How much does clinical prediagnosis correlate with electrophysiological findings?: a retrospective study.

Background: Electrodiagnostic testing (EDX) is important in the diagnosis and follow-up of neuropathic and myopathic diseases. This study aimed to demonstrate the compatibility between clinical prediagnosis and electrophysiological findings. Methods: EDX results from 2004 to 2020 at the physical medicine and rehabilitation (PM&R) clinic were screened. Tests with missing data, reevaluation studies, and cases of peripheral facial paralysis were excluded. The clinical prediagnosis and EDX results were recorded, and their compatibility was evaluated. Results: A total of 2,153 tests were included in this study. The mean age was 49.0±13.9 years and 1,533 of them (71.2%) were female. The most frequently referred clinic was the PM&R clinic (90.0%). Numbness (73.6%) was the most common complaint, followed by pain (15.3%) and weakness (13.9%). The most common prediagnosis was entrapment neuropathy (55.3%), radiculopathy (16.1%), and polyneuropathy (15.7%). Carpal tunnel syndrome was the most frequently identified type of entrapment neuropathy (78.3%). Six hundred and seventy EDX results (31.1%) were within normal limits. While the EDX results were consistent with the prediagnosis in 1,328 patients (61.7%), a pathology different from the prediagnosis was detected in 155 patients (7.2%). In the discrepancy group, the most common pathologies were entrapment neuropathy (51.7%), polyneuropathy (17.3%), and radiculopathy (15.1%). The most common neuropathy type was carpal tunnel syndrome (79.3%). Conclusion: After adequate anamnesis and physical and neurological examinations, requesting further appropriate tests will increase the prediagnosis accuracy and prevent unnecessary expenditure of time and labor.

Shifting sands: Indigenous conceptions of health and place in fragile times.

Place and health are deeply interconnected for Indigenous people, and place-based services have been established to better meet people's needs. The meaning of place, however, remains difficult to define, an issue compounded by non-Indigenous settler attempts to erase people's association with place. This paper argues that we must understand place as something more than a geographical locality, and consider the histories, experiences and feelings that connect people to place in the south coast of New South Wales (NSW), Australia. The paper focuses on the role of Aboriginal Community Controlled Organisations (ACCOs) as place-based entities which deliver a range of health and social services to local Aboriginal communities across Australia. This study was undertaken during a period of crisis when places and people's capacity to remain connected to them was perilous due to the 2019/20 bushfires, named in the media as the Black Summer Bushfires. The experience of living through this disastrous period elevated the importance of ACCOs and their unique and deep engagement with the communities they serve.

The influence of language on the formation of number concepts: Evidence from preschool children who are bilingual in English and Arabic.

We asked whether grammatical number marking has specific influence on the formation of early number concepts. In particular, does comprehension of dual case marking support young children's understanding of cardinality? We assessed number knowledge in 77 3-year-old Arabic-English bilingual children using the Give-a-Number task in both languages. Given recent concerns around the administration and scoring of the Give-a-Number task, we used two complementary approaches: one based on conceptual levels and the other based on overall test scores. We also tested comprehension of dual case marking in Arabic and number sequence knowledge in both languages. Regression analyses showed that dual case comprehension exerts a strong influence on cardinality tested in Arabic independent of age, general language skills, and number sequence knowledge. No such influence was found for cardinality tested in English, indicating a language-specific effect. Further analyses tested for transfer of cardinality knowledge between languages. These revealed, in addition to the findings outlined above, a powerful cross-linguistic transfer effect. Our findings are consistent with a model in which the direct effect of dual case marking is language specific, but concepts, once acquired, may be represented abstractly and transferred between languages.

Identifying and Exploring the Cognitive Nature of Threshold Concepts in Pharmacology to Improve Medical Students' Learning.

Phenomenon: Pharmacology is a fundamental healthcare discipline, but it can be difficult and counterintuitive for learners to learn. Navigation toward understanding pharmacology can be troublesome, but once the threshold to comprehension is crossed, learners can experience a transformative shift in their ways of thinking and practicing. We conducted an in-depth examination of threshold concepts within pharmacology, aiming to identify and prioritize their learning to improve the medical curriculum and enhance medical treatment and patient safety. Approach: We carried out a consensus generation process using the Nominal Group Technique (NGT) to identify potential threshold concepts in pharmacology. Participant groups of pharmacology experts and medical students considered, identified, reviewed, and ranked potential pharmacology threshold concepts within their own group. Then, using a logical, step-by-step approach, we combined the final ranked data from these multiple NGT sessions. We further analyzed these data using an abductive analysis approach; data were coded, categorized, reorganized, and conceptually mapped after critical evaluation. Conceptual themes were established corresponding to different phases of cognitive schema development. Findings: Six comprehensive conceptual themes were identified: Drug Mechanism of Action; Pharmacotherapeutics; Pharmacokinetics; Drug Receptor Interactions; Drug Terminology and Nomenclature; and Signaling Pathways. These concepts align with many of the key attributes of threshold concepts (e.g., troublesome, integrative and transformative). The cognitive schematic themes generated were (i) acquisition-troublesome; (ii) acquisition-transformative; (iii) automation-troublesome; (iv) automation-transformative. Insights: Transformative learning involves different stages of cognitive schema evolution, including acquisition, elaboration, and automation, and is influenced by both the inherent challenges of the concepts and limitations of human cognition. The high interactivity of these troublesome concepts challenge schema acquisition and automation. Troublesome concepts underpinning procedures or skills, while not easily explained by cognitive rules, can lead to slow, awkward, error-prone performance, creating additional barriers for practice. Integrating concepts into a coherent structure leads to the irreversible assimilation of knowledge and the transferability of both knowledge and skills, influencing learners' epistemological transitions and ontological transformations at theoretical and professional levels. Further work on designing instructional models around assisting and automating schemas around identified troublesome knowledge, while addressing the impact of cognitive load, has the potential to promote transformational learning.

Reflections on the regulatory field covering the development of paediatric medicinal products: a brief overview of current status and challenges.

Many medicinal products are initially developed and tested in adults, and often, only a limited amount of data on their safety and efficacy in children exist. Consequently, paediatric healthcare providers sometimes need to make informed decisions about using medicinal products in children based on available fragmentary data. Ethical guidelines emphasise the importance of protecting children and ensuring they receive safe and effective medical treatments. Paediatric clinical trials should be conducted to provide evidence-based care with specific attention to minimise risks to children. This highlights the dilemma of finding a balance between protecting children and adolescents (and avoiding unnecessary clinical trials) and obtaining reliable, robust and justified data to treat them adequately and not in an off-label manner with unknown risks. For years, paediatricians maintained that children and adolescents are not treated based on up-to-date scientific knowledge and justification. The slogan "children are not small adults" summarised the concerns in a catch phrase. Different stakeholders have taken a variety of actions to address this concern.

Informational and Practical Needs of Expectant Mothers with Chronic Hepatitis B in Ghana.

Hepatitis B virus infection is a global public health problem with disproportionately high endemicity in Africa and Ghana. The current national prevalence of hepatitis B among pregnant women in Ghana stands at 7.44%, highlighting the considerable threat of chronic hepatitis B on pregnant women and their general well-being. The study explored the informational and practical needs of pregnant women with chronic hepatitis B in Ghana. Fourteen pregnant women were selected purposefully using the exploratory descriptive qualitative design. Data were analyzed using thematic analysis. The findings showed that pregnant women with chronic hepatitis B lacked knowledge about the infection and were in great need of hepatitis B-related information. The study also revealed significant financial implications for treating the infection, necessitating policy reforms and stakeholder actions. To achieve effective coping, better health-seeking, and health-promoting behaviors for better health outcomes, it is crucial to provide targeted care that comprehensively covers the specific needs of pregnant women with chronic hepatitis B. It is also essential to consider including hepatitis B management in the National Health Insurance package to improve care quality.

Quantification of the donor-acceptor character of ligands by the effective fragment orbitals.

Metal-ligand interactions are at the heart of transition metal complexes. The Dewar-Chat-Duncanson model is often invoked, whereby the metal-ligand bonding is decomposed into the simultaneous ligand metal electron donation and the metal ligand back-donation. The separate quantification of both effects is not a trivial task, neither from experimental or computational exercises. In this work we present the effective fragment orbitals (EFOs) and their occupations as a general procedure beyond the Kohn-Sham density functional theory (KS-DFT) framework for the identification and quantification of donor-acceptor interactions, using solely the wavefunction of the complex. Using a common Fe(II) octahedral complex framework, we quantify the sigma-donor, pi-donor and pi-acceptor character for a large and chemically diverse set of ligands, by introducing the respective descriptors σd, πd and πa. We also explore the effect of the metal size, coordination number, and spin state on the donor/acceptor features. The spin-state is shown to be the most critical effect, inducing a systematic decrease of the sigma donation and pi-backdonation going from low spin to high spin. Finally, we illustrate the ability of the EFOs to rationalize the Tolman electronic parameter and the trans influence in planar square complexes in terms of these new descriptors.

Flexible Conceptual Representations.

A view that has been gaining prevalence over the past decade is that the human conceptual system is malleable, dynamic, context-dependent, and task-dependent, that is, flexible. Within the flexible conceptual representation framework, conceptual representations are constructed ad hoc, forming a different, idiosyncratic instantiation upon each occurrence. In this review, we scrutinize the neurocognitive literature to better understand the nature of this flexibility. First, we identify some key characteristics of these representations. Next, we consider how these flexible representations are constructed by addressing some of the open questions in this framework: We review the age-old question of how to reconcile flexibility with the apparent need for shareable stable definitions to anchor meaning and come to mutual understanding, as well as some newer questions we find critical, namely, the nature of relations among flexible representations, the role of feature saliency in activation, and the viability of all-or-none feature activations. We suggest replacing the debate about the existence of a definitional stable core that is obligatorily activated with a question of the degree and probability of activation of the information constituting a conceptual representation. We rely on published works to suggest that (1) prior featural salience matters, (2) feature activation may be graded, and (3) Bayesian updating of prior information according to current demands offers a viable account of how flexible representations are constructed. This proposal provides a theoretical mechanism for incorporating a changing momentary context into a constructed representation, while still preserving some of the concept's constituent meaning.

Study on the path of high-quality development of the construction industry and its applicability.

Exploring the influencing factors and enhancement paths of high-quality development of the construction industry is crucial for promoting sustainable development of the construction industry. Based on the concepts of "five development", this paper takes the construction industry data of 29 provinces (autonomous regions and municipalities) in China as a sample, utilizes comprehensively the combination method of NCA and fsQCA to build a high-quality development driving model of the construction industry, and explores the coupling effect of factors, like the level of scientific and technological innovation, structural degree, precast building model, external market vitality, resources, and environment, on the development of the industry, revealing the path of high-quality development of the construction industry and analyze its applicability. These findings demonstrate that: (1) The level of scientific and technological innovation, the degree of structure, and the vitality of the external market are the core conditions, and a single factor does not constitute the necessary conditions for the high-quality development of the construction industry; (2) There are three paths for the high-quality development of the construction industry, among which the number of representative cases of linkage development led by openness innovation coordination is the largest, and has strong applicability; (3) There are two non-high-quality development paths in the construction industry, and there is a non-simple opposition relationship with the three high-quality development paths in the construction industry.

MEG Evidence That Modality-Independent Conceptual Representations Contain Semantic and Visual Features.

The semantic knowledge stored in our brains can be accessed from different stimulus modalities. For example, a picture of a cat and the word "cat" both engage similar conceptual representations. While existing research has found evidence for modality-independent representations, their content remains unknown. Modality-independent representations could be semantic, or they might also contain perceptual features. We developed a novel approach combining word/picture cross-condition decoding with neural network classifiers that learned latent modality-independent representations from MEG data (25 human participants, 15 females, 10 males). We then compared these representations to models representing semantic, sensory, and orthographic features. Results show that modality-independent representations correlate both with semantic and visual representations. There was no evidence that these results were due to picture-specific visual features or orthographic features automatically activated by the stimuli presented in the experiment. These findings support the notion that modality-independent concepts contain both perceptual and semantic representations.

Brain-wide representation of social knowledge.

Understanding how the human brain maps different dimensions of social conceptualizations remains a key unresolved issue. We performed a functional magnetic resonance imaging (MRI) study in which participants were exposed to audio definitions of personality traits and asked to simulate experiences associated with the concepts. Half of the concepts were affective (e.g. empathetic), and the other half were non-affective (e.g. intelligent). Orthogonally, half of the concepts were highly likable (e.g. sincere) and half were socially undesirable (e.g. liar). Behaviourally, we observed that the dimension of social desirability reflected the participant's subjective ratings better than affect. FMRI decoding results showed that both social desirability and affect could be decoded in local patterns of activity through distributed brain regions including the superior temporal, inferior frontal, precuneus and key nodes of the default mode network in posterior/anterior cingulate and ventromedial prefrontal cortex. Decoding accuracy was better for social desirability than affect. A representational similarity analysis further demonstrated that a deep language model significantly predicted brain activity associated with the concepts in bilateral regions of superior and anterior temporal lobes. The results demonstrate a brain-wide representation of social knowledge, involving default model network systems that support the multimodal simulation of social experience, with a further reliance on language-related preprocessing.

How the mapping of threshold concepts across a master's programme in health professions education could support the development of mastersness.

INTRODUCTION: Global trends towards the professionalization of Health Professions Education (HPE) have catalyzed the proliferation of degree-awarding programmes in HPE. We apply the theoretical lens of threshold concepts to explore the required levels of Master's in HPE (MHPE) learning and teaching, with a view to determining how students might be supported to engage meaningfully with learning. METHODS: Qualitative data were collected with a series of nominal group discussions. The methodology and data analysis followed a consensus building approach. RESULTS: Four threshold concepts were identified: Being in the HPE world, the nature of HPE knowledge, the nature of HPE practice and the nature of HPE scholarship. We also mapped the threshold concepts to the World Federation for Medical Education (WFME) master's level academic skills and the Scottish Quality Assurance Agency (QAA) facets of mastersness. CONCLUSION: It is envisaged that our findings will enhance alignment between the outcomes and assessment in an MHPE programme, form the basis of understanding feedback received from students, and inform teaching and supervisory practices. The findings also complement the WFME and QAA frameworks by clarifying the depth and complexity of academic skills expected at master's level and informing teaching and learning approaches to support the development of the identified threshold concepts.

Medicinal chemistry curriculum and pedagogical practices at Canadian pharmacy schools: Towards standardization of practice.

INTRODUCTION: Medicinal chemistry instruction in PharmD programs at Canadian universities is considered an important foundational science. However, with few guidelines for the required content most programs have observed a decrease in hours of medicinal chemistry instruction. A Medicinal Chemistry Special Interest Group (SIG) was formed to address these issues nationally and initiated a pan-Canadian environmental scan to better understand the depth and breadth of medicinal chemistry instruction. METHODS: The SIG carried out an environmental scan to identify medicinal chemistry content, delivery and assessments in PharmD programs in Canada. RESULTS: Core medicinal chemistry concepts across the PharmD programs are in general agreement with those listed by the Accreditation Council for Pharmacy Education. Medicinal chemistry was typically taught as didactic lectures either as a standalone course or within a pharmacology course, although one program integrated some medicinal chemistry within therapeutics focused problem-based learning. There was no consistent time in program where medicinal chemistry occurred. CONCLUSIONS: The SIG found that similar medicinal chemistry content is taught across all Canadian PharmD programs, but incorporation of medicinal chemistry in therapeutics courses was minimal. Core concepts within six high-level overarching themes that guide our collective instruction were identified. The core concepts require developing high-level cognitive processes such as knowledge application and synthesis that practicing pharmacists are expected to possess for entry to practice. We the authors posit that in addition to providing a unique tool for pharmacists to employ in therapeutic decision-making, medicinal chemistry also provides early practice of important problem-solving and critical thinking skills.

Developmental stasis, sensitivity, and disturbance: Linking concepts to analytic methods using impulsivity and alcohol use.

The goals of this article are to (a) describe and contrast conceptual characteristics of periods of developmental sensitivity, disturbance, and stasis, and (b) translate these concepts to testable analytic models with an example dataset. Although the concept of developmental sensitivity is widely known, the concepts of developmental stasis and disturbance have received less attention. We first define the concepts and their principles and then, using repeated measures data on impulsivity and alcohol use from adolescence to young adulthood, propose the dual latent change score (LCS) growth model as one analytic approach for evaluating evidence for key characteristics of these developmental concepts via examination of intraindividual time-varying associations.

Neural dynamic foundations of a theory of higher cognition: the case of grounding nested phrases.

Because cognitive competences emerge in evolution and development from the sensory-motor domain, we seek a neural process account for higher cognition in which all representations are necessarily grounded in perception and action. The challenge is to understand how hallmarks of higher cognition, productivity, systematicity, and compositionality, may emerge from such a bottom-up approach. To address this challenge, we present key ideas from Dynamic Field Theory which postulates that neural populations are organized by recurrent connectivity to create stable localist representations. Dynamic instabilities enable the autonomous generation of sequences of mental states. The capacity to apply neural circuitry across broad sets of inputs that emulates the function call postulated in symbolic computation emerges through coordinate transforms implemented in neural gain fields. We show how binding localist neural representations through a shared index dimension enables conceptual structure, in which the interdependence among components of a representation is flexibly expressed. We demonstrate these principles in a neural dynamic architecture that represents and perceptually grounds nested relational and action phrases. Sequences of neural processing steps are generated autonomously to attentionally select the referenced objects and events in a manner that is sensitive to their interdependencies. This solves the problem of 2 and the massive binding problem in expressions such as "the small tree that is to the left of the lake which is to the left of the large tree". We extend earlier work by incorporating new types of grammatical constructions and a larger vocabulary. We discuss the DFT framework relative to other neural process accounts of higher cognition and assess the scope and challenges of such neural theories.

Invariant representations in abstract concept grounding - the physical world in grounded cognition.

Grounded cognition states that mental representations of concepts consist of experiential aspects. For example, the concept "cup" consists of the sensorimotor experiences from interactions with cups. Typical modalities in which concepts are grounded are: The sensorimotor system (including interoception), emotion, action, language, and social aspects. Here, we argue that this list should be expanded to include physical invariants (unchanging features of physical motion; e.g., gravity, momentum, friction). Research on physical reasoning consistently demonstrates that physical invariants are represented as fundamentally as other grounding substrates, and therefore should qualify. We assess several theories of concept representation (simulation, conceptual metaphor, conceptual spaces, predictive processing) and their positions on physical invariants. We find that the classic grounded cognition theories, simulation and conceptual metaphor theory, have not considered physical invariants, while conceptual spaces and predictive processing have. We conclude that physical invariants should be included into grounded cognition theories, and that the core mechanisms of simulation and conceptual metaphor theory are well suited to do this. Furthermore, conceptual spaces and predictive processing are very promising and should also be integrated with grounded cognition in the future.

Twenty years of big plant genera.

In 2004, David Frodin published a landmark review of the history and concepts of big plant genera. Two decades of taxonomic activity have taken place since, coinciding with a revolution in phylogenetics and taxonomic bioinformatics. Here we use data from the World Flora Online (WFO) to provide an updated list of big (more than 500 species) and megadiverse (more than 1000 species) flowering plant genera and highlight changes since 2004. The number of big genera has increased from 57 to 86; today one of every four plant species is classified as a member of a big genus, with 14% in just 28 megadiverse genera. Most (71%) of the growth in big genera since 2000 is the result of new species description, not generic re-circumscription. More than 15% of all currently accepted flowering plant species described in the last two decades are in big genera, suggesting that groups previously considered intractable are now being actively studied taxonomically. Despite this rapid growth in big genera, they remain a significant yet understudied proportion of plant diversity. They represent a significant proportion of global plant diversity and should remain a priority not only for taxonomy but for understanding global diversity patterns and plant evolution in general.

Evaluating ChatGPT-4's historical accuracy: a case study on the origins of SWOT analysis.

In this study we test ChatGPT-4's ability to provide accurate information about the origins and evolution of SWOT analysis, perhaps the most widely used strategy tool in practice worldwide. ChatGPT-4 is tested for historical accuracy and hallucinations. The API is prompted using a Python script with a series of structured questions from an Excel file and the results are recorded in another Excel file and rated on a binary scale. Our findings present a nuanced view of ChatGPT-4's capabilities. We observe that while ChatGPT-4 demonstrates a high level of proficiency in describing and outlining the general concept of SWOT analysis, there are notable discrepancies when it comes to detailing its origins and evolution. These inaccuracies range from minor factual errors to more serious hallucinations that deviate from evidence in scholarly publications. However, we also find that ChatGPT-4 comes up with spontaneous historically accurate facts. Our interpretation of the result is that ChatGPT is largely trained on easily available websites and to a very limited extent has been trained on scholarly publications on SWOT analysis, especially when these are behind a paywall. We conclude with four propositions for future research.

Differing gender diverse children have differing experiences with same- and other-gender peers.

How gender diversity is exhibited varies: some individuals feel similar to the other gender; others experience little similarity to either gender, and some feel similar to both genders. For children, do these variations relate to differing relationships with peers? The goal was to assess whether a community sample of children (884, Mage = 9.04, SD = .90, 51% boys/1 transgender boy; 57% non-Latinx) with differing types of gender diversity have differing relationship experiences and beliefs about same- and other-gender peers. Gender diversity was determined by gender self-concepts (Both-Gender Similar, Cross-Gender Similar, Low-Gender Similar); these were compared among themselves and to gender-typical children (Own-Gender Similar). Results confirmed that children who exhibited differing gender diversity patterns varied in their peer experiences such that gender self-concept matching was found: Children who felt more similar to other-gender peers reported more contact and felt included and efficacious with other-gender peers; children who felt more similar to same-gender peers reported more contact and felt included and efficacious with same-gender peers. These findings suggest that children with two of the atypical patterns (i.e., Cross-Gender and Both-Gender) may experience social benefits that gender typical children do not. These findings illustrate the variability and strengths among gender diverse children.

Cultural concepts of distress among Albanian young adults living in Switzerland - a qualitative study.

Objectives: Existing research recognizes the critical role that social, sociodemographic, and acculturative processes play in increasing vulnerability for experiencing psychological distress among second-generation migrants. However, to date, far too little attention has been given to the study of psychological distress in this social group. The main objective of this study is to examine cultural identities, as well as expressions and causes of psychological distress among second-generation Albanian-speaking migrants in Switzerland. Methods: Semi-structured qualitative interviews were conducted with 13 Albanian-speaking participants between 19 and 35 years of age using the interview of the Barts Explanatory Model Inventory. Data were analyzed by qualitative content analysis using MAXQDA-2018 software. Findings: Study participants showed bicultural identities, which caused value conflicts and a feeling of being "caught" between Swiss and Albanian culture. Some participants experienced the fear of disappointing their parents. Others find it difficult to deal with conflicting norms and values. Parentification was another important cause within their cultural concept of distress. At the same time, (implicit) social support, i.e., spending time with the family and the community, was an important coping mechanism. Conclusion: Second-generation immigrants are exposed to specific risk factors for psychological distress. A better understanding of these risk factors and their coping mechanisms is essential for providing them with meaningful support services, both in prevention and psychotherapy.