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Please see the Editorial Comment by Viktoriya Paroder discussing this article. Please see the Author Video associated with this article. Fistulizing perianal disease is a frequent, chronic, and oft...

Background The ‘OPTIMAL’ (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning suggests that autonomy, external focus of attention, and perceived competence can improve learning of simple motor tasks. The authors hypothesized that enhanced (vs. routine) autonomy and external (vs. internal) focus of attention would improve first-try performance of two medical motor tasks. Methods The authors conducted a randomized two-by-two factorial design study with high school students as participants. Task instructions promoted either enhanced or routine autonomy, and either external or internal focus of attention. These conditions were replicated in a crossover design for two common medical tasks (chest compressions on a manikin and a Fundamentals of Laparoscopic Surgery peg transfer task). Primary outcomes were objective measures of task performance (chest compression deviation from target depth; peg transfer time with penalties for errors). Secondary outcomes included subjective perceptions of confidence, autonomy, and workload. Results One hundred thirty-three high school students participated in this study. The primary outcomes concerning enhanced vs. routine autonomy demonstrated no statistically significant difference in either task (chest compression depth deviation: difference -0.7 mm [score range 0 to 37.5 mm]; 95% confidence interval (CI95) -3.85, 2.41; p = .65; peg transfer penalized time: rate ratio 1.03; CI95 0.91, 1.31; p = .79). The authors likewise found no statistically significant difference for external vs. internal focus of attention (depth deviation: difference 1.1 mm; CI95 -2.04, 4.17; p = .50; penalized time: rate ratio 0.89; CI95 0.75, 1.13; p = .33). The authors found no statistically significant differences for either comparison in confidence, autonomy and workload (p > .09; differences ranged from -0.83 to 0.79 [scale range 0 to 10]). Conclusions First-try performance of chest compressions and peg transfer by novice learners is not significantly affected by enhanced (vs. routine) autonomy or external (vs. internal) focus of attention.

Giving and receiving constructive feedback is a valuable skill and an evolving process due to improved understanding and changes in culture. This article provides a practical review of key elements of effective feedback skills and strategies for providing constructive feedback, with a focus on how to address recipients who may have impaired insight into the issue at hand. Commonly known tips and tricks include direct, immediate, and specific feedback delivered in a safe setting and in a conversational manner. This article specifically considers how the feedback will be heard or accepted by the intended recipient, in order for the educator to best overcome hurdles in relaying constructive criticism.

Purpose: The purpose of this clinical focus article is to illustrate how speech-language pathologist (SLP) characterization of anarthria can contribute to neurological diagnosis and to highlight the challenges associated with such an endeavor. Method: Used in this study are a retrospective chart review and clinicians' experience-based reflections. Results: A 65-year-old man, who, in the context of a neurodegenerative disease, presented with near-complete-loss of speech, was referred by neurologists to SLPs for further characterization of his speech difficulty. Assessment of his limited speech output revealed anarthria with mixed features (spastic and hypokinetic) with superimposed apraxia of speech. Conclusions: SLP characterization of anarthria to facilitate neurological diagnosis is challenging but possible. Clinical lessons learned from this unusual scenario are discussed.

Long non-coding RNAs (LncRNAs) play a vital role in the process of malignant transformation. In breast cancer (BC), lncRNAs field is currently under intensive investigations. Yet, the role of lncRNAs as promising diagnostic and/or prognostic biomarkers and as therapeutic target/tool among BC patients still needs a special focus from the biomedical scientists. In BC, triple negative breast cancer patients (TNBC) are the unlucky group as they are always represented with the worst prognosis and the highest mortality rates. For that reason, a special focus on TNBC and associated lncRNAs was addressed in this review. Colon cancer-associated transcript 1 (CCAT-1) is a newly discovered oncogenic lncRNA that has been emerged as a vital biomarker for diagnosis, prognosis and therapeutic interventions in multiple malignancies and showed differential expression among TNBC patients. In this review, the authors shed the light onto the general role of lncRNAs in BC and the specific functional activities, molecular mechanisms, competing endogenous ncRNA role of CCAT-1 in TNBC.

Objectives The animated medication information tool ‘Watchyourmeds’ provides information in an accessible manner through animated videos and therefore appears to be especially suitable for people with limited health literacy. This study aimed to assess the implementation of this animated medication information tool in Dutch community pharmacies, with a special focus on patients with limited health literacy. Methods A cross-sectional survey based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was sent to approximately 75% of the ±1900 community pharmacies in the Netherlands through email newsletters of pharmacy networks. Key findings 140 pharmacists (⁓10%) completed the survey and 125 of them (89%) indicated that they offered the animated medication information tool to their patients. 108 pharmacists indicated that the tool was offered to all patients, not only to patients with limited health literacy. The distribution method was primarily passive (patients were given a leaflet and were not explicitly pointed to or informed about the tool). Two frequently cited motivations for offering the tool were that it complemented other sources of information and that the health insurer provided a financial incentive. The main reasons patients refused to use the tool were that they had no access to or no affinity for the required technology. Conclusions This study demonstrated that the tool is used in community pharmacies and that it is offered to all patients, regardless of their presumed health literacy level. A more active method of offering the tool may be warranted to better reach patients with limited health literacy.

This systematized review sought to fill a gap in psilocybin research by investigating the structure and format of psilocybin-assisted psychotherapy (PAP), with a focus on the counseling components of the treatment.A systematized review of PAP was conducted by using the PubMed and PsycInfo databases to search for peer-reviewed studies of human clinical trials, published within the past 25 years, in which psilocybin was administered with psychological support in a clinical setting.Eleven articles matched the criteria necessary for inclusion in this review. PAP was found to consist of three stages: pretreatment sessions to prepare participants for psilocybin, treatment sessions in which psilocybin was administered, and posttreatment sessions to integrate the experience with daily life. Conventional psychotherapy was primarily seen in the pre- and posttreatment sessions. Psychotherapies included in PAP differed among studies, but most often included music therapy and a nondirective supportive approach to treatment.This systematized review found important commonalities among clinical trials of PAP published within the past 25 years and revealed key differences among studies in psychotherapy's incorporation into PAP. Additional research is needed to identify the unique effect of psychotherapy in PAP.

Adults (N = 54, 80.78 ± 6.08 years) who reported falling during the previous 12 months participated in a 12-week wobble board training program with internal focus or external focus (EF) instructions. Verbal manipulation checks were performed after training sessions as a self-report of the attentional foci used. The percentage of sessions in which participants reported using an EF (EFSR) was subsequently calculated. Mean velocity and mean power frequency in the anterior–posterior (MVELOAP and MPFAP) and medial–lateral (MVELOML and MPFML) direction were assessed during a 35-s wobble board task at Weeks 0, 6, 12, 13, 16, and 20, with the latter three as retention tests. Piecewise linear growth models estimated treatment effects on individual growth trajectories of MVELOAP and ML and MPFAP and ML during intervention and retention periods. Regardless of condition, MVELOML significantly decreased (π = −.0019, p = .005) and MPFML increased (π = .025, p SR had superior progression of MPFAP during the intervention (π = .0013, p = .025). Verbal manipulation checks suggest a preference for and advantage of EF for facilitating postural control performance and automaticity.

Purpose: To identify the 50 most cited original articles on meniscus injury and surgery from 2000 to 2019, and to perform a bibliometric analysis of the identified articles. Methods: A Clarivate Web of Science search, completed in June 2020, generated a list of the most cited articles related to meniscus research. Articles were sorted by number of times cited, and review articles or those unrelated to the meniscus were removed. Articles were classified as basic science or assigned the appropriate level of evidence. Extracted data included title, authors, journal, year of publication, country/institution of origin, total number of citations, and number of citations per year. Results: The final list of 50 included articles with a range of 106 to 490 citations and a mean of 162.34 total or 11.91 citations per year. The most cited articles appeared in 8 of the most influential journals in the field per the Journal Citation Index. Twenty-nine (58%) originated from institutions within the United States, and only 13 (26%) were published in 2010 or later. Overall, 25 (50%) were classified as therapeutic, only 5 (10%) were therapeutic randomized controlled studies, and 17 (34%) were basic science. “Arthroscopic meniscal repair or meniscectomy” appeared most frequently, with 16 (32%) falling into this subclassification. Conclusion: This study of the most cited meniscus articles showed a strong predominance for therapeutic studies, studies generated and published within the United States, and studies focused on topics of arthroscopic repair or removal. Overwhelmingly, included articles were published before 2010, affirming the criticism that bibliometric analysis favors older articles. Clinical relevance: This study provides information about which articles are driving the field relating to meniscus injuries and meniscus surgery in the last two decades.

Graphical abstract, Highlights • Use of POCUS aided in early identification of carcinoid heart disease. • POCUS may increase the diagnostic accuracy of the cardiac examination. • High-risk cardiac pathology can be visualized at earlier stages when POCUS is used.

To be a competent, dynamic, and effective teacher needs a lot of evaluation and reflection. A product of this thought should be learning outcomes that demonstrate mastery, fluency, and achievement of the learners, who are the main focus of teaching and learning. This paper aims to examine the book authored by Rollins by connecting the observations and experiences of the reviewer to the points, theories, and practices tackled by the author in her book. It is the hope of teachers around the globe to offer collaborative learning environment that will cater to the needs and diversities of learners.

Balance and postural control exercises are generally included as a part of exercise programs, during which movement practitioners can provide instructions to facilitate the performance of motor skills. Instructions can be used as cues to direct attentional focus, which has been found to affect the performance of motor skills, including balance and postural control tasks. However, no known studies to date have investigated the effect of both internal and external attentional focus instructions on static single leg balance performance, and it seems unclear whether effects of such instructions are related specifically to the direction of attention. The purpose of this study was to investigate the effect of instructing the direction of attentional focus on single leg static balance performance as reflected by the complexity of the center of pressure (COP) profile. Participants (N = 46) between the ages of 19–28 years old were randomly assigned to one of three group conditions: internal focus (INTn=15), external focus (EXTn=16) and control (CONn=15). Participants performed a thirty-five second static single leg balance task. Outcome measures were the scaling exponent determined from a detrended fluctuation analysis (DFA) to infer complexity of the COP profile in the anterior-posterior (AP) and medial-lateral (ML) directions, and root mean square error (RMSE) of the COP profile in AP and ML directions. A one-way analysis of variance (ANOVA) determined there were no statistically significant differences in the measured variables among groups. The results do not support the claim that manipulating the direction of attentional focus affects static single leg balance performance.

Background. The problem of diagnostics and treatment of malignant neoplasms of the lungs is urgent. Verification of a malignant process in the case of peripheral localization of a neoplasm in the lung using ultrasound bronchoscopy ranges from 30 to 85%. To improve the efficiency of ultrasound bronchoscopy, a modified biopsy technique for ultrasound bronchoscopy was developed and introduced into clinical practice at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine. The essence of the modified technique is that it becomes possible for ultrasound visual control over the passage and deployment of biopsy forceps in real time. The technique was patented, patent for invention RU №2719666 C1 was issued. Aim. To clarify the information content of ultrasound bronchoscopy using a modified technique. Materials and methods. On the basis of the endoscopic Department of Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in 2019 and 2020, ultrasound bronchoscopy using this technique was performed on 40 patients with suspected peripheral malignant neoplasm of the lungs. The diagnosis of malignant neoplasm was verified in 67.5% of cases. Using the standard biopsy technique, the probability of verification of lung malignant neoplasms in 2019 and 2020 was 57.7%. Thus, the modified biopsy technique made it possible to increase the verification probability by 9.8%. The modified technique is relatively safe, complications during the procedure were detected in 2 patients (in 3.8% of cases) and were successfully treated conservatively. During and after the procedure, the patients were monitored and monitored. The ultrasound bronchoscopy according to the modified technique was satisfactorily tolerated by the patients. Results. The period of examination of patients when using this technique does not increase. The technique replaces more invasive diagnostic procedures. Conclusion. The use of the modified technique will improve the information content of ultrasound bronchoscopy, shorten the examination time for patients and accelerate the appointment of special treatment methods.

The high resilience to biological treatments from the landfill leachate is generally associated with the presence of humic substances (HS). The brown color characteristic of this effluent is also related to these substances. Landfill leachate with low biodegradability can make biological treatments unfeasible, which can drive up the cost for the treatment of large leachate volumes. In this context, this research aimed to characterize the leachate in different seasonal periods, and verify the influence of HS species on the biodegradability of the effluent to assist in the selection of adequate treatment techniques. The HS quantification was performed using the modified Lowry method and speciation through fractionation according to the molar masses of the HS species. The tropical regions can be the precursor for the rapid stabilization of biodegradable organic matter. The warmer climate contributed to a reduced BOD/COD ratio (0.03) and the predominance of compounds of lower mass (e.g.: fulvic acids). The tests showed an HS concentration of 26.9% of the total COD in the raw leachate in the rainy season, which increased to 37.3% in the dry season. Approximately 70% of HS species refer to fulvic acids, a fraction identified as having the highest biologic treatment resilience. HIGHLIGHTS A method for HS determination in the presence of proteins was assessed.; Leachate is diluted during hydric surplus.; FA are the main compounds in stabilized leachate among the HS.; Leachate resilience to biodegradation is mainly derived from FA.; Hydraulic retention times longer than 20 days are not recommended due to cell lysis.

Numerous studies have shown the critical role of sirtuin-1 deacetylase (SIRT1) in the protection of renal cells from endogenous and exogenous stresses. A protective role for SIRT1 has been established in both podocytes and renal tubular cells in many kidney diseases, including diabetic nephropathy (DN). SIRT1 has also been shown to have nephroprotective effects in DN, in part through the deacetylation of transcription factors involved in disease pathogenesis, such as p53, FOXO, RelA / p65NF-KB, STAT3, and PGC1a / PPARy. Recently, it was found that podocyte-specific overexpression of SIRT1 attenuates proteinuria and kidney damage in an experimental model of DN, suggesting the possibility of using SIRT1 as a potential target for the treatment of kidney disease. In addition, SIRT1 agonists such as resveratrol and BF175 have been shown to reduce diabetic kidney damage in several experimental animal models. It has also been shown that puerarin, a Chinese herbal medicine, activates SIRT1, providing nephroprotection in a mouse model of DN. In addition to SIRT1 agonists, inhibitors of bromodomain, in particular, MS417, also have a nephroprotective effect. These results suggest that SIRT1 agonists and bromodomain inhibitors may be new potential therapeutic agents that slow the progression of DN.

People with intellectual disability mostly require life-long care that in many countries is provided by parents. The increased risk of marital breakdown in these families has been a focus of attent...

There is a growing expectation that healthcare should focus on the needs of the individual patient with the philosophy of person-centred practice as the central model for care delivery. Given the i...

Остеоартрит (ОА) является наиболее распространенной формой артрита, характеризующейся разрушением суставного хряща, воспалением синовиальной оболочки и ремоделированием субхондральной кости. Коленный сустав является самой распространенной локализацией ОА, и ОА коленного сустава наиболее часто поражает людей старше 50 лет. Кроме того, ОА является основной причиной боли у пожилых людей, хроническая боль в бедре и колене приводит к инвалидности и повышенному риску смертности от всех причин. Целью лечения ОА является уменьшение симптомов и замедление прогрессирования заболевания, что, в свою очередь, может снизить влияние ОА на качество жизни пациента. В настоящее время различные академические и профессиональные общества разработали руководящие принципы для стандартизации ведения пациентов с ОА и рекомендации доступных вариантов лечения. Физическая активность поддерживается всеми современными медицинскими обществами, в то время как в отношении назначения других вмешательств и лекарственных средств различные сообщества дают противоречивые доказательства. Последние обновленные рекомендации 2019 года по лечению пациентов с ОА коленных суставов, представленные Европейским обществом по клиническим и экономическим аспектам остеопороза, остеоартрита и заболеваний опорно-двигательного аппарата (ESCEO), включают 15 рекомендаций по лечению и обновленный ступенчатый алгоритм для менеджмента пациентов с ОА коленного сустава, что обеспечивает практическое руководство для врача в свете последних данных об эффективности и безопасности препаратов согласно данным недавних исследований. Алгоритм ESCEO подчеркивает сохраняющуюся важность нефармакологических вмешательств на всем протяжении лечения ОА. В статье рассматриваются преимущества и ограничения различных нефармакологических, фармакологических и хирургических методов лечения ОА с особым акцентом на их безопасность.

Introduction: Fever without a focus constitutes a major problem in children in the age group of three months to 36 months. Majority have viral infections but around 1.6 - 2% can have occult serious bacterial infection which needs early identification and treatment. The study was done to evaluate combination of CRP with Procalcitonin (PCT) as a marker of SBI in children (Three months - 36 months) with fever without focus in comparison with only PCT or CRP done separately. Methods: In this hospital based explorative study, 31 children between three months to 36 months of age with fever without any localising signs were enrolled. Relevant investigations were done to diagnose or rule out serious bacterial infection. Cut off of > 10 mg/dl for CRP and > 0.5 ng/ml for PCT was considered. Appropriate statistical analysis was done. Results: Among 31 recruited cases, 14 had occult serious bacterial infection with urinary tract infection being the most common cause. The combination PCT with CRP had sensitivity of 78.5%, specificity of 100%, and positive predictive value of 100% and negative predictive value of 85%. Diagnostic accuracy was 90.32% which did not have any statistically significant difference compared to PCT alone but significant compared to CRP alone. Conclusions: Combining CRP with procalcitonin did not have any added advantage over procalcitonin alone but combination of CRP and PCT and PCT alone is useful in detecting occult serious bacterial infections in children with fever without focus compared to CRP alone.

Callers making an emergency phone call can exhibit emotional displays about a current situation characterized by different forms of conduct such as shouting, howling each spoken word, speech distortion, crying, pleas for help, expressions such as “Oh God” (Whalen and Zimmerman, 1998). Since emotional outbursts can derail the call's progress, emotional callers are considered ‘non-compliant’ with the primary task, and dispatchers face practical challenges with caller management. Findings show how using a modal verb format can redirect callers to focus on a patient's care. Using conversation analysis, this article illustrates dispatchers' methods for redirecting an emotional caller's attention to complete a task, which works to calm callers and sustain their attention for the call's duration.

Familial hypercholesterolemia is characterized by a significant increase in serum low-density lipoprotein cholesterol concentration, which even in the absence of other risk factors leads to the development of atherosclerotic vascular lesions beginning in childhood. With significant prevalence in the population, familial hypercholesterolemia is rarely diagnosed in time due to the Long absence of clinical manifestations. Today the urgent task is to develop and implement programs of primary detection of familial hypercholesterolemia in children and adolescents. Early detection of patients with familial hypercholesterolemia and timely initiation of adequate lipid-lowering therapy will curb the rate of atherosclerosis progression, which will significantly reduce disability and mortality from cardiovascular diseases in older age groups. There are four types of screening: cascade, targeted, opportunistic and universal. Cascade screening is currently considered the most effective and cost-effective way to identify new patients with familial hypercholesterolemia among relatives of an index patient, the patient with the established diagnosis. Targeted screening is based on searching for individuals with familial hypercholesterolemia among groups of patients with the early development of atherosclerotic vascular lesions, for example, in cardiology or neurology hospitals. Opportunistic screening is a non-systematic, sporadic determination of cholesterol levels in patients seeking medical care for any reason. It is most applicable in primary care health care settings. Universal screening is a mass screening of certain age groups and is a highly effective way of early diagnosis, especially in combination with reverse cascade screening of parents, siblings, and other relatives of the index patient. Implementation of programs of early childhood detection of familial hypercholesterolemia, setting up systems of adequate routing of patients, timely prescription of effective lipid-lowering therapy will contribute to health preservation and prolongation of working age, development, and preservation of labor potential of the country.

Uwe Gründler,1 Eva Ekesbo,2 Martin Löwe,1 Adelheid Gauly3 1REFA Consulting AG, Dortmund, Germany; 2BetaHälsan AB, Lund, Sweden; 3Fresenius Medical Care, Global Medical Office, Bad Homburg, GermanyCorrespondence: Adelheid GaulyFresenius Medical Care Deutschland GMBH, Global Medical Office, 3 Else-Kröner-Strasse, Bad Homburg 61352, GermanyTel +49 6172 609 2260Email adelheid.gauly@fmc-ag.comPurpose: Innovative hemodialysis systems are designed to ensure user safety and reduce operational time to allow health-care personnel to focus on patient care. The 6008 CareSystem has been developed to simplify the extracorporeal circuit of the system through a disposable cassette, automate operation steps, and facilitate handling in comparison to its predecessor — the 5008 CorDiax. The present investigations were performed with the aim of evaluating usability, safety, and ergonomic aspects of the new therapy system.Methods: A time–motion study compared these two hemodialysis systems with video and time recording of handling steps required to prepare, operate, and dismantle a dialysis machine. The ergonomic burden on hands and finger joints was evaluated in a second study, again by video-recording the simulated operation of both dialysis systems.Results: The number of handling steps required for the 6008 CareSystem and critical contact points were reduced by 26% in comparison to the 5008 CorDiax for patients with arteriovenous fistula used for vascular access and by 22% for those with a catheter used for vascular access. Total process time was reduced by 2.83 and 2.57 minutes using fistulae and catheters for vascular access, respectively. The number of hand grips and finger and thumb presses was reduced by approximately 50% and required less strength to execute.Conclusion: The most recent hemodialysis system confirmed its ease of use and user safety through fewer handling steps and less physical burden on the user. Shorter operational time should enable more patient-focused care.Keywords: ergonomics, usability, hemodialysis equipment, safety

The clinical outcomes of COVID-19 patients highlight a significant minority of subjects with very rapid lethal outcomes subsequent to the almost complete healing after coronavirus infections for most of the subjects involved. In addition, the reckless use of some drugs and therapeutic protocols that have not shown any efficacy in reducing mortality in those patients where the progression of the disease was unstoppable suggests a different interpretative model in the pathogenesis of severe cases. Starting from the clinical data already known for almost twenty years on the behavior of human SARS coronaviruses, it is possible to develop a new hypothesis. The reference points taken into consideration are: i) the comparison of the histological evidence of the autoptic material; ii) the poor pharmacological response in subjects with severe phenotypes of the pathology; iii) the common element of endotheliitis in a subgroup of the population characterized by harmful clinical outcomes during the evolution of the pathology. The tendency to develop widespread, massive endothelial lesions not responding to any drug therapy or other interventions necessarily plays a crucial role in the onset of the systemic and severe stage of the disease. The present perspective opens the door to a different therapeutic approach both to the full-blown phase of COVID-19 and to the preventive phase or the very first manifestations of the disease. It is imperative to pay more attention to the protection of the vascular endothelium in subjects who already have a predisposition to the development of a severe evolution of this ailment rather than to give a simple antiviral therapy together with symptomatic drugs.

For two decades, the GOLD Initiative has consistently identified the use of bronchodilators as a priority in the pharmacotherapeutic strategy for COPD. The authors of international and national clinical guidelines consider fixed combinations of long-acting beta2-agonists (LABAs) and long-acting muscarinic receptor antagonists (LAMAs) as “first-line” drugs in most patients with COPD. Numerous clinical studies have shown that fixed LABAs/LAMAs combinations provide optimal bronchodilation and play a paramount role in preventing exacerbations of COPD. Outperforming placebo and active controls, LABAs, LAMAs, inhaled glucocorticosteroids (ICS)/LABAs combination bronchodilators may differ in their therapeutic potential. The available evidence base currently does not allow to make an unambiguous choice in favor of one or another fixed LABAs/ LAMAs combination. With the appearance of “triple” combinations (ICS/LABAs/LAMAs) on the pharmaceutical market, the issue of their comparison with “dual” bronchodilators has become particularly acute. Currently available data suggest that the use of “triple” therapy is not considered as a starting treatment option for COPD and is appropriate only in a subgroup of patients with a higher baseline risk of exacerbations: in the presence of a history of exacerbations ≥ 1, which required prescription of systemic antibiotics and/or glucocorticosteroids, or necessitated hospitalization during the previous year. Thus, ICS-containing therapy is justified only in cases of recurrent exacerbations of moderate COPD or single episodes of severe exacerbations, despite the continued administration of LABAs/LAMAs, as well as in certain categories of patients whose inflammatory profile suggests a “response” to ICS.

With the rapid development of various EEG-based features, PC machine robots can apply their fast massive parallel electronic computing AI capability to BCI systems. However, the machines do not have the human-equivalent chemical macromolecular hormone signals to understand human emotions. Machines cannot test people who are home alone with their loneliness, depression, drowsiness, happiness or remark the real hints through human being communication. But a minimum free energy of EEG discrete wavelet transform can indicate human emotion features and human being trend action. In this paper, we focus on EEG discrete wavelet transform at minimum free energy compared to operating effortlessly in visualization algorithm. In addition, we discuss EEG-based brain activities with the discrete wavelet energy spectrum for clinic treatment.

Objectives Posterior tibial tendon dysfunction (PTTD) affects the support of the medial longitudinal arch and stability of the hindfoot. The purpose of this study was to assess the relationships of PTTD with foot and ankle functions and foot deformities in patients with rheumatoid arthritis (RA). Methods A total of 129 patients (258 feet) who underwent magnetic plain and contrast-enhanced magnetic resonance imaging were enrolled in this study. Positive magnetic resonance imaging findings were defined as tenosynovitis and incomplete and complete rupture of the posterior tibial tendon. Foot and ankle functions were assessed using the Japanese Society for Surgery of the Foot standard rating system for the RA foot and ankle scale (JSSF-RA) and self-administered foot evaluation questionnaire. Plain radiographs were examined for the hallux valgus angle, first metatarsal and second metatarsal angle, lateral talo-first metatarsal angle, and calcaneal pitch angle. Results PTTD was associated with motion in the JSSF-RA (p = .024), activities of daily living in JSSF-RA (p = .017), and pain and pain-related factors in the self-administered foot evaluation questionnaire (p = .001). The calcaneal pitch angle was significantly lower in the feet with PTTD than in those without PTTD (median: 16.2° vs. 18.0°; p = .007). Conclusions The present study shows that PTTD was associated with foot and ankle functions and flatfoot deformity. Thus, a better understanding of PTTD in patients with RA is important for the management of foot and ankle disorders in clinical practice.

Approaches for rapid reviews that focus on streamlining systematic review methods are not always suitable for exploring complex policy questions, as developing and testing theories to explain these complexities requires configuring diverse qualitative, quantitative, and mixed methods studies. Our objective was therefore to provide a guide to selecting approaches for rapidly (i.e., within days to months) addressing complex questions related to health policy and system issues. We provide a two-stage, transdisciplinary collaborative process to select a rapid review approach to address complex policy questions, which consists of scoping the breadth and depth of the literature and then selecting an optimal approach to synthesis. The first stage (scoping the literature) begins with a discussion with the stakeholders requesting evidence to identify and refine the question for the review, which is then used to conduct preliminary searches and conceptually map the documents identified. In the second stage (selection of an optimal approach), further stakeholder consultation is required to refine and tailor the question and approach to identifying relevant documents to include. The approach to synthesizing the included documents is then guided by the final question, the breadth and depth of the literature, and the time available and can include a static or evolving conceptual framework to code and analyze a range of evidence. For areas already covered extensively by existing systematic reviews, the focus can be on summarizing and integrating the review findings, resynthesizing the primary studies, or updating the search and reanalyzing one or more of the systematic reviews. The choice of approaches for conducting rapid reviews is intertwined with decisions about how to manage projects, the amount of work to be done, and the knowledge already available, and our guide offers support to help make these strategic decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s13643-021-01834-y.

В статье приведены данные об этиологии, патогенезе, клинике, диагностике и лечении гипогликемии как частого неотложного состояния в случае сахарного диабета. Перечислены основные причины возникновения гипогликемического синдрома, а также врачебные ошибки, которые обусловливают возникновение этого осложнения в практике анестезиологии и интенсивной терапии, указаны методы его предупреждения. В конце статьи представлено собственное клиническое наблюдение длительного резистентного к лечению эпизода гипогликемии у больного с сахарным диабетом 2-го типа в послеоперационном периоде на фоне постоянного приема сахароснижающих препаратов и обсуждение этого случая.

This July, All-Russian Housing Congress brought together about five thousand participants, including specialists inhousing construction, real estate business, mortgage lending, information technologies, interregional transactions,education and training in the real estate market. Among the most relevant topics, discussed by the researchersand practitioners, the following ones can be highlighted: at present, the market of standard private housingconstruction is not mature enough, construction is mainly performed by the citizens themselves; the mortgagemarket, focused on this segment, is in its infancy; there is a need to introduce a standard for the integrateddevelopment of territories in respect of low-rise suburban housing construction, as due to its absence banksand investors do not have clear guidelines for assessing the investment attractiveness of projects; innovativeapproaches in the field of low-rise construction, latest methods of digitalization of investment and constructionactivities at all stages and levels of the project life cycle; developing a reliable mortgage lending mechanism forthis market segment; adoption and implementation of up-to-date standards for the integrated development of lowriseconstruction areas. According to the co-authors, the above-listed topics encompass the main directions forthe development of this industry.

Objectives: This study analyzed, through network analysis and data mining analysis, the relationship between herbs used in osteoporosis prescriptions, diversified the analysis of osteoporosis-related prescriptions, and analyzed the combination of herbs used in osteoporosis-related prescriptions.Methods: The prescriptions used in osteoporosis treatment and experiments were established by conducting a full survey of the papers published by the OASIS site. A database for osteoporosis-related prescriptions was established, herbs were extracted, and the frequency of frequent herbs and prescriptions were investigated using Excel (MS offices ver. 2013). Using the freeware R version 4.0.3 (2020-10-10), igraph, and arules package, network analysis was performed in the first second of prescription composition.Results: Among the osteoporosis-related prescriptions, the most studied prescriptions are as follows.: Yukmijihwang-tang (六味地黃湯) and Samul-tang (四物湯). In the osteoporosis prescription network, herbs with connection centrality, proximity centrality, mediation centrality, and eigenvector centrality appeared in the order of Rehmanniae Radix Preparata, Angelicae Gigantis Radix, Poria Sclerotium, Paeoniae Radix, and Glycyrrhizae Radix et Rhizoma. After extracting the herbal combination network, including the corresponding herbs, and clustering it, it can be divided into drugs of the Yukmijihwang-tang (六味地黃湯) series and the Samul-tang (四物湯).Conclusions: This study could assist researchers in diversifyingy formula analysis in future studies. Moreover, the herbal combination used in osteoporosis prescriptions could be used to search for osteoporosis prescriptions in other databases or to create a new prescription.

Effective management of the upper nasal vault is based on a thorough preoperative analysis and detailed understanding of the requisite principles and techniques utilized to modify the anatomic structures in this region. The surgeon must equally consider form and function when performing manipulation of the upper nasal vault. Special considerations apply when managing this anatomic region via an endonasal or closed approach. A review of this topic is presented with a focus on techniques as they apply to the endonasal rhinoplasty patient.

How diagnosis fits within the overall activity structure of surgical consultations remains under-researched. We set out to contribute to this developing area of research with a particular focus on responses to diagnosis as an achievement of patient agency. We identified 26 diagnostic sequences in a collection of 35 video recorded surgical consultations and examined these in detail using conversation analysis. The activity of diagnosis and the transition to treatment recommendation appear to be structured somewhat differently in surgeon-patient consultations than has been reported for primary care settings. In particular, patient responses to diagnosis are more frequent and more likely to be extended. The analysis provides evidence that both parties orient to surgeons' accountability for their own diagnostic reasoning, and also the medical authority of the referring doctor and the subjective experience of the patient. In delivering the diagnosis, the surgeon must be cognizant of the opinions of both the patient and the referring doctor, which may align to a greater or lesser extent with their own diagnosis.

The article presents data of the modern literature and our studies on the combined use of ursodeoxycholic acid and arginine glutamate in the pathology of the hepatobiliary system. Hepatobiliary diseases today remain a major socio-economic health problem worldwide, occupying a significant place in the structure of general somatic pathology in the clinic of internal medicine. Despite the apparent successes achieved over the past decades in the diagnosis and treatment of diseases of the hepatobiliary system, some issues are still not entirely resolved or there are contradictions about their treatment. It is known that not all hepatotropic drugs meet the requirements for active components that pathogenetically affect the links of pathological processes, which occur in the hepatobiliary tract. It is rather difficult to justify and systematize the treatment of hepatobiliary diseases with such a variety of causes of damage. The principles of modern therapy for most diseases of the hepatobiliary system include the administration of combinations of hepatotropic drugs. One of the most rational combinations of pharmacological agents for these purposes are preparations of ursodeoxycholic acid and arginine glutamate. These pharmacological agents are the drugs with the most substantial evidence base of clinical efficacy, significantly exceeding that of hepatotropic medications of other groups., Статья посвящена обзору данных современной литературы и собственных исследований комбинированного использования урсодезоксихолевой кислоты и аргинина глутамата при патологии гепатобилиарной системы. Болезни гепатобилиарной системы сегодня остаются серьезной социально-экономической проблемой здравоохранения во всем мире. Они занимают значительное место в структуре общесоматической патологии в клинике внутренней медицины. Несмотря на очевидные успехи, достигнутые за последние десятилетия в диагностике и лечении заболеваний гепатобилиарной системы, до сих пор некоторые вопросы окончательно не решены или есть противоречия по поводу их лечения. Известно, что не все гепатотропные препараты соответствуют требованиям к активным компонентам, которые патогенетически влияют на звенья патологических процессов в гепатобилиарном тракте. Обосновать и систематизировать лечение заболеваний гепатобилиарной системы при таком разнообразии причин, вызывающих поражение, довольно трудно. Принципы современной терапии большинства болезней гепатобилиарной системы преду­сматривают назначение комбинаций лекарственных гепатотропных средств. Одними из наиболее рациональных комбинаций фармакологических агентов являются препараты урсодезоксихолевой кислоты и аргинина глутамата. Данные фармакологические средства являются препаратами с наибольшей доказательной базой клинической эффективности, значительно превышающей таковую гепатотропных препаратов других групп., Стаття присвячена огляду даних сучасної літератури і власних досліджень комбінованого використання урсодезоксихолевої кислоти й аргініну глутамату при патології гепатобіліарної системи. Хвороби гепатобіліарної системи сьогодні залишаються серйозною соціально-економічною проблемою охорони здоров’я в усьому світі. Вони посідають значне місце в структурі загальносоматичної патології в клініці внутрішньої медицини. Незважаючи на очевидні успіхи, досягнуті за останні десятиріччя в діагностиці й лікуванні захворювань гепатобіліарної системи, до сьогодні деякі питання остаточно не вирішені або є протиріччя з приводу їх лікування. Відомо, що не всі гепатотропні препарати відповідають вимогам до активних компонентів, що патогенетично впливають на ланки патологічних процесів в гепатобіліарному тракті. Обґрунтувати й систематизувати лікування захворювань гепатобіліарної системи при такому розмаїтті причин, що викликають ураження, досить важко. Принципи сучасної терапії більшості захворювань гепатобіліарної системи передбачають призначення комбінацій лікарських гепатотропних засобів. Одними з найбільш раціональних комбінацій фармакологічних агентів є препарати урсодезоксихолевої кислоти і аргініну глутамату. Дані фармакологічні засоби є препаратами з найбільшою доказовою базою клінічної ефективності, що значно перевищує таку в гепатотропних препаратів інших груп.

Objective: The study was planned primarily to judge the effectiveness, safety, and adherence of the prescribed treatments in dermatophytosis along with the effect on the Quality of Life (QoL) of the affected individuals. Methods: In this prospective observational study, spanning over 5 months, participants (dermatophytosis patients) were assessed at baseline and 6 week-follow-up at study site. Information about their clinical presentation, QoL (Quality of Life) parameters, medication adherence, and adverse drug reaction (ADR) were entered in the Case Report Form (CRF) prepared by utilizing global standard tools such as 5D-itch scale, Dermatology Life Quality Index (DLQI), Medication Adherence Rating Scale (MARS), and WHO-ADR reporting form respectively. Results: Total 60 subjects (33 males and 27 females) had completed the study. Overall, tinea cruris (40%) was the most common variety followed by combination of tinea corporis and cruris (35%), tinea corporis (20%), and tinea incognito (3%). Pruritus was the predominant symptom. There was a significant (p

Digital transformation has been making its mark on organisations in healthcare and beyond over the last few years, with no signs of stopping. In the NHS, much of the focus has been on acute services until recently, but this focus is now shifting towards community services, with Sussex Community Foundation Trust (SCFT) being named as the first community Digital Aspirant Trust by NHSx. This article explores what digital transformation is and uses SCFT's experiences to illustrate how this can provide benefits for community nurses. It considers what the future of digital transformation might look like and how clinicians can help to ensure patients remain central to any change.

This article will review pacing in the context of acute care, with a focus on temporary pacing. Beginning with an overview of the heart's intrinsic electrical conduction system and its function, the discussion moves on to pacing, acute clinical presentations and indications for pacing. This includes an overview of temporary pacing, with the different approaches being percussion, transcutaneous, transvenous and epicardial. There are specific cardiac patient groups at high risk of developing bradyarrhythmias and, in the absence of other measures, potentially requiring emergency pacing. These groups include patients who have experienced a myocardial infarction following cardiac surgery and post transcatheter aortic valve implant. Nurses providing care for patients with temporary transvenous wires need an understanding of the potential complications and to recognise indications for moving on to a permanent pacing system.