Anthropometric Characteristics, Training Intensity Distribution, Physiological Profile and Performance of an Elite Trail Runner: A Longitudinal Case Study / Características Antropométricas, Distribución de la Intensidad del Entrenamiento, Perfil Fisiológico y Rendimiento de un Corredor de Montaña de Élite: Un Estudio de Caso Longitudinal

SUMMARY: Trail running (TR), an extreme endurance sport, presents unique challenges due to the variety of terrain and distances, where physiological capacity and body composition have been considered better predictors of performance. This longitudinal case study examines the impact of training intensity distribution (TID) on an elite trail runner's physiological profile and performance over four years. Two TID models were implemented: polarized (POL) and pyramidal (PYR). Physiological assessments included maximal oxygen consumption (VO2max), lactate thresholds (LT1 and LT2), and anthropometric characteristics. The training was classified according to the 3-zone intensity model (zone 1: below the first lactate threshold; zone 2: between the first and second lactate threshold; zone 3: above the second lactate threshold). During the four years, the average TID distribution was 75 % zone 1, 18 % zone 2, and 7 % zone 3. Physiological capacity increased by 7.14 % (14 to 15 km/h) for velocity at LT1 (vLT1) and 8.13 % (16 to 17.3 km/h) for velocity at LT2 (vLT2). The most significant increases were observed during the second year when the percentage of training time in zone 1 was lower (65 %) and in zone 2 greater (30 %) than those reported in other years. Consequently, vLT1 and vLT2 increased by 3.5 % (from 14.1 to 14.6 km/h) and 3.6 % (from 16.5 to 17.1 km/h), respectively. In conclusion, this case study revealed that emphasizing training in zone 2 (moderate intensity) and increasing the training load significantly improved performance at lactate thresholds. Despite modifying body composition, no influence on improving endurance performance was observed. These findings underscore the importance of TID in elite trail runners and highlight the potential to optimize physiological adaptations and performance outcomes.

Trail running (TR), un deporte de resistencia extrema, presenta desafíos únicos debido a la variedad de terrenos y distancias, donde la capacidad fisiológica y la composición corporal se han considerado mejores predictores del rendimiento. Este estudio de caso longitudinal examina el impacto de la distribución de la intensidad del entrenamiento (TID) en el perfil fisiológico y el rendimiento de un corredor de montaña de élite durante cuatro años. Se implementaron dos modelos TID: polarizado (POL) y piramidal (PYR). Las evaluaciones fisiológicas incluyeron el consumo máximo de oxígeno (VO2max), los umbrales de lactato (LT1 y LT2) y las características antropométricas. El entrenamiento se clasificó según el modelo de intensidad de 3 zonas (zona 1: por debajo del primer umbral de lactato; zona 2: entre el primer y segundo umbral de lactato; zona 3: por encima del segundo umbral de lactato). Durante los cuatro años, la distribución TID promedio fue 75 % zona 1, 18 % zona 2 y 7 % zona 3. La capacidad fisiológica aumentó un 7,14 % (14 a 15 km/h) para la velocidad en LT1 (vLT1) y un 8,13 % (16 a 17,3 km/h) para velocidad en LT2 (vLT2). Los incrementos más significativos se observaron durante el segundo año cuando el porcentaje de tiempo de entrenamiento en la zona 1 fue menor (65 %) y en la zona 2 mayor (30 %) que los reportados en otros años. En consecuencia, vLT1 y vLT2 aumentaron un 3,5 % (de 14,1 a 14,6 km/h) y un 3,6 % (de 16,5 a 17,1 km/h), respectivamente. En conclusión, este estudio reveló que enfatizar el entrenamiento en la zona 2 (intensidad moderada) y aumentar la carga de entrenamiento mejoró significativamente el rendimiento en los umbrales de lactato. A pesar de modificar la composición corporal, no se observó influencia en la mejora del rendimiento de resistencia. Estos hallazgos subrayan la importancia del TID en los corredores de trail de élite y resaltan el potencial para optimizar las adaptaciones fisiológicas y los resultados de rendimiento.

Color matching and color recovery in large composite restorations using single-shade or universal composites

Abstract This study assessed the color-matching ability and color recovery of unprepared teeth when using single-shade composites and a universal composite in large restorations. Buccal and palatine surface colors of molars were measured with a spectrophotometer (CIELAB) before preparing round cavities (6 mm in diameter, 2 mm in depth). The cavities were randomly filled with a single-shade composite (Omnichroma, Diamond One, or Vittra APS Unique) or a universal composite (Filtek Universal). Color measurements of the restored cavities were taken, and overall color differences (ΔEab and ΔE00) and differences in the whitening index for dentistry (ΔWID) from baseline were calculated. Additionally, visual assessments of a color match to the surrounding enamel were performed by forty evaluators (laypersons and undergraduate students of dentistry) in a viewing booth under illuminant D65, with rating scores from 0 (no color mismatch) to 4 (not acceptable). Data were analyzed using RM or one-way ANOVA (α = 0.05). Results showed that the restorations generally exhibited whiter colors (WID ranged from 27.9 to 41.3) than the unprepared teeth (WID ranged from 15.9 to 19.3). The composite Filtek Universal demonstrated the lowest color discrepancy (ΔWID = 8.6; ΔE00 = 10.8; and ΔE00 = 6.2), and no significant differences were observed among the evaluated single-shade composites. Furthermore, all composites showed similar and adequate color matches to the surrounding enamel. However, it is important to note that despite their ability to match the surrounding enamel reasonably, none of the composites evaluated in large restorations fully recovered the color observed in unprepared teeth.

Resumo Este estudo avaliou a habilidade de combinação de cores e recuperação de cor de dentes não preparados ao utilizar resinas compostas de única tonalidade e uma resina composta universal em grandes restaurações. As cores das superfícies bucais e palatinas de molares foram medidas com um espectrofotômetro (CIELAB) antes de preparar cavidades esféricas (6 mm de diâmetro, 2 mm de profundidade). As cavidades foram preenchidas aleatoriamente com uma resina composta de única tonalidade (Omnichroma, Diamond One ou Vittra APS Unique) ou com uma resina composta universal (Filtek Universal). Foram realizadas medições das cores das cavidades restauradas e calculadas as diferenças de cor globais (ΔEab and ΔE00)) e as diferenças no índice de clareamento para odontologia (ΔWID) em relação à cor inicial. Além disso, foram realizadas avaliações visuais da correspondência de cor com o esmalte circundante por quarenta avaliadores (leigos e estudantes de odontologia) em uma cabine de visualização sob iluminante D65, com pontuações de 0 (nenhuma discrepância de cor) a 4 (não aceitável). Os dados foram analisados usando RM ou ANOVA unidirecional (α = 0,05). Os resultados mostraram que as restaurações geralmente apresentavam cores mais brancas (WID variou de 27,9 a 41,3) do que os dentes não preparados (WID variou de 15,9 a 19,3). A resina composta Filtek Universal demonstrou a menor discrepância de cor (ΔWID = 8,6; ΔE00 = 10,8; and ΔE00 = 6,2), e não foram observadas diferenças significativas entre as resinas compostas de única tonalidade avaliadas. Além disso, todas as resinas compostas apresentaram correspondência de cor similar e adequada com o esmalte circundante. No entanto, é importante observar que, apesar de sua capacidade de corresponder razoavelmente com o esmalte circundante, nenhuma das resinas compostas avaliadas em grandes restaurações recuperou completamente a cor observada nos dentes não preparados.

Surrounding and background shades effect on color adjustment of single-shade composites

Abstract This study evaluated the effects of surrounding and background shades on the color adjustment potential (CAP) and visual color match of two single-shade composites, Vittra APS Unique and Charisma Diamond One. Cylinder-shaped specimens were constructed, consisting of either single-shade composites alone (simple) or composites surrounded by the Forma material at shades A1 or A3 (dual). Simple specimens using only the Forma at the specified shades were also prepared. Color measurements of simple specimens were taken against a gray background using a spectrophotometer. For dual specimens, the color of the inner composite was measured against a gray or chromatic (the same shade as the outer composite) background. Color differences (ΔE00) between the single-shade composites and the A1/A3 composite were calculated. CAP was determined by comparing data from simple and dual specimens. Four experienced dentists scored the color match (perfect to unacceptable) for each specimen using a viewing booth illuminated by an illuminant D65. Data were analyzed with repeated-measures ANOVA and the Kruskal-Wallis test. The results showed that both single-shade composites showed the lowest color discrepancies when they were compared to A1 and A3. Using a chromatic background only significantly affected the CAP when the outer composite was A3. The visual analysis showed poor color matches between the single-shade and control chromatic composites, except for Charisma Diamond One surrounded by A1. In conclusion, the CAP values of the evaluated single-shade composites were impacted by both surrounding shade and background color, and the color match of these materials tended to be poor.

Resumo Este estudo avaliou os efeitos da cor do entorno e do fundo no potencial de ajuste de cor (PAC) e na correspondência visual de cor de dois compósitos monocromáticos, Vittra APS Unique e Charisma Diamond One. Amostras em formato cilíndrico foram criadas utilizando os compósitos monocromáticos e de cor A1/A3. Algumas amostras dos compósitos monocromáticos foram circundadas pelos compósitos A1 ou A3, formando amostras duplas. Medidas de cor das amostras simples foram obtidas em um fundo cinza utilizando um espectrofotômetro. Para as amostras duplas, a cor do compósito interno foi medida em um fundo cinza ou cromático (com a mesma cor do compósito externo). As diferenças de cor (ΔE00) entre os compósitos de monocromáticos e os compósitos A1/A3 foram calculadas. O PAC foi determinado comparando os dados das amostras simples e duplas. Quatro dentistas experientes avaliaram a correspondência de cor (de perfeita a inaceitável) para cada espécime utilizando uma cabine de visualização iluminada por uma iluminante D65. Dados foram analisados por ANOVA de medidas repetidas e teste de Kruskal-Wallis test. Os resultados mostraram que ambos os compósitos monocromáticos apresentaram as menores discrepâncias de cor quando comparados a A1 que em relação a A3. O uso de um fundo cromático afetou significativamente o PAC apenas quando o compósito externo era A3. A análise visual mostrou correspondência de cor fraca entre os compósitos monocromáticos e os compósitos cromáticos de controle, com exceção do Charisma Diamond One circundado por A1. Em conclusão, os valores de PAC dos compósitos monocromáticos avaliados foram impactados tanto pela cor do entorno quanto pela cor de fundo, e a correspondência visual de cor desses materiais tendeu a ser ruim.

Reliability across content areas in progress tests assessing medical knowledge: a Brazilian cross-sectional study with implications for medical education assessments

ABSTRACT BACKGROUND: Brazilian medical schools equitably divide their medical education assessments into five content areas: internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. However, this division does not follow international patterns and may threaten the examinations' reliability and validity. OBJECTIVE: To assess the reliability indices of the content areas of serial, cross-institutional progress test examinations. DESIGN AND SETTINGS: This was an analytical, observational, and cross-sectional study conducted at nine public medical schools (mainly from the state of São Paulo) with progress test examinations conducted between 2017 and 2023. METHODS: The examinations covered the areas of basic sciences, internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. We calculated reliability indices using Cronbach's α, which indicates the internal consistency of a test. We used simple linear regressions to analyze temporal trends. RESULTS: The results showed that the Cronbach's α for basic sciences and internal medicine presented lower values, whereas gynecology, obstetrics, and public health presented higher values. After changes in the number of items and the exclusion of basic sciences as a separate content area, internal medicine ranked highest in 2023. Individually, all content areas except pediatrics remained stable over time. CONCLUSIONS: Maintaining an equitable division in assessment content may lead to suboptimal results in terms of assessment reliability, especially for internal medicine. Therefore, content sampling of medical knowledge for general assessments should be reappraised.

IMPACT OF LEADER'S INVOLVEMENT IN AGILE MATURITY ASSESSMENTS

Agile is the way we look at things happening around us. Agile is a behavior pattern, how you look at the world's complex situations, how you react to situations, how you visualize a solution, how you reach the solution. You can either think of a complex problem or a situation and worry about it or you break that into meaningful small chinks & try to solve it. Agile adds that fun element of tackling smaller challenges systematically. As we move from the traditional hierarchical working to self-managing and agility, it is evident for teams to see the radical shift in people's day-to-day behaviors. These new ways of working bring in an increased sense of ownership, proactive, open communication, accepting failures, and more importantly trust and transparency among team members. Agile maturity assessments are tools or processes used to evaluate and measure an organization's or team's level of agility and their effectiveness in implementing Agile principles and practices. These assessments help identify areas of strength and improvement, enabling organizations to enhance their Agile adoption and transformation journey

Understanding Clinical Competence: Understanding Student Assessment

The extent, purpose, and model of performance assessment should be guided by our understanding of clinical competence. We have come a long way from believing that competence is generic, fixed, and transferable across contents; to viewing competence as dynamic, incremental, contextual, and non-transferable. However, our pattern of assessment largely remains what it was many years ago. Contemporary educationists view competency assessment as different from traditional format. They place more emphasis on the role of expert subjective judgment, especially for performance and domain-independent competencies. Such assessments have conclusively shown their validity, reliability, and utility. They; however, require trained assessors, trust between the teachers and the taught, and above all, a political and administrative will for implementation.

Identificando las trayectorias de cambio terapéutico en psicoterapia breve en pacientes chilenos / Identifying trajectories of therapeutic change in brief psychotherapy in Chilean outpatients

Antecedentes: identificar subgrupos de pacientes que demuestren diferentes trayectorias de cambio terapéutico durante psicoterapia en contextos realistas es relevante para el desarrollo de procesos terapéuticos personalizados y efectivos. Objetivos: El presente estudio tuvo como objetivos (a) identificar trayectorias de cambios terapéutico en pacientes chilenos (b) explorar variables que puedan predecir la probabilidad de pertenecer a ciertas trayectorias y (c) examinar si estas diferentes trayectorias desembocan en distintos resultados terapéuticos. Método: se llevaron a cabo análisis de modelos de crecimientos mixto (Growth Mixture Modeling - GMM) y regresiones logísticas multinominales en una muestra de 400 pacientes chilenos recibiendo psicoterapia en un centro de salud mental privado. Resultados: se identificaron tres trayectorias de cambio terapéutico (a) disfunción inicial moderada con leve deterioro, (b) disfunción inicial leve con cambio favorable y (c) disfunción inicial severa con rápido cambio favorable. La edad de los pacientes fue considerada un factor predictor de trayectoria significativa, sugiriendo una peor prognosis para pacientes de mayor edad. Además, todas las trayectorias fueron predictoras del resultado terapéutico. Conclusiones: estos resultados pueden ser utilizados para desarrollar intervenciones enfocadas en el paciente, basadas en las trayectorias de cambio que exhiban.

Background: Identifying subgroups of patients that may show distinct trajectories of change during psychotherapy in realistic settings is relevant for the development of personalized therapeutic processes. Aims: The present study sought to (a) identify trajectories of change in Chilean patients; (b) explore variables that may predict the likelihood of belonging to certain trajectories; and (c) examine whether these different trajectories result in differences in treatment outcomes. Method: Growth mixture modeling (GMM) and multinomial logistic regression analysis were carried out on the data of 400 patients receiving psychotherapy at a private outpatient clinic in Chile. Results: Three trajectories of change were identified: (a) moderate initial dysfunction with slight deterioration, (b) mild initial dysfunction with favorable change, and (c) high initial dysfunction with rapid favorable change. Patient's age was found to be a significant predictor of trajectory assigned, suggesting a poorer prognosis for older patients. Moreover, the trajectories were significant predictors of treatment outcome. Conclusions: These results can be used to develop patient-specific therapeutic interventions based on the trajectories they exhibit.

Family members’ experiences as simulated patients in physical therapy performance-based assessments: A phenomenological exploration protocol

BACKGROUND@#The Covid-19 pandemic caused educational institutions to shift from traditional to distance learning. Higher educational institutions offering bachelor’s degrees in Physical Therapy (PT) adapted to the situation by employing various strategies to facilitate learning online. One of the strategies employed is inviting family members as simulated patients in various performance-based assessments (PBA). In the Philippines, the PT department at the University of Santo Tomas made similar changes in the delivery of its courses. Given that family members are one of the primary stakeholders of PT education, it is important to know their experience, insights, and knowledge gained about the profession of PT after playing as a simulated patient (SP) during online performance-based assessments.@*OBJECTIVES@#This study aims to explore how family members describe their experiences playing the role of patients in PT PBAs.@*METHODS@#This study will utilize a phenomenological explorative research design. Family members, including parents, siblings, grandparents, cousins, and household helpers who played the role of a patient in any PT PBAs such as case presentation, case discussion, and practical examination, will be invited to participate. Semi-structured one-on-one interviews will be used for data gathering. Qualitative data from interview transcriptions will be analyzed using thematic analysis using NVivo 12 plus program.@*EXPECTED RESULTS@#Family Members will offer experiences in role-playing as patients in PBAs. Main themes and findings will be generated from their sharing that will provide insights regarding the improvement of remote PT PBAs.

Serum levels of tumor markers and their clinical significance in epithelial ovarian cancer / 中南大学学报(医学版)

Objective: Tumor markers have been widely used clinically. Detection of serum CA125 is one of the commonly used clinical methods for early screening and early diagnosis of epithelial ovarian cancer, but it is difficult to diagnose epithelial ovarian cancer with a single specific tumor marker. In this study, the combinatorial tumor marker detection method was used to compare the value of each tumor marker alone and different combinations in the diagnosis of epithelial ovarian cancer. Methods: The clinical data of patients with epithelial ovarian cancer (n=65) and ovarian benign disease (n=29) were collected. Multiple tumor marker protein chip was used to detect cancer antigen 125 (CA125), carbohydrate antigen 242 (CA242), alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-HCG), carcinoembryonic antigen (CEA), cancer antigen 199 (CA199), neuron-specific enolase (NSE), Ferritin, cancer antigen 153 (CA153), and human growth hormone (HGH) serum levels, and to compare the differences between the benign and malignant ovarian tumors. The correlation between tumor markers and clinicopathologic features for ovarian epithelial carcinoma was analyzed by χ2 test. Spearman rank analysis showed the correlation between CA125 expression level and other tumor markers in epithelial ovarian cancer and the correlation between age and the above 10 tumor markers. Sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and diagnostic efficiency were used to evaluate the diagnostic value of single tumor marker and the combination of tumor markers. Results: The levels of β-HCG, NSE, CA153, and CA125 in the epithelial ovarian cancer group were higher than those in the ovarian benign disease group. The level of NSE in the serum of patients with epithelial ovarian cancer was related to the clinical stage of patients. In addition, the levels of CA242, β -HCG, CEA, NSE, Ferritin, CA153 in the serum of patients with epithelial ovarian cancer were positively correlated with CA125 (rs=0.497, P< 0.001; rs=0.612, P<0.001; rs=0.358, P=0.003; rs=0.680, P<0.001; rs=0.322, P=0.009; rs= 0.609, P<0.001, respectively), and the levels of β-HCG, Ferritin, CA153 were positively correlated with the patient's age (rs=0.256, P=0.040; rs=0.325, P=0.008; rs=0.249, P=0.046, respectively). In the diagnosis of epithelial ovarian cancer, the sensitivity, Youden index, and diagnostic efficiency of CA125 detection alone were higher than the results of the other 9 separate detections. When CA153, CA199, CA242, Ferritin, and CEA were combined with CA125, the sensitivity of the combined detection of different combinations was higher than that of CA125 alone. The combined detection sensitivities of CA125+CEA and CA125+Ferritin+CEA were 89.2％ and 90.8％, respectively, and the diagnostic efficiencies were both 84.1％, which were higher than those of other combinations. The Youden index of CA125+CEA joint detection was 0.616, which was higher than those of other combinations. Conclusion: CA125 has a high diagnostic value in the diagnosis of epithelial ovarian cancer. The detection of combined tumor markers in serum has higher sensitivity and specificity in epithelial ovarian cancer.

Carcinogenic drug exposure among health-sector workers: the need for exposure assessment and surveillance / Exposición a medicamentos cancerígenos en trabajadores del sector de la salud: necesidad de evaluación y vigilancia de la exposición / Exposição a fármacos carcinogênicos entre profissionais de saúde: necessidade de avaliação e vigilância da exposição

ABSTRACT Antineoplastic drugs (ANDs) used for chemotherapy can cause secondary cancers in treated patients and can pose carcinogenic risks to health-sector workers anywhere along these drugs' life cycle in a facility, from production to patient administration. Several PAHO/WHO Collaborating Centers (CCs) have experience addressing these hazards in the health sector. The objectives of this report are four-fold: 1) Provide an overview of longstanding research and prevention efforts, led by PAHO/WHO and its Occupational Health CCs, aimed at reducing the burden of occupational cancer in the Americas; 2) Discuss how robust AND exposure assessment and educational/outreach work by PAHO CCs can form the basis of exposure mitigation efforts among health-sector workers; 3) Through the presentation of original AND exposure assessment data from a pharmaceutical compounding facility in Chile, highlight relatively inexpensive methods by which such data can be generated; and 4) Discuss how effective, periodic environmental surveillance in healthcare facilities results in the identification of AND contamination in the work environment and enables the implementation of low-cost, high-impact interventions to reduce the risk of occupational cancer in health-sector workers, including in limited-resource settings. The risk of health-sector worker exposure to ANDs and other hazardous drugs is an important issue for inclusion within PAHO/WHO's broader efforts at reducing the impact of occupational cancer in the Americas. This report demonstrates that a wide range of accessible AND-exposure mitigation strategies are feasible at both a facility and a national policy level across the hemisphere.

RESUMEN Los medicamentos antineoplásicos empleados en quimioterapia pueden causar distintos tipos de tumores secundarios en pacientes tratados y presentar riesgos cancerígenos para los trabajadores del sector de la salud en cualquier momento del ciclo de vida de estos medicamentos en las instalaciones, desde su producción hasta su administración al paciente. Varios centros colaboradores de la OPS/OMS tienen experiencia en cuanto a cómo abordar estos peligros en el sector de la salud. Este informe persigue cuatro objetivos: 1) ofrecer una visión general de la labor de investigación y prevención de larga data, liderada por la OPS/OMS y sus centros colaboradores de salud ocupacional, encaminada a reducir la carga del cáncer ocupacional en la Región de las Américas; 2) abordar cómo una evaluación sólida de la exposición a los medicamentos antineoplásicos y la labor educativa y divulgativa de los centros colaboradores de la OPS pueden sentar las bases de los esfuerzos de mitigación de la exposición en los trabajadores del sector de la salud; 3) mediante la presentación de datos originales sobre la evaluación de la exposición a los medicamentos antineoplásicos en una instalación de compuestos farmacéuticos en Chile, destacar métodos relativamente asequibles gracias a los cuales se pueden recopilar dichos datos; y 4) examinar cómo la vigilancia ambiental efectiva y periódica en los centros de salud permite detectar casos de contaminación de medicamentos antineoplásicos en el entorno de trabajo y facilita la ejecución de intervenciones de bajo costo y alto impacto para reducir el riesgo de cáncer ocupacional en los trabajadores del sector de la salud, incluso en entornos de recursos limitados. El riesgo de exposición de los trabajadores del sector de la salud a los medicamentos antineoplásicos y otros medicamentos peligrosos es una cuestión importante para su inclusión en los esfuerzos más amplios de la OPS/OMS para reducir los efectos del cáncer ocupacional en la Región de las Américas. En este informe se demuestra que una amplia gama de estrategias accesibles de mitigación de la exposición a los medicamentos antineoplásicos es factible tanto a nivel de las instalaciones como de las políticas nacionales en toda la Región.

RESUMO Os medicamentos antineoplásicos usados para quimioterapia podem causar cânceres secundários em pacientes tratados e apresentar riscos carcinogênicos aos profissionais de saúde em qualquer momento do ciclo de vida desses fármacos dentro de um estabelecimento, desde sua produção até a administração ao paciente. Vários centros colaboradores da OPAS/OMS têm experiência em lidar com esses riscos no setor de saúde. Este relatório tem quatro objetivos: 1) fornecer uma visão geral dos esforços de longa data em pesquisa e prevenção liderados pela OPAS/OMS e por seus centros colaboradores de saúde ocupacional, cuja meta é reduzir a carga do câncer ocupacional nas Américas; 2) discutir como uma avaliação robusta da exposição aos antineoplásicos e o trabalho de extensão/educacional dos centros colaboradores da OPAS/OMS podem embasar os esforços de mitigação da exposição entre os profissionais de saúde; 3) por meio da apresentação de dados originais de avaliação da exposição a antineoplásicos obtidos de uma central de manipulação de medicamentos no Chile, destacar métodos relativamente econômicos para gerar esse tipo de dados; e 4) discutir como a vigilância ambiental eficaz e periódica em estabelecimentos de saúde resulta na identificação de contaminação por antineoplásicos no ambiente de trabalho e permite a implementação de intervenções de baixo custo e alto impacto para reduzir o risco de câncer ocupacional em profissionais de saúde, inclusive em contextos de recursos limitados. O risco de exposição dos profissionais de saúde aos medicamentos antineoplásicos e outros fármacos perigosos é uma questão importante a ser incluída nos esforços mais amplos da OPAS/OMS de reduzir o impacto do câncer ocupacional nas Américas. Este relatório demonstra a viabilidade de uma ampla gama de estratégias acessíveis de mitigação da exposição aos antineoplásicos, tanto no nível das instituições quanto no âmbito de políticas nacionais em todo o hemisfério.

Frailty and its associates in community-dwelling older adults

SUMMARY OBJECTIVE: While the literature contains several studies on the frailty assessed during hospitalization and/or outpatient settings and nursing homes, few studies have assessed frailty in community-dwelling older adults. We investigated the prevalence of frailty and associated factors among older adults in a sample of community-dwelling older adults. METHODS: We included community-dwelling older adults >60 years living in the Fatih District of the Istanbul Province. We conducted the study between November 2014 and May 2015. We collected the data such as age, sex, number of diseases and drugs, functional status, frailty, the presence of geriatric syndromes, common diseases, and quality-of-life assessment. Frailty was evaluated by the FRAIL scale. RESULTS: A total of 204 adults (mean age: 75.4±7.3 years) were included, of whom 30.4% were robust, 42.6% were pre-frail, and 27% were frail. In multivariate analyses, associated factors of frailty were the number of drugs [odds ratio (OR)=1.240, p=0.036], the presence of cognitive impairment (OR=0.300, p=0.016), and falls (OR=1.984, p=0.048). CONCLUSION: The present study established the prevalence of frailty in a large district in the largest metropolis in the country through a valid screening method. Our results suggest that clinicians should consider frailty evaluation in patients with multiple drug usage, cognitive impairment, and falls.

A systematic review of observational, naturalistic, and neurophysiological outcome measures of nonpharmacological interventions for autism

Objective: Naturalistic and neurophysiological assessments are relevant as outcome measures in autism intervention trials because they provide, respectively, ecologically valid information about functioning and underlying neurocognitive mechanisms. We conducted a systematic review to highlight which specific neurophysiological techniques, experimental tasks, and naturalistic protocols have been used to assess neural and behavioral functioning in autism intervention studies. Methods: Studies were collected from four electronic databases between October 2019 and February 2020: MEDLINE (via PubMed), PsycINFO, LILACS, and Web of Science, and were included if they used structured observational, naturalistic, or neurophysiological measures to assess the efficacy of a nonpharmacological intervention for ASD. Results: Fourteen different measures were used by 64 studies, with the Autism Diagnostic Observation Schedule the most frequently used instrument. Thirty-seven different coding systems of naturalistic measures were used across 51 studies, most of which used different protocols. Twenty-four neurophysiological measures were used in 16 studies, with different experimental paradigms and neurophysiological components used across studies. Conclusions: Cross-study variability in assessing the outcomes of autism interventions may obscure comparisons and conclusions about how different behavioral interventions affect autistic social communication and underlying neurophysiological mechanisms.

The role of lipids and fatty acid metabolism in the development of prostate cancer

The reprogramming of lipid metabolism and signaling pathways is the central aspect of cancer biology. It is hypothesized that tumor cells can alter the lipid spectrum in order to fulfill their metabolic requirements. Furthermore, they can alter potential tumors and suppressive mechanisms in which lipids' involvement is essential. Recently, more attentions have been given on the alteration of lipid metabolism during prostate cancer development, and investigations have shown unique regulation of "de novo" lipid synthesis in cancer cells. Cancer cells often use newer pathways and enzymes to simplify the synthesis of fatty acids, and the newly synthesized lipids affect cellular processes, which impacts cancer cell proliferation and survival outcomes. Herein, we aimed to study the influence of lipid profile alterations on the development of prostate cancer. We found that the total amounts of lipids and phospholipids were increased within tissues from men with the malignant prostate tumor as compared with the benign prostate tissue. Significant changes were also observed in the composition of saturated and unsaturated fatty acids within the malignant tumor tissues. Intensification of lipid peroxidation has also been observed in malignant prostate tumors compared to benign prostate tumors. Collectively, these findings further highlights the fact that lipid and fatty acids play unique regulatory roles in the cellular development of prostate malignant transformation.

Perception of medical students for online learning and assessment during the COVID era

Background: Online learning became a popular mode of education in the recent Corona Virus Disease-2019 (COVID-19) pandemic. For medical field in India, online mode of learning and assessment is novel. Aims and Objectives: This study aims at determining the attitude of students, identifying unacknowledged problems and their possible solutions associated with online learning, and to explore the future scope of online learning and assessment for medical education in India. Materials and Methods: The study population consisted of 199 medical students who had taken continuous six months of online learning and assessment in the 2020 COVID-19 pandemic period over varzious platforms such as Google Classroom, Zoom Meet, Cisco Webex etc. A questionnaire was made on Google form and distributed through online platforms, and students’ responses with informed consent were collected and analyzed. Responses were in form of Likert scale that ranged from “Strongly agree” to “Strongly disagree.” Results: About 41.4% of participants agreed that online learning and assessments save time and resources. About 78.3% of students agreed that technical errors make it difficult to continue online classes. About 78.3% of students agree that responsibility of learning is on students. About 77.7% of students agreed that academic integrity and honesty are vital in online assessment. Conclusion: If online classes can be improved by solving technical errors, better infrastructure, and faculty training, it may be continued as a supplement to classroom education for lectures, but not for practicals.

Blood formed elements of the women with uterine tumors as one of the criterion for assessment of severity of the pathology

The indicators for structural analysis of blood formed elements are prominent in the assessment of pathologies, diagnostics and the degree. Therefore, we aimed to evaluate the ongoing alterations that reflect on the structural characteristics of blood formed elements based on the hormonal imbalance among menopausal women with uterine tumors. Blood samples from the women with benign (n=20), malignant (n=20) uterine tumors, and healthy menopausal women (control, n=20) were used. Enzyme-linked Immunosorbent assay (ELISA) kits were used for the quantitative determination of hormones. The blood formed elements ultrastructure observations were conducted using transmission electron microscope. Compared to control (33.8±0.7 pg/mL), estradiol level was higher in benign (45.7±0.9 pg/mL) and malignant (70.7±3.7 pg/mL) cases (P< 0.001). Similar pattern was noted in testosterone levels [control=0.38±0.03 ng/mL, benign=0.55±0.04 ng/mL (P< 0.01), malignant=1.56±0.14 ng/mL (P< 0.001)] was higher in malignant cases. In contrast, progesterone levels were decreased in the disease cases [control=0.93±0.05 ng/mL, benign=0.44±0.003 ng/mL, malignant=0.31±0.02 ng/ml (P< 0.001)]. Assessments of the morphologic structure of erythrocytes revealed pathological forms of erythrocytes (poikilocytosis) in case of benign, as well as in malignant tumors. particularly target cells (codocytes), hamlet cells, teardrop cells (dacrocytes), sickle cell (drepanocytes) erythrocytes. Using ELISA and transmission electron microscopy our results demonstrate that in case of malignant uterine tumor quantitative/structural changes occur in blood formed elements indicating ongoing alterations in hormonal imbalance. Assessing these changes in structural characteristics would be useful in examining uterine pathologies and subsequent treatment plans

A Comparison between Objective Structured Practical Examination and Traditional Practical Examination as an Assessment Tool in Biochemistry

Introduction: The competency based medical curriculum implemented in 2019 stresses on assessment systems aligned to the teaching-learning process. Assessment drives the learning process, so assessment tools have to be objective, uniform, valid and reliable. Traditional practical examination is more subjective and prone to examiner bias and is suspect to its validity and reliability. OSPE has been advocated as a tool to be used in CBME as it possesses the requisite criteria of an ideal assessment tool. However OSPE is not widely used in our st country. Methods: In this study the performance of 1 MBBS students in traditional practical examination & OSPE was compared & perception of students towards it evaluated. 150 first MBBS students of 2020-21 batch were included. Assessment by traditional and OSPE was conducted on “Blood sugar Estimation”. OSPE was conducted with 2 observer & 3 response stations. Mean was calculated and analysed for statistical significance using MS Excel. A well-structured questionnaire was administered to the same students and a feedback was obtained about the process of OSPE. Results: There was statistically significant difference between the mean scores of traditional format and OSPE (P <0.001). Analysis of students' feedback showed that more students found OSPE better in terms of scoring, passing and catering to psychomotor domain evaluation. Anumber of students felt that OSPE was more useful and comfortable than the conventional pattern of examination. Most students did not find OSPE intimidating and opined that it should be kept as assessment method in internal and university examination. Interpretation & Conclusion: Our study observed OSPE scores to be better than traditional format. OSPE eliminated examiner bias by integration of cognitive, psychomotor and affective domains. Therefore we conclude that OSPE though time and labour intensive, should be introduced and adopted as an assessment tool.

Plastic surgery professional misconduct: a cross-sectional study on cases between 2008 and 2017, filed before the São Paulo State Medical Board

ABSTRACT BACKGROUND: In plastic surgery, a lack of ethical and moral behavior by professionals can result in unfortunate circumstances and can justify ethical-disciplinary procedures. OBJECTIVE: To review 421 plastic surgery professional-misconduct cases filed before the São Paulo State Medical Board (CREMESP) between 2008 and 2017. DESIGN AND SETTING: Cross-sectional study conducted in a medical council. METHODS: The cases were categorized according to sex, age, medical specialty (plastic surgery, other field or none), medical ethics code chapter(s) involved, ethics code articles violated and board ruling/outcome. RESULTS: Most of the defendants were men over 40 years of age who were experienced in their professional practice and who graduated from public and private universities all over Brazil; 47.74% had a specialist title in plastic surgery. Violation of professional responsibility (medical malpractice, recklessness or negligence) was the commonest complaint (28.43%), followed by medical advertising (24.19%) and poor doctor-patient relationship (10.39%), in violation of articles 18, 51, 75 and 1. Among the 233 cases adjudicated over this period, 133 resulted in disciplinary sanction, 80 were ruled in the physician's favor and 20 were dismissed. CONCLUSION: Classification of plastic surgery professional-misconduct cases creates possibilities for adopting preventive measures for good practice in this specialty, which would consequently reduce the number of complaints to the regional medical boards.

Active aging health determinants among working and retired Filipino older persons living in an urban academic campus

OBJECTIVES@#This study aims to describe the demographic profile and determine the proportion and Active Aging health determinants of staff, faculty, and retired employees who are 55 years of age and older.@*METHODS@#Mixed qualitative and quantitative methods, community-based, and participatory. Participants were working and retired faculty and staff, age 55 years and over, living within an urban campus of a University. The University Ethics Review Board approved the protocol. Focus group discussions (FGDs) led to the development of a pretested survey instrument. Additional health data were obtained using a validated Comprehensive Geriatric Assessment (CGA) tool. Trained and certified health professionals conducted the CGA. A Senior Geriatrician adjudicated the final diagnoses. Progress reports and validation workshops were conducted with study participants, content experts, and stakeholders. CSPRo, SPSS, and STATA were used to generate and analyze disaggregated data.@*RESULTS@#Two hundred thirty-one (n=231) agreed to participate. The matched dataset was used in data analysis, representing a total of n=192 completed both surveys and CGA interview. Of the top 10 Geriatrician diagnoses, the highest-ranking non-communicable disease was hypertension and the top sensory diagnosis was presbyopia. Three of the self-assessed conditions were vision-related. They had better oral health than the recent national report. Most were highly independent and functional. The majority rated their QOL as good. Most had access to health insurance and a University Health Service.@*CONCLUSION@#Non-communicable diseases and visual disorders were the most common medical problems among working and retired university workers 55 years and older, living within the campus. To reduce NCDs, maintain functional independence and achieve a better quality of life especially among the retired, programs for older persons are recommended. These include access to medication, improved health financing, and senior wellness programs during and after employment. The results of the study will help understand and create a Framework for Active Aging that is relevant to this academic community.

Case report: the use of the AWIN welfare assessment protocol to monitor a group of abandoned donkeys / Estudo de caso: o uso do protocolo AWIN de avaliação de bem-estar para monitorar um grupo de jumentos abandonados

The objective of this study was to reach a diagnosis of the living conditions of abandoned donkeys kept in a restricted farm area through the assessment of their welfare level utilizing the AWIN protocol as a methodological tool. These animals were supposed to be sent to slaughter, but after the activity was temporarily banned, they were abandoned by traders. The protocol of welfare assessment was associated with general environmental and sanitary conditions. Information regarding the mortality rates was also gathered. According to the welfare assessment results, the living conditions of these animals were acceptable in some areas, despite the insufficient shade and shelter, a 3-month food restriction period, and a mortality rate of over 70%. These results demonstrate that welfare assessment protocols must be adapted to crises and databases for welfare indicators in diverse conditions must be created.(AU)

O objetivo deste estudo foi formular um diagnóstico das condições de vida de jumentos abandonados mantidos em uma área restrita de uma propriedade através da avaliação de seu nível de bem-estar, utilizando o protocolo AWIN como ferramenta metodológica. Estes animais seriam destinados ao abate, porém, depois da suspensão temporária da atividade, foram abandonados pelos proprietários. O protocolo de avaliação de bem-estar foi associado às condições ambientais e sanitárias gerais. Informações sobre os índices de mortalidade também foram coletadas. De acordo com os resultados da avaliação de bem-estar, as condições de vida destes animais estavam aceitáveis em algumas áreas, embora não houvesse sombreamento e abrigo suficientes, um período de restrição alimentar de 3 meses e um índice de mortalidade acima de 70%. Estes resultados demonstram que protocolos de avaliação de bem-estar devem ser adaptados a situações de crise, e bancos de dados para indicadores de bem-estar em condições diversas devem ser criados.(AU)

Intra- and inter-rater reliability in the assessment and classification of the longitudinal plantar arch of children 6 to 10 years of age

Abstract Aims: This study aimed to analyze the intra- and inter-rater reliability in the assessment and classification of the longitudinal plantar arch of children from 6 to 10 years old in the eyes-open (EO) testing condition. Methods: A total of two-hundred and seventy-eight Brazilian children (556 feet), boys and girls, from 6 to 10 years of age participated in the study. The children's feet were examined on a baropodometric platform, and the Staheli index was used for calculating the plantar arch index. Footprint analyses were performed at two different times, with an interval of 7 to 10 days, by three physical therapists in a single testing condition, resulting in 3,336 footprints. To determine the reliability of the continuous measurements, the Intraclass Correlation Coefficients (ICC) with 95% confidence intervals (CIs), Standard error of the mean (SEM), absolute value and percentage, and the Minimum Detectable Change (MDC) were calculated. To determine the reliability of the longitudinal arch classification, inter-rater reliability was evaluated by Weighted Fleiss Kappa Coefficient and the test-retest reliability was estimated by Weighted Cohen Kappa Coefficient. Results: Regarding inter-rater reliability, we observed values of ICC ranging from 0.79 to 0.96; thus, the results were classified as substantial to excellent reliability), being the lowest ICC values occur for line B, mainly in the first assessments. SEM ranges from 0.08 to 0.21 (percentage: 3.74 to 28.7), being the best, the lowest SEM values occur for Plantar Arch Index assessments and the MDC varies between 0.22 and 0.59. Regarding intra-rater reliability, the results indicated excellent reliability: values of ICC range from 0.92 to 0.99, being the lowest ICC values also occurs for line B analysis. SEM ranges from 0.03 to 0.20 (percentage: 2.32 to 26.6), being the lowest SEM values occur for Plantar Arch Index assessments and MDC varies between 0.09 and 0.54. Analyzing the inter-rater reliability for the longitudinal arch classifications, we observed values of Weighted Fleiss Kappa Coefficient ranging from 0.83 to 0.87, expressing almost perfect agreement among the raters before and after evaluations. The test-retest reliability of the longitudinal arch classification resulted in values of Weighted Cohen Kappa Coefficient ranging from 0.80 to 0.996, expressing substantial to almost perfect agreement intra-rater. Conclusion: The study showed high reliability in the clinical assessment of the longitudinal plantar arch index of children from 6 to 10 years of age indicating that the Staheli method is applicable to pressure platform assessments with intra- and inter-rate reliability.