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PurposeTroponin T levels are routinely checked in trauma patients after experiencing a ground-level fall to identify potential cardiac causes of syncope. An elevated initial troponin prompts serial testing until the level peaks. However, the high sensitivity of the test may lead to repeat testing that is of little clinical value. Here, we examine the role of serial troponins in predicting the need for further cardiac workup in trauma patients after sustaining a fall.MethodsRetrospective review of all adult trauma activations for ground-level fall from January 1, 2021 to December 31, 2021 in patients who were hemodynamically and neurologically normal at presentation. Outcomes evaluated included need for cardiology consult, admission to cardiology service, outpatient cardiology follow-up, cardiology intervention and in-hospital mortality.ResultsThere were 1555 trauma activations for ground-level fall in the study period. The cohort included 560 patients evaluated for a possible syncopal fall, hemodynamically stable, Glasgow Coma Scale score of 15, and with a troponin drawn at presentation. The initial median troponin was 20 ng/L (13-37). Second troponin values were drawn on 58% (median 33 ng/L (22-52)), with 42% of patients having an increase from first to second test. 29% of patients had a third troponin drawn (median 42 ng/L (26-67)). The initial troponin value was significantly associated with undergoing a subsequent echo (p=0.01), cardiology consult (p50 ng/L as a threshold for further clinical evaluation would improve the utility of the test and likely reduce unnecessary hospital stays and costs for otherwise healthy patients.Level of evidenceLevel III.

This article explores the behavior of Brazilians in a post-pandemic world and their potential disregard for the dangers of COVID-19. It suggests that psychological factors, such as reduced fear and mental health issues, may contribute to this behavior. Additionally, social and economic factors, including poverty and limited resources, may impact people's ability to follow containment measures. The article emphasizes the importance of considering these factors when analyzing individual and community behavior during the pandemic. It also discusses the challenges faced by Brazil during and after the pandemic, including psychological impacts, social pressure to return to normal, and the neglect of mental health support. The text highlights the emergence of other health crises and the need for effective preventive measures. It concludes by calling for further research to understand the long-term effects of the pandemic and to strengthen public policies and health practices. [Extracted from the article]

Given experience in cluttered but stable visual environments, our eye‐movements form stereotyped routines that sample task‐relevant locations, while not mixing‐up routines between similar task‐settings. Both dopamine signaling and mindfulness have been posited as factors that influence the formation of such routines, yet quantification of their impact remains to be tested in healthy humans. Over two sessions, participants searched through grids of doors to find hidden targets, using a gaze‐contingent display. Within each session, door scenes appeared in either one of two colors, with each color signaling a differing set of likely target locations. We derived measures for how well target locations were learned (target‐accuracy), how routine were sets of eye‐movements (stereotypy), and the extent of interference between the two scenes (setting‐accuracy). Participants completed two sessions, where they were administered either levodopa (dopamine precursor) or placebo (vitamin C), under double‐blind counterbalanced conditions. Dopamine and trait mindfulness (assessed by questionnaire) interacted to influence both target‐accuracy and stereotypy. Increasing dopamine improved accuracy and reduced stereotypy for high mindfulness scorers, but induced the opposite pattern for low mindfulness scorers. Dopamine also disrupted setting‐accuracy invariant to mindfulness. Our findings show that mindfulness modulates the impact of dopamine on the target‐accuracy and stereotypy of eye‐movement routines, whereas increasing dopamine promotes interference between task‐settings, regardless of mindfulness. These findings provide a link between non‐human and human models regarding the influence of dopamine on the formation of task‐relevant eye‐movement routines and provide novel insights into behavior‐trait factors that modulate the use of experience when building adaptive repertoires. Using a double‐blind L‐Dopa intervention with healthy participants, we show that dopamine interacts with an individual's level of mindfulness to influence routine formation and cognitive control. These findings are the first empirical test of the theoretical suggestion that mindfulness and dopamine operate on the same underlying mechanisms that support task learning and habit formation. [ABSTRACT FROM AUTHOR]

Medical imaging diagnostic test accuracy research is strengthened by adhering to best practices for study design, data collection, data documentation, and study reporting. In this review, key elements of such research are discussed, and specific recommendations provided for optimizing diagnostic accuracy study execution to improve uniformity, minimize common sources of bias and avoid potential pitfalls. Examples are provided regarding study methodology and data collection practices based on insights gained by the liver imaging reporting and data system (LI‐RADS) individual participant data group, who have evaluated raw data from numerous MRI diagnostic accuracy studies for risk of bias and data integrity. The goal of this review is to outline strategies for investigators to improve research practices, and to help reviewers and readers better contextualize a study's findings while understanding its limitations. Level of Evidence: 5 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Abstract Gallstones are common in Western countries and increasing in developing countries through adoption of western lifestyle. Gallstones may cause life-threatening complications, including acute cholecystitis, acute cholangitis, and acute pancreatitis. Cholecystectomy is the treatment of choice for symptomatic gallstones. Presentation of symptomatic gallstones may be indistinguishable from that of other upper gastro-intestinal tract (UGI) pathologies. Some surgeons routinely perform preoperative UGI endoscopy to diagnose and treat concomitant UGI pathology. A prospective cross-sectional observational study was undertaken at University of Pretoria teaching hospitals to evaluate this practice. Patients aged 18 years and older, with symptomatic gallstones but did not satisfy Tokyo guidelines for acute cholecystitis were recruited. UGI endoscopy was performed before cholecystectomy. There were 124 patients, 110 (88.7%) females and 14 (11.3%) males, mean age 44.0 (13.2) (range: 22–78) years. Most common symptoms were right upper quadrant (RUQ) pain (87%), epigastric pain (59.7%), nausea (58.1%) and vomiting (47.9%). Clinically, 80% had RUQ tenderness and 52.4% epigastric tenderness. UGI endoscopy found 35.4% pathology, 28.2% were active, and comprised acute gastritis (27.4%), peptic ulcers (4.8%), duodenitis (3.2%) and oesophagitis (2.4%). Twelve patients had more than one pathology. This warranted treatment before elective cholecystectomy and justifies the practice of routine preoperative UGI endoscopy.

Problem solving behavior focuses on how students process to solve problems, while problem solving ability is a student's ability to solve problems. Problem solving behavior can identify students' problems in solving mathematical problems, so that students' mathematical problem solving abilities are achieved as expected. Therefore, it is important for students to develop their problem-solving behaviors. By paying attention to problem solving behavior, teachers can discover students' obstacles in solving problems. The study aims to describe the problem solving behavior of students with low, medium and high ability levels. The subjects of the study were first-year senior high school students. The students were given mathematical problem-solving questions and then interviewed. Based on the interview transcripts, the students were grouped based on the problem solving behavior rubric. However, a new category of problem solving behavior, i.e., semi-routine, was proposed because the existing behavior categories did not fully represent the observed problem solving behaviors. The results of this study showed that problem solving behaviors are categorized into apathetic, semi-routine, routine, semi-sophisticated, and sophisticated. Aspects of problem solving behaviors are knowledge ownership, control, beliefs, and affective. By improving students' problem-solving behavior, it is expected that students' mathematical problem solving abilities will also improve.

In combat sports, competition preparation is crucial, but research on this topic has been limited due to a lack of measurement tools. This study aimed to develop and validate the Multidimensional Assessment of Preparation for Sport Competition (MAPSC). In the first step, 61 athletes and 39 coaches collaborated to conceptualize and develop preliminary items, resulting in five domains (psychological, physical, emotional, environmental, and informational preparation) and the creation of 52 preliminary items. The second step collected data from 608 student-athletes and utilized exploratory and confirmatory factor analysis to test internal validity. The MAPSC was structured to include five-factors and 25 items. Finally, the correlations between MAPSC, self-management, and sport confidence, as well as differences in MAPSC based on winning experience in national competitions, were tested. In conclusion, MAPSC has been developed and confirmed as a valid measurement for assessing competition preparation strategies in combat sport. Coaches and athletes can use this tool to prepare for competitions systematically and strategically. [ABSTRACT FROM AUTHOR]

End-User Development has been proposed over the years to allow end users to control and manage their Internet of Things-based environments, such as smart homes. With End-User Development, end users are able to create trigger-action rules or routines to tailor the behavior of their smart homes. However, the scientific research proposed to date does not encompass methods that evaluate the suitability of user-created routines in terms of energy consumption. This paper proposes using Machine Learning to build a Digital Twin of a smart home that can predict the energy consumption of smart appliances. The Digital Twin will allow end users to simulate possible scenarios related to the creation of routines. Simulations will be used to assess the effects of the activation of appliances involved in the routines under creation and possibly modify them to save energy consumption according to the Digital Twin's suggestions. [ABSTRACT FROM AUTHOR]

Forensic medicine is a thriving application field for artificial intelligence (AI). Indeed, AI applications intended to forensic pathologists or forensic physicians have emerged since the last decade. For example, AI models were developed to help estimate the biological age of migrants or human remains. However, the uses of AI applications by forensic pathologists or physicians and their levels of integration in medicolegal practices are not well described yet. Therefore, a scoping review was conducted on PubMed, ScienceDirect, and Scopus databases. This review included articles that mention any AI application used by forensic pathologists or physicians in practice or any AI model applied in one expertise field of the forensic pathologist or physician. Articles in other languages than English or French or dealing mainly with complementary analyses handled by experts who are not forensic pathologists or physicians or with AI to analyze data for research purposes in forensic medicine were excluded from this review. All the relevant information was retrieved in each article from a grid analysis derived and adapted from the TRIPOD checklist. This review included 35 articles and revealed that AI applications are developed in thanatology and in clinical forensic medicine. However, those applications seem to mainly remain in research and development stages. Indeed, the use of AI applications by forensic pathologists or physicians is not actual due to issues discussed in this article. Finally, the integration of AI in daily medicolegal practice involves not only forensic pathologists or physicians but also legal professionals. [ABSTRACT FROM AUTHOR]

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Abstract Background Approximately 1% of low back pain is estimated to be caused by serious systemic diseases, including cancer, infection, or abdominal aortic dissection. This study aimed to determine the frequency of execution of non-MSK physical examination procedures among Quebec chiropractors and to identify the clinical context that prompts them to use these physical examination procedures. Methods Cross-sectional survey containing 44 questions administered to a random sample of Quebec chiropractors using a succession of online, postal and phone questionnaires. The 4-part survey questionnaire contained six demographic questions, 28 single-choice questions to determine the frequency of execution of non-MSK physical examination procedures, seven short clinical vignettes for which the respondents had to select the non-MSK examinations that would be required, and two questions inquiring about the proportion of new patients for which participants’ felt non-MSK examinations were necessary and whether appropriate assessments were performed. The questionnaire was pilot tested, and feedback received integrated prior to administration. We conducted descriptive statistics, Pearson correlations, and an ANOVA. Results The survey was completed by 182 chiropractors (response rate: 36.4%). The most commonly non-musculoskeletal examination performed daily were blood pressure (12.1%) and cranial nerves (4.9%). The most common tests never performed were oxygen saturation (68.7%), cardiac auscultation (69.2%), tibio-brachial index (71.4%), breast (86.8%), rectal (96.7%), testicular (95.6%), and vaginal (99.9%) exams. Female chiropractors and Quebec University in Trois-Rivières graduates reported that a significantly higher proportion of their new patients required a non-musculoskeletal physical examination compared to male participants (37.2% vs 28.3%) or Canadian Memorial Chiropractic College graduates (33.9% vs 19.9%). Reason for not performing a physical examination included the belief that another healthcare professional was better positioned to perform and/or interpret the related tests (76.4%). Conclusions Vital signs and cranial nerve examinations were the most frequency performed non-musculoskeletal examinations reported by chiropractors. Apart from the genitourinary exam almost never performed, most participants chose non-musculoskeletal examinations deemed appropriate for the patient’s presentation.

Objectives: The objective of this study was to evaluate the performance of the A.F. Genital System® in the detection of vaginal pathogens in patients with obstetrical and gynecological pathologies. Materials and Methods: A total of 197 vaginal swab samples were collected from patients presenting with various obstetrical and gynecological pathologies. The A.F. Genital System® and vaginal culture/traditional methods were used for pathogen detection. Results: The A.F. Genital System® demonstrated a detection rate of 68% for single vaginal infectious agents, outperforming the vaginal culture/traditional methods (52.8%). However, differences in detection rates were observed for specific pathogens, such as E. coli, Gardnerella vaginalis, Staphylococcus aureus, and Pseudomonas spp. Conclusions: Despite lower sensitivity for specific pathogens, the A.F. Genital System® showed a high correlation with reference tests, suggesting its potential utility as a diagnostic tool for identifying common vaginal pathogens in clinical settings.

Background: Approximately 1% of low back pain is estimated to be caused by serious systemic diseases, including cancer, infection, or abdominal aortic dissection. This study aimed to determine the frequency of execution of non-MSK physical examination procedures among Quebec chiropractors and to identify the clinical context that prompts them to use these physical examination procedures. Methods: Cross-sectional survey containing 44 questions administered to a random sample of Quebec chiropractors using a succession of online, postal and phone questionnaires. The 4-part survey questionnaire contained six demographic questions, 28 single-choice questions to determine the frequency of execution of non-MSK physical examination procedures, seven short clinical vignettes for which the respondents had to select the non-MSK examinations that would be required, and two questions inquiring about the proportion of new patients for which participants' felt non-MSK examinations were necessary and whether appropriate assessments were performed. The questionnaire was pilot tested, and feedback received integrated prior to administration. We conducted descriptive statistics, Pearson correlations, and an ANOVA. Results: The survey was completed by 182 chiropractors (response rate: 36.4%). The most commonly non-musculoskeletal examination performed daily were blood pressure (12.1%) and cranial nerves (4.9%). The most common tests never performed were oxygen saturation (68.7%), cardiac auscultation (69.2%), tibio-brachial index (71.4%), breast (86.8%), rectal (96.7%), testicular (95.6%), and vaginal (99.9%) exams. Female chiropractors and Quebec University in Trois-Rivières graduates reported that a significantly higher proportion of their new patients required a non-musculoskeletal physical examination compared to male participants (37.2% vs 28.3%) or Canadian Memorial Chiropractic College graduates (33.9% vs 19.9%). Reason for not performing a physical examination included the belief that another healthcare professional was better positioned to perform and/or interpret the related tests (76.4%). Conclusions: Vital signs and cranial nerve examinations were the most frequency performed non-musculoskeletal examinations reported by chiropractors. Apart from the genitourinary exam almost never performed, most participants chose non-musculoskeletal examinations deemed appropriate for the patient's presentation. [ABSTRACT FROM AUTHOR]

Existing studies of technology supporting meditation habit formation mainly focus on mobile applications which support users via reminders. A potentially more effective source of motivation could be contextual cues provided by meaningful objects in meaningful locations. This longitudinal mixed-methods 8-week study explored the effectiveness of such an object, Prana, in supporting forming meditation habits among seven novice meditators. First, the Meditation Intentions Questionnaire-24 and the Determinants of Meditation Practice Inventory-Revised were administered. The self-report habit index (SrHI) was administered before and after the study. Prana recorded meditation session times, while daily diaries captured subjective experiences. At the end of the study, the system usability scale, the ten-item personality inventory, and the brief self-control scale were completed, followed by individual semi-structured interviews. We expected to find an increase in meditation frequency and temporal consistency, but the results failed to confirm this. Participants meditated for between 16% and 84% of the study. The frequency decreased with time for four, decreased with subsequent increase for two, and remained stable for one of them. Daily meditation experiences were positive, and the perceived difficulty to start meditating was low. No relevant correlation was found between the perceived difficulty in starting to meditate and meditation experience overall; the latter was only weakly associated with the likelihood of meditating the next day. While meditation became more habitual for six participants, positive scores on SrHI were rare. Despite the inconclusive results, this study provides valuable insights into challenges and benefits of using a meditation device, as well as potential methodological difficulties in studying habit formation with physical devices. [ABSTRACT FROM AUTHOR]

Binge-watching is a phenomenon that involves the action of watching several chapters of a television series in digital format continuously, which produces effects to which students attribute meanings related to their occupational performance patterns. This being so, it is worth asking: What are the meanings that university students attribute to the effect of binge-watching on their occupational performance patterns? To this end, the article examines how this phenomenon occurs from a qualitative approach, collecting intentional data from 13 informants through semi-structured interviews. Identifying categories of analysis regarding the influence of binge-watching in students in their habits, routines, roles, feelings and emotions linked to it. As well as emerging categories such as the influence of COVID-19 on students' social interaction. The article manages to identify that the binge-watching affects in the habits and routines of university students, causing feelings of guilt, on the other hand, facilitates social interaction. It highlights the need to attempt research to understand how binge-watching influences occupational roles in different age ranges. [ABSTRACT FROM AUTHOR]

To establish phenomenologically whether there is an everyday dimension within the "sub-world" of science, this paper builds on Richard Grathoff's conceptual differentiation between "lifeworld" (Lebenswelt), "everyday world" (Alltagswelt), and "daily life" (Alltägliches Leben). Such a clarification is necessary because the notion of "lifeworld" in Husserl's or Schutz' oeuvre is ambiguous. It means both a universal ground and an everyday world. According to Grathoff, the lifeworld is a set of general and structural dimensions of sense that relate subjectivity and world-structure and thereby make possible the constitution of specific "worlds," including the everyday world. The latter, in contrast, exists due to its own cognitive style according to which lifeworldly dimensions become senseful. Still different from the everyday world is daily life, the routinized process through which certain qualities of the various cognitive styles are socially constructed. Grathoff's distinction helps to identify an internal quality within science, which includes, on the one hand, the scientific "daily life" of routine and familiarity, such as basic methods and epistemes, and, on the other hand, needs to be understood in terms of "contextualization" (Strassheim), as a realm of the new and "extraordinary," as in far-reaching theorizing efforts. [ABSTRACT FROM AUTHOR]

The study is a qualitative case study that seeks to determine whether students' mathematical discourses in solving polynomial inequalities are more ritualistic or explorative. A comprehensive analysis of students' routines was conducted through the observations of what they said and did (write, draw, and so on) around task situations in a small group. This study's participants were five 11th-grade students from a public high school. These participants were chosen using the maximum diversity method of sampling. The data for this study were obtained through small-group work. The small-group interactions lasted 80 minutes and were video-recorded with two cameras. The commognitive approach was used to analyze the student routines in this study. The criteria for analyzing routines were the performers' agentivity /external authority, focus on the goal or the procedure, and flexibility. The findings of this study revealed that the students' routines were neither purely ritualistic nor sheer explorative. Even those whose routines were ritualistic in all task situations thought about the procedure and asked logical questions about the task. In addition, the findings indicate that teachers can play an important role in encouraging students to engage in more exploratory mathematical discourse. This study contributes to the future research on students' discourse in the context of inequality. [ABSTRACT FROM AUTHOR]

Usando la prospettiva comognitiva, l’articolo presenta la nozione di profilo di apprendimento matematico e mostra come possa essere identificato attraverso l’analisi di un’intervista. Inoltre, viene esplorata l’ipotesi della modificabilità di tale profilo, nel caso di identità di fallimento, tramite l’implementazione di un percorso di introduzione al pensiero algebrico, progettato per il recupero di difficoltà in matematica. Nello specifico, analizzeremo il caso di Dario, uno studente con una storia di persistenti difficoltà in matematica, frequentante la seconda classe della scuola secondaria di secondo grado.

BACKGROUND: Rapid diagnostic tests (RDTs) that rely on the detection of Plasmodium falciparum histidine-rich protein 2 (PfHRP2) have become key tools for diagnosing P. falciparum infection. The utility of RDTs can be limited by PfHRP2 persistence, however it can be a potential benefit in low transmission settings where detection of persistent PfHRP2 using newer ultra-sensitive PfHRP2 based RDTs can serve as a surveillance tool to identify recent exposure. Better understanding of the dynamics of PfHRP2 over the course of a malaria infection can inform optimal use of RDTs. METHODS: A previously published mathematical model was refined to mimic the production and decay of PfHRP2 during a malaria infection. Data from 15 individuals from volunteer infection studies were used to update the original model and estimate key model parameters. The refined model was applied to a cohort of patients from Namibia who received treatment for clinical malaria infection for whom longitudinal PfHRP2 concentrations were measured. RESULTS: The refinement of the PfHRP2 dynamic model indicated that in malaria naïve hosts, P. falciparum parasites of the 3D7 strain produce 33.6 × 10-15 g (95% CI 25.0-42.1 × 10-15 g) of PfHRP2 in vivo per parasite replication cycle, with an elimination half-life of 1.67 days (95% CI 1.11-3.40 days). The refined model included these updated parameters and incorporated individualized body fluid volume calculations, which improved predictive accuracy when compared to the original model. The performance of the model in predicting clearance of PfHRP2 post treatment in clinical samples from six adults with P. falciparum infection in Namibia improved when using a longer elimination half-life of 4.5 days, with 14% to 67% of observations for each individual within the predicted range. CONCLUSIONS: The updated mathematical model can predict the growth and clearance of PfHRP2 during the production and decay of a mono-infection with P. falciparum, increasing the understanding of PfHRP2 antigen dynamics. This model can guide the optimal use of PfHRP2-based RDTs for reliable diagnosis of P. falciparum infection and re-infection in endemic settings, but also for malaria surveillance and elimination programmes in low transmission areas.

Abstract Objective: To assess the association between child ultra-processed food (UPF) consumption and home-school learning environment characteristics during school closures due to the COVID-19 pandemic in schoolchildren with low- and middle income in Chile. Design: Cross-sectional. UPF consumption was collected using the Nova screener. We apply the structured days hypothesis (SDH) to assess home-school learning environment characteristics with three constructs that summarised school preparedness for online teaching and learning, school closure difficulties for caregivers and child routine. We explored associations between child UPF consumption and home-school environment characteristics using multivariate linear regression analyses after controlling for child demographic and school characteristics. Setting: Low- and middle-income neighbourhoods in southeastern Santiago, Chile. Participants: Children from the Food Environment Chilean Cohort (n 428, 8–10 years old). Results: Based on the Nova score, child mean consumption of UPF was 4·3 (sd 1·9) groups. We found a statistically significant negative association between child routine for eating, play and study and child UPF consumption when we adjusted for child sociodemographic (model 1: β = –0·19, (95 % CI –0·40, 0·02)) and school characteristics (model 2: β = –0·20, (95 % CI –0·41, 0·00)). Associations between school preparedness for online teaching or school closure difficulties and UPF were not statistically significant. Conclusions: Variations in child routines during the COVID-19 pandemic were negatively associated with UPF intake in schoolchildren with low- and middle income. Our findings are consistent with the SDH, suggesting the school environment helps regulate eating behaviours. Future research should evaluate what happens when children return to in-person classes at school.

Chlamydia trachomatis and Neisseria gonorrhoeae are two of the most often reported bacterial infections in the United States. The rectum and oropharynx are important anatomic sites of infection and can contribute to ongoing transmission. Nucleic acid amplification tests (NAATs) are the mainstays for the detection of C. trachomatis and N. gonorrhoeae infections owing to their high sensitivity and specificity. Several NAATs have been evaluated for testing in rectal and pharyngeal infections. A few assays recently received clearance by the Food and Drug Administration, including one point-of-care test. Those assays can be used for testing in symptomatic individuals, as well as for asymptomatic screening in certain patient populations. Routine screening for C. trachomatis in pharyngeal specimens is not recommended by the Centers for Disease Control and Prevention, though it is often performed due to the use of multiplex assays. While expanding the types of settings for screening and using self-collected rectal and pharyngeal specimens can help to increase access and uptake of testing, additional research is needed to determine the potential benefits and costs associated with increased screening for rectal and pharyngeal C. trachomatis and N. gonorrhoeae infections on a population level.

BackgroundAccurate malaria diagnosis and appropriate treatment at local health facilities are critical to reducing morbidity and human reservoir of infectious gametocytes. The current study assessed the accuracy of malaria diagnosis and treatment practices in three health care facilities in rural western Kenya.MethodsThe accuracy of malaria detection and treatment recommended compliance was monitored in two public and one private hospital from November 2019 through March 2020. Blood smears from febrile patients were examined by hospital laboratory technicians and re-examined by an expert microscopists thereafter subjected to real-time polymerase chain reaction (RT-PCR) for quality assurance. In addition, blood smears from patients diagnosed with malaria rapid diagnostic tests (RDT) and presumptively treated with anti-malarial were re-examined by an expert microscopist.ResultsA total of 1131 febrile outpatients were assessed for slide positivity (936), RDT (126) and presumptive diagnosis (69). The overall positivity rate for Plasmodium falciparum was 28% (257/936). The odds of slide positivity was higher in public hospitals, 30% (186/624, OR:1.44, 95% CI = 1.05-1.98, p

An intense level of academic pressure causes students to experience stress, and if this stress is not addressed, it can cause adverse mental and physical effects. Since the pandemic situation, students have received more assignments and other tasks due to the shift of classes to an online mode. Students may not realize that they are stressed, but it may be evident from other factors, including sleep deprivation and changes in eating habits. In this context, this paper presents a novel ensemble learning approach that proposes an architecture for stress level classification. It analyzes certain factors such as the sleep hours, productive time periods, screen time, weekly assignments and their submission statuses, and the studying methodology that contribute to stress among the students by collecting a survey from the student community. The survey data are preprocessed to categorize stress levels into three categories: highly stressed, manageable stress, and no stress. For the analysis of the minority class, oversampling methodology is used to remove the imbalance in the dataset, and decision tree, random forest classifier, AdaBoost, gradient boost, and ensemble learning algorithms with various combinations are implemented. To assess the model's performance, different metrics were used, such as the confusion matrix, accuracy, precision, recall, and F1 score. The results showed that the efficient ensemble learning academic stress classifier gave an accuracy of 93.48% and an F1 score of 93.14%. Fivefold cross-validation was also performed, and an accuracy of 93.45% was achieved. The receiver operating characteristic curve (ROC) value gave an accuracy of 98% for the no-stress category, while providing a 91% true positive rate for manageable and high-stress classes. The proposed ensemble learning with fivefold cross-validation outperformed various state-of-the-art algorithms to predict the stress level accurately. By using these results, students can identify areas for improvement, thereby reducing their stress levels and altering their academic lifestyles, thereby making our stress prediction approach more effective. [ABSTRACT FROM AUTHOR]

Objective: Research shows that cognitively healthy older adults with mild executive function (EF) weaknesses are vulnerable to the negative impacts of life complexity (or daily busyness) when performing instrumental activities of daily living (IADLs). However, past research assessed life complexity only at one timepoint, not capturing daily fluctuations. Importantly, fluctuations in busyness can themselves have deleterious impacts on functioning. This study extended past research by examining whether (1) variability in daily busyness would be more detrimental than level of busyness to performance of IADLs, and (2) EF assessed at home would moderate deleterious impact of busyness on IADLs. Method: Fifty-two community-dwelling older adults aged 60 to 95 completed daily IADL tasks and daily measures of EF and busyness via ecological momentary assessment, independently at home for 18 days. Results: (1) In a subset of participants with mild EF weaknesses, high variability in busyness across days was associated with fewer tasks completed correctly ; and (2) across all participants (regardless of EF), high levels of daily busyness were associated with fewer tasks completed on time. Conclusions: Findings indicate that high variability in daily busyness, potentially reflecting a lack of daily routine, was associated with IADL errors among cognitively healthy older adults with mild EF weaknesses. Additionally, consistently high levels of busyness were associated with failures to complete tasks, or failures to complete them on time, regardless of EF. These results further support the Contextually Valid Executive Assessment (ConVExA) model, which posits that EF and contextual factors interact to predict functional outcomes. [ABSTRACT FROM AUTHOR]

The objective of this proposal is to present a theoretical reflection on the concept of projects absorptive (absorption) capacity and the role of managers' and employees' commitment in the implementation of work routines. The general problem lies in a context of simultaneous project implementation, which can create additional pressure on employees with regard to available resources. The development of a theoretical framework, highlighting project implementation demands, absorptive capacity, routines and commitment, thus leads to the proposal of a three-stage conceptual framework. The first moment represents the project during its implementation. The second moment specifically concerns absorptive capacity as a resource and the final moment highlights the relationship between absorptive capacity and commitment. Ultimately, this theoretical approach attempts to demonstrate that examining the project's absorptive capacity reveals a significant theoretical originality, and that digging deeper into the concepts of commitment and work routines pushes the limits of project management research. [ABSTRACT FROM AUTHOR]

Today, diverse literacies, and mathracy (mathematical literacy) among them, are considered "21st-century skills", indispensable for those who live in the ever-changing reality rife with increasingly sophisticated technology. Findings of research conducted in recent decades in many places around the globe has consistently shown that mathracy is not an automatic result of school learning: even those who manage to master school mathematical discourse do not tend to use this discourse in life. This fact leads to several questions: If we agree that mathracy is a combination of two abilities, the ability to participate in mathematical discourse and the ability to apply this discourse in life activities, why is the first ability not enough to develop the second? What makes school graduates unwilling to resort to mathematical discourse in everyday life? Finally, what are the ways in which it is possible to overcome the obstacles and thereby promote the development of mathracy? The answers to these questions offered in this article are based on a theory, according to which all our moves -- everything we do in various life situations -- is built from routines we have developed over the course of our lives. This claim is reinforced by what can be deduced from what the new neuroscience tells us about our responses to diverse needs and requirements. The article ends with a number of practical tips for teachers who aspire to develop mathracy in their students. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between child ultra-processed food (UPF) consumption and home-school learning environment characteristics during school closures due to the COVID-19 pandemic in schoolchildren with low- and middle income in Chile. Design: Cross-sectional. UPF consumption was collected using the Nova screener. We apply the structured days hypothesis (SDH) to assess home-school learning environment characteristics with three constructs that summarised school preparedness for online teaching and learning, school closure difficulties for caregivers and child routine. We explored associations between child UPF consumption and home-school environment characteristics using multivariate linear regression analyses after controlling for child demographic and school characteristics. Setting: Low- and middle-income neighbourhoods in southeastern Santiago, Chile. Participants: Children from the Food Environment Chilean Cohort (n 428, 8–10 years old). Results: Based on the Nova score, child mean consumption of UPF was 4·3 (sd 1·9) groups. We found a statistically significant negative association between child routine for eating, play and study and child UPF consumption when we adjusted for child sociodemographic (model 1: β = –0·19, (95 % CI –0·40, 0·02)) and school characteristics (model 2: β = –0·20, (95 % CI –0·41, 0·00)). Associations between school preparedness for online teaching or school closure difficulties and UPF were not statistically significant. Conclusions: Variations in child routines during the COVID-19 pandemic were negatively associated with UPF intake in schoolchildren with low- and middle income. Our findings are consistent with the SDH, suggesting the school environment helps regulate eating behaviours. Future research should evaluate what happens when children return to in-person classes at school. [ABSTRACT FROM AUTHOR]

Purpose: To establish the clinical necessity of routine targeted ophthalmic examination of newborns with congenital cytomegalovirus (CMV) infection during the neonatal period. Methods: This retrospective study included consecutive neonates that were referred for ophthalmological screening within the context of a proven congenital CMV infection. The presence of CMV-related ocular and systemic findings was determined. Results: Among the 91 patients included in this study, 72 (79.12%) were symptomatic with one or more of the following manifestations: abnormal brain ultrasound (42; 46.15%), small for gestational age (29; 31.87%), microcephaly (23; 25.27%), thrombocytopenia (14; 15.38%), sensory neural hearing loss (13; 14.29%), neutropenia (12; 13.19%), anemia (4; 4.4%), skin lesions (4; 4.4%), hepatomegaly (3; 3.3%), splenomegaly (3; 3.3%), direct hyperbilirubinemia (2; 2.2%). Not one single neonate in this cohort had any of the ocular findings surveyed. Conclusion: The presence of ophthalmological findings among neonates with congenital CMV infection during the neonatal period is infrequent, suggesting that routine ophthalmological screening may be safely deferred for the post-neonatal period. [ABSTRACT FROM AUTHOR]

BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) surveillance rates are suboptimal in clinical practice. We aimed to elicit providers opinions on the following aspects of HCC surveillance: preferred strategies, barriers and facilitators, and the impact of a patients HCC risk on the choice of surveillance modality. METHODS: We conducted a web-based survey among gastroenterology and hepatology providers (40% faculty physicians, 21% advanced practice providers, 39% fellow-trainees) from 26 US medical centers in 17 states. RESULTS: Of 654 eligible providers, 305 (47%) completed the survey. Nearly all (98.4%) of the providers endorsed semi-annual HCC surveillance in patients with cirrhosis, with 84.2% recommending ultrasound ± alpha fetoprotein (AFP) and 15.4% recommending computed tomography (CT) or magnetic resonance imaging (MRI). Barriers to surveillance included limited HCC treatment options, screening test effectiveness to reduce mortality, access to transportation, and high out-of-pocket costs. Facilitators of surveillance included professional society guidelines. Most providers (72.1%) would perform surveillance even if HCC risk was low (≤0.5% per year), while 98.7% would perform surveillance if HCC risk was ≥1% per year. As a patients HCC risk increased from 1% to 3% to 5% per year, providers reported they would be less likely to order ultrasound ± AFP (83.6% to 68.9% to 57.4%; P < .001) and more likely to order CT or MRI ± AFP (3.9% to 26.2% to 36.1%; P < .001). CONCLUSIONS: Providers recommend HCC surveillance even when HCC risk is much lower than the threshold suggested by professional societies. Many appear receptive to risk-based HCC surveillance strategies that depend on patients estimated HCC risk, instead of our current one-size-fits all strategy.

Most rapid diagnostic tests for Plasmodium falciparum malaria target the Histidine-Rich Proteins 2 and 3 (HRP2 and HRP3). Deletions of the hrp2 and hrp3 genes result in false-negative tests and are a threat for malaria control. A novel assay for molecular surveillance of hrp2/hrp3 deletions was developed based on droplet digital PCR (ddPCR). The assay quantifies hrp2, hrp3, and a control gene with very high accuracy. The theoretical limit of detection was 0.33 parasites/µl. The deletion was reliably detected in mixed infections with wild-type and hrp2-deleted parasites at a density of >100 parasites/reaction. For a side-by-side comparison with the conventional nested PCR (nPCR) assay, 248 samples were screened in triplicate by ddPCR and nPCR. No deletions were observed by ddPCR, while by nPCR hrp2 deletion was observed in 8% of samples. The ddPCR assay was applied to screen 830 samples from Kenya, Zanzibar/Tanzania, Ghana, Ethiopia, Brazil, and Ecuador. Pronounced differences in the prevalence of deletions were observed among sites, with more hrp3 than hrp2 deletions. In conclusion, the novel ddPCR assay minimizes the risk of false-negative results (i.e., hrp2 deletion observed when the sample is wild type), increases sensitivity, and greatly reduces the number of reactions that need to be run.

The hidden curriculum refers to various dimensions of pedagogical activity that concern (professional) knowledge, power relations and the socio-cultural context in which educators operate. The article presents ways in which school counsellors understand the hidden curriculum. The findings of qualitative analysis of interviews with 37 school counsellors are presented. Focus is given to how school counsellors understand the term hidden curriculum, recognise and respond to it. While the results revealed that school counsellors know the basic definitions of the hidden curriculum, deeper analysis of their answers showed this understanding is often incomplete and inadequate. In the future, greater attention should be paid to the extent to which the hidden curriculum is recognised and present in both schools generally and the work of the school counselling service.

BackgroundRapid diagnostic tests (RDTs) play a key role in malaria case management. The most widely used RDT identifies Plasmodium falciparum based on immunochromatographic recognition of P. falciparum histidine-rich protein 2 (PfHRP2). Deletion of the paralogous pfhrp2 and pfhrp3 genes leads to false-negative PfHRP2-based RDTs, and has been reported in P. falciparum infections from South America and Africa. However, identification of pfhrp2/pfhrp3 deletions has usually been based only on failure to amplify these genes using PCR, without confirmation based on PfHRP2 protein expression, and understanding of the true prevalence of deletions is incomplete.MethodsDeletions of pfhrp2/pfhrp3 in blood samples were investigated from cross-sectional surveys in 2012-13 in three regions of varied malaria transmission intensity in Uganda. Samples with positive Giemsa-stained thick blood smears, but negative PfHRP2-based RDTs were evaluated by PCR amplification of conserved subunit ribosomal DNA for Plasmodium species, PCR amplification of pfhrp2 and pfhrp3 genes to identify deletions, and bead-based immunoassays for expression of PfHRP2.ResultsOf 3516 samples collected in cross-sectional surveys, 1493 (42.5%) had positive blood smears, of which 96 (6.4%) were RDT-negative. Of these 96 RDT-negative samples, P. falciparum DNA was identified by PCR in 56 (58%) and only non-falciparum plasmodial DNA in 40 (42%). In all 56 P. falciparum-positive samples there was a failure to amplify pfhrp2 or pfhrp3: in 25 (45%) pfhrp2 was not amplified, in 39 (70%) pfhrp3 was not amplified, and in 19 (34%) neither gene was amplified. For the 39 P. falciparum-positive, RDT-negative samples available for analysis of protein expression, PfHRP2 was not identified by immunoassay in only four samples (10.3%); these four samples all had failure to amplify both pfhrp2 and pfhrp3 by PCR. Thus, only four of 96 (4.2%) smear-positive, RDT-negative samples had P. falciparum infections with deletion of pfhrp2 and pfhrp3 confirmed by failure to amplify the genes by PCR and lack of expression of PfHRP2 demonstrated by immunoassay.ConclusionFalse negative RDTs were uncommon. Deletions in pfhrp2 and pfhrp3 explained some of these false negatives, but most false negatives were not due to deletion of the pfhrp2 and pfhrp3 genes.

BackgroundDespite major reductions in malaria burden across Myanmar, clusters of the disease continue to persist in specific subregions. This study aimed to assess the predictors of test positivity among people living in Paletwa Township of Chin State, an area of persistently high malaria burden.MethodsFour villages with the highest malaria incidence from Paletwa Township were purposively selected. The characteristics of 1045 subjects seeking malaria diagnosis from the four assigned village health volunteers from January to December, 2018 were retrospectively analyzed. Their household conditions and surroundings were also recorded using a checklist. Descriptive statistics and logistic regression models were applied to investigate potential associations between individual and household characteristics and malaria diagnosis.ResultsIn 2017, the Paletwa township presented 20.9% positivity and an annual parasite index of 46.9 cases per 1000 people. Plasmodium falciparum was the predominant species and accounted for more than 80.0% of all infections. Among 1045 people presenting at a clinic with malaria symptoms, 31.1% were diagnosed with malaria. Predictors for test positivity included living in a hut [adjusted odds ratios (a OR): 2.3, 95% confidence intervals (CI): 1.2-4.6], owning farm animals (aOR: 1.7, 95% CI: 1.1-3.6), using non-septic type of toilets (aOR: 1.9, 95% CI: 1.1-8.4), presenting with fever (aOR: 1.9, 95% CI: 1.1-3.0), having a malaria episode within the last year (aOR: 2.9, 95% CI: 1.4-5.8), traveling outside the village in the previous 14 days (aOR: 4.5, 95% CI: 1.5-13.4), and not using bed nets (a OR: 3.4, 95% CI: 2.3-5.1). There were no statistically significant differences by age or gender in this present analysis.ConclusionsThe results from this study, including a high proportion of P. falciparum infections, little difference in age, sex, or occupation, suggest that malaria is a major burden for these study villages. Targeted health education campaigns should be introduced to strengthen synchronous diagnosis-seeking behaviors, tighten treatment adherence, receiving a diagnosis after traveling to endemic regions, and using bed nets properly. We suggest increased surveillance, early diagnosis, and treatment efforts to control the disease and then to consider the local elimination.

BackgroundChildren affected by infectious diseases may not always have a detectable infectious etiology. Diagnostic uncertainty can lead to prolonged hospitalizations, inappropriately broad or extended courses of antibiotics, invasive diagnostic procedures, and difficulty predicting the clinical course and outcome. Cell-free plasma next-generation sequencing (cfNGS) can identify viral, bacterial, and fungal infections by detecting pathogen DNA in peripheral blood. This testing modality offers the ability to test for many organisms at once in a shotgun metagenomic approach with a rapid turnaround time. We sought to compare the results of cfNGS to conventional diagnostic test results and describe the impact of cfNGS on clinical care in a diverse pediatric population at a large academic children's hospital.MethodsWe performed a retrospective chart review of hospitalized subjects at a tertiary pediatric hospital to determine the diagnostic yield of cfNGS and its impact on clinical care.ResultsWe describe the clinical application of results from 142 cfNGS tests in the management of 110 subjects over an 8-month study period. In comparison to conventional testing as a reference standard, cfNGS was found to have a positive percent agreement of 89.6% and negative percent agreement of 52.3%. Furthermore, 32.4% of cfNGS results were directly applied to make a clinical change in management.ConclusionsWe demonstrate the clinically utility of cfNGS in the management of acutely ill children. Future studies, both retrospective and prospective, are needed to clarify the optimal indications for testing.

Rapid and accurate pathogen identification is necessary for appropriate treatment of pneumonia. Here, we describe the use of shotgun metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage for pathogen identification in pneumonia in a large-scale multicenter prospective study with 159 patients enrolled. The results of mNGS were compared with standard methods including culture, staining, and targeted PCR, and the clinical impact of mNGS was evaluated. A positive impact was defined by a definitive diagnosis made using the mNGS results, or change of management because of the mNGS results, leading to a favorable clinical outcome. Overall, mNGS identified more organisms than standard methods (117 versus 72), detected 17 pathogens that consistently were missed in all cases by standard methods, and had an overall positive clinical impact in 40.3% (64 of 159) of cases. mNGS was especially useful in identification of fastidious and atypical organisms causing pneumonia, contributing to detection of definitive pathogens in 45 (28.3%) cases in which standard results were either negative or insufficient. mNGS also helped reassure antibiotic de-escalation in 19 (11.9%) cases. Overall, mNGS led to a change of treatment in 59 (37.1%) cases, including antibiotic de-escalation in 40 (25.2%) cases. This study showed the significant value of mNGS of bronchoalveolar lavage for improving the diagnosis of pneumonia and contributing to better patient care.

BackgroundDetection of galactomannan (GM) from bronchoalveolar lavage fluid (BALF) or serum is broadly used for diagnosis of invasive aspergillosis (IA), although the sensitivity of GM from serum is lower in non-neutropenic patients. We evaluated the Aspergillus galactomannan Lateral Flow assay (LFA) with digital readout from serum in a mixed cohort of patients.MethodsWe performed a retrospective two-centre study evaluating the LFA from serum of patients with clinical suspicion of IA obtained between 2015 and 2021 at the University of California San Diego and the Medical University of Graz. The sensitivity and specificity was calculated for proven/probable aspergillosis versus no aspergillosis. Correlation with same-sample GM was calculated using Spearman correlation analysis and kappa statistics.ResultsIn total, 122 serum samples from 122 patients were analysed, including proven IA (n = 1), probable IA or coronavirus-associated pulmonary aspergillosis (CAPA) (n = 27), and no IA/CAPA/non-classifiable (n = 94). At a 0.5 ODI cut-off, the sensitivity and specificity of the LFA was 78.6% and 80.5%. Spearman correlation analysis showed a strong correlation between serum LFA ODI and serum GM ODI (ρ 0.459, p

End-User Development has been proposed over the years to allow end users to control and manage their Internet of Things-based environments, such as smart homes. With End-User Development, end users are able to create trigger-action rules or routines to tailor the behavior of their smart homes. However, the scientific research proposed to date does not encompass methods that evaluate the suitability of user-created routines in terms of energy consumption. This paper proposes using Machine Learning to build a Digital Twin of a smart home that can predict the energy consumption of smart appliances. The Digital Twin will allow end users to simulate possible scenarios related to the creation of routines. Simulations will be used to assess the effects of the activation of appliances involved in the routines under creation and possibly modify them to save energy consumption according to the Digital Twin’s suggestions.

This paper examines the emergence of temporal coordination among multiple interdependent routines in a complex work setting that does not allow for up-front scheduling. We propose that when actors continuously have to prioritize their expected contributions to multiple interdependent routines, they address this challenge by orienting not just toward routines but also toward person-roles. Drawing on an ethnographic study of an agile consulting project team confronted with continued scheduling failures, we demonstrate how the dynamics of prioritizing enabled the actors to resolve what at first appeared to be an irresolvable and highly complex problem of temporal coordination. We add to the literature on routine dynamics and temporality by setting forth the dynamics of prioritizing as an explanation for the temporal patterning of complex work settings. We introduce the notion of role–routine ecologies as a novel way to conceptualize such complex work settings and contribute to developing a performative theory of person-roles and their significance for coordinating. [ABSTRACT FROM AUTHOR]