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Purpose of review: As many physicians include screening ECGs for sports clearance of young athletes, the question arises: who should interpret these ECGs? We provide an overview of who currently interprets these ECGs and offer insight on how to improve this process. Recent findings: Wide variation in training in interpretation of ECGs exists among the providers interpreting screening ECGs of young athletes. The International Criteria is effective at identifying risk and reducing false positives when interpreting ECGs in athletes 12–35 years old, but no standardized training/certification requirements exist. Data is lacking for the use of the International Criteria in athletes outside of these ages. Summary: We propose that licensed physicians with competency utilizing the International Criteria should interpret ECGs in young athletes ages 12–35 years old. It is reasonable to require training/certification as evidence of competency. Patients < 12 or > 35 years old should be considered on a case-by-case basis. Future studies may expand the age parameters. The advancement and use of automated ECG interpretation software and artificial intelligence have the potential to make ECG screening more accurate, cost-effective, and available. [ABSTRACT FROM AUTHOR]

This study aims to investigate the feasibility of establishing international capital budgeting Criteria (ICBC) that are more suitable for international companies in making investment decisions (ID). It highlights the equations related to measuring the results of international capital budgeting (CB) Criteria that contribute to achieving and predicting future cash flows. The research sample consisted of analysts, investors, academics, financial managers, and individuals interested in foreign investments and financial data analysis across various service contract fields. The researcher distributed 343 valid survey forms for analysis. The questionnaire included a set of paragraphs and questions, and the data were collected and categorized using the statistical software (SPSS 24). The study concludes that ICBC based on discounted cash flows (DCF) are preferred measures for making optimal ID in the Iraqi environment. [ABSTRACT FROM AUTHOR]

Objective: Because the International left atrial enlargement electrocardiographic (ECG) screening criteria (ECG-LAE) for athletes are rarely fulfilled in young athletes, we compared it with evidence-based criteria from a recent clinical outcome study of ECG left atrial abnormality (ECG-LAA). Design: Retrospective analyses. Setting: Routine preparticipation ECG screening in California. Participants: Four thousand four hundred thirty-eight young individuals (18.5 ± 5.4 years, 40% women). Assessment of Risk Factors: The International criteria for ECG-LAE were applied: prolonged P wave duration of ≥120 ms in leads I or II AND negative portion of ≥1mmin depth in lead V1. This was compared with Stanford criteria for ECG-LAA: prolonged P wave duration of ≥140 ms odds ratio (OR) negative portion in V1 and V2 greater than 1 mm. Main Outcome Measures: Differences in the classification of abnormal ECGs between the 2 criteria applied to the same population of young athletes. Results: Only 33 (0.7%) of our subjects fulfilled the International criteria for ECG-LAE while 110 (2.5%) fulfilled the ECG-LAA criteria. Adding our new ECG-LAA criterion and considering it a major criterion raised the abnormal ECG prevalence and athletes referred for further evaluation from 2.9% to 4.4%. Conclusions: The Stanford evidence-based criterion for ECG-LAA incorporating V2 and replacing "or" for "and" regarding P wave duration increased the yield of abnormal classification for P waves. Future follow-up studies are needed to confirm that this new criterion should be included in future ECG screening consensus documents. [ABSTRACT FROM AUTHOR]

External evaluation has a critical function to promote quality. In this study, the Turkish Higher Education System's teaching quality was examined through multiple perspectives. For this purpose, the institutional external evaluation reports prepared for 115 higher education institutions in Turkey were analyzed according to the International Quality Assurance Standards, National Institutional External Criteria, and the literature's quality indicators. The content analyses, which were conducted independently by the researchers, were compared to derive the findings. findings revealed findings revealed a lack of conceptual components, accountability, and detailed submission reports in terms of reporting. The analysis concluded that the input dimension was prioritized, whereas the process and output dimensions were neglected in the external evaluation criteria. Three different quality indicators revealed that the level of quality teaching in Turkish higher education was low. The implications were developed to promote quality teaching.

Evidence has emerged that internal mammary chain (IMC) radiotherapy reduces breast cancer mortality, leading to changes in treatment guidelines. This study investigated current IMC radiotherapy criteria and the percentages of patients irradiated for breast cancer in England who fulfilled them. A systematic search was undertaken for national guidelines published in English during 2013–2018 presenting criteria for 'consideration of' or 'recommendation for' IMC radiotherapy. Patient and tumour variables were collected for patients who received breast cancer radiotherapy in England during 2012–2016. The percentages of patients fulfilling criteria stipulated in each set of guidelines were calculated. In total, 111 729 women were recorded as receiving adjuvant breast cancer radiotherapy in England during 2012–2016 and full data were available on 48 095 of them. Percentages of patients fulfilling IMC radiotherapy criteria in various national guidelines were: UK Royal College of Radiologists 13% (6035/48 095), UK National Institute for Health and Care Excellence 18% (8816/48 095), Germany 32% (15 646/48 095), Ireland 56% (26 846/48 095) and USA 59% (28 373/48 095). Differences between countries occurred because in Ireland and the USA, treatment may be considered in some node-negative patients, whereas in the UK, treatment is considered if at least four axillary nodes are involved or for high-risk patients with one to three positive nodes. In Germany, treatment may be considered for all node-positive patients. There is substantial variability between countries in criteria for consideration of IMC radiotherapy, despite guidelines being based on the same evidence. This will probably lead to large variations in practice and resource needs worldwide. • Criteria for consideration of IMC RT vary substantially between countries. • IMC RT may be considered for ∼13–18% in the UK (high-risk N+ disease). • A third of patients for breast cancer radiotherapy have node-positive disease. • IMC RT may be considered for up to 60% in the US (includes high-risk N0 disease). [ABSTRACT FROM AUTHOR]

Copyright of Dirasat: Educational Sciences is the property of University of Jordan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of SSEM-Journal is the property of Schwiez Zschr Sportmed Sporttraumatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper has aimed to evaluate and analyze the Iranian English textbook as the material for students in second year of middle schools by taking the opinions of English teachers into account. The research was done by administering a standard questionnaire to 60 English teachers. The researchers evaluated and analyzed the textbook via different ideas about the book from English teachers. The collected data were analyzed by Chi Square. The data analysis revealed that the hypotheses of the study are proved. The results indicated that the textbook did not conform to international criteria; and also the teachers’ ideas were totally negative about the textbook.

Copyright of Medicina Sportiva Bohemica et Slovaca is the property of Ceska spolecnost telovychovneho lekarstvi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The recent proceedings of congresses and forums on sepsis were used to write this review. The available definitions of sepsis and ideas on its etiology and pathogenesis are critically analyzed. There is information on new concepts of sepsis and data on a search for new targets, diagnostic and therapeutic approaches, and biomarkers. It is hypothesized that there is a mechanism of action of bacteria on mitochondrial dysfunction and human hormonal regulation with low-molecular weight exometabolites, namely aromatic microbial metabolites.

Purpose: To validate the international criteria for the diagnosis of ocular sarcoidosis as proposed by the First International Workshop on Ocular Sarcoidosis (FIWOS). Methods: A retrospective case-control study examined 370 consecutive uveitis patients at Tokyo Medical and Dental University Hospital. The study group consisted of 50 patients with biopsy-proven sarcoidosis and 320 control patients with other uveitis entities. Predictive values [sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)] were calculated for seven clinical signs, five laboratory tests, and the diagnostic criteria. Results: With the exception of the liver enzyme tests, there was a significantly higher incidence of positive results for all clinical signs and laboratory tests in the biopsy-proven sarcoidosis patients than in the control uveitis patients. Although variability was noted in the predictive values of the seven clinical signs and five laboratory tests, the sensitivity, specificity, PPV, and NPV of the FIWOS criteria, which were based on the combined results of the clinical signs and laboratory tests, were 1.000, 0.956, 0.781, and 1.000, respectively. Conclusions: The FIWOS criteria have high predictive values for diagnosing ocular sarcoidosis. To further confirm these findings, an international prospective multicenter study should be undertaken in the future. [ABSTRACT FROM AUTHOR]

From a large series of 1009 probands with pathogenic FBN1 mutations, data for 320 patients <18 years of age at the last follow-up evaluation were analyzed (32%). At the time of diagnosis, the median age was 6.5 years. At the last examination, the population was classified as follows: neonatal Marfan syndrome, 14%; severe Marfan syndrome, 19%; classic Marfan syndrome, 32%; probable Marfan syndrome, 35%. Seventy-one percent had ascending aortic dilation, 55% ectopia lentis, and 28% major skeletal system involvement. Even when aortic complications existed in childhood, the rates of aortic surgery and aortic dissection remained low (5% and 1%, respectively). Some diagnostic features (major skeletal system involvement, striae, dural ectasia, and family history) were more frequent in the 10- to <18-year age group, whereas others (ascending aortic dilation and mitral abnormalities) were more frequent in the population with neonatal Marfan syndrome. Only 56% of children could be classified as having Marfan syndrome, according to international criteria, at their last follow-up evaluation when the presence of a FBN1 mutation was not considered as a major feature, with increasing frequency in the older age groups. Eighty-five percent of child probands fulfilled international criteria after molecular studies, which indicates that the discovery of a FBN1 mutation can be a valuable diagnostic aid in uncertain cases. The distributions of mutation types and locations in this pediatric series revealed large proportions of probands carrying mutations located in exons 24 to 32 (33%) and in-frame mutations (75%). Apart from lethal neonatal Marfan syndrome, we confirm that the majority of clinical manifestations of Marfan syndrome increase with age, which emphasizes the poor applicability of the international criteria to this diagnosis in childhood and the need for follow-up monitoring in cases of clinical suspicion of Marfan syndrome. [ABSTRACT FROM AUTHOR]

Primary care clinicians fulfill critical roles of screening for, diagnosing, and managing cardiovascular disease. In young athletes, primary structural and electrical diseases are the focus. Coronary artery disease is the chief concern in older athletes. Sudden cardiac arrest may be the initial presentation of disease and is more common in young athletes than historically appreciated. The traditional preparticipation evaluation, or sports physical, is limited in its ability to accurately raise suspicion of underlying disease. The 12-lead electrocardiogram is a more accurate screening tool. Contemporary risk stratification and treatment protocols may allow for safe return to sport on a case-by-case basis., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To identify electrocardiographic findings, especially deep Q and S waves in lead III, that differentiate athletes from patients with hypertrophic cardiomyopathy (HCM)., Methods: Digital ECGs of athletes and patients with HCM followed at the Stanford Center for Inherited Cardiovascular Disease were studied retrospectively. All patients with HCM had an echocardiogram performed. A multivariable logistic regression model was used to calculate ORs for various demographic and ECG characteristics. Linear regression was used to correlate ECG characteristics with echocardiogram findings., Results: We studied 1124 athletes and 240 patients with HCM. The average Q+S wave amplitude in lead III (III Q+S ) was significantly higher in patients with HCM compared with athletes (0.71±0.69 mV vs 0.21±0.17 mV, p<0.001). In patients with HCM, III Q+S directly correlated with interventricular septal (IVS) thickness on echocardiography (ρ=0.45, p<0.001). In a multivariable analysis adjusted for demographic and ECG characteristics, higher III Q+S values remained independently associated with HCM compared with athletes (OR=4.2 per 0.5 mV, p<0.001). In subgroup analyses of young patients, African-American subjects and subjects without left axis deviation (LAD), III Q+S remained associated with HCM. The addition of III Q+S >1.0 mV as an abnormal finding to the International Criteria for athletic ECG interpretation improved sensitivity from 64.2% to 70.4%, with a minimal decrease in specificity., Conclusion: Large Q and S waves in lead III distinguished athletes from patients with HCM, independent of axis and well-known ECG markers associated with HCM. The correlation between IVS thickness in patients with HCM and III Q+S suggests a partial explanation for this association., Competing Interests: Competing interests: VF: Partial owner, Cardiac Insight (Seattle, Washington). This company develops advanced body-worn sensing and computing technologies for cardiac diagnostics that uniquely enhance clinical efficacy. One of their products is the Cardea 20/20 ECG, which is designed to assess the cardiac risk evaluation of young athletes. EA: Founder, Personalis (Menlo Park, California). This company focuses on advanced genomic sequencing and analytics solutions to support the development of personalised therapeutics., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aim: To study the clinical and laboratory characteristics of autoimmune hepatitis (AIH), and compare them with International Autoimmune Hepatitis Group (IAHG) criteria., Methods: Sixty consecutive patients with AIH attended the University Clinic at Tabriz University of Medical Sciences, Iran for a 12 mo period and were assessed in a case series study. Serological and biochemical evaluations were carried out in all patients. Autoantibodies, such as antinuclear antibody (ANA), anti-smooth muscle antibody (ASMA), anti-liver-kidney microsomal antibody (ALKM-1) type 1, and perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) were evaluated in these patients. A liver biopsy was performed after diagnosis of the disease. Patients were evaluated in terms of their signs and symptoms, and laboratory results and the degree to which they corresponded with the diagnostic criteria of IAHG. In this study, both a comprehensive diagnostic scoring system and a simplified diagnostic scoring system were employed for AIH., Results: Sixty patients, 20 male, 40 female, mean age 39.45 ± 17.50 years, participated in the study. Treatment began immediately after enrolment into the study. The percent distribution of the study population into definite and probable did not change after the treatment. The most common symptoms in descending order were fatigue (100%), icter (66.7%), abdominal discomfort (33.3%), abdominal distension (28.3%), dark urine (23.3%), edema (23.3%), hematemesis (20.0%), pruritus (20.0%), melena (11.7%) and pale stool (10.0%). At the physical examination, splenomegaly, ascites, hepatomegaly, epigastric tenderness and an abdominal mass were found in 50.0%, 16.7%, 13.3%, 5.0% and 3.3% of patients, respectively. Hypergammaglobulinemia was detected in 95.0% of cases. ALKM-1, P-ANCA, ANA and ASMA were positive in 71.4%, 66.7%, 42.4% and 19.4% of cases, respectively. Portal hypertensive gastropathy (45.0%), esophageal varices (41.7%) and cirrhosis (40.0%) were the most prevalent complications of AIH, and there was no evidence of primary sclerosing cholangitis, ulcerative colitis and overlap syndrome in these patients. According to IAHG criteria, 80.0% of cases had a definite diagnosis, 15.0% had a probable diagnosis and 5.0% had no AIH. The percent distribution of the study population into definite, probable and no AIH did not change after using the simplified diagnostic scoring system for AIH., Conclusion: This research showed that the majority of cases in our study were appropriately diagnosed according to the IAHG criteria and simplified scoring system. Thus, these criteria are very useful.