy consumption, by investigating the direct, and moderating effects integrated regulation and external regulation, as well as habit, have on the relationship between intention and behavior. The study draws on a large sample of household energy consumers who completed online surveys two months apart. The findings reveal a strong indirect relationship between integrated regulation and behavior through intention, and a significant, direct, and negative relationship between external regulation and behavior. While external regulation moderated the positive relationship between intentions and behavior, the moderating effects of integrated regulation and habit were not significant. Further, a direct effect for habit on behavior was found. These findings suggest regulation types play different roles in affecting consumer intentions and behavior, and support the importance of habit as a predictor of energy consumption.
Sleep medicine catalogue of knowledge and skills – Revision
Authors: Penzel Thomas , Pevernagie Dirk , Bassetti Claudio , Peigneux Philippe , Paunio Tiina , McNicholas Walter T. , Dogas Zoran , Grote Ludger , Rodenbeck Andrea , Cirignotta Fabio , d’Ortho Marie‐Pia , Nobili Lino , Paiva Teresa , Pollmächer Thomas , Riemann Dieter , Zucconi Marco , Hill Elizabeth A. , Arnardottir Erna‐Sif , Parrino Liborio
Published: May 2021

The ‘catalogue of knowledge and skills’ for sleep medicine presents the blueprint for a curriculum, a textbook, and an examination on sleep medicine. The first catalogue of knowledge and skills was presented by the European Sleep Research Society in 2014. It was developed following a formal Delphi procedure. A revised version was needed in order to incorporate changes that have occurred in the meantime in the International Classification of Sleep Disorders, updates in the manual for scoring sleep and associated events, and, most important, new knowledge in sleep physiology and pathophysiology. In addition, another major change can be observed in sleep medicine: a paradigm shift in sleep medicine has taken place. Sleep medicine is no longer a small interdisciplinary field in medicine. Sleep medicine has increased in terms of recognition and importance in medical care. Consequently, major medical fields (e.g. pneumology, cardiology, neurology, psychiatry, otorhinolaryngology, paediatrics) recognise that sleep disorders become a necessity for education and for diagnostic assessment in their discipline. This paradigm change is considered in the catalogue of knowledge and skills revision by the addition of new chapters.
Solitary plasmacytoma of the maxilla: A rare case report of identification and management within an oral surgery department
Authors: Dawar Heather , Ornsby Valerie , Wall Michael
Published: May 2021

Plasmacytoma is a rare malignant tumour originating from the plasma cells. This may present itself in the bone marrow (myelomatous) as a solitary bone plasmacytoma or in the soft tissues, as an extramedullary plasmacytoma. Solitary bone plasmacytomas in the head and neck region are very uncommon and initial symptoms may be non‐specific and vague. However, the risk of progression towards multiple myeloma with these conditions is high, and therefore early diagnosis is essential for positive therapy outcomes. An 81‐year‐old patient presented with a pedunculated soft tissue mass in the upper left maxilla. This demonstrated symptoms in keeping with a pyogenic granuloma; however, the rapid growth and haemorrhagic nature raised concerns. Histological examination of the maxillary soft tissue mass revealed dense plasma cell infiltrate, consistent with a solitary plasmacytoma. Extensive investigations were performed to exclude multifocal involvement. Treatment involved complete surgical excision and radiotherapy. The patient remained stable and progression free at 6‐month review. The objective of this clinical case report is to highlight this unusual oral pathology to avoid incorrect diagnosis.
Incidence of Simonsiella in the oral cavity of dogs
Authors: Nyby M D , Gregory D A , Kuhn D A , Pangborn J
Published: May 2021

The gliding bacterium Simonsiella (Cytophagales, Simonsiellaceae) was found in palate samples from 66 out of 67 dogs. It is considered a common resident in the oral cavities of dogs.
Bactericidal Effect of Anaerobic Broth Exposed to Atmospheric Oxygen Tested on
Peptostreptococcus anaerobius
Authors: Frölander Fred , Carlsson Jan
Published: May 2021

Peptostreptococcus anaerobius
strain VPI 4330-1 was used as the test organism in an evaluation of the bactericidal effect of anaerobic broth exposed to air. The test organism, grown under anaerobic conditions in Trypticase soy broth, was diluted in buffered salt solution, and about 2 × 10
4
cells were suspended in 10 ml of an aerated broth. Ninety percent of the cells were killed within 15 min in actinomyces broth and within 50 min in Trypticase soy broth. All cells survived for 2 h in fluid thioglycolate medium. Addition of DABCO [1,4-diazabicyclo (2.2.2) octane] or mannitol to Trypticase soy broth did not influence the death rate of the organism, whereas superoxide dismutase decreased the death rate. Addition of catalase or manganese dioxide to the broth kept all the cells viable for 2 h. Of the three broth media tested, actinomyces broth reduced oxygen at the highest rate and Trypticase soy broth reduced it at the slowest rate. Hydrogen peroxide could be demonstrated in actinomyces broth and in Trypticase soy broth but not in fluid thioglycolate medium. In addition to catalase, manganese dioxide also removed all hydrogen peroxide from Trypticase soy broth, and superoxide dismutase significantly decreased the concentration of hydrogen peroxide in the broth. The results suggest that hydrogen peroxide mediated the toxic effect of atmospheric oxygen in these broth media.
Studies on neutralization of human serum bactericidal activity by sodium amylosulfate
Authors: Traub W H
Published: May 2021

The synthetic anticoagulant sodium amylosulfate (SAS) at concentrations of 125 to 2,000 microgram/ml failed to completely neutralize the bactericidal activity of 80 and 50% (by volume) fresh human serum. Furthermore, SAS failed to inhibit the alternative pathway of complement activation in 80% (by volume) fresh human serum that had been chelated with 0.01 M magnesium ions plus 0.01 M ethyleneglycol-bis(beta-aminoethylether)-N,N-tetraacetic acid. However, SAS at 250 to 1,000 microgram/ml effectively neutralized the bactericidal activity of 20% (by volume) fresh human serum. Therefore, SAS (at 250 to 1,000 microgram/ml) should be used only in blood samples that have been diluted at least fivefold (less than or equal to 20% [by volume]) in suitable broth media.
Chromatographic Separations of Alphavirus Strains by Hydroxylapatite
Authors: Jahrling P. B. , Beall J. L.
Published: May 2021

Hydroxylapatite column chromatography methods were developed to characterize selected alphavirus populations. Different conditions of pH and phosphate molarity were required to obtain satisfactory elution profiles and separations for Western equine encephalomyelitis virus strains, compared with Eastern equine encephalomyelitis virus and Semliki Forest virus strains. Raising the pH of the buffers effected earlier elutions of all viruses. Selection of phosphate gradients with more gentle slopes and adjustment to the proper pH effected better separations of virus subpopulations. Elution profiles were not affected by 0.85% NaCl, 10% fetal calf serum, or 1% bovine serum albumin, which are common constituents of virus-stabilizing diluents. Passage of Western equine encephalomyelitis and Semliki Forest viruses in BHK-21, Vero, or duck embryo cell cultures or in suckling mouse brains did not usually affect elution profiles, unless passage also resulted in a shift in the plaque size marker. Essentially all infectious virus applied to the column was recoverable in appropriate fractions. This permitted accurate determinations of heterogeneity within alphavirus populations. For Western equine encephalomyelitis large-plaque (LP) and small-plaque (SP) virus populations, it was possible to detect ratios of 1 LP in a population of 10
6
SP, and 1 SP in 10
3
LP by using linear phosphate gradients. When stepwise elution procedures were used, it was possible to detect ratios of 1 SP in a population of 10
5
LP. Hydroxylapatite column chromatography therefore appears to be a useful tool for characterizing alphaviruses and for isolating minority subpopulations of viruses of biological or epidemiological importance from apparently homogeneous virus stocks.
Antibody response to Serratia marcescens isolated from patients with malignant diseases
Authors: Griffiths E K , Surgalla M J , Fitzpatrick J E , Neter E
Published: May 2021

Sixty-four patients with malignant diseases from whom Serratia marcescens was isolated from various sources were studied regarding their antibody responses to somatic O antigens of this microorganism. Antibodies were titrated by the passive hemagglutination test. An antibody response was considered present when either a fourfold or greater rise in antibody titers between two consecutive serum specimens was demonstrated, or when elevated titers (greater than or equal to 40 for serogroup O14 and greater than or equal to 160 for all others) were present in the first available specimen. Overall, 31% of subjects mounted an immune response, but there were differences depending upon the infection site. Seventy-one percent of patients with S. marcescens bacteremia responded immunologically; whereas the percentage for patients with Serratia present in the respiratory tract was only 22%, in the urinary tract, 31%, and in wounds, 26%. Documentation of an immune response to the patient's own infecting strain of Serratia aids in the differentiation between infection and contamination and possibly also between clinical disease and colonization. In addition, immunoglobulin samples collected in different decades were examined to determine whether the background level of antibodies to S. marcescens had changed in the general population over the years. No difference in antibody titers to 13 O antigens was observed in immunoglobulin preparations from 1951, 1962, 1971, and 1975.
Use of immunoperoxidase for rapid diagnosis of mucocutaneous herpes simplex virus infection
Authors: Benjamin D R
Published: May 2021

The indirect immunoperoxidase method was applied to the rapid diagnosis of mucocutaneous herpes simplex virus infection. Specimens were obtained directly from lesions at various stages in their evolution. The immunoperoxidase method identified herpes simplex virus-infected cells in 91% of vesicular lesions which were positive by standard virological culture. At later stages, the number of cases that could be diagnosed decreased appreciably. The immunoperoxidase method appears to be a rapid and reliable method for the diagnosis of early herpes simplex virus infection.
An Evaluation of Computer-Based Instruction in Microbiology
Authors: MERKEL SUSAN M. , WALMAN LAURA B. , LEVENTHAL JEREMY S.
Published: May 2021

There has been a tremendous increase in the availability of computer-based instructional (CBI) materials. Some studies have shown an improvement in learning when CBI is used. However, many researchers believe the current studies are inadequate. While CBI software should be thoroughly tested by developers, as educators, we should be concerned about whether or not the CBI materials we use are improving learning in our classrooms with our students. We present an evaluation of a computer-based hypermedia tutorial that was delivered over our General Microbiology website. We found that CBI was at least as effective as text-based material. However, of all students who used CBI, only those who explored most of the site benefited from using the site. Tracking each student’s use of the CBI was critical for understanding who was learning and why.
Nutrition content of summative examinations within an Australian 4-year graduate entry medical course: 2013–2016
Authors: Perlstein Robyn , McLeod Janet , Bell Colin , Nowson Caryl
Published: May 2021

Background

Poor nutrition is a major contributor to chronic disease, but the level of nutrition education in medical training is limited. Deakin University Medical School has been working to embed more nutrition into the curriculum since 2009.

Aim

To assess the nutrition content of all summative examinations in the Bachelor of Medicine, Bachelor of Surgery over a 4-year period.

Methods

The type, amount and scope of nutrition-related questions were assessed in all summative examinations delivered to all 4-year levels from 2013 to 2016. These were assessed independently and analysed for nutrition content. The amount of nutrition was quantified, and the nutrition topic areas and nutrition competencies addressed were documented.

Results

Less than 10% of summative examination questions contained any nutrition content. For first-year and second-year students, these examinations included an average yearly total of 433 multiple choice questions (MCQs) (range 337–530) and 47 short answer questions (SAQs) (range 33–62). Third-year and fourth-year students had 150 MCQs on average per year and no SAQs. The percentage of nutrition-related questions across all 4 years ranged from 6% in 2013 to 10% in 2016. The proportion of SAQs with nutrition content ranged from 12% in 2013 to 19% in 2016. Basic nutritional sciences, accounted for 60% of nutrition content and, 25% addressed dietary strategies for prevention and treatment of disease, and skills-based nutrition competencies represented approximately 10% of all questions.

Summary and conclusions

Minimal nutrition was included in the summative examinations. There did not appear to be any consistent increase in the nutrition content of MCQs over the 4-year period but there was some indication of an increase in nutrition content in SAQs. Longer term evaluation is required to confirm this trend. Only a small number of nutrition questions were skills based, most focused on basic nutritional science. Examinations included few skills-based nutrition questions, and consideration of setting a minimum level of nutrition in examinations could assist in ensuring the development of appropriate nutrition competencies in medical graduates.
Development and validation of a risk prediction model for in-hospital major cardiovascular events in patients hospitalised for acute myocardial infarction
Authors: Wu Chaoqun , Huo Xiqian , Liu Jiamin , Zhang Lihua , Bai Xueke , Hu Shuang , Li Xi , Lu Jiapeng , Zheng Xin , Li Jing , Zhang Haibo
Published: May 2021

Objectives

Patients admitted to hospital with acute myocardial infarction (AMI) have considerable variability in in-hospital risks, resulting in higher demands on healthcare resources. Simple risk-assessment tools are important for the identification of patients with higher risk to inform clinical decisions. However, few risk assessment tools have been built that are suitable for populations with AMI in China. We aim to develop and validate a risk prediction model, and further build a risk scoring system.

Design

Data from a nationally representative retrospective study was used to develop the model. Patients from a prospective study and another nationally representative retrospective study were both used for external validation.

Setting

161 nationally representative hospitals, and 53 and 157 other hospitals were involved in the above three studies, respectively.

Participants

8010 patients hospitalised for AMI were included as development sample, and 4485 and 11 223 other patients were included as validation samples in their corresponding studies.

Primary and secondary outcome measures

The in-hospital major adverse cardiovascular events (MACE) was defined as death from any cause, recurrent AMI, or ischaemic stroke.

Results

The proportion of in-hospital MACE was 11.7%, 8.8% and 11.4% among the development sample and two external-validation samples, respectively. Nine predictors (ie, age, sex, left ventricular ejection fraction, Killip class, systolic blood pressure, creatinine, white blood cell count, heart rate and blood glucose) were independently associated with in-hospital MACE. The model performed well on both discrimination and calibration capability, with areas under the Receiver Operating Characteristic Curve (ROC) curve of 0.85, 0.74 and 0.80, and calibration slopes of 0.98, 0.84 and 0.97 in the development sample and two external validation samples, respectively. A point-based risk scoring system was built with good discrimination and reclassification ability.

Conclusions

A prediction model using readily available clinical parameters was developed and externally validated to estimate risks of in-hospital MACE among patients with AMI, thereby better informing decision-making in improving clinical care.
Heavy $$Z^\prime $$ bosons in the secluded $$U(1)^\prime $$ model at hadron colliders
Authors: Frank Mariana , Selbuz Levent , Turan Ismail
Published: May 2021

We study $$Z^{\prime }$$

Z
′

phenomenology at hadron colliders in an $$U(1)^{\prime }$$

U

(
1
)

′

extended MSSM. We choose a $$U(1)^{\prime }$$

U

(
1
)

′

model with a secluded sector, where the tension between the electroweak scale and developing a large enough mass for $$Z^{\prime }$$

Z
′

is resolved by incorporating three additional singlet superfields into the model. We perform a detailed analysis of the production, followed by decays, including into supersymmetric particles, of a $$Z^{\prime }$$

Z
′

boson with mass between 4 and 5.2 TeV, with particular emphasis on its possible discovery. We select three different scenarios consistent with the latest available experimental data and relic density constraints, and concentrate on final signals with $$2\ell +\not \! \! E_{T}$$

2
ℓ
+

⧸

E
T

, $$4\ell +\not \! \! E_{T}$$

4
ℓ
+

⧸

E
T

and $$6\ell +\not \! \! E_{T}$$

6
ℓ
+

⧸

E
T

. Including the SM background from processes with two, three or four vector bosons, we show the likelihood of observing a $$Z^\prime $$

Z
′

boson is not promising for the HL-LHC at 14 TeV. While at 27 and 100 TeV, the situation is more optimistic, and we devise specific benchmark scenarios which could be observed.
Epileptic Capgras-Like Delusions in a Patient with Right Frontal Meningioma: Case Report
Authors: Colombo Eleonora , Messina Stefano , Verde Federico , Locatelli Marco , Poletti Barbara , Silani Vincenzo , Ticozzi Nicola
Published: May 2021

Capgras syndrome is a condition characterized by the belief that a relative has been replaced by an almost identical imposter. The disorder has been reported in several neurological diseases. We describe the uncommon case of a transient Capgras syndrome manifesting as focal temporal seizures in a woman with a right frontal meningioma. Our patient represents an exceptional case of Capgras syndrome for several reasons, namely, the association with meningioma, very rarely reported before, the transient manifestation of symptoms, and, most importantly, the epileptic etiology of reduplicative paramnesias. Lastly, our report also confirms the importance of frontal and right hemisphere dysfunction in generating Capgras syndrome-like delusions.
Pseudotumoral Demyelinating Lesions: A Presentation of Acute Disseminated Encephalomyelitis
Authors: Belfkih Rachid , Khayat Omar Ghomari , H’daidane Hind , El Amrani Fatima Zahra
Published: May 2021

Pseudotumoral forms of demyelination are related to central nervous system demyelinating disorders, usually considered to be an atypical presentation of multiple sclerosis including its different varieties such as Balo’s, Schilder’s, and Marburg diseases. These lesions could also be seen in myelin oligodendrocyte glycoprotein antibody-associated demyelination, acute disseminated encephalomyelitis (ADEM), and neuromyelitis optica spectrum disorder. The pseudotumoral aspect may be mistakenly considered as an abscess or a cancerous tumor, in which case, patients could endure unnecessary possibly harmful brain biopsy and have a delay in their disease diagnostics and management. Once latter differential diagnosis is discarded, pseudotumoral demyelination prompts uncertainties concerning the nature of the underlying demyelinating condition as prognosis and management differ from multiple sclerosis to other syndromes, especially whether a chronic treatment is needed or not. In this case report, we present a 35-year-old male patient hospitalized in the department of neurology for a rapidly progressive onset of encephalopathy and polyfocal neurological deficits, with pseudotumoral lesions shown on brain MRI. On further investigations, ADEM was the more likely diagnosis that could fit the patient’s clinical and radiological presentation. Thence, he was put on high dose of intravenous corticosteroids, with a followed good recovery within the first week of the treatment.
Temporal Trends in the Incidence of Ischemic Stroke in Young Adults: Dijon Stroke Registry
Authors: Béjot Yannick , Duloquin Gauthier , Thomas Quentin , Mohr Sophie , Garnier Lucie , Graber Mathilde , Giroud Maurice
Published: May 2021

Introduction: Stroke is associated with major consequences in terms of socioeconomic impact and lost disability-adjusted life in young victims, thus justifying a careful surveillance of epidemiological trends. This study aimed to assess changes in the incidence of ischemic stroke in young adults over a long period. Methods: All cases of first-ever ischemic stroke that occurred among adults aged 18–55 years were prospectively recorded using the population-based Dijon Stroke Registry, from 1985 to 2017. Sex-specific annual incidence rates were calculated and were presented according to 6 time periods. Incidence rate ratios (IRRs) were determined to assess sex differences in stroke incidence. Results: Over the whole study period, 4,451 patients suffered a first-ever ischemic stroke. Among these patients, 469 (10.5%) were young adults (median age: 46 years, IQR: 39–50; 53.9% men). Incidence rates rose from the study period 2003 to 2007 compared with previous periods and remained stable thereafter, both in men and women. Hence, incidence per 100,000 per year was globally 11.0 (95% CI: 9.4–12.7) before 2003 and 22.9 (20.3–25.6) thereafter. In individuals aged 18–45 years, incidence rates were 5.4 (4.3–6.9) overall, 4.1 (2.7–6.0) in men, and 6.7 (4.9–9.0) in women, before 2003. After 2003, incidence rates rose to 12.8 (10.7–15.1) overall, 12.0 (9.2–15.4) in men, and 13.6 (10.6–17.0) in women. In this age group, the men/women IRR was 0.78 (95% CI: 0.62–1.26, p = 0.08), although sex differences decreased over time (IRR = 0.62; 95% CI: 0.36–1.02, p = 0.046 before 2003, vs. IRR = 0.88; 95% CI: 0.62–1.26, p = 0.48 after 2003). In individuals aged 45–55 years, incidence rates before 2003 were 47 (37–61) in men and 25 (17–35) in women (IRR = 1.90; 95% CI: 1.24–2.97, p < 0.001), and they increased to 82 (67–100) in men and 46 (35–59) in women (IRR = 1.79; 95% CI: 1.29–2.49, p < 0.001) after 2003. Conclusions: The incidence of ischemic stroke in young adults increased during the early 2000s and remained stable thereafter. These results highlight the priority need for dedicated prevention strategies for the young to reduce the burden of stroke.
The Experience, Prerequisites, and the Barriers in Organizing a Specialized Rehabilitation Program for Patients with Pulmonary Hypertension
Authors: Palevičiūtė Eglė , Gumbienė Lina , Jurevičienė Elena , Šimbelytė Toma , Laucevičienė Ieva , Laucevičius Aleksandras , Barysienė Jūratė , Eichstaedt Christina A. , Benjamin Nicola , Grünig Ekkehard , Čelutkienė Jelena
Published: May 2021

Background: Pulmonary hypertension (PH) is a severe progressive disease, associated with reduced exercise capacity and poor quality of life. Although scientific evidence supports the incorporation of specialized training in the treatment of PH, it is only available in a few countries. Objectives and Methods: This article aims to share the experience of implementing a PH rehabilitation program, to summarize the barriers and prerequisites for launching this service, and to assess its early effect. We retrospectively analyzed our pathway in organizing this program, by singling out essential steps. Results: The preparation phase took about 14 months. Establishing and running of a PH rehabilitation program required dedicated rehabilitation specialists to join the multidisciplinary PH expert team. Team members needed to gain special knowledge on exercise training in severely compromised patients; thus, supervision and education by experienced consultants was crucial. The main eligibility criteria for patients were stable status, optimal medical treatment, and motivation to undergo the training. The first results evaluating the effect of a specialized PH training program in 9 patients are promising. Seven of them improved their functional capacity over the period of 15 weeks. Conclusions: Despite a number of challenges and barriers, the implementation of a specialized rehabilitation program should be encouraged in a few dedicated PH expert centers per country, who are capable to fulfill all prerequisites and organizational aspects. Local PH experts, supervision by an experienced center, in-patient rehabilitation facilities, dedicated personnel, equipment, and patient motivation are essential.
Limiar pressórico de dor no assoalho pélvico de mulheres idosas com e sem fibromialgia: um estudo transversal
Authors: Schlemmer Gessica Bordin Viera , Arruda Guilherme Tavares de , Pereira Marisa Bastos , Braz Melissa Medeiros
Published: May 2021

Objetivo: Este estudo teve como objetivo comparar o limiar de pressão dolorosa no assoalho pélvico de mulheres idosas com e sem fibromialgia. Métodos: Foi realizado um estudo duplo-cego com 28 idosas de 60 a 75 anos, divididas em dois grupos, com diagnóstico médico de fibromialgia (GF) e sem fibromialgia (GWF). A avaliação foi realizada em uma única reunião, de forma individual, na qual os dados do histórico ginecológico, obstétrico-clínico e médico e informações sobre o assoalho pélvico foram obtidos por voluntários previamente treinados. A avaliação do limiar de dor à pressão foi realizada com o uso de algômetro por um dos pesquisadores. Foram utilizados os testes t de Student bicaudal, teste U de Mann-Whitney e qui-quadrado. Todos os testes foram realizados com nível de significância de 5%. Resultados: O limiar de pressão da dor mostrou que o GF apresentou menores valores de percepção da dor em relação à GWF (p <0,001 para o lado esquerdo) e (p <0,001 para o lado direito). Conclusão: O GF apresentou limiar de dor à pressão mais baixa, o que pode estar relacionado à patologia, que causa dor generalizada e sensibilização central.
Efeitos da realidade virtual em crianças e adolescentes com paralisia cerebral baseada na Classificação Internacional de Funcionalidade, Incapacidade e Saúde: revisão sistemática
Authors: Pereira Gabriela Santos , Santos Heyriane Martins dos , Brandão Thayane Correa Pereira , Silva Jéssica Lima da , Kaczmarek Mara Cristina Dias , Pinheiro Vanessa Viana , Fonseca Junior Paulo Roberto , Silva Soraia Micaela
Published: May 2021

Objective: This review aimed to address the effects of therapy with virtual reality in children and adolescents with cerebral palsy according to International Classification of Functioning, Disability and Health (ICF), with the intention of gathering data that elucidate how the application of ICF can result in better understanding of the characteristics presented in a health situation. Methods: The articles were searched in the MEDLINE (Pubmed), PEDro, LILACS e SCIELO platforms, published until May 2019. Physiotherapy Evidence Database - PEDro was used as a method for evaluating, was included articles with a score ≥ 6 (six) in PEDro. Results: Six articles were included in this review. In general, significant results were observed regarding “Body functions” related to the improvement of upper and lower limb function after intervention with VR when compared to conventional therapy. In the “Activity” domain, we observed results in gait, balance and overall motor skills of children with CP after VR intervention. Conclusion: The effects of Virtual Reality in children with CP related to ICF are positive, but more results were found associated with the domain "Body functions" and "Activity", so it is suggested that further studies be done to verify the effects of VR on “Participation” and “Environmental Factors”.
Prevalência de distúrbios osteomusculares e fatores associados na população idosa: revisão sistemática
Authors: Oliveira Bruna Nunes de , Dilélio Aliteia Santiago , Saes Mirelle de Oliveira
Published: May 2021

Objective: To describe the prevalence of musculoskeletal disorders and associated factors in the elderly population from a systematic review. Methods: For the selection of articles, a search was carried out in the PUBMED, SciELO, LILACS and WEB OF SCIENCE databases during August 2018. The descriptors indexed in the Health Sciences Descriptors (DeCS) and in the Medical Subject Headings were used (MeSHTerms). Results: Initially, 6,290 articles were identified, excluding 19 duplicates. The titles were read in the Mendeley Software, 132 articles were selected for reading the abstracts and, after 60 articles for reading in full. At the end, 21 articles were selected, excluding those that did not answer the guiding question and did not have an outcome equivalent to the proposal of this review. Evidence has shown that there is great variability in the prevalence of musculoskeletal disorders in the elderly, ranging from 0.6% to 72.1% and in the instruments used to measure them. Despite the literature consolidating the association of musculoskeletal disorders with female gender and advanced age, there is no consensus about its association with functional capacity and the use of health services. Conclusion: It was also observed that alcoholism, smoking, physical inactivity, obesity and systemic arterial hypertension are associated with musculoskeletal disorders in the elderly. The high prevalences identified refer to the importance of planning health actions that aim to prepare professionals and public health services to serve this growing portion of the population.
Validação psicométrica da Social Physique Anxiety Scale para brasileiros com amputação de membros
Authors: Ferreira Filho Roberto Gomes , Neves Angela Nogueira
Published: May 2021

Physical-social anxiety is about the sensation of discomfort experienced when there is a real or imagined situation, in which part or the whole body is exposed to the judgment of another person. To verify the factorial structure of the Brazilian version of the Social Physique Anxiety Scale in a reference sample of amputees. Confirmatory factor analysis was performed with data obtained from a sample of 100 participants, 99% of whom were men, with an average age of 48.26 (± 18.26; max= 82; min= 15) years, and time average amputation of 76.36 (± 95.36; max= 504; min= 1) months, to determine the best fit between the one-dimensional and two-dimensional models. Construct reliability values and Conbrach's alpha test were calculated to determine evidence of reliability. For construct validity, evidence of convergent and discriminant validity was generated. Evidence of convergent validity was generated by the average extracted variance (AVE) and by the analysis of the correlation with a similar construct measure. For the discriminant validity, it was verified if there was a theoretically expected difference between two groups. The model with the best fit was the one-dimensional model after the elimination of four items (RMSEA= 0.074, χ2/df= 1.54, CFI= 1, NFI= 0.98, NNFI= 1, AGFI= 0.98, GFI= 0.99, AIC= 62.84). Evidence of internal and discriminant reliability was satisfactorily generated for the measurement model, with a caveat to convergent validity, with a low value of the extracted average variance.  The scale can be used in Brazil to assess physical and social anxiety in amputees.