ERRATUM: Optimal upfront surgery for gastric adenocarcinoma. Real life situation in Brazil. Results comparable to neoadjuvant treatment

ABSTRACTBackground: Complete neoadjuvant treatment for gastric cancer is not always tolerated due to nutritional and clinical reasons, such as gastric outlet obstruction. In this context, upfront surgery becomes an alternative. Aims: The aim of the study was to compare upfront resection with neoadjuvant systemic therapy followed by surgery and identify factors influencing their outcomes. Methods: Retrospective study of 410 patients with locally advanced gastric adenocarcinoma followed between 2012 and 2020, comparing upfront surgery and perioperative treatment. Patients with early tumor (cT1N0), metastasis, and stump cancer were excluded. The comparison was stratified by stage without the influence of systemic treatment (primary stage). Resections with D2 dissection, no residual tumor (no R2), and no complications were considered optimal surgery. Results: Upfront resection was performed in 216 patients (85% of upfront surgeries). Gastrectomy after neoadjuvant treatment was performed in 47 cases (76% of indications), and another four were resected among 39 previous unsuccessful surgeries (10%). In total, there were 51 resections after chemotherapy. Independent factors associated with overall survival at 60 months were: preoperative chemotherapy (57.3% vs. 40.7%, p=0.029); complication rate; D2 lymphadenectomy; and primary stage. Initial cases showed a better outcome in the neoadjuvant group without statistical significance (p=0.447), but it was present in more advanced tumors (p=0.027). Optimal surgery was achieved in 68.6% of the neoadjuvant group and 51.9% of the upfront group (p=0.030) and resulted in similar overall survival (56.6% vs. 52.4%, p=0.904). Conclusions: Optimal upfront surgery followed by adjuvant therapy, particularly with D2 dissection, is effective and was not statistically inferior to neoadjuvant treatment.

<p>Playing computer games has often been theorised to be linked to the wellbeing of users. However, the variables involved and the relationships and interactions between them have not been established. The purpose of the present study was to investigate, whether there are core aspects of game usage that are related to increased or decreased wellbeing, and the extent to which these depend on players’ real-life situations. The project comprised three studies and used an exploratory sequential mixed-methods design. In the first study, the ways in which players use games were investigated. To identify the key aspects of game usage for distinguishing and describing how players use games, in-depth interviews were conducted with 23 players of different games. This data and two subsequent quantitative tests, the first with 314 participants and the second with 770 participants, were used to develop a game-usage questionnaire and a framework with eight factors. The relationship between game usage and wellbeing was investigated in a longitudinal study conducted over nine months with 531 participants. Personality – as proxy for internal characteristics – and basic psychological needs – as proxy for participants’ situations in life – were taken into account as potential moderators of that relationship. Results showed that the overall correlations between game usage and wellbeing are weak and subsumed by players’ needs and personality. However, there were interactions between game usage and needs: Some game usage factors seem to directly reflect real-life situations and wellbeing; others seem to be common responses to real-life situations with no impact on wellbeing; and others again appear to impact wellbeing depending on the real-life situation. Social game usage seems to be a key factor with relevance for wellbeing. The contribution of this thesis is twofold. It provides a general framework of game usage that can be used in the field of game studies to interpret and compare findings more meaningfully, and it was shown that it is important to consider a person’s game usage in context of their real-life situations. In addition, main game usage factors for future research on wellbeing and digital games are suggested.</p>

<p>Playing computer games has often been theorised to be linked to the wellbeing of users. However, the variables involved and the relationships and interactions between them have not been established. The purpose of the present study was to investigate, whether there are core aspects of game usage that are related to increased or decreased wellbeing, and the extent to which these depend on players’ real-life situations. The project comprised three studies and used an exploratory sequential mixed-methods design. In the first study, the ways in which players use games were investigated. To identify the key aspects of game usage for distinguishing and describing how players use games, in-depth interviews were conducted with 23 players of different games. This data and two subsequent quantitative tests, the first with 314 participants and the second with 770 participants, were used to develop a game-usage questionnaire and a framework with eight factors. The relationship between game usage and wellbeing was investigated in a longitudinal study conducted over nine months with 531 participants. Personality – as proxy for internal characteristics – and basic psychological needs – as proxy for participants’ situations in life – were taken into account as potential moderators of that relationship. Results showed that the overall correlations between game usage and wellbeing are weak and subsumed by players’ needs and personality. However, there were interactions between game usage and needs: Some game usage factors seem to directly reflect real-life situations and wellbeing; others seem to be common responses to real-life situations with no impact on wellbeing; and others again appear to impact wellbeing depending on the real-life situation. Social game usage seems to be a key factor with relevance for wellbeing. The contribution of this thesis is twofold. It provides a general framework of game usage that can be used in the field of game studies to interpret and compare findings more meaningfully, and it was shown that it is important to consider a person’s game usage in context of their real-life situations. In addition, main game usage factors for future research on wellbeing and digital games are suggested.</p>

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BackgroundGender bias exists in healthcare and affects how pain is assessed and managed. This bias affects patient outcomes and their trust in healthcare professionals. We also know that future clinicians develop their attitudes early in training. Medical school is therefore an opportunity to shape the values of future doctors and to combat systemic gender bias in healthcare. This systematic review aims to explore medical student perceptions of the relationship between patients’ gender and their pain, so that recommendations can be made for developing medical education.MethodsEmbase, MEDLINE, PsychINFO, LILACS, Global Index Medicus, PakMediNet and ERIC were searched for articles relating to medical student perceptions of gender and pain, with no geographical or language limitations. Quality was assessed using the Medical Education Research Study Quality Index and the Critical Appraisal Skills Programme checklist.ResultsNine publications were identified, two qualitative and seven quantitative. All studies had methodological limitations. Many different study designs were used, although most involved simulated patients. All studies referred to gender as binary. Multiple studies found that women’s pain is more likely to be underestimated by medical students and that the patient’s gender drives different approaches during clinical history taking, examination and management in these simulated situations. Only one study found no effect of patients’ gender on students’ perception of their pain.ConclusionsWhilst there is a paucity of high-quality studies in this area, patients’ gender was found to affect how their pain is perceived by medical students. No studies explored where students’ attitudes towards gender and pain arise from, and few involved ‘real life situations’. We propose that further work into medical student perceptions in ‘real situations’ is needed. This will help to inform how undergraduate medical education can be developed to tackle gender bias, and ultimately improve outcomes for patients.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-024-03660-0.

Background is that Human Resource Development Council Review (2024) highlights a skills mismatch in Botswana’s labor market. The review points out that graduates often possess more theoretical knowledge than practical skills, underscoring the need to profile skills and competency gaps (https://www.resaerchgate.net/profile/sue-askew/publication/27469567-potfolios for learning assessment and professional development in highereducation). Rationale for using Performance Based Assessments and Portfolios-Principles and Processes of Outcome Based Curriculum is that they help educators apply principles, processes and procedures of developing, assessing and moderating Outcome Based Curriculum / syllabus / content to equip learners to execute enabling outcomes-performance criteria outcomes-learning outcomes-culminating outcomes (apply-analyze-synthesize-create-evaluate-solve) real life and hypothetical situations. This study evaluates the application of Principles and Processes of Outcome Based Curriculum-Performance Based Assessments and Portfolios in Botswana. It investigates whether the Principles and Processes of Outcome Based Curriculum is reflected during the implementation of Botswana curriculum, specifically Foundations of Education curriculum at Serowe College of Education. Qualitative research approach; purposive sampling was used to select respondents who could best provide answers to the research objectives in this study. Qualitative analysis was used to synchronize and analyze data from the following various sources using triangulation under each research objective or theme: Principles of assessment and moderation in Outcome Based Curriculum; qualitative interviews from Course: FOE 111 Educational Psychology (Theories of Child Development and Human Learning) & Course: FOE 122 Early Childhood Education; ethnographic design participant in-depth immersion personal observations and experiences of the researcher; Question and answer during FOE meeting; End of Semester Moderation and Quality Assurance Report; relevant theories and philosophies. Findings: Principles and Processes of Outcome Based Curriculum are applied in Performance Based Assessments and Portfolios in Botswana. Model or approach to assessing Performance Based Assessments and Portfolios lived in Botswana-Serowe College of Education Curriculum is a hybrid of [Portfolios:-execute enabling outcomes (small skills)-performance criteria outcomes-learning outcomes-culminating outcomes (apply-analyze-synthesize-create-evaluate-solve) in real life and hypothetical situations)] + [End of Semester written examinations conditioning learners to apply-analyze-synthesize-create-evaluate-solve in real life and hypothetical situations under a specific allocated time to enhance learners ability to function efficiently and effectively under a given time frame]. Quality assurance standards that Performance Based Assessments and Portfolios should meet are applied in Botswana. The two models or approaches to assessing an Outcome Based Curriculum (OBE) in Botswana are in line with Principles and Processes of Outcome Based Curriculum and therefore should be retained or maintained. Recommendations: To implement OBC effectively, consider the following steps: Define Clear Learning Outcomes: Ensure that each course has specific, measurable outcomes that students are expected to achieve. Design Assessment Methods: Choose assessment methods that align with these outcomes. This could include portfolios, projects, presentations, exams, and other activitieshttp://en.wikipedia.org/wiki/outcome-based-education. Provide Continuous Feedback: Use formative assessments to give students regular feedback on their progress. Summative Evaluation: Decide whether to use portfolios, exams, or a combination of both for final assessment. Grading System: Determine whether to use a pass/fail system or a more detailed grading scale. Significance of the study is that results obtained in this work will help ensure that a hybrid of [Portfolios:-execute enabling outcomes-performance criteria outcomes-learning outcomes-culminating outcomes (apply-analyze-synthesize-create-evaluate-solve) in real life and hypothetical situations] + [End of Semester written or practical examinations where learners apply-analyze-synthesize-create-evaluate-solve in real life and hypothetical situations under a specific allocated time to enhance learners’ ability to execute skills efficiently and effectively in given specific times].

Introdução: o envelhecimento populacional é um fenômeno mundial que se acelerou nas últimas décadas. A vida cada vez mais prolongada tem sido alvo de questionamentos e preocupações, no sentido de que esse prolongamento seja vivido com qualidade e vitalidade. Objetivo: estudar o estilo e o grau de satisfação com alguns aspectos da vida da população de sessenta anos e mais residente no município de Botucatu. Casuística e Método: foram entrevistados 365 idosos residentes no município de Botucatu, escolhidos por meio de amostragem estratificada proporcional e aleatória, utilizando-se os mapas dos setores censitários fornecidos pelo IBGE. O instrumento utilizado foi uma adaptação para a realidade brasileira da Escala de Qualidade de Vida de Flanagan e do Perfil do Estilo de Vida Individual desenvolvido por Nahas. Resultados: a maioria dos idosos entrevistados estava casada, tinha baixa escolaridade e renda média de um a três salários mínimos. Os idosos, em geral, residiam no município há mais de 20 anos e em famílias relativamente pequenas, tinham bons hábitos alimentares, referiram satisfação com sua vida emocional, com a saúde, com a família, com seus amigos e com o lazer e praticavam pouca atividade física em comparação a outras faixas etárias. Algumas mudanças ocorreram no perfil do idoso durante esses últimos 20 anos, houve aumento na população do sexo feminino em 3,6%, melhora da escolaridade e idosos com idades mais avançadas. Entretanto a renda individual e per capita não se mantiveram estáveis nesse período. Conclusão: os resultados obtidos revelam que a população de idosos de Botucatu tem sofrido mudanças em relação ao seu perfil com tendência à melhora do padrão de vida dos idosos neste período. Essas mudanças são reflexos do que está ocorrendo a nível mundial, relacionada à transição demográfica e a modernidade. Apesar de viverem num cenário de baixa renda e escolaridade, têm bons hábitos de vida e se consideram felizes.

To examine the interplay between situational, social and psychological factors in gay men's decisions about HIV risk behaviour, using multiple hypothetical situations. The sample included 79 gay men from Sydney recruited through flyers, press advertisements or personal contact at gay venues. Subjects were presented with 20 hypothetical situations graphically on a computer, which included different levels of attraction to partner, intoxication, attractiveness to partner, condom availability, desire for anal sex by subject, insistence of partner on using a condom and time constraints in each situation. Subjects used a computerized graphic rating scale to indicate the likelihood of unprotected anal sex in each situation, the frequency with which they had experienced the hypothetical situation in real life and satisfaction with their response. The probability of having unsafe anal sex in any given situation was the dependent variable. All other variables were predictors. A vector of predictors accounted for 30% of the variance (r = 0.54). Ratings of the probability of anal sex increased with the frequency that subjects had experienced hypothetical situations in real life, attraction to partner, attractiveness to partner and time elapsed since real life experience similar to the hypothetical one. Ratings of the probability of anal sex decreased with condom availability. Our results suggest that interventions must address the way that individuals interact with their partner and their environment in order to be successful.

Transfer of fear reduction through systematic desensitization

Hyperthyroidism is one of the main endocrinopathies during pregnancy. The aim of this project was to identify the degree of control of hyperthyroid pregnant women based on the recommendations of the American Thyroid Association (ATA) in a real situation without the availability of propylthiouracil. This was a descriptive, retrospective and longitudinal study, including medical files of pregnant women with hyperthyroidism between 18 and 35 years. They were classified as having "Adequate" control if their thyroid profiles were within the recommendations of the ATA and had no adrenergic symptoms; and were categorized as having "Inadequate" control if they were not stabilized with monotherapy, or if they required high doses of antithyroid drugs or beta-blockers or showed serious complications including the need of an Intensive Care Unit (ICU) for mothers or neonates. The Chi square test was performed between treatment groups during the third trimester and the complications of pregnant women or neonates. A total of 173 hyperthyroid pregnant women were studied with an average age of 21 ± 4.7 years. Of the 33 patients with hyperthyroidism who received monotherapy with methimazole until the end of pregnancy, 23 (69.69%) were classified as having "Adequate" control. In a real life situation there is delay in the diagnosis of hyperthyroidism during pregnancy but even without propylthiuracil, an “Adequate” control can be reached in up to 20.53% of cases based on a methimazole monotherapy.

A study on implementing authentic assessment program through workshop was conducted to investigate the improvement of the competence of science teachers in designing performance assessment in real life situation at school level context. A number of junior high school science teachers and students as participants were involved in this study. Data was collected through questionnaire, observation sheets, and pre-and post-test during 4 day workshop. This workshop had facilitated them direct experience with seventh grade junior high school students during try out. Science teachers worked in group of four and communicated each other by think-pair share in cooperative learning approach. Research findings show that generally the science teachers’ involvement and their competence in authentic assessment improved. Their knowledge about the nature of assessment in relation to the nature of science and its instruction was improved, but still have problem in integrating their design performance assessment to be implemented in their lesson plan. The 7th grade students enjoyed participating in the science activities, and performed well the scientific processes planned by group of science teachers. The response of science teachers towards the workshop was positive. They could design the task and rubrics for science activities, and revised them after the implementation towards the students. By participating in this workshop they have direct experience in designing and trying out their ability within their professional community in real situation towards their real students in junior high school.

DEA is a non-parametric technique for measuring the relative technical efficiencies of similar decision making units (DMUs) with multiple inputs and multiple outputs. In smoe real life situations, DMUs may perform different types of functions and can be segregated into independent components such that each component has its own set of inputs and outputs. Owing the importance of the internal structure of the DMUs, DEA has been extended to multi-component DEA (MC-DEA) which is a technique for measuring the technical efficiencies of the DMUs and their components. The conventional DEA and MC-DEA approaches require crisp input and output data which may not always be available precisely. However, in real life problems, data might be imprecise or vague which can suitably be represented by fuzzy numbers. Many researchers have proposed methods to deal with fuzzy parameters in DEA and MC-DEA. However, in real situations, the decision variables can also take fuzzy forms. Therefore, the aim of the present paper is fourfold: (i) to extend DEA in the presence of undesirable outputs to fully fuzzy DEA (FFDEA) for measuring the fuzzy technical efficiencies of the DMUs in fully fuzzy environments where all decision variables and parameters are taken as fuzzy numbers, in particular triangular fuzzy numbers, (ii) to extend MC-DEA in the presence of undesirable outputs to multi-component fully fuzzy DEA (MC-FFDEA) for measuring the fuzzy technical efficiencies of DMUs and their components in fully fuzzy environments, (iii) to propose a new ranking function approach to transform both the FFDEA and MC-FFDEA models into crisp linear programming problems, and (iv) to present numerical examples in order to validate the effectiveness and advantages of the proposed approach over the existing ones.

Hyperthyroidism is one of the main endocrinopathies during pregnancy. The aim of this project was to identify the degree of control of hyperthyroid pregnant women based on the recommendations of the American Thyroid Association (ATA) in a real situation without the availability of propylthiouracil. This was a descriptive, retrospective and longitudinal study, including medical files of pregnant women with hyperthyroidism between 18 and 35 years. They were classified as having "Adequate" control if their thyroid profiles were within the recommendations of the ATA and had no adrenergic symptoms; and were categorized as having "Inadequate" control if they were not stabilized with monotherapy, or if they required high doses of antithyroid drugs or beta-blockers or showed serious complications including the need of an Intensive Care Unit (ICU) for mothers or neonates. The Chi square test was performed between treatment groups during the third trimester and the complications of pregnant women or neonates. A total of 173 hyperthyroid pregnant women were studied with an average age of 21 ± 4.7 years. Of the 33 patients with hyperthyroidism who received monotherapy with methimazole until the end of pregnancy, 23 (69.69%) were classified as having "Adequate" control. In a real life situation there is delay in the diagnosis of hyperthyroidism during pregnancy but even without propylthiuracil, an “Adequate” control can be reached in up to 20.53% of cases based on a methimazole monotherapy.

Ports play an essential role in nation’s economic growth by fostering trade and development. Making a master plan for port development includes several actions that need to be taken before a final master plan is decided. Implementing such actions in a real situation as a try out for port development will result in time and financial loss, not to mention the effect to the environment and availability of space. Port Constructor is introduced last year as the newest tool to simulate all the planning and development process of a port and see the result of every action in relatively short time. Port Constructor is a serious game, it looks like a game, but it also has a learning objective that needs to be achieved. The primary function of this game is that players can take several actions, undertake tasks, and experience situations which would be impossible to be tried in a real life situation. In addition, Port Constructor allows players to have a position as a port planner and developer, which may not be possible in reality, and experience a real situation within a short period of time. By developing their own port scenario (or real-port scenario) in the Port Constructor, the player will have a real experience as a port planner. This study was conducted to assess the Port Constructor game as a learning tool in port planning and development both for student and more experienced port developers. Furthermore, this study also provides a way of developing scenarios inside the Port Constructor game as well as ensuring that the aim of this game can be achieved by doing a game session together with students and professionals participants. The game sessions were held to prove the playability of the game as a single-player and multi-player game. Resulting in a better outcome when the game played as a multi-player game because players can have a discussion before deciding the next actions that they will take. Examples of several port layouts are provided to prove the flexibility of this game that can be used to accommodate uncertainty of port development when using in the future. In conclusion, developers believe that Port Constructor can be a useful instrument for the learning process of people at the educational level as well as for port developers on their port planning course and project.

Thai nursing students' experiences when attending real life situations involving cardiac life support: A Phenomenological study