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Nutritional support, which is a process of substrate provision with all the nutrients necessary for life for various categories of patients who do not have the opportunity for proper natural nutrition, is a mandatory basic component of their intensive treatment. The practical implementation of nutritional support has two aspects: clinical and organizational. Currently, all components of the clinical aspect are well developed and tested and there are no reasons not to use them in everyday clinical practice. The least resolved and worked out in the majority of our medical institutions remains the organizational aspect, which often does not allow for the proper realization of this type of medical treatment. The article contains the main organizational options for decision the existing problem and many years of practical experience in implementing nutritional support in a multidisciplinary emergency hospital.

Este artigo trata da memória sobre a comida do passado por meio de relatos de pessoas inseridas na categoria de velhos/idosos no Brasil, aquelas acima de 60 anos. Envolvem recordações sobre como eram a alimentação e a comida da infância. Todas as 14 pessoas com quem conversamos optaram por falar das memórias ligadas, sobretudo, ao afeto e aos bons momentos, mesmo quando entremeavam no relato algumas dificuldades de escassez alimentar ou de pobreza. Foram entrevistadas pessoas idosas com idade entre 65 e 84 anos. Todas elas residentes da região Sudoeste do Paraná, a maioria é descendente de italianos, alemães e poloneses. Quase todas nasceram no Rio Grande do Sul ou em Santa Catarina e se mudaram para a referida região depois de adultas, quando da política da Marcha para Oeste, do governo Getúlio Vargas em início da década de 1940. As lembranças trouxeram curiosidades a respeito de práticas alimentares, modos de fazer e uso de termos sobre comida onde mesclam a língua originária dos seus avós/pais, colonos, com a língua portuguesa, criando dialetos. Os depoimentos foram em vários momentos emotivos, trazendo muitas lembranças agradáveis, e outras nem tanto, mas foram considerados pelas idosas (os) que se dispuseram a contar um momento importante, tido como uma oportunidade de falar um pouco do passado para pessoas interessadas em escutá-las. O método foi qualitativo, usando a ferramenta principal da história oral.

Abstract Physical capacity prior allogeneic stem cell transplantation (allo-HCT) has been shown as a relevant prognostic factor for survival after transplant. Therefore, we evaluated feasibility and preliminary efficacy of a high-intensity interval training (HIIT) and moderate to high-intensity resistance exercise (RE) to increase physical capacity in patient’s prior allo-HCT. In this multicentre single arm pilot study, a supervised exercise program was performed twice weekly for 4–12 weeks prior allo-HCT, depending on the individual time remaining. Outcomes were feasibility (recruitment, adherence, safety), physical capacity (cardiorespiratory fitness [VO2peak], muscle strength) and patient reported outcomes (physical functioning, fatigue). Thirty patients were intended, 16 could be included, and 14 completed post intervention assessment (75% male, 55 ± 11 years). The study was stopped early due to a low recruitment rate. Nine patients (64%) reached the initial minimum planned number of eight exercise sessions. Individual adherence was high with 92% for HIIT and 85% for RE. 87% of all performed exercise sessions were completed without complaints and VO2peak increased significantly from 20.4 to 23.4 ml/kg/min. The low recruitment rate suggests that initiation of the intervention concept immediately before allo-HCT is feasible only in a small number of patients. In particular, the timeframe directly prior allo-HCT seems too short for exercise interventions, although the exercise program was designed to improve outcomes in a very short time frame. HIIT and RE were feasible, effective and well accepted by the included patients.

Synopsis: Corneal epithelial wavefront error and epithelial thickness variance qualify as highly sensitive and specific biomarkers for epithelial basement membrane dystrophy (EBMD). The biomarkers show a normalization after treatment of EBMD with phototherapeutic keratectomy. Purpose: To gauge the diagnostic value of epithelial basement membrane dystrophy (EBMD), a novel spectral-domain optical coherence tomography (SD-OCT)-based imaging modality for simultaneous morphological (thickness profile) and refractive (optical wavefront) assessment of the corneal epithelial layer in one of the most common but often underdiagnosed corneal dystrophies. Methods: In this prospective observational study, a total of 32 eyes of 32 patients diagnosed with EBMD and 32 eyes of 32 healthy control subjects were examined with high-resolution anterior segment SD-OCT (MS-39; CSO, Florence, Italy). Various epithelial thickness and epithelial wavefront-derived terms were compared between groups and receiver operating characteristic (ROC) curves were computed to analyze the diagnostic capacity of the respective parameters. A total of 17 of 32 EBMD patients underwent treatment with phototherapeutic keratectomy (PTK) and were followed up for 3 months. Results: Epithelial thickness variance (60.4 ± 56.7 µm versus 7.6 ± 6.1 µm) and interquartile range (11.0 ± 6.9 versus 3.3 ± 1.9 µm) were markedly elevated in EBMD patients as compared with healthy controls (both with p < 0.001). Epithelial wavefront analysis showed a highly statistically significant excess in all examined aberration terms in EBMD patients (all with p < 0.001). Significantly greater areas under the curve (AUCs) were yielded by the epithelial wavefront-derived parameters (e.g., total epithelial wavefront error: AUC = 0.966; 95% confidence interval (CI) 0.932–1) than by the epithelial thickness-derived parameters (e.g., variance: AUC = 0.919; 95% CI 0.848–0.990). Conclusions: Corneal epithelial wavefront aberrometry proved valuable as an objective biomarker for EBMD, with high sensitivity and specificity. PTK resulted in a reduction of morphological and refractive epithelial irregularities in EBMD.

Online learning environments are challenging for deaf and hard of hearing (DHH) individuals. A major concern is split attention, which occurs when one simultaneously attends to multiple stimuli, a situation that characterizes most multimedia presentations and instruction that combines sound, text, images, graphs or charts, and video. Needing to take notes adds another stimulus. DHH learners face this issue when auditory content is accommodated visually, in combination with visually presented content. No one can view multiple visual signals simultaneously. Learners must choose to view one signal and miss others; view signals sequentially, which requires additional time and hinders class participation; or switch between visual signals, losing elements of each. This process increases auditory and visual fatigue and cognitive load, ultimately compromising learning. Several ways are suggested to achieve more equitable access to instructional content for learners challenged by the problem of split attention.

This study examined the longitudinal prediction of decoding, oral reading fluency (ORF), and bilingual language proficiency (BLP) on student reading comprehension (RC) outcomes in Spanish and in English. Participants were first-grade Latinx students attending bilingual programs. Findings indicated that BLP initial status and gains were significant predictors of Spanish and English RC at the end of second grade. English and Spanish decoding in first grade, in addition to BLP, explained 27 percent of the variance in English reading comprehension. However, only Spanish decoding was a significant predictor of Spanish reading comprehension. Once English and Spanish second grade ORF scores were added to the model, decoding no longer explained any of the variance in RC. BLP, English ORF initial status and gains, and Spanish gains explained 47 percent of the variance in English reading comprehension. BLP and Spanish ORF initial status explained 46 percent of the variance in Spanish RC. [For the corresponding grantee submission, see ED618408.]

Supporting changes in undergraduate science, technology, engineering, and mathematics (STEM) instruction requires an understanding of the relationship between STEM instructors' conceptions and practices. In this study, the authors used the Teacher-Centered Systematic Reform (TCSR) model as a framework to understand how instructors' conceptions are related to their instructional practices. This multiple methods study included interviews and classroom observations of 22 STEM instructors. We used qualitative methods to describe instructors' conceptions of how students learn and quantitative methods, including a hierarchical cluster analysis, to analyze the types of relationships that exist between their conceptions and practices. Results indicated instructors had a wide range of conceptions that exist along a continuum from teacher-centered to student-centered. While many faculty members perceived student-centered practices as valuable, they conceptualized these practices in different ways. Instructors implemented a wide range of instructional practices, and these practices varied independently of conceptions. We identified three distinct clusters of participants based on the relationships between instructors' conceptions and practices: congruent lecturers, congruent active learning facilitators, and incongruent lecturers. In the first two clusters, instructors' conceptions were aligned with their instructional practices. However, incongruent lecturers thought that students learn through active learning approaches but primarily lectured in their courses. Instructors in this group described several personal and contextual factors that influenced the relationship between their conceptions and practices. The results include an in-depth portrayal of one participant in each cluster. We found that student-centered conceptions may be necessary but are not sufficient for instructors to implement active learning. Implications focus on instructional and institutional change efforts. To promote instructional change most effectively, it is important to address each component of the TCSR model, including personal and contextual factors. A focus on conceptions and practices alone may not sufficiently support faculty members in overcoming barriers that limit active learning instruction.

Purpose: Explore how different automated scoring (AS) models score reliably the expressive language and vocabulary knowledge in depth of young second grade Latino English learners. Design/methodology/approach: Analyze a total of 13,471 English utterances from 217 Latino English learners with random forest, end-to-end memory networks, long short-term memory, and other AS models. Findings: Random forest outperformed the other AS models as measured by the mean of quadratic weighted kappa (QWK = 0.70) followed by the end-to-end memory networks--long short-term memory (QWK = 0.69) across all tasks and data points. The QWK between humans was 0.90, while the human-machine agreement of three AS models and humans ranged from 0.66 to 0.70. Practical implications: Examine closely misclassifications between human and machine scoring to better understand the specific words and structures the systems were not capturing. Originality/value: Discuss findings in the context of developing efficient and reliable ways to analyze the natural speech of young English learners. This information could guide the vocabulary and language proficiency instruction in the early grades.

This meta-analysis aims to quantitatively synthesize the relation between the essential components of reading and reading comprehension in children whose first language is Spanish and who are learning to read in Spanish in a monolingual setting. Searches were conducted in WOS, Scopus, and ERIC from 2000 to 2021. We used a random effects model and Fisher's z as an index of effect size. We found 33 studies involving 146 effect sizes between the essential components of reading and reading comprehension. The essential components included phonological awareness, morphological awareness, alphabetic principle, fluency, vocabulary, and oral comprehension. Results of the meta-analysis revealed that (1) most studies have focused on understanding the relation between phonological awareness or alphabetic principle and reading comprehension, (2) the largest effect sizes were between phonological awareness and reading comprehension, and between fluency and reading comprehension, and (3) there is a large heterogeneity across studies which is explained, in part, by factors such as age, country where the study was conducted, and the reading comprehension tests used. Implications for practice and future research are discussed.

PurposeTo compare different corneal keratometry readings (swept-source-OCT-assisted biometry and Scheimpflug imaging) with a novel software platform for calculation of toric intraocular lenses.SettingDepartment of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.DesignRetrospective, non-randomized, clinical trial.MethodsTwenty-three eyes undergoing toric intraocular lens implantation were included. Inclusion criteria were preoperative regular corneal astigmatism of at least 1.00 D, no previous refractive surgery, no ocular surface diseases and no maculopathies. Lens exchange was performed with CALLISTO eye (Zeiss). For each patient, the expected postoperative residual refraction was calculated depending on three different corneal parameters of two different devices: standard K-front (K) and total keratometry (TK) obtained by a swept-source-OCT-assisted biometry system (IOL Master 700, Zeiss) as well as total corneal refractive power (TCRP) obtained by a Scheimpflug device (Pentacam AXL, Oculus). Barrett’s formula for toric intraocular lenses was used for all calculations within a novel software platform (EQ workplace, Zeiss FORUM®). Results were statistically compared with postoperative refraction calculated according to the Harris dioptric power matrix.ResultsThe standard K values (mean PE 0.02 D ± 0.45 D) and TK values (mean PE 0.09 D ± 0.43 D) of the IOL Master 700 reached similar results (p = 0.96). 78% of eyes in both K and TK groups achieved SE within ±0.5 D of attempted correction and all eyes (100%) were within ±1.0 D of attempted correction in both groups. By contrast, the prediction error in the IOL calculation using the TCRP of the Scheimpflug device was significantly greater (mean PE −0.56 D ± 0.49 D; p = 0.00 vs. standard K and p = 0.00 vs. TK) with adjusted refractive indices. Thirty-nine and Ninety-one percentage of eyes in the TCRP group achieved SE within ±0.5 D (p = 0.008 K vs. TCRP and p = 0.005 TK vs. TCRP) and ± 1.0 D (p = 0.14 vs. TCRP) of attempted correction, respectively.ConclusionAll three corneal parameters (standard K, TK, TCRP) performed well in calculating toric IOLs. The most accurate refractive outcomes in toric IOL implantation were achieved by IOL calculations based on swept-source-OCT-assisted biometry. The SS-OCT-based K-front and TK values achieve comparable results in the calculation of toric IOLs.

IntroductionThe Fugl-Meyer Motor Assessment (FMMA) is recommended for evaluating stroke motor recovery in clinical practice and research. However, its widespread use requires refined reliability data, particularly across different health professions. We therefore investigated the interrater reliability of the FMMA scored by a physical therapist and a physician using video recordings of stroke patients.MethodsThe FMMA videos of 50 individuals 3 months post stroke (28 females, mean age 71.64 years, median National Institutes of Health Stroke Scale score 3.00) participating in the ESTREL trial (Enhancement of Stroke Rehabilitation with Levodopa: a randomized placebo-controlled trial) were independently scored by two experienced assessors (i.e., a physical therapist and a physician) with specific training to ensure consistency. As primary endpoint, the interrater reliability was calculated for the total scores of the entire FMMA and the total scores of the FMMA for the upper and lower extremities using intraclass correlation coefficients (ICC). In addition, Spearman’s rank order correlation coefficients (Spearman’s rho) were calculated for the total score and subscale levels. Secondary endpoints included the FMMA item scores using percentage agreement, weighted Cohen’s kappa coefficients, and Gwet’s AC1/AC2 coefficients.ResultsICCs were 0.98 (95% confidence intervals (CI) 0.96–0.99) for the total scores of the entire FMMA, 0.98 (95% CI 0.96–0.99) for the total scores of the FMMA for the upper extremity, and 0.85 (95% CI 0.70–0.92) for the total scores of the FMMA for the lower extremity. Spearman’s rho ranged from 0.61 to 0.94 for total and subscale scores. The interrater reliability at the item level of the FMMA showed (i) percentage agreement values with a median of 77% (range 44–100%), (ii) weighted Cohen’s kappa coefficients with a median of 0.69 (range 0.00–0.98) and (iii) Gwet’s AC1/AC2 coefficients with a median of 0.84 (range 0.42–0.98).Discussion and conclusionThe FMMA appears to be a highly reliable measuring instrument at the overall score level for assessors from different health professions. The FMMA total scores seem to be suitable for the quantitative measurement of stroke recovery in both clinical practice and research, although there is potential for improvement at the item level.

IntroductionClinical assessment of upper limb sensorimotor function post-stroke is often constrained by low sensitivity and limited information on movement quality. To address this gap, recent studies proposed a standardized instrumented drinking task, as a representative daily activity combining different components of functional arm use. Although kinematic movement quality measures for this task are well-established, and optical motion capture (OMC) has proven effective in their measurement, its clinical application remains limited. Inertial Measurement Units (IMUs) emerge as a promising low-cost and user-friendly alternative, yet their validity and clinical relevance compared to the gold standard OMC need investigation.MethodIn this study, we conducted a measurement system comparison between IMUs and OMC, analyzing 15 established movement quality measures in 15 mild and moderate stroke patients performing the drinking task, using five IMUs placed on each wrist, upper arm, and trunk.ResultsOur findings revealed strong agreement between the systems, with 12 out of 15 measures demonstrating clinical applicability, evidenced by Limits of Agreement (LoA) below the Minimum Clinically Important Differences (MCID) for each measure.DiscussionThese results are promising, suggesting the clinical applicability of IMUs in quantifying movement quality for mildly and moderately impaired stroke patients performing the drinking task.

IntroductionConvenience foods are a double-edged sword in that they provide quick and easy nutrition but may promote non-communicable diseases related to excess intakes of sugar, fat, and salt. To inform the German national reduction and innovation strategy for less sugar, fat, and salt in processed foods, the present study sought to analyse the consumption frequency of selected convenience foods and to determine sociodemographic and behavioural factors that characterise frequent users.MethodsIn a representative computer-assisted telephone interview survey in the adult German population (N = 3,997) conducted in 2018, consumption frequency of 21 convenience foods was assessed. To characterise frequent in contrast to non-frequent users, data on sociodemographics and behavioural aspects were compared. Statistical analyses comprised chi-square tests with Bonferroni correction as well as Spearman’s rank correlation. Cramer’s V was used to determine the strength of an association.ResultsOverall and among frequent users (7.7% of the sample) sweet convenience foods and savoury cooking aids were consumed most frequently. Around 75% of the participants indicated little-to-no consumption of 19 of the 21 convenience foods. Male gender (p

O texto pretende compreender, na perspectiva da relação filosofia da educação, psicanálise e educação, a viabilidade da institucionalização de práticas dialógicas informadas como contraponto e prevenção à violência na educação. Para isso, trata das dificuldades de seus registros em arquivos e o imperativo de (re)construir mediações dialogadas e propositivas, com vistas a sua melhor compreensão e enfrentamento na convivência da relação educando e educador. O objetivo é investigar hermeneuticamente as contribuições de Freud, Adorno e Derrida sobre a relação entre violência, linguagem e memória. Além disso, pretende auscultar os professores e gestores de escolas públicas de cinco (5) municípios gaúchos, através da análise de uma experiência de ensino e pesquisa realizada através do curso de Ciências da Religião – UAB/UFSM. O intuito é compreender de forma edificante o lugar vago da docência de forma dialogada e esclarecida, pretendendo (re)construir mediações teóricas e estratégias de intervenção como forma de enfrentamento à violência na/da educação. Nesse sentido, levanta subsídios na reflexão dialógica da prática pedagógica de educadores das redes de ensino, no sentido de problematizar o significado da relação teoria e prática na formação de professores, em tempos de exceção normalizadora e da ausência de arquivos contendo informações específicas de cada escola.

Summary: The isolated perfused kidney is a classic ex vivo preparation for studying renal physiology in general and vascular function. Here, we present a protocol for assessing myogenic tone in isolated mouse kidneys as well as vasodilatory and vasoconstrictive responses, expressed as perfusion pressure. We describe steps for pre-operative preparation, kidney and renal artery isolation, and connection of renal artery with glass cannula. We then detail how to measure pressure changes in perfused kidneys and the myogenic tone.For complete details on the use and execution of this protocol, please refer to Cui et al.1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

The early years of teaching are important for science teachers, but little is known about how science teachers develop professionally in their early years. This mixed methods study took a longitudinal view of the early years of teaching. Following 95 secondary science teachers over a 5-year period, this study examined the beliefs, pedagogical content knowledge (PCK), and practices of the teachers during and after their induction programming. It drew upon the conceptual framework of opportunities to learn to contemplate the experiences of the teachers in relationship to their beliefs, PCK, and practices. Interviews and observations comprised the data in the study, which were analyzed quantitatively and qualitatively and then integrated to understand the teachers' development. The quantitative analysis revealed that the early career teachers experienced no significant change in their beliefs over time but did experience significant change in their PCK and in some of their instructional practices. The qualitative analysis highlighted the difficulty in changing the instruction of the teachers, administrative decisions that constrained or contributed to the learning of the new teachers, and the different professional learning opportunities new teachers drew upon over time. These results suggest that early professional development experiences provided some support for the newly hired teachers, but not enough to challenge their beliefs or establish the instructional repertoires envisioned in the science education reforms. To better support the development of early career science teachers, they need strategic learning opportunities over time that involve administrators, colleagues, and science teacher educators.

To frame their work, biology education researchers need to consider the role of literature reviews, theoretical frameworks, and conceptual frameworks as critical elements of the research and writing process. However, these elements can be confusing for scholars new to education research. This "Research Methods" article is designed to provide an overview of each of these elements and delineate the purpose of each in the educational research process. We describe what biology education researchers should consider as they conduct literature reviews, identify theoretical frameworks, and construct conceptual frameworks. Clarifying these different components of educational research studies can be helpful to new biology education researchers and the biology education research community at large in situating their work in the broader scholarly literature.

Abstract Despite advances in allogeneic hematopoietic cell transplantation, acute graft-versus-host disease (aGVHD) remains its leading complication, yet with heterogeneous outcomes. Here, we analyzed aGVHD phenotypes and clinical classifications in depth in large, multicenter cohorts involving 3019 patients and addressed prevailing gaps by developing data-driven models. We compared, tested and verified these along with all conventional classifications in independent cohorts and found that data-driven grading outperformed conventional grading in Akaike information criterion and concordance index metrics. Data-driven classifications refined aGVHD assessment with up to 12 severity grades, which were associated with distinct nonrelapse mortality (NRM) and confirmed the key role of intestinal aGVHD. We developed an online calculator for physicians to implement principal component-derived grading (PC1). These results provide substantial insight into the evaluation of aGVHD phenotypes and multiorgan involvement, which relegates the exclusive reporting of overall aGVHD severity grades in transplant registries and clinical trials. Data-driven aGVHD grading provides an expandable platform to refine classification and transplant risk assessment.

Abstract Background Ultra-processed food (UPF) consumption increases the risk of type 2 diabetes in various high-income countries, with some variation in the magnitude across studies. Our objective was to investigate the association of UPF consumption and specific subgroups with incident type 2 diabetes in Brazilian adults. Methods The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort study of 15,105 adults (35–74 years) enrolled in public institutions in Brazil (2008–2010). We followed participants with two clinic visits (2012–2014; 2017–2019) and annual telephone surveillance. After excluding those with diabetes at baseline, who died or were lost in the follow-up, with missing data, with implausible energy food intake, or reporting bariatric surgery, there were 10,202 participants. We used the NOVA classification to assess UPF consumption based on a food frequency questionnaire. We defined type 2 diabetes by self-report, medication use, or comprehensive laboratory tests. We estimated relative risks (RR) and 95% confidence intervals (95% CI) using robust Poisson regression. Results Median UPF consumption was 372 g/day. Over 8.2 (0.7) years of follow-up, we detected 1799 (17.6%) incident cases. After adjustment for socio-demographics, family history of diabetes, and behavioral risk factors, comparing the fourth (≥ 566 g/day) with the first (

Resumo A capacidade institucional e o aparato normativo do Estado são importantes campos de disputas pela produção do espaço e pelo reconhecimento de direitos sociais. Tais disputas ganham especial relevância na cidade do Rio de Janeiro, marcada por intensas desigualdades sociais. Nesse quadro, as políticas de urbanização de favelas consolidadas entre as décadas 1990 e 2010 representam importante reconhecimento das favelas enquanto espaços de moradia popular. Este artigo analisa as políticas de urbanização de favelas realizadas no Rio de Janeiro nesse período, focando nos modelos institucionais e conteúdos normativos, situando-as nas conjunturas políticas locais e tendo o direito à moradia como norteador. Observam-se a continuidade e centralidade relativa dessas políticas no período analisado, contudo, são ressaltadas importantes contradições e limitações.