Search

Natural gas flaring, with its harmful environmental, health, and economic effects, is common in the Nigerian oil and gas industry because of a lower tax regime for flared gases. Based on the adverse effects of flared gas, the Nigerian government has renewed and improved its efforts to reduce or eliminate gas flaring through the application of natural gas utilisation techniques. However, because the conventional approach to flare gas utilisation is heavily reliant on achieving scale, fuel, and end-product prices, not all technologies are technically and economically viable for typically capturing large and small quantities of associated gas from various flare sites or gas fields (located offshore or onshore). For these reasons, this paper reviews and compares various flare gas utilisation options to guide their proper selection for appropriate implementation in the eradication of routine gas flaring in Nigeria and to promote the Zero Routine Flaring initiative, which aims to reduce flaring levels dramatically by 2030. A qualitative assessment is used in this study to contrast the various flare gas utilisation options against key decision drivers. In this analysis, three natural gas utilisation processes—liquefied natural gas (LNG), gas to wire (GTW), and gas to methanol (GTM)—are recommended as options for Nigeria because of their economic significance, technological viability (both onshore and offshore), and environmental benefits. All these gas utilisation options have the potential to significantly reduce and prevent routine gas flaring in Nigeria and can be used separately or in combination to create synergies that could lower project costs and product market risk. This article clearly identifies the environmental benefits and the technical and economic viability of infrastructure investments to recover and repurpose flare gasses along with recommendation steps to select and optimise economies of scale for an associated natural gas utilisation option. Cranfield University

Sindrome del seno silente: revisione sistematica e proposta di definizione, diagnosi e trattamento.La sindrome del seno silente (SSS) è una rara patologia caratterizzata da collasso delle pareti del seno mascellare con deiscenza del pavimento orbitario. A causa della rarità di questa sindrome, la letteratura mostra confusione circa la sua definizione, diagnosi e trattamento. È stata condotta una revisione sistematica fedele alle procedure PRISMA sulla SSS con focus su definizione, criteri diagnostici e trattamento (28 studi, 276 pazienti). L’analisi ha mostrato come la definizione predominante della SSS includa l’evidenza sia di enoftalmo che di atelettasia mascellare. Sebbene la definizione originaria accetti solo la presenza di collasso del seno spontaneo, ultimamente la presenza di disturbi nasosinusali e una storia pregressa di trauma facciale vengono inclusi nei criteri diagnostici. La maggior parte degli studi (28) ha considerato le immagini TC sufficienti per la diagnosi radiologica, mentre 7 hanno richiesto anche la RMN.Il trattamento prevalente è la FESS (Functional Endoscopic Sinus Surgery) (17 studi), lasciando l’intervento di ricostruzione orbitaria come procedura di salvataggio in caso di mancata risoluzione clinica. Sebbene la letteratura inizi a coordinarsi riguardo la diagnosi di SSS, è necessario un consenso riguardo alla definizione e alla gestione terapeutica.Silent sinus syndrome (SSS) is a rare disease consisting of a collapse of maxillary sinus walls with concomitant orbital floor descent. Due to its rareness, the literature highlights some confusion on its definition, diagnosis and management. A PRISMA-compliant systematic review was performed on SSS with focus on definition, diagnosis and therapeutic management. Twenty-eight studies were selected, with 276 patients evaluated. The analysis revealed that the leading definition of SSS includes evidence of both enophtalmos and maxillary atelectasia. Although the definition of SSS accepts only spontaneous sinus collapse, the presence of sinonasal diseases and history of facial trauma are starting to be included in the criteria. Most studies (n = 21) considered CT scans satisfactory for diagnosis of SSS, while 7 also performed MR. The majority of SSS were successfully treated with isolated functional endoscopic sinus surgery (n = 17), sparing orbital reconstruction as a rescue procedure in case of non-satisfactory long-term resolution of signs. Although the literature is starting to coordinate on diagnosis of SSS, our review revealed the necessity of consensus on its definition and management.

Change necessitates companies to alter their established routines. But how flexible are routines, and how can they be changed? Research has given very different answers to this question. While some researchers see routines as rigid and opposed to change, others see them as flexible and a source of change. The problem is not only that these positions are unrelated, but that there is no foundation that conceptually encompasses and connects both elements of routines, rigidity and changeability, which is why these two facets currently present as opposites. Current research tends towards the second position, neglecting the rigidity of routines. This paper offers an action-based microfoundation of routine change expanding Feldman and Pentland’s ostensive-performative approach beyond feedback processes. The focus of the theoretical conceptualization of routines is on action-specific knowledge acquired and applied through repetition. This action-based microfoundation allows the contradictory views of previous research to be positioned in a larger context. Routines are flexible, but only incrementally; they exhibit rigidity towards radical change. Building on this theoretical conceptualization, this paper distinguishes four types of routine changes: routinization/expansion, adaptation, problem fixing, and deliberate routine exchange. This distinction can contribute significantly to the focus of research and thus make it more rigorous. It also allows the rigidities of routines to be taken into account more strongly than before, thereby significantly increasing the relevance of routine research.

Objective: Gallbladder cancer is a type of cancer that is difficult to diagnose. Although its prevalence is low, it may differ from one society to another. The current study evaluates whether the histopathological evaluation of specimen should be performed after cholecystectomy. Methods: This research was designed as a retrospective, cross-sectional registry study. The diagnosis-related group data of 112,884 patients who underwent cholecystectomy in 2016 in hospitals affiliated with the Turkish Ministry of Health were used in the study. Descriptive statistics were used in the analysis of demographic data, diagnosis and types of procedures, and the chi-square analysis was used to compare the distribution of gallbladder cancer. Results: Approximately 19% of the patients who underwent cholecystectomy were in the age group of 65 years and over. Approximately 75% were women. The rate of laparoscopic cholecystectomy was found to be higher in female patients. Because of the histopathological examination of the cholecystectomy specimen, 0.10% of the patients were diagnosed with gallbladder cancer. The incidence of benign neoplasms of the gallbladder was equal in men and women. Gallbladder cancer was seen at a higher rate in men than in women and in the >= 65-year group compared to the

During the COVID-19 pandemic, lockdowns provided an opportunity to assess what factors, including changes in an owner’s routine and time spent at home, were associated with changes in dog behaviour. We undertook a longitudinal survey over a period of 8 months during which we asked about people’s work patterns, dog management, and their dogs’ behaviour. Generalized linear models revealed that the pre-existence of signs of potential separation-related problems, and especially vocalisation, self-injury, and chewing to escape confinement, was associated with an increase in a range of separation issues. Dogs showing separation-related signs prior to COVID were also more likely to develop more problems during lockdown. Management changes tended to result in increased physical and social stress, with a range of potential compensatory actions taken by the dog, however these signs of stress did not generally appear to be connected to separation-related issues. Survival analysis was used to investigate the emergence of specific issues over time. This indicated that a change to working from home was related initially to a decreased risk of aggression towards the owner, but over time, those who continued to work from the home were at an increased risk of this problem. No other significant time-related relationships were found.

In the context of brain tumour response assessment, deep learning-based three-dimensional (3D) tumour segmentation has shown potential to enter the routine radiological workflow. The purpose of the present study was to perform an external evaluation of a state-of-the-art deep learning 3D brain tumour segmentation algorithm (HD-GLIO) on an independent cohort of consecutive, post-operative patients. For 66 consecutive magnetic resonance imaging examinations, we compared delineations of contrast-enhancing (CE) tumour lesions and non-enhancing T2/FLAIR hyperintense abnormality (NE) lesions by the HD-GLIO algorithm and radiologists using Dice similarity coefficients (Dice). Volume agreement was assessed using concordance correlation coefficients (CCCs) and Bland–Altman plots. The algorithm performed very well regarding the segmentation of NE volumes (median Dice = 0.79) and CE tumour volumes larger than 1.0 cm3 (median Dice = 0.86). If considering all cases with CE tumour lesions, the performance dropped significantly (median Dice = 0.40). Volume agreement was excellent with CCCs of 0.997 (CE tumour volumes) and 0.922 (NE volumes). The findings have implications for the application of the HD-GLIO algorithm in the routine radiological workflow where small contrast-enhancing tumours will constitute a considerable share of the follow-up cases. Our study underlines that independent validations on clinical datasets are key to asserting the robustness of deep learning algorithms.

This paper uses a combination of digital ethnographic methods and in-depth interviewing to examine productivity and wellness culture on YouTube in the wake of the 2020 “that girl” trend. The first section focuses on how the interviewees relate to productivity and routine. Second, conceptions of authenticity in “that girl” content are analyzed on both the content creation side and the viewer side. The third section examines how influencers and viewers negotiate boundaries as an act of self-preservation in creating and consuming productivity content. The last section focuses on TikTok and how reactions to wellness and productivity content differ depending on whether it is short-form or long-form. I explore the effect of consuming “that girl” content on viewers while keeping in constant dialogue with creators’ own conceptions of their content’s impact by examining their values and beliefs surrounding authenticity, productivity, and consumerism. Drawing upon updated theories of front stage and backstage behavior for the digital world (Goffman 1956) such as porous authenticity (Abidin 2018) and the productivity of negative affect (Berryman and Kavka 2018; Reade 2020), I find that productivity and wellness influencers operate in a gray area of constructed intimacy with their viewers. Further, I find that influencers depend on their community of subscribers to give their work meaning, while viewers often attach themselves more to a genre of content than a specific creator and negotiate boundaries with wellness content to mitigate the negative effects it can have on their mental health.

Although COVID-19 affects older people more severely, health policies during the first wave of the pandemic often prioritized younger individuals. We investigated whether age had influenced the access to a diagnostic test for SARS-CoV-2 infection and whether clinical complexity and healthcare resources availability could have impacted such differences. This work included 126,741 Italian participants in the EPICOVID19 web-based survey, who reported having had contacts with known/suspected COVID-19 cases (epidemiological criterion) and/or COVID-19-like signs/symptoms (clinical criterion) from February to June 2020. Data on sociodemographic, medical history and access to SARS-CoV-2 nasopharyngeal swab (NPS) were collected. Logistic regressions estimated the probability of accessing NPS as a function of age and the possible modifying effect of chronic diseases' number and residential areas in such association. A total of 6136 (4.8%) participants had undergone an NPS. Older participants had lower NPS frequencies than the younger ones when reporting epidemiological (14.9% vs. 8.8%) or both epidemiological and clinical criteria (17.5% vs. 13.7%). After adjustment for potential confounders, including epidemiological and clinical criteria, the chance of NPS access decreased by 29% (OR=0.71, 95%CI:0.63-0.79) in older vs. younger individuals. Such disparity was accentuated in areas with greater healthcare resources. In conclusion, in the first wave of the pandemic, age may have affected the access to COVID-19 diagnostic testing, disadvantaging older people.

We investigate in what percentage of cases and to what extent radiological reports change when radiologists directly communicate with patients after imaging examinations. One hundred twenty-two consecutive outpatients undergoing MRI examinations at a single center were prospectively included. Radiological reports of the patients were drafted by two radiologists in consensus using only the clinical information that was made available by the referring physicians. Thereafter, one radiologist talked directly with the patient and recorded the duration of the conversation. Afterwards, the additional information from the patient was used to reevaluate the imaging studies in consensus. The radiologists determined whether the radiological report changed based on additional information and, if yes, to what extent. The degree of change was graded on a 4-point Likert scale (1, non-relevant findings, to 4, highly relevant findings). Following direct communication (duration 170.9 ± 53.9 s), the radiological reports of 52 patients (42.6%) were changed. Of the 52 patients, the degree of change was classified as grade 1 for 8 patients (15.4 %), grade 2 for 27 patients (51.9%), grade 3 for 13 patients (25%), and grade 4 for 4 patients (7.7%). The reasons leading to changes were missing clinical information in 50 cases (96.2%) and the lack of additional external imaging in 2 cases (3.8%). Radiologists should be aware that a lack of accurate information from the clinician can lead to incorrect radiological reports or diagnosis. Radiologists should communicate directly with patients, especially when the provided information is unclear, as it may significantly alter the radiological report. • Direct communication between radiologists and patients for an average of 170’s resulted in a change in the radiological reports of 52 patients (42.6%). • Of the 42.6% of cases where the reports were changed, the alterations were highly relevant (grades 3 and 4) in 32.7%, indicating major changes with significant impact towards patient management.

Background The COVID-19 pandemic has resulted in the diversion of health resources away from routine primary care delivery. This disruption of health services has necessitated new approaches to providing care to ensure continuity. Objectives To summarize changes to the provision of routine primary care services during the pandemic. Methods Rapid literature review using PubMed/MEDLINE, SCOPUS, and Cochrane. Eligible studies were based in primary care and described practice-level changes in the provision of routine care in response to COVID-19. Relevant data addressing changes to routine primary care delivery, impact on primary care functions and challenges experienced in adjusting to new approaches to providing care, were obtained from included studies. A narrative summary was guided by Burns et al.’s framework for primary care provision in disasters. Results Seventeen of 1,699 identified papers were included. Studies reported on telehealth use and public health measures to maintain safe access to routine primary care, including providing COVID-19 screening, and establishing dedicated care pathways for non-COVID and COVID-related issues. Acute and urgent care were prioritized, causing disruptions to chronic disease management and preventive care. Challenges included telehealth use including disparities in access and practical difficulties in assessing patients, personal protective equipment shortages, and financial solvency of medical practices. Conclusions Substantial disruptions to routine primary care occurred due to the COVID-19 pandemic. Primary care practices’ rapid adaptation, often with limited resources and support, demonstrates agility and innovative capacity. Findings underscore the need for timely guidance and support from authorities to optimize the provision of comprehensive routine care during pandemics., Lay Summary The COVID-19 pandemic has resulted in considerable disruption to health services including regular primary care. As a consequence, primary care practices have had to adopt new ways of providing care to ensure ongoing availability of services. However, little is known about the type of measures taken by care providers and challenges encountered in reorganizing services. The aim of this research was to provide a detailed understanding of changes in the way primary care was delivered and to identify difficulties experienced by patients and providers in adjusting to new approaches. The 17 studies included in the review indicate that primary care providers quickly put in place strategies including telehealth (e.g. telephone and video consultations) and infection control measures to ensure safe access to care. Furthermore, urgent and short-term care were prioritized resulting in interruptions to other services, including management of preexisting or long-term illnesses. Challenges included barriers to accessing telehealth such as inadequate internet connection and practical difficulties in examining patients, personal protective equipment shortages, and financial losses by practices. Adequate support from authorities is needed to enhance the provision of comprehensive primary care during pandemics.

Puritans were wary of routine or of regular piety, as their theology convinced them that the Christian life ought to consist of steady and observable progress towards godliness. This created a distinct fear of ‘backsliding’ or of religious stasis, and could produce anxiety if their lives failed to match this ideal. The essay explores various ways puritans tried to manage this problem, from ‘pacing’ their moral progress to attempts to shock themselves out of routine by making the daily business of repentance transformative. It concludes by analysing one particular widely-used technique, namely the devotional use of martyr-narratives, in which puritans placed themselves imaginatively in order to awaken their drowsy piety; and by suggesting that this may have sharpened their readiness to see the world in confrontational terms. Les puritains se méfiaient de la routine ou d’une piété égale et invariable car leur théologie enseignait que la vie du chrétien devait consister en une progression régulière et notable vers la sainteté. Cette exigence causait une peur très nette de la « régression » ou de la stagnation religieuse et pouvait susciter de l’anxiété chez les puritains dont la vie n’était pas à la hauteur de cet idéal. Cet article explore les différentes manières dont les puritains s’efforçaient de répondre à ce problème, en « rythmant » leur progrès moral, ou en interrompant la routine et en donnant à la repentance quotidienne un caractère transformateur. L’article analyse enfin une technique particulièrement répandue alors : l’usage dévotionnel des récits de martyrs dans lesquels les puritains s’imaginaient jouer un rôle afin de réveiller leur piété assoupie. Il suggère en conclusion que cette technique a peut-être renforcé la tendance des puritains à voir le monde en termes de conflits.

Ankle and distal radius fractures are two of the most common musculoskeletal injuries. Over the last decades their incidences have risen due to increasing participation in athletic activities and ageing of the population. Current national and international protocols recommend frequent outpatient clinic visits in which radiographs of the fractured extremity are obtained. The general aim of this thesis was to evaluate the added value of routine radiography in the follow-up of ankle and distal radius fractures. Specifically, we were interested in investigating whether a follow-up protocol which focuses on reducing the number of routine follow-up radiographs was able to deliver care that was comparable to the current standard of care, but without sacrificing quality nor safety, whilst increasing cost-effectiveness. Chapter 1 provides background information on the epidemiology of ankle and distal radius fractures. It also outlines the current standard of care during treatment and follow-up of the affected patients. In chapter 2 an overview of the current literature on routine radiography in extremity fractures is given. Despite the common occurrence of extremity fractures, limited data were available on the added value of routine radiography at the time that our systematic review was performed in 2018. We identified eleven studies; however, due to theirretrospective design and thus incumbent biases, the resultant quality or certainty of the evidence was considered low. Despite this, the treatment plan was modified in a very small percentage of the cases (ranging from 0 to 2.6%); therefore, the added value of routine radiography seems limited.Following our review in 2018, we conducted a retrospective analysis in four level 1 trauma centres in the Netherlands in order to determine the impact of routine radiographs on treatment strategy for patients with ankle fractures. Chapter 3 illustrates that, in accordance with studies outlined in chapter 2, the use of routine radiographs in the follow-up of ankle fracture patients in the Netherlands was common. In total, 80% of radiographs obtained after more than three weeks of follow-up were considered routine,and only 1.2% of these radiographs resulted in a change of treatment strategy. However, due to its retrospective design, the strength of the evidence was also considered low given its limitations.Chapters 4 and 5 report on the results of a multi-centre randomized controlled trial (RCT) in which participants with an ankle fracture were randomized between the current standard of care consisting of routine follow-up radiography (routine care) and a reduced imaging follow-up regimen. The clinical and functional outcomes outlined in chapter 4 suggest that routine radiographs at week 6 and 12 can be omitted without compromising treatment outcomes. Specifically, functional outcome measured with the Olerud and Molander Ankle Score was non-inferior in the reduced imaging group, while secondary outcomes, such as American Association of Orthopedic Surgeons (AAOS) foot and ankle scores, Health-Related Quality of Life (HRQoL), pain, health perception and self-perceived recovery did not differ between groups. The median number of radiographs obtained was 4 in the reduced imaging group and 5 in the routine care group (a reduction of 20%). Similar numbers and types of complications were observed in both groups; therefore, modifying the current standard of care can be implemented without sacrificing quality nor safety. In chapter 5 the results of the economic evaluation of the reduced-imaging follow-up strategy for ankle fracture patients are presented. Patients randomized to reduced imaging had a similar HRQoL in comparison with patients randomized to routine care. Costs for radiographic imaging were significantly lower in the reduced imaging group (a difference of €48 (95% CI: €-72 to €-28)). Other costs, including overall costs did not statistically differ between the groups. The probability of cost-effectiveness was 0.45 at a willingness-to-pay of €20,000 per QALY. Chapters 6 and 7 report on the outcomes from the same RCT, but which focused on patients with a fracture of the distal radius. Similar to the results of the RCT on anklefractures, functional outcome (measured with the Disabilities of Arm, Shoulder and Hand questionnaire [DASH]) was no worse than the reduced imaging group (chapter 6). Secondary outcomes such as HRQoL, pain and complications demonstrated similar outcomes between the groups. The number of radiographs obtained per patient decreased 25% to median 3 in the reduced imaging group from median 4 in the routine care group. The results of the economic evaluation described in chapter 7 demonstrated similarities to the results of the study on ankle fractures. HRQoL was similar, and costs for radiographic imaging were significantly lower in the reduced imaging group (this reduction was €48 per patient (95% CI: -68 to -27)). The probability of cost-effectiveness was 0.8 to 0.9 at willingness-to-pay of €20,000 to €80,000 per QALY.Following these analyses, we investigated which factors could encourage or discourage physicians to modify their practice behaviours, namely reduce their reliance on routine follow-up radiographs of extremities. These so-called “barriers and facilitators” were queried among orthopaedic trauma surgeons in the Netherlands (chapter 8). In total, 130 respondents (57%) completed the questionnaire, 71% indicated that they would stop ordering routine radiographs if they demonstrated no added value. In short, we identified three facilitators which were found to be independent predictors for the intention to de-implement routine radiographs: 1) ‘the reduced imaging follow-up protocol will lead to lower healthcare costs’; 2) ‘incorporation of the reduced imaging follow-up in regional protocols’; and 3) ‘reduced imaging will result in time-savings for the patient’. There was no barrier that was found to be an independent predictor for the intention to reduce the reliance on routine radiographs. With the three facilitators in mind, a proper de-implementation strategy can be drafted for the Netherlands, and other populations similar as ours. In chapter 9, I present general conclusions and discuss the clinical implications and future perspectives regarding the effectiveness and cost-effectiveness of routine radiography in ankle and distal radius fractures. This large multi-center study demonstrates that the number of routine radiographs in those with ankle and distal radius fractures can be reduced without sacrificing quality nor safety, while resulting in more cost-effective care

[ES] Dada la reciente situación causada por la pandemia de la COVID y el confinamiento, gran cantidad de personas empezaron a realizar deporte en casa, tanto profesionales como principiantes. Es aquí donde apareció la oportunidad de realizar XtraFit, una aplicación móvil diseñada para todo tipo de usuarios que realicen o quieran empezar a realizar del deporte. XtraFit tiene como objetivo facilitar los entrenamientos de los deportistas, registrando, por ejemplo, cual ha sido el volumen, repeticiones y pesos de cada rutina y ejercicios o cual ha sido el ritmo de una sesión de cardio, facilitando así recordar los anteriores entrenamientos y generando datos y gráficas para realizar un mejor seguimiento de estos. Este TFG será desarrollado como un proyecto de emprendimiento con el apoyo de start.inf, el espacio de emprendimiento de la ETSinf. Por lo tanto se realizará siguiendo una dinámica de equipo, donde parte de la funcionalidad y trabajo será común, y otra parte será diferenciada. En concreto, en este proyecto nos focalizaremos en las funcionalidades relacionadas con los entrenamientos de cardio de los usuarios. Se desarrollará tanto la parte de interfaz como la de la capa de servicios y de persistencia necesarias. Para la interfaz y parte de la lógica de negocio Android Studio utilizando el SDK multiplataforma Flutter utilizando el lenguaje de programación Dart, dándose así la posibilidad de exportar la aplicación tanto a Android, IOS y/o Web. Además, para la capa de persistencia se utilizará Firebase, una plataforma para el desarrollo de aplicaciones web y aplicaciones móviles propiedad de Google., [EN] Given the recent situation caused by the COVID pandemic and confinement, many people started to do sport at home, both professionals and beginners. This is where the opportunity appeared for XtraFit, a mobile application designed for all types of users who do or want to start doing sports. XtraFit aims to facilitate the training of athletes, recording, for example, what has been the volume, repetitions and weights of each routine and exercises or what has been the pace of a cardio session, thus facilitating remembering previous workouts and generating data and graphs for better monitoring of these. This project has been carried out as a team within the framework of an entrepreneurship project under the supervision of Start.Inf. The development team is formed by the students Jorge Mena Escribá and Christian García García. This application has been developed in Android Studio using the SDK cross-platform Flutter using the Dart programming language, giving the possibility to export the application to Android, IOS and / or Web.

Deux perspectives se dégagent des données exposées de cet article. La première consiste à appréhender les ressorts de l’articulation des rituels et des routines dans la vie quotidienne, soit à penser ensemble des « objets » qui se rencontrent peu dans la littérature. La seconde ouvre la réflexion sur la place des petits rituels de passage au cours de la diversification alimentaire que l’on désigne comme « rituels éphémères ». Dans une perspective diachronique, l’article aborde la pluralité des pratiques rituelles durant la socialisation familiale ordinaire et, d’un point de vue synchronique, il étaye une conception dynamique des rituels, du fait des mutations à l’œuvre au cours de la socialisation alimentaire du jeune enfant. Comme il s’agit de pratiques rituelles domestiques, singulières et éphémères, elles s’apparentent à des « petits riens », ce qui contribue à les invisibiliser. Notre propos est de montrer la place qu’elles occupent, au contraire, non seulement dans la socialisation de l’enfant, mais aussi plus largement dans les socialisations alimentaires familiales. La perspective proposée contribue en filigrane à questionner la position liminale du petit enfant au cours de la diversification alimentaire et à regarder comment la production domestique de rituels fixe des « petits passages » dans la socialisation de l’enfant contribuant à la définition de nouveaux répertoires alimentaires et statuts de mangeur. Two insights can be drawn from the data presented in this article. The first one consists in examining the articulation between daily rituals and routines, two “objects” too often treated separately in scientific literature. The second one allows for a reflection on the impact of the small rites of passage inherent to the diversification of food consumption and which are defined as “ephemeral rituals”. From a diachronic perspective, this article deals with the multiplicity of ritual practices that take place during family socialisation. From a synchronic point of view, it supports a dynamic view of rituals as a result of the changes at work during the food socialisation of the young child. As these rituals and daily habits are unique and ephemeral, they are considered as “little nothings”, and this contributes to their inconspicuousness. This article intends to highlight their importance not only to the child’s individual socialisation process, but also to family food socialisation. This perspective implicitly questions the liminal status of the child during the process of diversification of food consumption. It also examines how the household production of rituals sets “minor transitions” in the children’s socializing phase, thus leading to the definition of new foods and to the acknowledgement of their status as eaters.

Le plaisir est de plus en plus considéré comme un potentiel allié pour la régulation des comportements alimentaires, dans un contexte où les injonctions sanitaires et nutritionnelles restent fortes. Cet article interroge la relation quotidienne au plaisir alimentaire chez les mangeurs urbains en France, en analysant les routines et micro-activités dans lesquelles il est exprimé. Des focus groups et sessions ethnographiques (observation à domicile couplée avec un entretien semi-directif) ont été conduits. Les mangeurs mettent en place des « rituels plaisir », correspondant à une prise alimentaire dans un lieu, à un moment, et dans un contexte social bien précis. Ces « routines ritualisées » (Dupuy & Rochedy 2018) leur permettent de répondre aux pressions sociétales pesant au quotidien sur l’alimentation. Ils contribuent à équilibrer les comportements alimentaires sur le long terme, en assurant des plaisirs réguliers tout en les rendant socialement acceptables. Food pleasure is increasingly considered as an ally for the regulation of eating behaviours, in a context where health and nutritional injunctions remain strong. This article explores the daily relationship to food pleasure among urban eaters in France, by analysing their food routines and micro-activities. Focus groups and ethnographic sessions (home observations and semi-structured interviews) were conducted. The eaters set up “pleasure rituals”, corresponding to ritualised food intakes in a specific place, at a given time and in a precise social context. These “ritualized routines” (Dupuy and Rochedy 2018) allow them to respond to societal pressures on food on a daily basis. They help to balance eating behaviours over the long term, ensuring regular pleasures while making them socially acceptable.

Introduction and hypothesis To quantify and compare the outcomes of routine vs. urologist-requested diagnostic testing for recurrent urinary tract infections (rUTI). Methods A retrospective cohort study of patients with rUTI referred to a large non-academic teaching hospital between 2016 and 2018 (Hospital A) and a university hospital between 2014 and 2016 (Hospital B). Electronic medical records were reviewed for baseline and diagnostic data. Women underwent the following assessments routinely: urinalysis, voiding diary, flowmetry in Hospital A and urinalysis, voiding diary, flowmetry, ultrasound, abdominal x-ray and cystoscopy in Hospital B. All other diagnostics were performed by indication in each hospital. Results We included 295 women from Hospital A and 298 from Hospital B, among whom the mean age (57.6 years) and mean UTI frequency (5.6/year) were comparable, though more were postmenopausal in Hospital A. We identified abnormalities by flowmetry or post-void residual volumes in 134 patients (Hospital A: 79; Hospital B: 55), cystoscopy in 14 patients (Hospital A: 6; Hospital B: 8) and ultrasound in 42 patients (Hospital A: 16; Hospital B: 26), but these differences were not significant. Diagnostics altered treatment in 117 patients (e.g., pelvic floor muscle training, referral to another specialist, surgical intervention), mostly due to flowmetry and post-void residual volume measurement. The retrospective design and absence of follow-up data limit these results. Conclusions The routine use of cystoscopy and ultrasound in female patients with rUTIs should not be recommended as they yield few abnormalities and lead to additional costs.

International audience; Après avoir situé notre approche des phénomènes de récurrence discursive, nous présentons les routines épistolaires attestées par un corpus de correspondances peu lettrées de la Première Guerre mondiale et proposons d’appréhender les variations qu’introduisent certains épistoliers comme des modulations stylistiques. Si l’analyse outillée permet de démontrer l’existence de préconstruits discursifs, caractéristiques du genre épistolaire, elle met en effet aussi en évidence la capacité des scripteurs à sortir de la routine, à personnaliser l’expression de leurs sentiments à l’égard de leur famille et de leurs amis et à tracer leur cheminement singulier dans l’écriture. Par une exploration minutieuse de chaque sous-corpus, il semblerait possible d’observer, non seulement dans les ouvertures et les clôtures, mais aussi dans l’ensemble de la lettre, une co-construction discursive, portée par le double ressort de l’imitation de l’autre et de l’invention personnelle, dans une dialectique de la routine et du style.

Heart failure (HF) is the main cause of mortality worldwide, particularly in the elderly. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the gold standard biomarker for HF diagnosis and therapy monitoring. It is determined in blood samples by the immunochemical methods generally adopted by most laboratories. Saliva analysis is a powerful tool for clinical applications, mainly due to its non-invasive and less risky sampling. This study describes a validated analytical procedure for NT-proBNP determination in saliva samples using a commercial Enzyme-Linked Immuno-Sorbent Assay. Linearity, matrix effect, sensitivity, recovery and assay-precision were evaluated. The analytical approach showed a linear behaviour of the signal throughout the concentrations tested, with a minimum detectable dose of 1 pg/mL, a satisfactory NT-proBNP recovery (95–110%), and acceptable precision (coefficient of variation ≤ 10%). Short-term (3 weeks) and long-term (5 months) stability of NT-proBNP in saliva samples under the storage conditions most frequently used in clinical laboratories (4, − 20, and − 80 °C) was also investigated and showed that the optimal storage conditions were at − 20 °C for up to 2.5 months. Finally, the method was tested for the determination of NT-proBNP in saliva samples collected from ten hospitalized acute HF patients. Preliminary results indicate a decrease in NT-proBNP in saliva from admission to discharge, thus suggesting that this procedure is an effective saliva-based point-of-care device for HF monitoring.

Background Children affected by infectious diseases may not always have a detectable infectious etiology. Diagnostic uncertainty can lead to prolonged hospitalizations, inappropriately broad or extended courses of antibiotics, invasive diagnostic procedures, and difficulty predicting the clinical course and outcome. Cell-free plasma next-generation sequencing (cfNGS) can identify viral, bacterial, and fungal infections by detecting pathogen DNA in peripheral blood. This testing modality offers the ability to test for many organisms at once in a shotgun metagenomic approach with a rapid turnaround time. We sought to compare the results of cfNGS to conventional diagnostic test results and describe the impact of cfNGS on clinical care in a diverse pediatric population at a large academic children’s hospital. Methods We performed a retrospective chart review of hospitalized subjects at a tertiary pediatric hospital to determine the diagnostic yield of cfNGS and its impact on clinical care. Results We describe the clinical application of results from 142 cfNGS tests in the management of 110 subjects over an 8-month study period. In comparison to conventional testing as a reference standard, cfNGS was found to have a positive percent agreement of 89.6% and negative percent agreement of 52.3%. Furthermore, 32.4% of cfNGS results were directly applied to make a clinical change in management. Conclusions We demonstrate the clinically utility of cfNGS in the management of acutely ill children. Future studies, both retrospective and prospective, are needed to clarify the optimal indications for testing.

Le travail, cette valeur centrale au fil de tous les temps, continue à entacher la vie en commun de l’ensemble des catégories sociales, y compris celle au troisième âge. Tous les foyers, les familles et les espaces se constituent, directement ou indirectement, autour de cette valeur qui ne cesse de décevoir ! Dans cette nouvelle division internationale du travail, travail et dignité ne semblent pas cohabiter pour longtemps du moment qu’une partie non négligeable des travailleuses et travailleurs tente de donner sens à leur oeuvre pour ne pas la réduire à une simple quête de pain (gagne pain). Le signe le plus parlant de cette nouvelle configuration est celui des centres d’appel où des jeunes ingénieurs, des titulaires de masters et des docteurs s’adonnent à des activités répétitives dans un système routinier et à très faible valeur ajoutée, passant la journée à répondre aux appels, à donner des renseignements ou à accomplir une vente via le net. Cet article dresse une radioscopie du processus de production de ces systèmes fermés, conçus pour standardiser les tâches, minimiser l’innovation et contrôler l’exception., Work, this central value over all time, continues to mar the common life of all social categories, including that of senior citizens. All homes, families and spaces are formed, directly or indirectly, around this value which never ceases to disappoint! In this new international division of labor, work and dignity do not seem to coexist for long as long as a significant part of workers try to give meaning to their work so as not to reduce it to a simple quest for bread. The most telling sign of this new configuration is that of the call centers where young engineers, masters and doctors perform repetitive activities in a routine system with very low added value, spending the day answering calls to give information or to make a sale via the net. This article takes an x-ray of the production process of these closed systems, designed to standardize tasks, minimize innovation and control exception.

This paper proposes a new conceptualization of business model (BM) that rigorously exploits the important insights this notion offers and links them to related views developed in economics and business studies. We develop the foundations of a BM concept consistent with the principles of generalized Darwinism (GD) and with contributions already developed within this framework. Thus, we demonstrate the relevance of GD as a unifying framework for developing the evolutionary theory of firm and industry. We suggest analysing BM as a generative replicator hosted by the firm, which structures interactions between the members of this organization and the social entities of its industrial environment. We argue that GD allows us to clarify the nature and boundaries of the BM concept and to specify its relationships to other key evolutionary concepts, such as organizational routines.

This study is a qualitative research by using the descriptive method that aims to examine the behaviour of eighteen students in Bandung, Indonesia. Six issues related to geometry were given to eighteen of second-grade junior high school students with heterogeneous abilities. The problems given to the students contained all of the problem-solving strategies such as guessing and checking, make a picture, make a list, make a table, working backwards, looking patterns, and using a logical reason, solving simple problems and making questions. Data collection was conducted through mathematical problem-solving tests, recording students’ presentations, and interviewing among researchers and students after doing the problems. The result of recording was a video during the presentation process, and the interview would explore their understanding of the given problems to see the behaviour used by subjects of the research. The data in this research showed that many students’ behaviour identified; in the relevant literature, there are terms of the behaviour of problem-solving naive, routine, and sophisticated. However, the category "naïve," "routine," and "sophisticated" did not fully draw various behaviours observed, it was obtained additional category termed behavioural problem solver "naïve," "routine," "semi-sophisticated" and "sophisticated". It was due to the category of regular students can be divided into two, some students can be directed, and some of them cannot be directed to sophisticated behaviour. Thus, the routine category can be classified into two categories: routine and semi-sophisticated.

Identification challenges have resulted in young carers research largely being conducted with those who access support. Positive and negative impacts have been evidenced but there remains little consideration of the wider population. This phenomenology defines young carers as a spectrum of children with different experiences and aims to study the larger group. Participants were recruited from schools and projects, resulting in a mixed sample of young carers who were accessing support but also those who were unknown to services. Participants attended three interviews that initially gathered data on their caring role and family circumstances, before focusing on their health and well-being in the context of change. All interviews were transcribed and analysed at a whole-text and in-depth level to identify shared understanding. A study of the wider spectrum enabled the emergence of perception of control over their caring responsibilities as key to routine development. Although high levels of control helped some participants manage their roles, threats to control were identified, including instability in the care receiver’s condition, excessive caring and medical tasks. The original findings demonstrate how researching the wider spectrum can aid understanding of problematic care, and highlights the importance of recruiting young carers as a hard-to-reach group.

Chlamydia trachomatis and Neisseria gonorrhoeae are two of the most often reported bacterial infections in the United States. The rectum and oropharynx are important anatomic sites of infection and can contribute to ongoing transmission. Nucleic acid amplification tests (NAATs) are the mainstays for the detection of C. trachomatis and N. gonorrhoeae infections owing to their high sensitivity and specificity. Several NAATs have been evaluated for testing in rectal and pharyngeal infections. A few assays recently received clearance by the Food and Drug Administration, including one point-of-care test. Those assays can be used for testing in symptomatic individuals, as well as for asymptomatic screening in certain patient populations. Routine screening for C. trachomatis in pharyngeal specimens is not recommended by the Centers for Disease Control and Prevention, though it is often performed due to the use of multiplex assays. While expanding the types of settings for screening and using self-collected rectal and pharyngeal specimens can help to increase access and uptake of testing, additional research is needed to determine the potential benefits and costs associated with increased screening for rectal and pharyngeal C. trachomatis and N. gonorrhoeae infections on a population level.

Background Accurate malaria diagnosis and appropriate treatment at local health facilities are critical to reducing morbidity and human reservoir of infectious gametocytes. The current study assessed the accuracy of malaria diagnosis and treatment practices in three health care facilities in rural western Kenya. Methods The accuracy of malaria detection and treatment recommended compliance was monitored in two public and one private hospital from November 2019 through March 2020. Blood smears from febrile patients were examined by hospital laboratory technicians and re-examined by an expert microscopists thereafter subjected to real-time polymerase chain reaction (RT-PCR) for quality assurance. In addition, blood smears from patients diagnosed with malaria rapid diagnostic tests (RDT) and presumptively treated with anti-malarial were re-examined by an expert microscopist. Results A total of 1131 febrile outpatients were assessed for slide positivity (936), RDT (126) and presumptive diagnosis (69). The overall positivity rate for Plasmodium falciparum was 28% (257/936). The odds of slide positivity was higher in public hospitals, 30% (186/624, OR:1.44, 95% CI = 1.05–1.98, p p p p = 0.004). RDT was the most sensitive (73.8%, 95% CI = 39.5–57.4) and specific (89.2%, 95% CI = 78.5–95.2) followed by hospital microscopy (sensitivity 47.6%, 95% CI = 38.2–57.1) and specificity (86.7%, 95% CI = 80.8–91.0). Presumptive diagnosis had the lowest sensitivity (25.7%, 95% CI = 13.1–43.6) and specificity (75.0%, 95% CI = 50.6–90.4). RDT had the highest non-treatment of negatives [98.3% (57/58)] while hospital microscopy had the lowest [77.3% (116/150)]. Health facilities misdiagnosis was at 27.9% (77/276). PCR confirmed 5.2% (4/23) of the 77 misdiagnosed cases as false positive and 68.5% (37/54) as false negative. Conclusions The disparity in malaria diagnosis at health facilities with many slide positives reported as negatives and high presumptive treatment of slide negative cases, necessitates augmenting microscopic with RDTs and calls for Ministry of Health strengthening supportive infrastructure to be in compliance with treatment guidelines of Test, Treat, and Track to improve malaria case management.

INTRODUCTION: Mid-regional proadrenomedullin (MR-proADM), a novel biomarker, has recently gained interest particularly with regards to its potential in assisting clinicians' decision making in patients with suspicion of infection in the emergency department (ED). A group of international experts, with research and experience in MR-proADM applications, produced this review based on their own experience and the currently available literature.AREAS COVERED: The review provides evidence related to MR-proADM as a triaging tool in avoiding unnecessary admissions to hospital and/or inadequate discharge, and identifying patients most at risk of deterioration. It also covers the use of MR-proADM in the context of COVID-19. Moreover, the authors provide a proposal on how to incorporate MR-proADM into patients' clinical pathways in an ED setting.EXPERT OPINION: The data we have so far on the application of MR-proADM in the ED is promising. Incorporating it into clinical scoring systems may aid the clinician's decision making and recognizing the 'ill looking well' and the 'well looking ill' sooner. However there are still many gaps in our knowledge especially during the ongoing COVID-19 waves. There is also a need for cost-effectiveness analysis studies especially in the era of increasing cost pressures on health systems globally.

Personnel protective equipment (PPE) are recommended during surgery even in COVID-19 negative patients especially in a high-prevalence region due to its higher false-negative rates. However, the use of PPE has not been universal mainly due to the perception of discomfort and associated stress and fatigue. This study was done to understand the pattern of PPE use by cancer surgeons during the pandemic and the associated discomfort, stress, and fatigue with its use. The survey, consisting of 29 questions, was circulated widely across the country by email and chat groups among cancer surgeons. The study was registered with the Clinical Trials Registry of India (CTRI/2020/08/027050). We received a total of 342 evaluable responses that could be included for analysis. All the respondents used appropriate PPE in different combinations. N-95 mask and the face shield were the two components of the PPE that gave rise to a lot of discomforts. Fogging (of face shields) (p

OBJECTIVE. The purpose of this study is to evaluate whether imaging diagnostic test accuracy (DTA) studies with positive conclusions or titles have a shorter time to publication than those with nonpositive (i.e., negative or neutral) conclusions or titles. MATERIALS AND METHODS. We included primary imaging DTA studies from systematic reviews published in 2015. The conclusion and title of each study were extracted, and their positivity was classified independently in duplicate. The time from study completion to publication was extracted and calculated. A Cox regression model was used to evaluate associations of conclusion and title positivity with time to publication, with adjustment made for potentially confounding variables. RESULTS. A total of 774 imaging DTA studies were included; time from study completion to publication could be calculated for 516 studies. The median time from completion to publication was 18 months (interquartile range, 13-26 months) for the 413 studies with positive conclusions, 23 months (interquartile range, 16-33 months) for the 63 studies with neutral conclusions, and 25 months (interquartile range, 15-38 months) for the 40 studies with negative conclusions. A positive conclusion was associated with a shorter time from study completion to publication compared with a nonpositive conclusion (hazard ratio, 1.31; 95% CI,1.02-1.68). Of all included studies, 39 (5%) had positive titles, 731 (94%) had neutral titles, and 4 (< 1%) had negative titles. Positive titles were not significantly associated with a shorter time to study publication (hazard ratio, 1.12; 95% CI, 0.75-1.69). CONCLUSION. Positive conclusions (but not titles) were associated with a shorter time from study completion to publication. This finding may contribute to an overrepresentation of positive results in the imaging DTA literature.

To evaluate the reproducibility of mid-trimester intracranial anatomy assessment. Women undergoing mid-trimester scan (between 18th to 25th gestational weeks) for fetal anatomy assessment were included in the study. Measurements of lateral ventricle (LV), cisterna magna (CM) and transverse cerebellar diameter (TCD) were obtained for reproducibility analyses. Inter-observer reproducibility analysis was made with correlation coefficients. A total of 162 women were included in the analysis while one woman was excluded from the study due to diagnosis of vermian agenesis. Correlation coefficient (CC) of cisterna magna measurements have shown weak to moderate interclass correlation (r=0.28, P=0.001). Measurements of lateral ventricle have shown moderate to strong interclass correlation (r=0.73, P, NA

Background Inactivity is frequent among older patients during hospitalization. It is unknown how patients' daily activity pattern (diurnal profile) vary between hospitalization and after discharge. This study aims to describe and compare the distribution of physical activity and sedentary behavior in acutely hospitalized older patients during hospitalization and after discharge. Methods We included data on 80 patients (+65 years) admitted with acute medical illness from the STAND-Cph trial. Physical activity and sedentary behavior were measured as daily number of steps, uptime (walking/standing) and sedentary behavior (lying/sitting) with an activity monitor (activPAL3, PAL Technologies Ltd). The patients wore the monitor for three periods of one week: during hospitalization, after discharge, and four weeks after discharge. Results The patients’ median age was 80 years [IQR: 75;88], 68% were female and the median De Morton Mobility Index (DEMMI) was 57 [IQR: 48;67]. The daily median uptime was 1.7 h [IQR: 1;2.8] during hospitalization, 4.0 h [IQR: 2.7;5.4] after discharge and 4.0 h [IQR: 2.8;5.8] four weeks after discharge. The daily median number of steps was 728 [IQR: 176;2089], 2207 [IQR: 1433;3148], and 2622 [IQR: 1714;3865], respectively, and median daily sedentary behavior was 21.4 h (IQR: 20.7;22.4), 19.5 h (IQR: 18.1;21.0) and 19.6 h (IQR: 18.0;20.8), respectively. During hospitalization, a small activity peak was observed between 9-11 AM without any notable variation after. At discharge and four weeks after discharge, a peak in physical activity was seen between 9-12 AM and at 5 PM. Conclusion Older hospitalized patients spend most of their time being sedentary with their highest activity between 9-11 AM. Daily activity doubles after discharge with one extra peak in the afternoon. Daily routines might be disrupted, and older patients have the potential to be more physically active during hospitalization. Interventions that encourage physical activity during hospitalization are warranted.

Introduction: Prosthetic valve dysfunction is a potentially critical complication of heart valve replacement. An easy and quickly applicable diagnostic procedure is required for recognizing the prosthetic valve dysfunction. The purpose of this study was to prospectively define the diagnostic value of D-dimer and INR level in predicting prosthetic valve dysfunction. Methods: This cross-sectional study was performed in 70 patients suspected to have prosthetic valve dysfunction admitted to Imam Ali Hospital, affiliated with Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran. Cinefluoroscopy, as the gold standard diagnostic test, was used for the diagnosis of prosthetic valve dysfunction in enrolled patients. Two milliliters of blood from each patient were taken into a tube containing sodium citrate anticoagulant. To evaluate D-dimer, the cutoff value was set at 500 ng/ml. Also, to evaluate international normalized ratio (INR), the cutoff value was set at 2. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the serum markers were used to describe predictive properties. Results: Of 70 patients, 27 (38.6%) were male and 43 (61.4%) were female, and the mean age was 54.67±15.11 years (range, 18 to 80 years). Of 70 patients, 27 (38.6%) had prosthetic heart valve malfunction demonstrable by fluoroscopy, and 19 patients (27.1%) had D-dimer levels >500 ng/ml. Elevated D-dimer levels (>500 ng/ml) have been indicated to have sensitivity of 70.4%, and hence an NPV of 84.3%, specificity of 100%, PPV of 100%, NLR of 0.3, and the infinity value of PLR for predicting prosthetic valve dysfunction. There was a significant relationship between fluoroscopy and D-dimer test (P=0.001). A kappa coefficient value of 0.745 indicated a substantial agreement between D-dimer and fluoroscopy testing. Mixing test (combination of D-dimer and INR) showed to have 100% sensitivity, and hence a NPV of 69.8%, specificity of 69.8%, PPV of 51.8%, NLR of 1.41, and PLR of 1.44 for predicting prosthetic valve dysfunction. Conclusion: D-dimer with moderate sensitivity and high specificity is an ideal marker for the diagnosis of prosthetic valve dysfunction in suspected patients. Enhanced plasma D-dimer level is not by itself diagnostic of a prosthetic valve dysfunction but may alert physicians to refer the patient for more detailed examination, preferably by fluoroscopy. Mixing test with 100% sensitivity can apply as a rule-out test.

Gene fusions involving NTRK1, NTRK2, and NTRK3 are rare drivers of cancer that can be targeted with histology-agnostic inhibitors. This study aimed to determine the nationwide landscape of NTRK/TRK testing in the Netherlands and the usage of pan-TRK immunohistochemistry (IHC) as a preselection tool to detect NTRK fusions. All pathology reports in 2017–2020 containing the search term ‘TRK’ were retrieved from the Dutch Pathology Registry (PALGA). Patient characteristics, tumor histology, NTRK/TRK testing methods, and reported results were extracted. NTRK/TRK testing was reported for 7457 tumors. Absolute testing rates increased from 815 (2017) to 3380 (2020). Tumors were tested with DNA/RNA-based molecular assay(s) (48%), IHC (47%), or in combination (5%). A total of 69 fusions involving NTRK1 (n = 22), NTRK2 (n = 6) and NTRK3 (n = 41) were identified in tumors from adult (n = 51) and pediatric (n = 18) patients. In patients tested with both IHC and a molecular assay (n = 327, of which 29 NTRK fusion-positive), pan-TRK IHC had a sensitivity of 77% (95% confidence interval (CI), 56–91) and a specificity of 84% (95% CI, 78–88%). These results showed that pan-TRK IHC has a low sensitivity in current routine practice and warrants the introduction of quality guidelines regarding the implementation and interpretation of pan-TRK IHC.

Prostor i mjesto nisu pojmovi koji se izričito vežu za fizičku lokaciju, već imaju dublje značenje. Glavna je zadaća ovog rada bila dubinski istražiti medijski posredovano iskustvo mjesta i prostora, percepciju i odnos studenata prema pojmu 'mjesto', temeljenim na programu Work&Travel. Uz pomoć rutinizacije kojoj su se prepustili nakon dolaska u Sjedinjene Američke Države, gdje se program i održava, dogodila se tranzicija u kojoj prostor dobiva na važnosti i postaje mjesto. Na stjecanje rutine veliki je utjecaj ostavila komunikacija s lokalnim stanovništvom, upoznavanje okruženja i svakodnevno korištenje javnog prijevoza, nakon čega su se ispitanici upoznali s osjećajem poznatog i osjećajem pripadnosti. Inače neprimjetne promjene pokazale su se itekako važnima za kreiranje mišljenja o situacijama koje se svakodnevno oko njih događaju. Ono što se nekada uzimalo zdravo za gotovo, u ovom je istraživanju doprinijelo razumijevanju svakodnevice i okruženja., Space and place are not terms that are explicitly related to a physical location, but have a deeper meaning. The main task of this paper was in-depth research of the media-mediated experience of place and space, students' perceptions and attitudes towards the term 'place', based on the Work & Travel programme. With the help of the routinization that they experienced after the arrival in the United States, where the programme is being held, a transition has taken place in which space is gaining in importance and becoming a place. The acquisition of the routine was greatly influenced by communication with the local population, getting to know the environment and the daily use of public transport, after which the respondents got acquainted with the feeling of familiarity and the feeling of belonging. Otherwise imperceptible changes have now proven to be very important for creating opinions about the situations that happen around them on a daily basis. What was once taken for granted in this research has contributed to an understanding of everyday life and the environment.

Realizar pruebas de poligrafía en la actualidad ha ganado un papel importante al interior de las compañías, cuyo objetivo es el de generar cultura de confianza y confiabilidad en sus empleados, es allí donde los resultados acordes a la necesidad del cliente y basados en la normatividad se vuelven prioritarios al momento de la contratación, seguimiento o posible investigación de una situación específica. Encontrar que las compañías año tras año realizan de manera constante exámenes de poligrafía tanto preempleo como rutina, muestra que dicha práctica llegó para quedarse y que lo encontrado fortalece el nivel de satisfacción del cliente final; es gratificante encontrar que los porcentajes de aplicación crecen y que se eliminan mitos y falsas especulaciones sobre dicha herramienta. Dejando como principal mensaje la evidente necesidad de apropiarse del examen de poligrafía, incluirlo en sus procesos y darle de manera acertada la utilidad para la cual está diseñado. Carrying out polygraphy tests today has gained an important role within companies, whose objective is to generate a culture of trust and reliability in their employees, where the results according to the client's need and based on regulations become priority at the time of hiring, monitoring or possible investigation of a specific situation. Finding that companies constantly perform both pre-employment and routine polygraph examinations year after year, shows that this practice is here to stay and that it has strengthened the level of satisfaction of the end customer; It is gratifying to find that the application rates are growing and that myths and false speculations about this tool are eliminated. Leaving as the main message the evident need to appropriate the polygraph exam, include it in its processes and give it the usefulness for which it is designed in a correct way. Especialización

Rodrigue (23 ans) et Célestin (21 ans) sont frères et habitent ensemble dans un appartement à Lyon. Ils étudient à l’université (l’un en master 2, l’autre en licence). Rodrigue a invité plusieurs de ses amis étudiants – Maxime, Xavier et Benoît – à venir passer la soirée chez eux pour jouer à des jeux vidéo dans leur salon. Il y a à boire (des sodas et de la bière), à manger (des pizzas) et, surtout, des consoles (PlayStation 2 et PlayStation 3) et différents jeux sur lesquels le groupe va po...

Dans le chapitre précédent, nous avons montré la diversification des publics de jeux vidéo qui s’accompagne d’une diversification des formes de pratique. Une manière de saisir ces différences est d’analyser leur dimension routinière. À l’instar d’autres dispositifs numériques, les jeux vidéo offrent aux personnes toute une gamme d’outils, aussi bien pour organiser que pour occuper leur temps et ainsi forger leurs routines. Les loisirs électroniques constituent ainsi, aujourd’hui, un analyseur...

Covid-19 innebar nya rutiner för fastighetsmäklarna med ökat krav på användning av digitalkommunikation för att möta kunder och genomföra bostadsaffärer. Eftersomfastighetsmäklarnas intäkter helt löper på försäljningsprovision kan de nya rutinerna medförakonsekvenser för mäklares ekonomiska överlevnad. Syftet med studien var därför attanalysera hur mäklare förändrat och digitaliserat sina rutiner under Covid-19 pandemin, ijämförelse med före pandemin, för att utveckla kundrelationer, genomföra bostadsaffärersamt säkra sin ekonomiska överlevnad. Studien genomfördes med hjälp av intervjuer avmäklare, tematisering och jämförelse med rutinteorin och tidigare forskning. Resultatetvisade att mäklare genomförde färre personliga möten i hemmet och mäklarkontoret. Deutvecklade rutiner för att kombinera personliga och digitala möten, upprätthöll digitalkommunikation via hemarbete, videovisningar och sociala medier. De effektiviserade ävensina digitala rutiner genom obligatorisk föranmälan till visningar, digital avtalssignering ochanvändning av en digital plattform som kallas sälj- och köpcoachen. En av slutsatserna sommanifesterades under studien var det ökade avståndet mellan mäklare och kund, vilketkompenserades genom ökad digital användning av video, digital signering samt sälj- ochköpcoachen. Denna ökade digitalisering innebar förbättrad effektivitet i mäklarnas arbete attutveckla kundrelationer, genomföra bostadsaffärer och säkra sin ekonomiska överlevnad.Mäklarna antas därför fortsätta ompröva och effektivisera sin digitala kommunikation medkunder på nya oväntade sätt i framtiden. Covid-19 meant new routines for real estate agents with increased requirements for the use ofdigital communication to meet customers and carry out housing transactions. A real estateagents income runs entirely on sales commission, therefore could the new routines that camealong with the pandemic have negative consequences on their financial survival. The purposeof the study was therefore to analyze how real estate agents changed and digitized theirroutines during the Covid-19 pandemic, compared to before the pandemic, to developcustomer relationships, conduct housing transactions and ensure their financial survival. Thestudy was conducted through interviews with brokers, thematization and comparison withroutine theory and previous research. The results showed that brokers conducted fewerpersonal meetings in the home and in their office. They developed routines for combiningpersonal and digital meetings, maintained digital communication via homework, video viewsand social media. They also streamlined their digital routines through mandatory pre-registration for screenings, digital contract signing and use of a digital platform called thesales and buying coach. One of the conclusions that manifested during the study was theincreased distance between broker and customer due to the pandemic. However, this wascompensated by increased usage of digital video, digital signing and the sales- and buyingcoach. The increased digitalisation meant improved efficiency in the brokers' work to developcustomer relationships, carry out housing transactions and secure their financial survival.Brokers are therefore expected to further develop and streamline their digital communicationwith customers in new unexpected ways in the future.

ilustraciones, fotografías Siento el cuerpo como un dispositivo poderoso preparado para plegar y desplegar conocimiento. Pero en los procesos académicos tradicionales parece ser programado para ser plano y archivado. Esta investigación busca pasar por el cuerpo las “rutinas de pensamiento” con el objetivo de resignificar el concepto de “rutina” y abrir la posibilidad de alternativas de pensamiento que emerjan de la consideración de lo esencial del cuerpo en los procesos formativos. El texto se presenta en dos grandes partes: un primer estado que se encuentra desplegado y que manifiesta el cuerpo al comienzo de un proceso, donde se transita por lecturas, experiencias y reflexiones; y un segundo estado, que pretende estar plegado, donde entablo un diálogo conmigo misma sobre los redireccionamientos que he tenido a lo largo de la maestría. El lector verá desplegarse un recorrido de mi proceso de investigación, partiendo desde la comodidad de las rutinas tradicionales, pasando por incomodidades personales, tanto familiares como escolares, hasta llegar a aquellos puntos de quiebre en el tiempo y en el papel que transformaron y liberaron una acción pedagógica, la cual explora una rutina de pensamiento propia que se cuestiona sobre la incomodidad de los cuerpos inconscientes en el aula. Es el resultado de un viaje por las voces de la maestría, entre recuerdos y presencias, ecos y conciencias, claridades y confusiones, durante una investigación viva que va de lo planeado a lo inesperado, del pasado al presente y del aula a la vida, todo en un esfuerzo por reescribir un pedacito de mi propia historia. (Texto tomado de la fuente) I feel the body as a powerful device prepared to fold and unfold knowledge. But in traditional academic processes it seems to be programmed to be flat and kept away. This research seeks to pass through the body the "thinking routines" with the purpose of giving a new meaning to the concept of "routine" and opening the possibility of other alternatives which emerge from the consideration of the essentials of the body in the formative processes. The text is presented in two states: a first one that is unfolded and that manifests the body at the beginning of a process, where it goes through readings, experiences, and reflections; and a second state, pretends to be folded, where I start a dialogue with myself about the redirections that I have had throughout the masters. The reader will see a journey of my research process unfold, starting from the comfort of traditional routines, going through personal inconveniences, both from my family and from my school, until reaching those breaking points in time and in the actual paper that transformed and liberated a pedagogical action, which explores a routine of my own thought that questions the discomfort of unconscious bodies in the classroom. It is the result of a journey through the voices of the masters, between memories and presences, echoes and consciences, clarities, and confusions, during a live investigation that goes from the planned to the unexpected, from the past to the present and from the classroom to life, all in an effort to rewrite a little piece of my own history. Maestría Magíster en Educación Artística Creación

BackgroundUnderstanding pre-diagnostic test use could reveal diagnostic windows where more timely evaluation for cancer may be indicated.AimTo examine pre-diagnostic patterns of results of abnormal blood tests in patients with bladder and renal cancer.Design and settingA retrospective cohort study using primary care and cancer registry data on patients with bladder and renal cancer who were diagnosed between April 2012 and December 2015 in England.MethodThe rates of patients with a first abnormal result in the year before cancer diagnosis, for ‘generic’ (full blood count components, inflammatory markers, and calcium) and ‘organ-specific’ blood tests (creatinine and liver function test components) that may lead to subsequent detection of incidental cancers, were examined. Poisson regression was used to detect the month during which the cohort’s rate of each abnormal test started to increase from baseline. The proportion of patients with a test found in the first half of the diagnostic window was examined, as these ‘early’ tests might represent opportunities where further evaluation could be initiated.ResultsData from 4533 patients with bladder and renal cancer were analysed. The monthly rate of patients with a first abnormal test increased towards the time of cancer diagnosis. Abnormalities of both generic (for example, high inflammatory markers) and organ-specific tests (for example, high creatinine) started to increase from 6–8 months pre-diagnosis, with 25%–40% of these patients having an abnormal test in the ‘early half’ of the diagnostic window.ConclusionPopulation-level signals of bladder and renal cancer can be observed in abnormalities in commonly performed primary care blood tests up to 8 months before diagnosis, indicating the potential for earlier diagnosis in some patients.

Most rapid diagnostic tests for Plasmodium falciparum malaria target the Histidine-Rich Proteins 2 and 3 (HRP2 and HRP3). Deletions of the hrp2 and hrp3 genes result in false-negative tests and are a threat for malaria control. A novel assay for molecular surveillance of hrp2/hrp3 deletions was developed based on droplet digital PCR (ddPCR). The assay quantifies hrp2, hrp3, and a control gene with very high accuracy. The theoretical limit of detection was 0.33 parasites/µl. The deletion was reliably detected in mixed infections with wild-type and hrp2-deleted parasites at a density of >100 parasites/reaction. For a side-by-side comparison with the conventional nested PCR (nPCR) assay, 248 samples were screened in triplicate by ddPCR and nPCR. No deletions were observed by ddPCR, while by nPCR hrp2 deletion was observed in 8% of samples. The ddPCR assay was applied to screen 830 samples from Kenya, Zanzibar/Tanzania, Ghana, Ethiopia, Brazil, and Ecuador. Pronounced differences in the prevalence of deletions were observed among sites, with more hrp3 than hrp2 deletions. In conclusion, the novel ddPCR assay minimizes the risk of false-negative results (i.e., hrp2 deletion observed when the sample is wild type), increases sensitivity, and greatly reduces the number of reactions that need to be run.

Since 1948, Shannon theoretic methods for modeling information have found a wide range of applications in several areas where information plays a key role, which goes well beyond the original scopes for which they have been conceived, namely data compression and error correction over a noisy channel. Among other uses, these methods have been applied in the broad field of medical diagnostics since the 1970s, to quantify diagnostic information, to evaluate diagnostic test performance, but also to be used as technical tools in image processing and registration. This review illustrates the main contributions in assessing the accuracy of diagnostic tests and the agreement between raters, focusing on diagnostic test performance measurements and paired agreement evaluation. This work also presents a recent unified, coherent, and hopefully, final information-theoretical approach to deal with the flows of information involved among the patient, the diagnostic test performed to appraise the state of disease, and the raters who are checking the test results. The approach is assessed by considering two case studies: the first one is related to evaluating extra-prostatic cancers; the second concerns the quality of rapid tests for COVID-19 detection.

The diagnostic approach to the biliary tree disorders can be challenging, especially for biliary strictures. Albeit the great diagnostic impact of endoscopic retrograde cholangiopancreatography (ERCP) which allows one to obtain fluoroscopic imaging and tissue sampling through brush cytology and/or forceps biopsy, a considerable proportion of cases remain indeterminate, leading to the risk of under/over treated patients. In the last two decades, several endoscopic techniques have been introduced in clinical practice, shrinking cases of uncertainties and improving diagnostic accuracy. The aim of this review is to discuss recent advances and emerging technologies applied to the management of biliary tree disorders through peroral endoscopy procedures.

A logística interna enxuta têm recebido grande destaque nos últimos anos, buscando garantir a eficiência dos fluxos dentro das dependências das organizações. Ela envolve fluxos de materiais, informações e pessoas, assim como apresenta diversos fluxos principais e secundários, visando garantir o atendimento da demanda do cliente. Ela ainda está relacionada às rotas pelos quais os entes perpassam e as rotinas de atividades dos seus agentes de fluxo. Por ser tratada como um elemento avançado do Lean, ela envolve fluxos de materiais, informações e pessoas nas suas dependências interna, bem como apresenta interseções e interações entre fluxos e elementos. Muitas empresas focam em melhorias pontuais nos seus fluxos, sem contar com os impactos que elas podem provocar nos demais. Os três Rs iniciais do Lean, quais sejam: o ritmo, a rota e a rotina estão diretamente ligados, resultando em impactos entre si e gerando riscos ao correto funcionamento dos fluxos. Ainda, a manifestação da resiliência de forma não projetada pode contribuir para geração de riscos, ocasionando interferências significativas em outros setores e fluxos interligados. Nesse sentido, a complexidade da logística interna requer que mecanismos de resiliência sejam projetados de forma a lidar melhor com eventos inesperados que possam provocar a ruptura dos seus fluxos. Esse estudo buscou adotar a Design Science Research (DSR) e a Action Research (AR) como abordagens metodológicas para desenvolver um framework de análise da logística interna enxuta baseada nos 5Rs (Ritmo, Rotina, Rota, Riscos e Resiliência), sendo aplicada no fluxo de medicamentos em um hospital universitário de grande porte. A framework foi concebida por meio de uma revisão sistemática da literatura (RSL) e entrevistas com especialistas lean, resultando em três módulos principais, quais sejam: (i) a delimitação de escopo; (ii) a análise dos 5Rs em profundidade; e (iii) proposição de melhorias, monitoramento e replicação das análises. Os principais resultados mostraram a identificação de 45 riscos e 59 oportunidades de melhorias, sendo 5 delas implementadas no fluxo de medicamentos. Ainda, os impactos de R foram estudados, permitindo estabelecer as relações entre eles. Dentre os benefícios da aplicação do framework estão: adquirir conhecimento aprofundado sobre o fluxo relacionado aos processos logísticos internos de uma organização, identificar as oportunidades de melhorias, aumentar a capacidade de resiliência organizacional do sistema e entender as relações de complexidade na logística interna enxuta. Lean internal logistics have received great attention in recent years, seeking to ensure the efficiency of flows within organizations' premises. It involves flows of materials, information, and people, as well as presenting several main and secondary flows, aiming to guarantee the fulfillment of customer demand. It is still related to the routes through which entities pass through and the activity routines of their flow agents. Because it is treated as an advanced element of Lean, it involves flows of materials, information, and people in its internal dependencies, as well as presents intersections and interactions between flows and elements. Many companies focus on specific improvements in their flows, not counting the impacts they can cause on others. The three initial Rs of Lean, namely: the rhythm, the route and the routine are directly linked, resulting in impacts between them and generating risks to the correct functioning of the flows. Also, the manifestation of resilience in an unplanned way can contribute to the generation of risks, causing significant interference in other sectors and interconnected flows. In this sense, the complexity of internal logistics requires that resilience mechanisms be designed in order to better deal with unexpected events that may cause the disruption of their flows. This study sought to adopt Design Science Research (DSR) and Action Research (AR) as methodological approaches to develop a lean internal logistics analysis framework based on the 5Rs (Rhythm, Routine, Route, Risks and Resilience), being applied in the flow of medicines in a large university hospital. The framework was conceived through a systematic literature review (RSL) and interviews with lean experts, resulting in three main modules, namely: (i) scope delimitation; (ii) an in-depth analysis of the 5Rs; and (iii) proposition of improvements, monitoring, and replication of analyses. The main results showed the identification of 45 risks and 59 opportunities for improvement, 5 of which were implemented in the drug flow. Still, the impacts of R were studied, allowing to establish the relationships between them. Among the benefits of applying the framework are acquiring in-depth knowledge about the flow related to an organization's internal logistics processes, identifying opportunities for improvement, increasing the system's organizational resilience capacity and understanding the complexity relationships in lean internal logistics.

Anhand einer Analyse von autoethnografischen Tagebucheinträgen zur Nutzung digitaler Technologien wurde die Morgenroutine von Studierenden rekonstruiert. In den Blick wurde Art, Dauer, Intensität und Häufigkeit der Nutzung genommen und eine dichte Beschreibung angefertigt. Die Forschungsfrage war, ob es sich bei der Morgenroutine um eine digitale Praktik handelt. Im Ergebnis kann die Morgenroutine als digitale Praktik gefasst werden, die erstens auf dem Wunsch nach Gemeinschaft fußt und zweitens zur Informationsaneignung dient. Ebenfalls wurde festgestellt, dass einige Teilnehmenden eine Verhaltensanpassung wie einen bewussten Routinedurchbruch im Rahmen des Seminars vollziehen, um der Routine entgegenzuwirken. Zudem kommt es aufgrund externer Einflüsse zu Veränderungen von Routinen. Based on an analysis of auto-ethnographic diary entries on the use of digital technologies, the morning routine of students was reconstructed. The type, duration, intensity and frequency of use were examined and a dense description was drawn up. The research question was whether the morning routine is a digital practice. As a result, the morning routine can be seen as a digital practice that is firstly based on the desire for community and secondly serves to acquire information. It was also found that some participants adapt their behavior, such as a conscious breakthrough in routines, in the course of the seminar in order to counteract the routine. In addition, there are changes in routines due to external influences.

We conducted a sociological survey, the purpose which was to discover how many students pay attention healthy lifestyle and physical exercises in the daily routine of students. Нами был проведен социологический опрос, целью которого являлось выявить как много студентов уделяют внимание здоровому образу жизни и занятиям физическими упражнениями в режиме дня студентов.

Thrombin generation (TG) is a better determinant of the overall function of the hemostatic system than routinely used clotting time-based assays and can be studied more in detail by thrombin dynamics analysis. Platelet poor plasma is often used to measure TG, however, measuring the contribution of the platelets is also important as patients with a low platelet count or with dysfunctional platelets have an increased risk of developing bleeding. In this study, platelet rich plasma (PRP) was collected from 117 healthy individuals. PRP was measured undiluted and diluted to a varying platelet concentration of 10*109/L to 400*109/L. Prothrombin conversion and thrombin inactivation were calculated from the data obtained by the TG parameters and coagulation factor levels (antithrombin, α2Macroglobulin (α2M) and fibrinogen). Reference ranges of TG and thrombin dynamics in PRP of 117 healthy individuals were established. Peak, velocity index and the maximum rate of prothrombin conversion increased linearly with platelet count, but endogenous thrombin potential reached a maximum at 150*109/L as seen in a subset population (n = 20). More extensive analysis revealed that a platelet count below 50*109/L did not affect TG parameters (except for the ETP). Correlation analysis indicated that the platelet count mainly affected the rate of prothrombin conversion. Inhibition of thrombin by antithrombin and α2M increased with increasing TG, but the ratio of inhibition by antithrombin or α2M remained the same independently of the total thrombin formed. In conclusion, TG and thrombin dynamics were assessed in PRP of healthy donors to provide reference values for future TG studies in PRP. Increasing the platelet count mainly affected the rate of prothrombin conversion and TG, rather than the total amount of thrombin formed.

Head and neck examinations are commonly performed by all physicians. In the era of the COVID‐19 pandemic caused by the SARS‐CoV‐2 virus, which has a high viral load in the upper airways, these examinations and procedures of the upper aerodigestive tract must be approached with caution. Based on experience and evidence from SARS‐CoV‐1 and early experience with SARS‐CoV‐2, we provide our perspective and guidance on mitigating transmission risk during head and neck examination, upper airway endoscopy, and head and neck mucosal surgery including tracheostomy.

Background Infective endocarditis (IE) is characterized by high rates of in-hospital death, and Staphylococcus aureus infection predicts a worse prognosis. We aimed to assess if admission inflammatory biomarkers (white blood cell – WBC – count, C-reactive protein — CRP, and procalcitonin) are informative on microbiological etiology and short-term outcomes. Methods Data from 236 patients admitted for IE from January 2013 to June 2018 were retrieved from a multicenter registry. Results Fifty-two patients (22%) were infected by S. aureus. WBC, CRP and procalcitonin had area under the curve (AUC) values for S. aureus infection of 0.595, 0.675, and 0.727, respectively. Adding procalcitonin to WBC improved discrimination over WBC alone (p = 0.045), and procalcitonin predicted S. aureus infection independently from the other inflammatory biomarkers and patient characteristics. Patients with WBC ≥ 12,800/mm3, CRP ≥ 130 mg/L, and procalcitonin ≥ 1.7 ng/mL had an almost 20-fold higher risk of S. aureus infection than patients with all biomarkers Conclusions Among patients with IE, high levels of inflammatory biomarkers on admission, particularly procalcitonin, are associated with a higher likelihood of S. aureus infection, and a higher risk of in-hospital mortality.

Background Presumptive diagnosis and prescription of anti-malarial medicines to malaria rapid diagnostic test (RDT)-negative patients is a common practice among health care workers (HCWs) in Nigeria. There is paucity of data on HCWs adherence to RDT result in Sokoto metropolis, Nigeria. The study was conducted to determine HCWs adherence to malaria test result and the influencing factors. Methods A cross-sectional study was conducted among 262 HCWs selected by multistage sampling technique from primary and secondary health facilities in Sokoto metropolis. Data on demographic characteristics, adherence to RDT result and its influencing factors were collected from the HCWs. Adherence was categorized into good if adherence score is ≥ 4 and poor if otherwise. Chi-squared test was used to test association between adherence to test results and patients’ fever presentation, expectation to be given anti-malarials, prior HCWs’ case management training, among others. Independent predictors of adherence to RDT results were ascertained. Results Respondents’ mean age was 33.5 ± 7.9 years, 190 (72.5%) worked in Primary Health Care facilities, 112 (42.8%) were Community Health Workers, 178 (67.9%) had National Diploma Certificate. The median years of practice was 5.0 (IQR: 3–10) years, while 118 (45.0%) had at most 4 years of practice. Overall, 211 (80.5%) had good adherence to RDT results. About 108 (89.3%) of HCWs who had training on malaria case management and 35 (89.7%) certificate holders had good adherence to RDT results. Predictors of adherence to test results were presence of fever in the patient [adjusted odds ratio (aOR): 2.53, 95% confidence interval (CI) 1.18–5.43], patients’ expectation to be given anti-malarial medicines by the HCW (aOR: 3.06, 95% CI 1.42–6.58) and having been trained on malaria case management (aOR: 2.63; 95% CI 1.26–5.44). Conclusion High level of adherence to RDT results among HCWs in Sokoto metropolis could be attributed to prior malaria case management training and HCWs’ confidence in the national treatment guidelines. Continual training and supportive supervision of HCWs on malaria case management might optimize the current level of adherence to RDT results in Sokoto metropolis, Nigeria. Similarly, patients/caregivers’ health education could aid better understanding of the need for anti-malarials thus reducing unnecessary demand.

The measurement of serum phosphate concentration is crucial for patients with advanced chronic kidney disease (CKD) and those on maintenance dialysis, as abnormal phosphate levels may be associated with severe health risks. It is important to monitor serum phosphate levels on a regular basis in these patients; however, such measurements are generally limited to every 0.5-3 months, depending on the severity of CKD. This is due to the fact that serum phosphate measurements can only be performed at regular clinic visits, in addition to cost considerations. Here we present a portable and cost-effective point-of-care device capable of measuring serum phosphate levels using a single drop of blood (