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IntroductionThere is growing evidence suggesting that dual-task training benefits people with Parkinson’s disease (PD) on both physical and cognitive outcomes. However, there is no known data regarding professionals’ educational needs and barriers to its implementation. This study aimed to explore the barriers and educational needs of healthcare and exercise professionals to integrate dual-task training into their practice with people with PD.MethodsWe conducted a study based on a web survey. Social media channels were used to recruit a convenience sample of exercise and healthcare professionals working with people with PD.ResultsOf the 185 eligible responses, the majority were physiotherapists (68.1%) followed by occupational therapists (10.8%). Most participants attended Parkinson specific training (88.6%) and employed the treatments set up in individual one on-one sessions (58.9%). We identified several barriers to dual-task training implementation, with lack of time (to prepare materials), staying creative and/ or accessing new ideas, unreliable tools for measuring gains, and insufficient expertise as the most referred by participants. The educational needs most referred included accessing examples of interventions in general, knowing what strategies to apply and their application for people with different symptoms.DiscussionOur results highlight that professionals remain challenged to integrate dualtask training into PD clinical care mainly due to knowledge gaps, difficulties in accessing new ideas, and lack of time.

Peer review supports the integrity and quality of scientific publishing. However, although it is a fundamental part of the publishing process, peer review can also be challenging for reviewers, editors, and other stakeholders. The present study aims to explore the nurses’ motivations, barriers, and facilitators in engaging in a peer review process. This qualitative, descriptive exploratory study will be developed in partnerships with three research centers. Researchers followed the consolidated criteria for reporting qualitative research (COREQ) checklist to ensure the quality of this study protocol. According to the selection criteria, the purposive sampling will be used to recruit nurse researchers that act as peer reviewers for several scientific journals in various fields of knowledge. Interviews will be conducted until data have been sufficiently consistent with meeting the initial objectives. Researchers will develop a guide comprising a set of open-ended questions to collect participants’ characteristics, descriptive review behavior, and perceptions regarding their motivations, barriers, and facilitators. Researchers will analyze data using an inductive process of content analysis with the help of the QDA Miner Lite database. Findings from this study will generate knowledge that may help stakeholders identify facilitating factors and barriers and guide the development of strategies to remove or minimize these barriers.

Abstract Background Falling and gait difficulties in people with Parkinson’s disease (PD) are associated with impaired reactive postural adjustments and impairments in attentional resources. Combined intensive balance motor and cognitive exercise can be beneficial. However, uncertainties persist regarding the true effects and safety when applying such training. Using trampoline beds may be a favorable safe environment for a highly intensive, cognitive, and balancing training approach. The primary goal of this randomized controlled trial is to assess the effects of an intensive cognitive-motor training program in a safe trampoline environment in addition to usual care on balance impairment, gait, physical capacity, fear of falling, falls frequency and severity, cognition, and clinical impairments in people with mild or moderate PD. Methods Sixty participants diagnosed with idiopathic PD, in stage 2–4 Hoehn and Yahr, with a clinical history of gait deficits and a fall history (at least one fall in the last 6 months) will be recruited and randomly allocated to an intervention group receiving cognitive-motor trampoline training or a control group undergoing their usual care. The intervention will consist of 8-week individual training sessions (1-h training, 3 days per week) led by specialized physiotherapists that will provide progressive, challenging training, and guarantee safety. Assessment will be conducted prior to and immediately after the 8-week intervention and at 3 months follow-up after participating in the study. Primary outcome measures will be balance performance (assessed using the Mini-BEST Test and nonlinear analysis) and change in gait parameters (Motor and Cognitive Timed-Up-Go and nonlinear analysis). Secondary outcomes will be change in clinical improvement (Movement Disorder Society Unified Parkinson’s Disease Rating Scale), falls (falls weekly registry), fear of falling (assessed using the Falls Efficacy Scale), physical capacity (6-min walk test), and cognition (Montreal Cognitive Assessment). Discussion This study will provide new evidence on the benefits of intensive cognitive-motor balance training on a trampoline for people living with PD. Better guidance on how professionals can apply safer dual-task balance and gait training in rehabilitation is needed. Trial registration ISRCTN Registry ISRCTN13160409 . Retrospectively registered on February 23, 2022

Introduction The purpose of VIKING II is to create an observational cohort of volunteers with ancestry from the Northern Isles of Scotland, primarily for identifying genetic variants influencing disease. The new online protocol is separate to, but follows on from, earlier genetic epidemiological clinic-based studies in the isolated populations of Orkney and Shetland. These populations are favourable for the study of rarer genetic variants due to genetic drift, the large number of relatives, and availability of pedigree information. They are known to be genetically distinct from mainland British populations. Methods and Analysis Online methods are being used to recruit ~4,000 people who have Northern Isles ancestry, living anywhere in the world. The option for participants to have actionable genetic results returned is offered. Consent will be taken electronically. Data will be collected at baseline through an online questionnaire and longitudinally through linkage to NHS data in the electronic health record. The questionnaire collects a variety of phenotypes including personal and family health. DNA will be extracted from saliva samples then genome-wide genotyped and exome sequenced. VIKING II aims to capitalise on the special features of the Northern Isles populations to create a research cohort that will facilitate the analysis of genetic variants associated with a broad range of traits and disease endpoints, including otherwise rare variants that have drifted to high frequency in these populations. Ethics and Dissemination The South East Scotland Research Ethics Committee gave the study a favourable opinion. VIKING II is sponsored by the University of Edinburgh and NHS Lothian. Summary research findings will be disseminated to participants and funding bodies, presented at conferences and reported in peer-reviewed publications. Article Summary Strengths and limitations of this study • Detailed data and biological sample collection of research volunteers with unique ancestry. • Consent for access to routinely collected clinical EHR data and for future re-contact, providing a longitudinal component. • Optional consent for return of actionable genetic results. • ~4,000 participants is a relatively small number for certain types of genetic analyses, so the cohort is underpowered on its own, in some study designs. • Resources to maintain the cohort, and to store data and DNA samples, are significant, with sustainability dependent on infrastructure support and funding.

BackgroundDual-task training is an emerging field used for people with Parkinson disease (PD) to improve their physical and cognitive well-being, but the patients’ acceptability, safety, and adherence to such training in online settings are unknown. ObjectiveThis study aims to evaluate the acceptability of a dual-task cognitive and motor online training program for people with PD as a group online community program. MethodsPeople with PD were invited to participate in an online program (PD3 Move) consisting of physical and vocal exercises in response to different cognitive challenges displayed as dynamic backgrounds on Zoom. The program ran twice per week for 16 weeks. Patient acceptability was assessed at 4 months by monitoring attendance rates and feedback from an exit questionnaire emailed to all participants assessing satisfaction, perceived benefit, safety, and willingness to continue and recommend to others. ResultsThe online program was delivered to 15 participants (n=9, 60%, females) with a diagnosis of PD, a mean age of 69.4 (SD 9.3) years, and Hoehn and Yahr (H&Y) stages I-IV. The attendance rate was high, with participants coming to more than 13 (81%) of the sessions. Participants were very satisfied (n=8, 53%) or satisfied (n=7, 47%) with the program. Participants reported that what they most liked were the new cognitive physical challenges. The 3 main facilitators to participating were perceiving the benefits, instructor’s flexibility and engagement, and the social interaction moments with others. The 3 main difficulties were dealing with motor fluctuations (n=3, 20%), difficulties in using technology (n=2, 13%), and difficulty hearing instructions due to hearing loss (n=2, 13%). Patients had favorable perceived benefits of the program, with 14 (93%) considering it very useful for the current management of health and 1 (7%) moderately useful. No adverse events were reported, and all participants said that they were willing to continue the program and recommend it to others. ConclusionsOur findings suggest that the online cognitive and motor program was well received, safe, and perceived to be of benefit to this group of medically stable people with PD in H&Y stages I-IV. Access to specialized care and enhancement of long-term adherence to regular exercise can be achieved with online community group programs.

Background Access to specialised early intervention mental health services for children, including group counselling for parents/carers, is still a challenge in non-metropolitan areas of Australia. Aim To gain understanding of the acceptability of a school-based targeted parenting group program delivered via telehealth by exploring the experiences of parents/carers, clinicians and school staff, and asking what works, how, why and in what circumstances. Methods Caregivers, clinicians and school staff involved in the delivery of a mental health program via telehealth into primary schools in two rural Local Health Districts (LHDs) in southern New South Wales (NSW) were invited to participate in interviews and/or focus group discussions. Thematic analysis of the data was conducted with reference to realist theory. Findings We conducted semi-structured interviews with 12 caregivers, five semi-structured interviews and two focus group discussions with school staff from six participating schools, and three focus groups with seven clinicians who delivered the intervention. We found that the intervention and micro contexts interacted to influence acceptability by initiating or enhancing cohesion among caregivers, establishing channels of communication between caregivers and teachers, and connection between caregivers and clinicians despite geographic distance. Several adaptations were made to strengthen the therapeutic alliance between caregivers and clinicians. Conclusion Relationships crucial to the success of delivering psychological group counselling were established. Regional community contexts can facilitate acceptability of parenting group counselling delivered into schools via telehealth. Implementation of the program was flexible enough to allow clinicians to adjust their approach and materials to better suit the telehealth modality.

The inverse finite element method is a technique that can be used for material model parameter characterization. The literature shows that this approach may get caught in the local minima of the design space. These local minimum solutions often fit the material test data with small errors and are often mistaken for the optimal solution. The problem with these sub-optimal solutions becomes apparent when applied to different loading conditions where significant errors can be witnessed. The research of this paper presents a new method that resolves this issue for Mooney–Rivlin and builds on a previous paper that used flat planes, referred to as hyperplanes, to map the error functions, isolating the unique optimal solution. The new method alternatively uses a constrained optimization approach, utilizing equality constraints to evaluate the error functions. As a result, the design space’s curvature is taken into account, which significantly reduces the amount of variation between predicted parameters from a maximum of 1.934% in the previous paper down to 0.1882% in the results presented here. The results of this study demonstrate that the new method not only isolates the unique optimal solution but also drastically reduces the variation in the predicted parameters. The paper concludes that the presented new characterization method significantly contributes to the existing literature.

ABSTRACT – This study investigated how Nigerian newspapers contributed to sensitizing and sustaining public attention on the issue of the schoolgirls that were abducted by the Boko Haram group in Chibok, northeastern Nigeria. The study analyzed the direction/slant, frequency, and prominence of news stories, feature articles, editorials, special reports, interpretative articles, and news analysis on the abduction as published in three major Nigerian newspapers. Using the content analytical technique, the study found that there was no day in the period under investigation that the issue of the abducted Chibok girls did not get attention in the press. The study also found that the press discharged its corporate social responsibility by setting and sustaining public consciousness on the injustice and inhumanity of the abduction. Furthermore, a connection was established between the unrelenting crusade mounted by non-governmental organizations, especially the #BringBackOurGirls movement, for the release of the abducted girls, sustained public interest provided by the Press, and the eventual government action that culminated in the release of 164 out of the 276 girls initially abducted. This study, therefore, recommends continued publicity by the media in its role as a social crusader to ensure that the remaining Chibok and other abductees are rescued from their Boko Haram abductors. RESUMO – Este estudo investigou como os jornais nigerianos contribuíram para sensibilizar e manter a atenção do público sobre a questão das estudantes que foram sequestradas pelo grupo Boko Haram em Chibok, no nordeste da Nigéria. O estudo analisou o direcionamento/ponto de vista, a frequência e proeminência das notícias, artigos de destaque, editoriais, reportagens especiais, artigos interpretativos e análises de notícias sobre o sequestro nas publicações dos três principais jornais nigerianos. Usando técnica analítica de conteúdo, o estudo identificou que, no período investigado, não houve um dia em que a pauta do sequestro não tenha recebido atenção da imprensa. O estudo descobriu também que a imprensa cumpriu sua responsabilidade social corporativa ao estabelecer e manter a consciência pública sobre a injustiça e desumanidade do sequestro. Além disso, uma conexão foi estabelecida entre a cruzada incessante montada por organizações não governamentais, especialmente o movimento #BringBackOurGirls, pela libertação das meninas, e sustentou o interesse público proporcionado pela imprensa e a eventual ação governamental que culminou com a libertação de 164 das 276 garotas inicialmente sequestradas. Portanto, este estudo recomenda a continuidade da visibilidade proporcionada pela mídia no seu papel de cruzada social para assegurar que Chiboks e outros raptados sejam resgatados dos seus sequestradores do Boko Haram. RESUMEN – En este estudio se investiga cómo los periódicos nigerianos contribuyeron a sensibilizar y mantener la atención pública sobre la cuestión de las niñas secuestradas por el grupo Boko Haram en Chibok, al noreste de Nigeria. El estudio analizó la dirección/orientación, frecuencia y prominencia de las noticias, artículos de fondo, editoriales, informes especiales, artículos interpretativos y análisis periodísticos sobre el secuestro, publicados en tres importantes periódicos nigerianos. Mediante el uso de la técnica del análisis de contenido, el estudio llegó a la conclusión de que no había ningún día en el período investigado en que el asunto de las niñas Chibok secuestradas no recibiera atención en la prensa. También se encontró que la prensa cumplió con su responsabilidad social corporativa al establecer y mantener la conciencia pública sobre la injusticia y la falta de humanidad del secuestro. Además, se estableció una conexión entre la implacable cruzada montada por organizaciones no gubernamentales, especialmente el movimiento #BringBackOurGirls, por la liberación de las niñas secuestradas, el interés público sostenido proporcionado por la prensa, y la eventual acción gubernamental que culminó en la liberación de 164 de las 276 niñas inicialmente secuestradas. Por lo tanto, en este estudio se recomienda que los medios de comunicación continúen otorgando publicidad, en su rol público de luchadores sociales, para garantizar que los restantes Chibok y otros secuestrados sean rescatados de sus secuestradores de Boko Haram.

Physiotherapy and exercise are associated with motor and non-motor benefits in Parkinson’s disease (PD). Community exercise programs may increase ongoing exercise participation and help people with Parkinson’s disease actively participate in their health management. But there is still limited knowledge about these programs regarding their benefits, safety, implications over the long-term, and effective implementation. These questions could hold relevant clinical implications. In this perspective article, we identify the current challenges and reflect upon potential solutions to help community exercise to be implemented as an additional anchor to personalize management models for Parkinson’s disease.

Abstract Background A pattern of major and minor congenital anomalies, facial dysmorphic features, and neurodevelopmental difficulties, including cognitive and social impairments has been reported in some children exposed to sodium valproate (VPA) during pregnancy. Recognition of the increased risks of in utero exposure to VPA for congenital malformations, and for the neurodevelopmental effects in particular, has taken many years but these are now acknowledged following the publication of the outcomes of several prospective studies and registries. As with other teratogens, exposure to VPA can have variable effects, ranging from a characteristic pattern of major malformations and significant intellectual disability to the other end of the continuum, characterised by facial dysmorphism which is often difficult to discern and a more moderate effect on neurodevelopment and general health. It has become clear that some individuals with FVSD have complex needs requiring multidisciplinary care but information regarding management is currently lacking in the medical literature. Methods An expert group was convened by ERN-ITHACA, the European Reference Network for Congenital Malformations and Intellectual Disability comprised of professionals involved in the care of individuals with FVSD and with patient representation. Review of published and unpublished literature concerning management of FVSD was undertaken and the level of evidence from these sources graded. Management recommendations were made based on strength of evidence and consensus expert opinion, in the setting of an expert consensus meeting. These were then refined using an iterative process and wider consultation. Results Whilst there was strong evidence regarding the increase in risk for major congenital malformations and neurodevelopmental difficulties there was a lack of high level evidence in other areas and in particular in terms of optimal clinical management.. The expert consensus approach facilitated the formulation of management recommendations, based on literature evidence and best practice. The outcome of the review and group discussions leads us to propose the term Fetal Valproate Spectrum Disorder (FVSD) as we feel this better encompasses the broad range of effects seen following VPA exposure in utero. Conclusion The expert consensus approach can be used to define the best available clinical guidance for the diagnosis and management of rare disorders such as FVSD. FVSD can have medical, developmental and neuropsychological impacts with life-long consequences and affected individuals benefit from the input of a number of different health professionals.

Objectives To systematically review the evidence base for a systems approach to healthcare design, delivery or improvement.Design Systematic review with meta-analyses.Methods Included were studies in any patients, in any healthcare setting where a systems approach was compared with usual care which reported quantitative results for any outcomes for both groups. We searched Medline, Embase, HMIC, Health Business Elite, Web of Science, Scopus, PsycINFO and CINAHL from inception to 28 May 2019 for relevant studies. These were screened, and data extracted independently and in duplicate. Study outcomes were stratified by study design and whether they reported patient and/or service outcomes. Meta-analysis was conducted with Revman software V.5.3 using ORs—heterogeneity was assessed using I2 statistics.Results Of 11 405 records 35 studies were included, of which 28 (80%) were before-and-after design only, five were both before-and-after and concurrent design, and two were randomised controlled trials (RCTs). There was heterogeneity of interventions and wide variation in reported outcome types. Almost all results showed health improvement where systems approaches were used. Study quality varied widely. Exploratory meta-analysis of these suggested favourable effects on both patient outcomes (n=14, OR=0.52 (95% CI 0.38 to 0.71) I2=91%), and service outcomes (n=18, OR=0.40 (95% CI 0.31 to 0.52) I2=97%).Conclusions This study suggests that a systems approaches to healthcare design and delivery results in a statistically significant improvement to both patient and service outcomes. However, better quality studies, particularly RCTs are needed.PROSPERO registration numberCRD42017065920.

Given the variety of exercise programs available for people with Parkinson’s disease (PD), such individuals may struggle to make decisions about what exercise to perform. The objective of this study was to assess the usefulness, satisfaction, and preferences regarding participation in a PD-personalized educational and exercise boot camp program. Attendees participated in a four-day program consisting of exercise sessions, workshops, and social activities. We collected demographic and clinical information. We assessed satisfaction and preferences immediately after. At one-month follow-up, participants assessed usefulness and changes in exercise habits. Eight individuals diagnosed with PD, with a mean age of 59.5 ± 6.8 years, participated. All participants felt “very satisfied” and likely to attend future events. The two favorite sessions were: cognitive stepping and dance-based movements. At one-month follow-up, participants considered the program “very useful” and reported changes in their exercise routine. Our results suggest that the boot camp program was considered useful and capable of influencing participants’ exercise habits.

The article presents the responses to the First World War in Detroit, a booming multicultural community at the time. Drawing on a variety of sources, including previously unpublished archival material, the author describes the various conflicted ethnic and social groups reluctantly entering the war. The article demonstrates how difficult it was to achieve and maintain social cohesion in a country that still was not directly related to the war.

The goal of this exploration is to observationally test the connection between total quality management and SMEs' performance. Specifically, it looks at whether organizational culture (OC) has an interceding impact on the TQM-SMEs performance relationship. Established on the literature review of TQM, OC and SMEs performance, the theoretical model for this investigation was formed. A self-controlled survey was utilized to gather information from the SMEs owners-managers in the South-western region of Nigeria. In determining the relationship, SEM-PLS 3.0 was utilized. Measurable results add to the literature by showing a positive direct impact of TQM and OC on SMEs' performance, and a critical and positive aberrant impact of TQM on SMEs' performance through OC. The quantitative cross-sectional research configuration explored an example of assembling SMEs. Subjective methods or a contextual investigation approach for additional data examination could be utilized for subsequent research. The results of this exploration give awareness into SMEs' owners-managers in the present unique manufacturing setting, concentrating on TQM as an instrument for improving their performance. The outcomes can help SMEs by giving direction with regards to the OC, on account of its impact on the effective execution of TQM, in this way improving the dimension of performance. The examination expands the TQM literature with an extensive comprehension of TQM from the point of view of SMEs in Nigeria. It fills the void in observational examinations that research the joint impact of TQM and OC on SMEs' performance.

Osteopathia striata with cranial sclerosis (OSCS) is an X-linked dominant condition characterised by metaphyseal striations, macrocephaly, cleft palate, and developmental delay in affected females. Males have a more severe phenotype with multi-organ malformations, and rarely survive. To date, only frameshift and nonsense variants in exon 2, the single coding exon of AMER1, or whole gene deletions have been reported to cause OSCS. In this study, we describe two families with phenotypic features typical of OSCS. Exome sequencing and multiplex ligation-dependent probe amplification (MLPA) did not identify pathogenic variants in AMER1. Therefore, genome sequencing was employed which identified two deletions containing the non-coding exon 1 of AMER1 in the families. These families highlight the importance of considering variants or deletions of upstream non-coding exons in conditions such as OSCS, noting that often such exons are not captured on probe or enrichment-based platforms because of their high G/C content.

ObjectiveHigh sensitivity plasma cardiac troponin-I (cTnI) is emerging as a strong predictor of cardiac events in a variety of settings. We have explored its utility in patients with myotonic dystrophy type 1 (DM1).Methods117 patients with DM1 were recruited from routine outpatient clinics across three health boards. A single measurement of cTnI was made using the ARCHITECT STAT Troponin I assay. Demographic, ECG, echocardiographic and other clinical data were obtained from electronic medical records. Follow up was for a mean of 23 months.ResultsFifty five females and 62 males (mean age 47.7 years) were included. Complete data were available for ECG in 107, echocardiography in 53. Muscle Impairment Rating Scale score was recorded for all patients. A highly significant excess (p = 0.0007) of DM1 patients presented with cTnI levels greater than the 99th centile of the range usually observed in the general population (9 patients; 7.6%). Three patients with elevated troponin were found to have left ventricular systolic dysfunction (LVSD), compared with four of those with normal range cTnI (33.3% versus 3.7%; p = 0.001). Sixty two patients had a cTnI level < 5ng/L, of whom only one had documented evidence of LVSD. Elevated cTnI was not predictive of severe conduction abnormalities on ECG, or presence of a cardiac device, nor did cTnI level correlate with muscle strength expressed by Muscle Impairment Rating Scale score.ConclusionsPlasma cTnI is highly elevated in some ambulatory patients with DM1 and shows promise as a tool to aid cardiac risk stratification, possibly by detecting myocardial involvement. Further studies with larger patient numbers are warranted to assess its utility in this setting.

[This corrects the article DOI: 10.1371/journal.pone.0174166.].

Introduction: The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE. Aim: The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE. Methods: In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted. Results: The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. Conclusion: The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An evidence-based unified definition of lifelong and acquired premature ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. Sex Med 2014;2:41–59.

Introduction: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. Aim: The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method: A comprehensive literature review was performed. Results: This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion: Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60–90.

This article argues that Lincoln is not a universal hero, but rather an indigenous, U.S., ethnocentric one. Lincoln has generally been absent as a model in European social and public life, rarely emphasized as an essential part of education or in the public forum. Among the reasons given for this difference are inaccurate references to his ecumenical qualities and the often negative attitude in Europe towards a U.S. popular taste culture which is an expression of values, a vital, half-wild, half-tame, communal expression of ‘We, the People of the United States.’ Especially in the 20th century, U.S. popular culture and popular icons have often been regarded in Europe as an expression of lowbrow entertainment. But in the U.S., ‘popular’ is much closer to ‘grassroots’ in the full, Whitmanesque meaning of the term. Some things don’t translate.

This Cultural History essay’s focus is age, aging, longevity and the consciousness of a generation in contemporary United States and the verifiable foundations of these issues: how age is real and artificial both. Frames that define understanding of age are physical, of course, but frames are also created and imposed by a civilization. This essay seeks to analyze what aging means for the US Baby Boomer generation, a group which, as no other in the nation’s history, defined itself as young. To accomplish this investigation the essay tries to blend Cultural History, Cohort Analysis, Sociology of Mass Media, American Studies, and Cross-cultural analysis. Key American civilization traits are used as analytical tools: The Promised Land, Progress, Superabundance, Innocence, Rejuvenation, Success, Opportunity, Ingenuity, Technology, Declaration of Independence, The Constitution, The Founding Fathers, Isolationism

Antonio Martín Morales1, Vincenzo Mirone2, John Dean3, Pierre Costa41Department of Urology, Hospital Carlos Haya, Malaga, Spain; 2Department of Urology, University Federico II, Naples, Italy; 3St. Peter’s Sexual Medicine, The London Clinic, London, UK; 4Center Hospitalier Caremeau, Nîmes, FranceAbstract: Many men with erectile dysfunction (ED) also have associated underlying cardiovascular and metabolic conditions, for which they are likely to be taking medication. Therefore, cardiovascular safety and potential drug interactions are two of the major concerns when using PDE-5 inhibitors in these patients. The PDE-5 inhibitor, vardenafil, is characterized by a rapid onset of action, increased duration of erection, high rates of first-dose success and reliable efficacy that can be maintained with continued use. In both clinical trials and real-life observational studies, vardenafil has demonstrated a favorable efficacy and safety profile in men with ED, including those with associated underlying conditions such as diabetes, hypertension and dyslipidemia. Importantly, the concomitant use of medication for these conditions is not associated with any noteworthy changes in the efficacy and safety of vardenafil. The evidence presented in this review supports the use of vardenafil as a first-line treatment for men with ED, including those with underlying conditions.Keywords: vardenafil, erectile dysfunction, efficacy, safety, underlying conditions

Abraham Lincoln has constantly moved among and stirred Americans in the common, shifting ground of their popular, visual, and digital imagination. Nowadays, Lincoln is larger than the sum of his parts. This is due partly to his own prismatic personality, partly to his political genius, partly to the special needs of the American nation and its people. If Lincoln did not exist, someone, somehow, would have tried to construct a representative figure who came close to the mark of what the Civil War, the fight for Union, the failure of Succession, the liberty of the slaves and the material-spiritual expansion of America meant. But Lincoln existed. Lincoln hit the target. Here was witness, cause, martyr and lodestone all packed into one.

This essay tries to offer an overview of adaptation, an initiation into this subject for the educated reader who is not a communications or film specialist. The essay will reference "The Social and Cultural Construction of Abraham Lincoln in U.S. Movies and on U.S. TV”—but mainly with an eye to the larger issue of cinematographic adaptation itself.

An end product is the result of a process. The design, construction, and use of books and movies depend each upon the particular dynamics of how they come into existence. Here is an outline of how they are made.