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In evidence-based medicine, constructing research questions is the most important part of research integration. Formulating a research question is the first step to conducting a credible and valuable research. Patient, intervention, comparison, outcome (PICO) is a specialized framework used by most researchers to formulate a research question and facilitate resource review. In the heart ward of Razi Hospital, Birjand University of Medical Sciences, according to the needs assessments, PICO was implemented during the Journal Club to familiarize students with research and increase their level of knowledge, attitude, as well as clinical reasoning skills. In this article, we explain the case of a 36-year-old woman with typical chest pain for 3 hours due to severe stress, without cardiac risk factors referring to the emergency room. The clinical examination was normal. The ST elevation was observed in the aVR lead. The question is “Should we perform an invasive intervention for this patient?

This study aimed to analyze the kinematic development of a rehabilitation cable robot for patients with cerebral palsy problems. For this purpose, the walking pattern of a healthy person was analyzed in the robot by extracting his kinematic model. Therefore, a seven-link model was considered, and changes in the mass center of the links and then movements during the gait cycle were obtained with the angles related to joint changes. Next, the person’s integration with the rehabilitation cable robot was investigated with the resolution of the direct kinematic problem. In addition, the change-related outputs of the cables were obtained by the person’s movement and the attached belt. The robot was further proposed because the specific change diagram of the cables facilitates understanding how much motor torque is needed to change the length of the cable. It is noteworthy that the static person balance is provided in the existing rehabilitation robots. However, in this structure, the balance is done by the six degrees of freedom robot so that the robot can return the person to the original path when he loses his balance. Cable systems for the lower limbs (thighs and shanks) are also simulated to rehabilitate the patient. The obtained results from the simulation and the obtained output from kinematic equations for lower limb movements were also compared, and the highest deference was 2.2, 1.8, 1.8, and 1.5% for shank-back, shank-front, thigh-back, and thigh-front of the leg in the corresponding points in the outputs of both software, respectively.

BackgroundBorderline personality disorder is a major mental illness characterized by sustained relationship instability, impulsive behavior, and intense affects. Adherence is a complex behavior, from minor refusals to abandonment of treatment, which can be affected by various factors. Therefore, the present study aimed to investigate the factors affecting pharmacological and psychotherapy adherence, patients' attitude toward medication, and assessing medication and treatment adherence in patients with borderline personality disorder referred to an outpatient referral clinic in Tehran, Iran.MethodsThe study was a cross-sectional study. The files of patients with borderline personality disorder referred to the outpatient clinic of the Tehran Psychiatric Institute were reviewed as the first step. Data were collected using the Drug Attitude Inventory-10 (DAI-10) questionnaire and a questionnaire to determine the attitude of patients toward pharmacological and psychotherapy treatment as well as therapeutic adherence. After collecting data, patients' therapeutic adherence was divided into poor, partial, and good compliance.ResultsNinety-four patients were involved in the study, and fifty-four were women. Findings of DAI showed that 54 (57.4%) participants had negative attitudes toward medication, while 38 (40.4%) participants showed a negative attitude toward psychotherapy treatment. Additionally, the percentage of patients with good psychotherapy adherence (44.7%) was higher than that of patients with good medication adherence (31.9%). The most common reasons for discontinuation of treatment were medication side effects (53.1%), dissatisfaction with the therapist (40.3%), and then fear of medication dependence (40%). Patients with higher education levels and a positive history of hospitalization in a psychiatric ward had better adherence to psychotherapy (P < 0.05).ConclusionResults of the current study show that attitude toward psychotherapy is more favorable than pharmacotherapy among patients with BPD. The rationale may be that medications are mainly prescribed for comorbid conditions and do not have substantial effects on the BPD symptoms, resulting in low medication adherence.

ObjectivesTo report two different presentations of migraine with the olfactory hallucinations. A case with the typical hallucinatory olfactory symptoms preceding migraine headaches and another case with longstanding olfactory hallucinations.BackgroundMigraine prevails in about 12% of the general population, with the migraine aura accountable for at least one-third of these cases. The most common aura is the visual aura, followed by the sensory aura, speech, and motor auras. Olfactory hallucinations preceding the headache phase of migraine are rare. To date, the International Classification of Headache Disorders (ICHD) has not recognized them as a subset of migraine aura.ResultsThis report presents a patient with a typical Phantosmia (PO) aura before her migraine headache and a patient who experiences a longstanding PO aura.ConclusionThe olfactory hallucination may present differently in patients with migraine disease. Based on the clinical significance of migraine with olfactory hallucinations, we propose that the ICHD classify this phenomenon as a subtype of aura in the future. However, larger studies are still required to better assess the pathophysiology of this phenomenon.

In recent years, non-communicable diseases (NCDs) have accounted for about 70% of the worldchr('39')s deaths. The most common NCDs are cardiovascular disease, cancer, diabetes mellitus, and chronic respiratory diseases. These diseases have four common risk factors, including inadequate physical activity, unhealthy diet, smoking, and excessive alcohol consumption. Cardiovascular diseases, despite their high prevalence, are the most preventable chronic diseases. The most common risk factor for cardiovascular disease is high blood pressure, which can be prevented if it is diagnosed and controlled carefully. Recent guidelines have changed the methods of blood pressure measurement, definition, and treatments. Recently, more emphasis has been placed on Out-of-Office Blood Pressure Measurement. Therefore, it is necessary to consider the methods of measuring blood pressure at home and 24-hour Holter blood pressure monitoring, as well as understanding its standards. The use of automatic arm sphygmomanometers to measure blood pressure is more acceptable than manual ones (mercury or Aneroid). The most accepted definitions of hypertension are BP≥140/90 mm Hg in the clinic, the average blood pressure at home≥135/85 mm Hg, and the average blood pressure in 24-hour Holter monitoring≥130/80 mm Hg. Proper treatment of hypertension by changing lifestyle and proper medication therapy can control blood pressure and prevent serious complications. Today, the use of combination drugs, especially a single pill in a single dose, has been emphasized. This study aimed to review the most recent hypertension treatment protocols based on the guidelines of the American Heart Association (AHA 2017), the European Society of Cardiology (ESC 2018), the British Heart Association (NICE 2019), and the International Society of Hypertension (ISH 2020). Furthermore, this study attempted to assess the symptoms, complications, methods of diagnosing, definitions, as well as pharmacological and non-pharmacological treatments of hypertension.

The effect of the width to thickness ratio on the bendability of sheet metal is investigated using the finite element method (FEM) employing the Gurson–Tvergaard–Needleman (GTN) model. Strain path changes in the sheet with change in the width/thickness ratio. It is shown that bendability and fracture strain increase significantly by decrease in the width/thickness ratio. The stress state is almost uniaxial when the stress ratio (α) is close to zero for narrow sheets. Stress ratio is nothing but the major stress to minor stress ratio. This delays the growth and coalescence of micro-voids as the volumetric strain and stress triaxiality (pressure/effective stress) decrease. On the other hand, ductility decreases with increase in α for wider sheets. Fracture bending strain is calculated and, as expected, it increases with decrease in the width/thickness ratio. Furthermore, a brief study is performed to understand the effect of superimposed hydrostatic pressure on fracture strain for various sheet metals with different width/thickness ratios. It is found that the superimposed hydrostatic pressure increases the ductility, and that the effect of the width/thickness ratio in metals on ductility is as significant as the effect of superimposed hydrostatic pressure. Numerical results are found to be in good agreement with experimental observations.

Background and purpose: Almost half of non-specific knee pain can be attributed to patellofemoral pain syndrome (PFPS). There is paucity of information about the effects of different types of combination therapies including exercise and taping and optimizing training variables. The aim of this study was to evaluate the effectiveness of combination of taping and quadriceps strengthening and hamstring stretching exercises on PFPS. Materials and methods: In a randomized clinical trial, 60 male patients (20-50 years old) with PFPS were randomly divided into four groups: 1) Quadriceps strengthening exercise and taping, 2) Hamstring stretching exercise and taping, 3) Quadriceps strengthening and hamstring stretching exercise, and 4) Quadriceps strengthening, hamstring stretching exercise, and taping. Pain and functional outcomes were assessed before and immediately after treatment using VAS scale, KOOS scale, and 6 MWT test. Data were analyzed in SPSS V20. Results: Compared to beginning of the study, significant decrease in mean VAS scores (P

Accurate estimation of offshore wind turbine (OWT) modal parameters has a prominent effect on the design loads, lifetime prediction, and dynamic response of the system. Modal parameters can vary during the operation of OWTs. This paper studies the variation and sensitivity analysis of an OWT’s modal parameters with respect to operational and environmental conditions. Three finite element models of a jacket-supported OWT at the Block Island Wind Farm are created within the OpenSees, SAP2000, and OpenFAST platforms and validated using experimental measurements. The OpenFAST model is used to simulate the modal parameters of the turbine under various wind speed, rotor speed, power, yaw angle, mean sea level, blade pitch angle, and soil spring values. The model-predicted modal parameters of the first fore–aft (FA) and side–side (SS) modes are compared to those identified from experimental measurements. Results from the simulations show that the first FA natural frequency and damping ratio mostly depend on the rotor speed and wind speed, respectively, while yaw angle and mean sea level do not have a visible effect. It is observed that there is about 8% stiffening in the first FA frequency and an aerodynamic damping of 7.5% during the operation of the OWT.

Objectives: Scholars have demonstrated the consequences of cultural stressors on Latino/a adolescents' depressive symptoms and prosocial behaviors. However, there is little understanding of how different combinations of cultural stressors and assets might differentially relate to depressive symptoms and prosocial behaviors, particularly in young adulthood. This study used latent profile analysis to identify varying levels of cultural stressors (foreigner objectification and U.S. marginalization) and assets (family respect values and ethnic identity commitment) among Latino/a young adults. We then examined how profiles differentially relate to three forms of prosocial behaviors (care-based, altruistic, and public) and depressive symptoms. Method: Data derived from a national convenience sample of 1,288 U.S. Latino/a 18–21-year olds who completed a survey. Most were born in the United States (85%) and identified as women (72%). Results: Latent profile analysis revealed three profiles: (1) low cultural stressors/moderate cultural assets, (2) moderate cultural stressors and assets, and (3) high cultural stressors and assets. Profile 3 reported higher care-based prosocial behaviors compared to those with Profile 1; yet, those with Profile 1 had higher care-based prosocial behaviors compared to those with Profile 2. For altruistic and public prosocial behaviors, Profile 1 had higher and lower scores, respectively, compared to the other two profiles. Profile 1 showed lower scores for depressive symptoms compared to the other two profiles. Conclusions: Results indicate a nuanced interrelated pattern of cultural stressors and assets that vary and differentially relate to prosocial behaviors and depressive symptoms in Latino/a young adults. Public Significance Statement: This study finds that different levels of cultural stressors and cultural assets are differentially associated with Latino/a young adults' prosocial behaviors and depressive symptoms. In general, a strong connection to ethnic/racial identity and family respect values when facing high levels of cultural stressors seems to promote greater forms of some prosocial behaviors. However, strong cultural assets might not alone be sufficient to protect Latino/a young adults from the mental health consequences of cultural stressors. [ABSTRACT FROM AUTHOR]

There is an expectation that schools generate certainty in migrant children’s lives in the processes of resettlement in host communities. However, there is also a critical body of literature highlighting a tension between an inflexible system of mass compulsory schooling that predominates in most affluent “destination” countries and the complex multi-dimensional nature of migrant children’s lives. In this paper, we examine the relationship between migrant children settling in an English city and their schooling, drawing on empirical data from two schools and a youth organization. Our empirical themes focus on the management of migrant children’s pace of learning and integration. Drawing on data from two English city schools we highlight factors that both “speed up” and “slow down” processes of resettlement. [ABSTRACT FROM AUTHOR]

Context Omnipod DASH Insulin Management System is a tubeless insulin pump that overcomes the physical inconveniences of conventional tubed insulin pump therapy (IPT). Objective We compared treatment satisfaction with Omnipod DASH System to usual care (multiple daily injections [MDIs] or tubed IPT) in adults with type 1 diabetes using self-monitoring blood glucose (SMBG). Methods Adults with type 1 diabetes on MDI (n = 40) or IPT (n = 25) from 4 diabetes centers in Australia were randomly assigned in a 1:1 nonblinded manner to Omnipod DASH System (Omnipod group) or continue usual care (Usual Care group) for 12 weeks, followed by a further 12-week extension during which all participants used the device. The primary outcome was treatment satisfaction assessed by change in Diabetes Technology Questionnaire "current" (ΔDTQ-current) score at 12 weeks (study end). Secondary outcomes included ΔDTQ-current following extension and other participant-reported outcomes (PROs) measuring quality of life, burden of disease treatment, and glycemic and device-related outcomes at 12 weeks (study end) and 24 weeks (end extension). Results Treatment satisfaction improved more in the Omnipod group vs the Usual Care group (ΔDTQ-current score of 16.4 [21.2] vs 0.0 [12.8]; P <.001) at study end. Significantly greater improvements in other PROs and glycated hemoglobin A1c were also observed. Improvements in DTQ-current and other PROs comparing study end and end extension were similar. While percentage in time in range change from baseline did not differ at study end (−2.0 [12.7] %), it was significantly greater at end extension (5.6 [10.9] %; P =.016). Conclusion The Omnipod DASH System resulted in greater treatment satisfaction at 12 weeks in adults with type 1 diabetes using SMBG that was sustained after 24 weeks of device use without compromising sleep quality and fear of hypoglycemia. Improvements in glycemia were also observed. [ABSTRACT FROM AUTHOR]