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BackgroundHome hospitalization is widely accepted as a cost-effective alternative to conventional hospitalization for selected patients. A recent analysis of the home hospitalization and early discharge (HH/ED) program at Hospital Clínic de Barcelona over a 10-year period demonstrated high levels of acceptance by patients and professionals, as well as health value-based generation at the provider and health-system levels. However, health risk assessment was identified as an unmet need with the potential to enhance clinical decision making. ObjectiveThe objective of this study is to generate and assess predictive models of mortality and in-hospital admission at entry and at HH/ED discharge. MethodsPredictive modeling of mortality and in-hospital admission was done in 2 different scenarios: at entry into the HH/ED program and at discharge, from January 2009 to December 2015. Multisource predictive variables, including standard clinical data, patients’ functional features, and population health risk assessment, were considered. ResultsWe studied 1925 HH/ED patients by applying a random forest classifier, as it showed the best performance. Average results of the area under the receiver operating characteristic curve (AUROC; sensitivity/specificity) for the prediction of mortality were 0.88 (0.81/0.76) and 0.89 (0.81/0.81) at entry and at home hospitalization discharge, respectively; the AUROC (sensitivity/specificity) values for in-hospital admission were 0.71 (0.67/0.64) and 0.70 (0.71/0.61) at entry and at home hospitalization discharge, respectively. ConclusionsThe results showed potential for feeding clinical decision support systems aimed at supporting health professionals for inclusion of candidates into the HH/ED program, and have the capacity to guide transitions toward community-based care at HH discharge.

IntroductionBoth recessive and dominant genetic forms of Parkinson's disease have been described. The aim of this study was to assess the contribution of several genes to the pathophysiology of early onset Parkinson's disease in a cohort from central Spain.Methods/patientsWe analyzed a cohort of 117 unrelated patients with early onset Parkinson's disease using a pipeline, based on a combination of a next-generation sequencing panel of 17 genes previously related with Parkinson's disease and other Parkinsonisms and CNV screening.ResultsTwenty-six patients (22.22%) carried likely pathogenic variants in PARK2, LRRK2, PINK1, or GBA. The gene most frequently mutated was PARK2, and p.Asn52Metfs*29 was the most common variation in this gene. Pathogenic variants were not observed in genes SNCA, FBXO7, PARK7, HTRA2, DNAJC6, PLA2G6, and UCHL1. Co-occurrence of pathogenic variants involving two genes was observed in ATP13A2 and PARK2 genes, as well as LRRK2 and GIGYF2 genes.ConclusionsOur results contribute to the understanding of the genetic architecture associated with early onset Parkinson's disease, showing both PARK2 and LRRK2 play an important role in Spanish Parkinson's disease patients. Rare variants in ATP13A2 and GIGYF2 may contribute to PD risk. However, a large proportion of genetic components remains unknown. This study might contribute to genetic diagnosis and counseling for families with early onset Parkinson's disease.

Phlebectasia is an abnormal dilatation of an isolated vein, which may affect any vein, and is rarely symptomatic. Internal jugular vein phlebectasia (JVP) presents as fusiform neck mass during straining or triggered by Valsalva maneuver. Due to its rarity, it is often misdiagnosed and ignored. Most cases are reported in children and sometimes later in age. The authors here report a case of right internal JVP, with an unusual coexisting presentation of tongue deformity in an Indian female patient. The aim of documenting this case is to sensitize the oral physician of this rare neck mass which is seldom reported in the dental literature. Furthermore, phlebectasia should be one of the differential diagnosis of neck mass. Although there are rarely any complications recorded in the literature, thorough investigations (ultrasound with Doppler) are needed for correct diagnosis and referral if needed. Diagnosis would prevent unnecessary surgical interventions. The patients are generally followed up by conservative treatment.

Abstract Background Children in third-world settings including Papua New Guinea (PNG) experience early onset of carriage with a broad range of pneumococcal serotypes, resulting in a high incidence of severe pneumococcal disease and deaths in the first 2 years of life. Vaccination trials in high endemicity settings are needed to provide evidence and guidance on optimal strategies to protect children in these settings against pneumococcal infections. Methods This report describes the rationale, objectives, methods, study population, follow-up and specimen collection for a vaccination trial conducted in an endemic and logistically challenging setting in PNG. The trial aimed to determine whether currently available pneumococcal conjugate vaccines (PCV) are suitable for use under PNG’s accelerated immunization schedule, and that a schedule including pneumococcal polysaccharide vaccine (PPV) in later infancy is safe and immunogenic in this high-risk population. Results This open randomized-controlled trial was conducted between November 2011 and March 2016, enrolling 262 children aged 1 month between November 2011 and April 2014. The participants were randomly allocated (1:1) to receive 10-valent PCV (10vPCV) or 13-valent PCV (13vPCV) in a 1-2-3-month schedule, with further randomization to receive PPV or no PPV at age 9 months, followed by a 1/5th PPV challenge at age 23 months. A total of 1229 blood samples were collected to measure humoral and cellular immune responses and 1238 nasopharyngeal swabs to assess upper respiratory tract colonization and carriage load. Serious adverse events were monitored throughout the study. Of the 262 children enrolled, 87% received 3 doses of PCV, 79% were randomized to receive PPV or no PPV at age 9 months, and 67% completed the study at 24 months of age with appropriate immunization and challenge. Conclusion Laboratory testing of the many samples collected during this trial will determine the impact of the different vaccine schedules and formulations on nasopharyngeal carriage, antibody production and function, and immune memory. The final data will inform policy on pneumococcal vaccine schedules in countries with children at high risk of pneumococcal disease by providing direct comparison of an accelerated schedule of 10vPCV and 13vPCV and the potential advantages of PPV following PCV immunization. Trial registration ClinicalTrials.gov CTN NCT01619462 , retrospectively registered on May 28, 2012

BACKGROUND: Mindfulness-based interventions (MBIs) are well-positioned to address health disparities among racial-ethnic minority communities, given their focus on stress reduction and potential for greater accessibility and acceptability than conventional mental health treatments. Yet, there are currently no peer-reviewed studies of MBIs in an Arab, Middle Eastern, or North African (MENA) American sample. Addressing this gap in the literature is critical for advancing integrative health equity, given the high burden of stress and high prevalence of stress-related health conditions among Arab/MENA Americans. OBJECTIVE: The present study sought to explore perceptions of mindfulness among Arab/MENA Americans and identify potential cultural adaptations to MBIs for this population. METHODS: 4 focus groups were conducted with 26 Arab/MENA American adults who had participated in an introductory mindfulness workshop. Participants were asked about their experience learning mindfulness skills, the usefulness of mindfulness for problems they face, the alignment of mindfulness with their cultural values and practices, and suggestions for adapting mindfulness programs. Qualitative coding of focus group session transcriptions was conducted to identify themes in the data. CONCLUSION: The participants in this study described experiencing high levels of stress and identified micro- and macro-level stressors related to their Arab/MENA American identity, including discrimination, exclusion, historical and intergenerational trauma, and protracted sociopolitical crises in their heritage countries. They viewed mindfulness as a potentially useful approach to coping with stress. At the same time, participants identified aspects of mindfulness that could be adjusted to better align with their cultural values and experiences. Potential adaptations to MBIs for Arab/MENA Americans were identified based on suggestions from participants and issues they raised while discussing cultural strengths, stressors they face, and perceived barriers and facilitators to engaging in mindfulness practice.

Researchers used a qualitative research method of inquiry with a phenomenological approach to explore the lived experiences among faculty mentors and Graduate Research Assistants (GRA) who participated in a GRA training program. Following data analysis, several factors were identified that were consistent with a positive research training environment: faculty modeled positive and appropriate scientific attitudes; faculty helped students get involved in research in a non-threatening manner; and faculty helped students understand that research studies are not perfect. Several factors were also consistent with Community Cultural Wealth: linguistic, social, navigational, resistant, and aspirational capital. Several implications from this study are that institutions of higher education should continue to explore programs to support research training environments and community cultural wealth among culturally diverse students.

We used a phenomenological research design to explore the impact of a Faculty Learning Community (FLC) to support STEM faculty members' development of cultural wealth principles and teaching practices. In this study, we analyzed teaching philosophy statements to learn how the FLC shaped STEM faculty participants' expression of teaching beliefs and values. Because effective teaching philosophy statements are linked to good teaching and transparently designed assignments, the language used to articulate teaching values can inform how we build equity-minded and culturally relevant educational spaces. Findings demonstrated that some faculty members developed and articulated teaching beliefs and intended practices that were consistent with culturally relevant teaching and cultural wealth. However, the study did not discover evidence of practice intentions that reflected these culturally relevant pedagogical principles related to the specific assessment of student learning. We discuss implications for faculty developers at HSIs to support STEM faculty members' use of culturally relevant and community engaged concepts and teaching approaches.

Guided by a Culturally Relevant Pedagogy framework, we used a phenomenological research design to explore nine Latinx graduate students' lived experiences in online courses at a Hispanic Serving Institution (HSI). In this study, we analyzed nine Latinx graduate students' interview transcripts that focused on lived experiences with online learning. The following themes emerged from phenomenological data analysis: accessibility, organization and structure, distractions and connectivity, instructor approachability, communication, flexibility with online learning and self-paced, active learning, guidelines and purpose for assignments, and criteria for success. We structure findings around three effective teaching practices: (1) designing an effective learning environment, (2) structuring intentional learning experiences, and assessing teaching effectiveness. We also provide implications for faculty developers at HSIs.

In this text, with an autobiographical methodology, we consider what it has meant for us to position ourselves as feminists in academia, inhabiting research lines and spaces in the field of Gender Studies. In our context, where universities are divided into teaching departments based on areas of knowledge, placing ourselves in a peripheral, subordinate field such as that which is termed Gender and/or Feminist Studies, as well as involving a dual task, this has positioned us at times as 'traitors' to our fields of knowledge. In this paper, we aim to go beyond analyses demonstrating the subordinate place women occupy in universities to explore how, although situating ourselves in this in--between place resulted in a dual task and has been a source of conflict, it has also been a space of escape (from the hierarchies which are the backbone of departments) and of oxygen (by enabling dialogue between knowledge and disciplines from our ethnographic perspective).

Jaundice syndrome is a diagnostic challenge for physicians. It must be diagnosed based on its etiology, which depends on liver function test results, clinical manifestations, and age of presentation, and the objective is to rule out the most common causes and then the rare causes. We describe the case of a male patient aged 86 years who had jaundice and was diagnosed as having primary sclerosing cholangitis based on liver biopsy findings. It is a chronic, progressive cholestatic liver disease with unknown etiology until now. Primary sclerosing cholangitis is characterized by inflammation, fibrosis, and stenosis of small, medium, and large intrahepatic and extrahepatic biliary ducts. Although it is a rare entity in geriatric patients, certain characteristics are infrequently considered in clinical practice; thus, considering all characteristics of this disease would help physicians make the diagnosis earlier. It is a condition that should be considered when jaundice is associated with pruritus and elevated levels of peripheral eosinophils and immunoglobulin E.

The wine production process has a high energy demand of about 1,750 million kWh per year in the EU. Saving energy, responsible consumption and efficient use of energy sources are key aspects to consider for the competitiveness and viability of the sector. Therefore, the TESLA project (Transfering Energy Save Laid on Agroindustry), funded by the European Commission, has conducted 39 energy audits in wineries from four countries (Spain, France, Portugal and Italy). The information collected has allowed them to carry out a comparative analysis of energy efficiency measures through a technical-economic study, calculating the period of return on investment and performing a sensitivity analysis to determine the break-even point for each of the investments analysed. The results show that the replacement of chillers by more efficient ones, the installation of variable speed drives on pumps, the introduction of management and control measures such as the implementation of a Building Management System (BMS) and the installation of energy analysers for identification of consumption by use are the measures that have the greatest quantitative impact.

Radiograph play as an important adjunct, in addition to history and clinical evaluation for the diagnosis of pathologies in head and neck region. A good and ideal diagnostic radiograph is essential for this purpose. An ideal radiograph is one that provides a great deal of information, the image exhibits proper density and contrast, have sharp outlines, and are of the same shape and size as the object being radiographed. Dental radiographs are subjected to various phases (procedures) right from the manufacturing and packaging until it is been exposed and processed. The diagnostic quality of a dental radiograph may be affected during any of these procedures and even after that. The authors here have noticed an interesting fault which is seldom mentioned in the literature.

ABSTRAK Pendahuluan : Cedera kepala adalah suatu gangguan traumatik dan fungsi otak yang disertai atau tanpa disertai perdarahan interstitial dalam substansi otak tanpa diikuti terputusnya kontinuitas otak. Kualitas hidup (Quality of Life) digunakan dalam bidang pelayanan kesehatan untuk menganalisis emosional seseorang, faktor sosial, dan kemampuan untuk memenuhi tuntutan kegiatan dalam kehidupan secara normal dan dampak sakit dapat berpotensi untuk penurunan kualitas hidup terkait kesehatan. Tujuan penelitian ini untuk mengetahui gambaran kualitas hidup pada pasien pasca cedera kepala di Kabupaten Kediri. Metode : Desain penelitian adalah Deskriptif, besar sampel 6 responden yang memenuhi kriteria penelitian dengan menggunakan teknik total sampling dan variabel tunggal penelitian gambaran kualitas hidup pada pasien pasca cedera kepala di Kabupaten Kediri. Teknik pengumpulan data mengunakan kuesioner, pengelolaan data dengan prosentase yang diinterpretasikan secara kualitatif. Pelaksanaan penelitian tanggal 26 Mei – 30 Juni 2018. Hasil : Dari hasil penelitian diatas didapatkan hasil bahwa setengah dari responden memiliki kualitas hidup cukup baik yaitu 50% dan setengah dari responden memiliki kualitas hidup baik yaitu sebanyak 50%. Analisis : Faktor – faktor yang mempengaruhi kualitas hidup pada pasien dengan cedera kepala adalah usia yaitu sekitar usia > 50 tahun, status perkawinan yaitu responden yang belum menikah dan riwayat lama rawat inap. Kesimpulan : Oleh karena itu diharapkan responden mampu meningkatkan kesehatan yang lebih baik. Hal tersebut dapat dilakukan dengan cara meningkatkan keyakinan serta meningkatkan potensi dalam diri meliputi penekanan pada aspek spiritual, motivasi dan semangat baik dalam diri responden sendiri maupun dari keluarga terdekat dari responden sehingga kualitas hidupnya akan menjadi lebih baik. Kata kunci : Cedera Kepala, Kualitas Hidup