Adequate Guidance Research Articles

Initial Experience with the 4D Mini-TEE Probe in the Adult Population

Background: Transesophageal echocardiography (TEE) is a vital diagnostic tool in clinical practice, particularly in transcatheter interventions where it aids in both pre-operative planning and intra-operative guidance. Traditional TEE probes often require general anesthesia due to patient discomfort. However, the development of miniaturized TEE probes presents a promising alternative, enabling routine examinations and interventions with minimal sedation. This study evaluates the feasibility of performing a complete 2D/4D TEE protocol with the new 4D mini-TEE probe in the echocardiography department and its application in transcatheter interventions. Methods: This is a retrospective study that included 30 consecutive patients from two high-volume European hospitals (Interbalkan Medical Center, Thessaloniki, Greece, and Rennes University, France) that underwent TEE or transcatheter interventions. The new 4D mini-TEE 9VT-D probe (GE Healthcare) was utilized. The quality of the images and the tolerance of the probe were assessed in the cath lab during interventions and in the echocardiography department during routine TEE examinations. Results: Direct comparison of the 4D mini-TEE probe with the standard 6VT-D probe confirmed the excellent image quality of this new pediatric probe. Most of the patients required minimal sedation or local oropharyngeal anesthesia, with satisfactory tolerance reported. Most of the transcatheter procedures did not require general anesthesia and intubation, resulting in shorter procedural time. Both 2D and 4D imaging modalities offered adequate intra-operative guidance for transcatheter procedures. Conclusions: The 4D mini-TEE probe delivers exceptional imaging capabilities for routine examinations and transcatheter interventions without needing sedation. Its use reduces esophageal trauma and the need for general anesthesia, enhancing patient comfort and safety.

Safety and feasibility of transcatheter closure of atrial septal defects in small children weighing less than 10 kg.

When young patients with an oval fossa defect present early with symptoms of heart failure and pulmonary hypertension, surgical treatment is recommended in small bodyweight rather than transcatheter closure. Outcomes of device closure in consecutive symptomatic children weighing under 10 kg were compared with young children aged below 4 years but weighing above 10 kg. Transthoracic echocardiography under conscious sedation guided the procedure in all without need for balloon sizing, transesophageal echocardiogram, and intubation anaesthesia. Symptoms, anthropometry, shunt ratio, pulmonary pressures, defect and device size, percentage oversizing, device/body weight ratio, complications, and post-procedural growth spurt were compared. Ninety-six patients weighing under 10 kg were compared with 160 patients weighing above 10 kg. In total, 83.3% of patients in the study group and 25% of controls were severely malnourished. The median indexed defect size was 35.2 mm/sq.m and 27.4 mm/sq.m, and the device was oversized by 8.7% and 14.2% in the study group and controls, respectively. The device/body weight ratio was 1.93 in study group and 1.4 in controls. Procedure was successful in all except one patient weighing under 10 kg who had a device embolisation. Both groups showed significant growth spurts and proportion, with severe malnutrition reduced to 42% and 11% in the two groups. Device closure was feasible and safe in patients under 10 kg. Transthoracic echocardiographic imaging on conscious sedation provided adequate guidance. Symptoms and growth significantly improved after intervention. Despite a larger defect size, smaller patients had comparable outcomes. In symptomatic children under 10 kg needing early closure, transcatheter intervention should not be deferred.

Organizational Climate Related to Patient-Perpetrated Sexual Harassment: VA Primary Care Provider Perceptions.

Patient-perpetrated sexual harassment toward health care providers is common and adversely affects provider well-being, workforce outcomes, and patient care. Organizational climate for sexual harassment-shared perceptions about an organization's practices, policies, and procedures-is one of the strongest predictors of harassment prevalence. We conducted a pilot survey assessing provider perceptions of the Veterans Health Administration (VA)'s climate related to patient-perpetrated sexual harassment. Responding providers completed a survey assessing: (1) experiences with patient-perpetrated sexual harassment, (2) beliefs about VA's responses to patient-perpetrated sexual harassment of staff, and (3) perceptions of VA's organizational climate related to sexual harassment for each of 4 perpetrator-target pairings (patient-perpetrated harassment of staff, patient-perpetrated harassment of patients, staff-perpetrated harassment of staff, and staff-perpetrated harassment of patients). Respondents included 105 primary care providers (staff physicians, nurse practitioners, and physician assistants) at 15 facilities in the VA Women's Health Practice-Based Research Network. Seventy-one percent of responding providers reported experiencing patient-perpetrated sexual harassment in the past 6 months. Respondent perceptions of VA's responses to patient-perpetrated harassment of staff were mixed (eg, indicating that VA creates an environment where harassment is safe to discuss but that it fails to offer adequate guidance for responding to harassment). Respondents rated organizational climate related to patient-perpetrated harassment of staff as significantly more negative compared with climate related to other perpetrator-target pairings. Future work with representative samples is needed to corroborate these findings, which have potential ramifications for VA's ongoing efforts to create a safe, inclusive environment of care.

Echocardiography-guided percutaneous closure of oval-shaped secundum atrial septal defects

BackgroundAn atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population.ObjectiveTo assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs.MethodsThis single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio < 0.75, a circular index of 1.33, or ultrasound visualization of an oval shape. Device size was chosen to be 0–4 mm larger than the defect’s longest diameter, based on transthoracic and transesophageal ultrasound measurements.ResultsWe identified 78 patients (33.3% children, 20.5% males) with a mean age of 27.4 ± 16.3 years and a mean weight of 46.8 ± 19.8 kg. The mean longest diameter and mean shortest diameter of ASDs were 23.3 ± 6.8 mm and 15.8 ± 5 mm, respectively. The mean ratio of the shortest to longest diameter was 0.7 ± 0.1. Percutaneous closure was not attempted in 7/78 (9%) patients. Three out of 71 (4.2%) procedures were fluoroscopy-guided upfront due to technical difficulties, and 5/71 (7%) were converted to fluoroscopy-guided closure. Overall procedural success rate was 98.6% (70/71) including 63/71 (88.7%) performed with zero fluoroscopy. Mean device size was 26.5 ± 7.1 mm. Mean procedural time was 45.3 ± 22.6 min. Eleven intraprocedural complications occurred including 6 arrhythmias, 3 pericardial effusions, and 2 device dislodgements.ConclusionTranscatheter closure of oval-shaped ASD is safe and feasible. Echocardiography is adequate for adequate operative guidance.

Effectiveness of Health Behaviour Modification for Chronic Non-communicable Disease Patients with Health Coaches at Khiensa Hospital, Surat Thani Province

Background: Patients with chronic noncommunicable diseases often struggle to control their blood sugar and blood pressure levels, and they frequently experienced physical, mental, and self-care practice issues that needed to be addressed. However, they may not receive adequate guidance, or the guidance they receive may be mismatched to their needs, or they may be misunderstandings between providers and patients. Therefore, medical treatment alone is insufficient; lifestyle and behavioural changes are also required throughout treatment. Objectives: This quasi-experimental study aimed to investigate the effectiveness of health behaviour modification for chronic non-communicable disease patients through health coaching at Khiensa Hospital, Surat Thani Province. Methods: The study included 550 participants who underwent a three-month health behaviour change process for patients with chronic non-communicable diseases. Each group of ten participants was supervised by a single health coach. Health literacy, health behaviour modification, and blood sugar levels were assessed before and after participating in the process using structured questionnaires. The data were analyzed by using a paired t-test to compare the mean scores of the effectiveness of health behaviour modification for chronic non-communicable disease patients through health coaching using STATA. Result: The results showed that the average health literacy scores related to chronic noncommunicable diseases increased significantly from 162.0 to 170.2 after intervention. Similarly, the average health behaviour modification scores increased significantly from 51.4 to 55.1. Furthermore, average blood sugar levels decreased from 114.1 mg/dl to 109.2 mg/dl. Our statistical analysis revealed that the significant differences in the average scores of health literacy, health behaviour modification, and blood sugar levels before and after participating in the process (t=170.3, 151.6, and 95.0, respectively, p&lt;0.001). Conclusion: The Ministry of Public Health should develop policies to support and prioritize holistic patient care and promote proactive health promotion services for patients through intensive health promotion program activities led by health coaches to enhance the effectiveness of care for chronic non-communicable disease patients.

Effect of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly: A meta-analysis of randomized clinical trials.

In patients undergoing hemiarthroplasty in the elderly, the choice of the cemented method remains controversial. This meta-analysis was undertaken to compare the impact of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly. This study included randomized controlled trials comparing the postoperative effects of cemented vs uncemented in patients with hemiarthroplasty. With no language restrictions, we searched Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Cochrane Collaboration), Clinical Trials.gov, the ISRCTN registry, as well as gray literature with no language restrictions from January 1966 to April 2023. Data were quantitatively summarized using a random-effects model. The primary outcome was 1-year mortality. This study included 13 randomized controlled trials with 3485 patients. The primary outcomes of the meta-analysis showed that cemented fixation in elderly patients undergoing hemiarthroplasty was superior to noncemented in 1-year mortality (risk ratio [RR] = 0.87, 95% confidence interval [CI]: 0.77, 0.97). Moreover, cemented was associated with a reduced risk of intraoperative periprosthetic fracture (RR = 0.19, 95% CI: 0.07, 0.50), postoperative periprosthetic fracture (RR = 0.34, 95% CI: 0.16,0.72), and loosening (RR = 0.33, 95% CI: 0.11, 0.97). Cemented hemiarthroplasty is superior to noncemented in terms of survival. Moreover, cementation reduces the incidence of some implant-related complications. More extensive trials are needed to provide adequate guidance for choosing the proper cemented method.

How Students Learn during the Pre-Briefing and Observation of Facilitation in a High-Fidelity Patient Simulation: A Narrative Analysis.

The rapid development of technology has led to the emergence of innovative teaching approaches, such as high-fidelity patient simulation (HFPS). HFPSs have been shown to significantly enhance students' decision-making and intellectual skills. This study aimed to investigate how students learn from the pre-briefing to observation period of the facilitation of the HFPS based on the original quasi-experimental studies. This study analyzed the narratives from 92 students in the intervention group about their learning during the pre-briefing and observation of facilitation. The results indicated that the students learned more independently, received better support and resources for learning, were provided with more appropriate and safe care for the simulated case, and developed higher-level intellectual skills, such as self-directed learning, critical thinking, and clinical reasoning. Importantly, the structured guidelines provided roles and responsibilities and guiding questions or aspects for observation that directed the students to learn more actively and effectively while performing their roles in the HFPS. The structured guidelines serve as a roadmap to instruct students on learning during pre-briefing and applying what they have learned during the facilitation of the HFPS. This roadmap includes the learning journey from novice to competence in knowledge and skills and also from knowing to application. Therefore, this study's results have contributed important knowledge about well-structured HFPS guidelines for all stages of the HFPS, addressing the need for adequate guidance and learning support during the pre-briefing and observation of facilitation. The elements identified during the pre-briefing and observation of facilitation are crucial for directing students to learn and significantly enhance their understanding and application of knowledge and skills, ultimately promoting the development of higher-level intellectual skills, professionalism, and engagement. Nurse educators can incorporate these elements into HFPS training in curricula to enhance students' involvement and optimize the HFPS as an effective teaching tool with structured guidelines providing guidance and support throughout various stages of HFPS training.

Development of a digital app-based sambo sports book for students at high school level extracurricular activities

The survey in North Sumatra was conducted by researchers in the areas of Medan, Tanah Karo, Tebing Tinggi, Asahan, Serdang Bedagai, Deli Serdang, Labuhan Batu, Tanjung Balai, Humbahas, and Binjai, many coaches and athletes still do not have adequate guidance in Indonesian. Most of the information is still in foreign languages, making it difficult to understand Sambo's techniques and rules. This study aims to develop a digital application-based sambo sports book. Method, in this research, uses the research and development (R&amp;D) method. The research subjects consisted of 10 athletes, coaches, and sambo sports enthusiasts for the main field trial and 20 athletes, coaches, and sambo sports enthusiasts for the operational field trial. Data were collected through observation, interviews, and questionnaires, with instruments in the form of feasibility assessment sheets from sambo sports experts, linguists, media experts, and user subjects. Data analysis was carried out using a percentage quantitative descriptive technique. The results showed that this digital application-based sambo sports book was very good and feasible. This book has great potential to improve the understanding of sambo techniques and rules among athletes, coaches, and sambo enthusiasts by providing easy-to-understand guidelines in Indonesian and emphasizing the importance of technology-based approaches in Sambo.

피해자 진술 제도를 둘러싼 영미권의 논쟁과 그 정책적 함의

This study aims to examine the potentially controversial elements of the current victim statement system in Korea and to find solutions to them so that the system can develop in the right direction. The potential issues under discussion are drawn from the experience of Western societies, particularly the Anglo-American region. The main concerns of this article include the following issues: the conditions of acceptable statement content, the issue of allowing victims' sentencing opinions, the permissibility of references to victims' values and characteristics, the form of delivery of victim statements (oral statements, written statements, proxy statements by third parties, standard forms, etc.), the use of video or music in victim statements, and the right of the defendant to cross-examine victim’s statement. The debates and policy implications of each of these topics are organized through two frameworks: an instrumental model, which focuses on the impact of victim statements on sentencing, and an expressive model, which focuses on the victim's well-being and communicative abilities. The analysis found that the controversy and confusion surrounding the victim statement system stems in part from a lack of clarity on the purpose of the system and inadequate practical guidance for its operation. Based on this discussion, this article suggests that the following are important considerations for proper operation of victim statements: clarifying the purpose of the system and providing adequate guidance to victims; limiting prejudicial and inflammatory statements and expressions; exploring non-adversarial and eclectic approaches to the issue of a defendant's right to cross-examine a victim about his or her statements; involving victim support workers in the preparation of victim statements; and ensuring that victim statements are oriented toward victim restitution and healing.

Experiences and Perceptions of Cervical Cancer Screening Using Self-Sampling among Under-Screened Women in Flanders.

Primary Human Papillomavirus (HPV) screening on samples collected by women themselves has proven to be an effective strategy for cervical cancer screening (CCS) and may increase participation rates in women who do not partake (regularly) in screening. The aim of this study is to investigate reasons for non-participation and perceptions of CCS using self-sampling methods among under-screened women in Flanders. Individual interviews with 15 underscreened women aged 30-64 years were conducted. During the interviews, participants were given the opportunity to try out a urine and vaginal self-sampling kit. Thematic analysis was based on Ajzen's model of the Theory of Planned Behavior. The results showed that 14 out of 15 participants were more likely to participate in CCS if they had the option to self-sample. One of the main findings was a lack of knowledge on different aspects of cervical cancer. Most women had a positive attitude toward cancer screening and primary prevention such as HPV vaccination. Subjective norms were influenced by healthcare professionals, peers, and organized government initiatives. Informational, organizational, contextual, and emotional factors were mentioned as barriers as well as facilitators for participation. Additionally, high self-efficacy was considered to make self-sampling more convenient. All women showed the intention to use at least one method of self-sampling. We can conclude that women who do not participate in CCS would be more motivated to participate using self-sampling methods. Adequate education and guidance should be provided.

University Dropout: A Systematic Review of the Main Determinant Factors

Introduction This research is a systematic review aimed at synthesizing scientific evidence on the causes of university dropout, focusing on the subcategories of vocational guidance, academic performance, socioeconomic status, and institutional aspects between 2020 and June 2024. Methods Only articles addressing university dropout were considered, analyzing dimensions such as vocational guidance, academic performance, socioeconomic status, and institutional aspects. Articles published in indexed scientific journals with double-blind, double-blind peer, or open reviews between 2020 and June 2024 were included. The main databases used were Scopus, Web of Science, and Google Scholar. To assess the risk of bias in qualitative studies, the criteria from the article “Validity criteria for qualitative research: three epistemological strands for the same purpose” were used. For quantitative studies, the criteria from the article “Evaluating survey research in articles published in Library Science journals” were followed. For mixed-method studies, both sets of criteria were combined. Results A total of 23 studies were included: 15 quantitative (65.22%), 3 qualitative (13.04%), and 5 mixed-method (21.74%). All studies (100%) addressed the subcategories of socioeconomic status and institutional aspects. Regarding the academic performance subcategory, 86% of the studies addressed it, while the vocational guidance subcategory was covered by 73.91% of the studies. Conclusions Vocational guidance, academic performance, socioeconomic status, and institutional aspects are crucial for reducing university dropout. Providing adequate professional guidance, academic support, financial assistance, and strong institutional support is fundamental to improving student retention and academic success.

Canadian national sport organisations’ eating disorder-related policies and practice guidelines: a summative content analysis

ABSTRACT Athletes are at significant risk of developing eating disorders (EDs). To address EDs in sport, policies can support the prevention, management, and return to sport following EDs. Although Canadian National Sport Organisations (NSOs) must comply with a universal code of conduct to address maltreatment in sport, there may be a need for additional policies and guidelines to address EDs. The purpose of this study was to examine the scope and content of ED-related policies and practice guidelines within Canadian NSOs. We searched all publicly available policy and guideline documents from Canada’s 64 NSOs and screened them for keywords related to disordered eating, body image, nutrition, diet, and exercise, yielding 98 policies and 39 guidelines. We conducted a summative content analysis to examine the contextual use of our keywords and the sociocultural implications of such use. No NSO had specific policy or practice guidelines addressing EDs. Policies described body shaming-related maltreatment using standard language from the universal code of conduct. Within guidelines, ED-related topics were discussed in relation to mental health, athlete development, nutrition, coaching female athletes, positive body image, and weight management. Comparing content within policies and guidelines revealed a lack of coherence, wherein policies outlined ‘what not to do’ but guidelines did not provide adequate guidance on ‘what to do’, drawing instead on weight-normative and gendered discourse to address ED topics. This study provides insight into the current state of systemic (in)action surrounding EDs in Canadian sport and serves as a preliminary step towards the development of ED policy.

How I treat: Coronavirus disease 2019 in leukemic patients and hematopoietic cell transplant recipients.

Among immunocompromised hosts, leukemia patients, and hematopoietic cell transplant recipients are particularly vulnerable, facing challenges in balancing coronavirus disease 2019 (COVID-19) management with their underlying conditions. In this How I Treat article, we discuss how we approach severe acute respiratory syndrome coronavirus 2 infections in daily clinical practice, considering the existing body of literature and for topics where the available data are not sufficient to provide adequate guidance, we provide our opinion based on our clinical expertise and experience. Diagnostic approaches include nasopharyngeal swabs for polymerase chain reaction testing and chest computed tomography scans for symptomatic patients at risk of disease progression. Preventive measures involve strict infection control protocols and prioritizing vaccination for both patients and their families. Decisions regarding chemotherapy or hematopoietic cell transplantation in leukemia patients with COVID-19 require careful consideration of factors such as COVID-19 severity and treatment urgency. Treatment protocols include early initiation of antiviral therapy, with nirmatrelvir/ritonavir or remdesivir. For cases of prolonged viral shedding, distinguishing between viable and non-viable viruses remains challenging but is crucial for determining contagiousness and guiding management decisions. Overall, individualized approaches considering immune status, clinical presentation, and viral kinetics are essential for effectively managing COVID-19 in leukemia patients.

Milk Quality and Economic Sustainability in Dairy Farming: A Systematic Review of Performance Indicators

The dairy industry plays a vital role in the global food system, providing a wide range of dairy products that are consumed by millions of people worldwide. Dairy farming provides a daily source of income, creating employment opportunities not only on farms, but also in transportation, milk processing, and the agricultural supply and services sectors. The increasingly pressing challenges and the high competition in the dairy industry, particularly in saturated markets, emphasize the importance for farms to undertake a comprehensive economic sustainability analysis that extends beyond mere yield monitoring. Empirical studies have found a weak adoption of robust performance measurement and control systems in dairy farms. Given the intricate macroeconomic landscape in developed nations and the imperative to address the multifaceted challenges of the industry, this study employs a systematic literature review (SLR) to evaluate whether academic research offers adequate guidance on economic performance indicators. The study finds out that the current repertoire of indicators, while relevant and partially related to quality attributes, fails to encapsulate the intricate interplay of variables and the nature of economic sustainability, highlighting the need to adopt additional indicators into the dimensions of operational efficiency and effectiveness, strategic investments, and financial strength.

Virtue ethics and the unsettled ethical questions in controlled human infection studies.

Controlled human infection studies (CHIs) involve the intentional infection of human subjects for a scientific aim. Though some past challenge trials have involved serious ethical abuses, in the last few decades, CHIs have had a strong track record of safety. Despite increased attention to the ethics of CHIs during the COVID-19 pandemic, CHIs remain controversial, and there has been no in-depth treatment of CHIs through the lens of virtue ethics. In this article, we argue that virtue theory can be helpful for addressing CHIs that present a constellation of controversial, unresolved, and/or under-regulated ethical issues. We begin with some brief background on virtue ethics. We then substantiate our claim that some CHIs raise a constellation of ethical issues that are unresolved in the ethics literature and/or lack adequate regulatory guidance by demonstrating that CHIs can present indeterminate social value, risks to third parties, limitations on the right to withdraw from research, and questions about the upper limit of allowable risk. We argue that the presence of a virtuous investigator, with virtues such as prudence, compassion, and integrity, is especially important when these unresolved research ethics issues arise, which is the case for certain types of controlled human infection studies. We use the historical example of Walter Reed and the Yellow Fever Commission to illustrate this claim, and we also highlight some contemporary examples. We end by sketching some practical implications of our view, such as ensuring that investigators with experience running CHIs are involved in novel CHI models.

Towards engineering higher quality intelligent environments: a multi case study approach

This study addresses the need to enhance the quality of Intelligent Environments, recognizing their unique characteristics and the absence of adequate guidance on quality management during development. It pursues three primary objectives: proposing a novel quality-in-use model, presenting an enhanced version of the User-Centered Intelligent Environment Development Process, and reporting on the application of these approaches through a multiple case study. To embed quality into systems, we advocate for the integration of quality characteristics from ISO/IEC 25000 standards with functional requirements. Stakeholders collaboratively define targets using measures from quality standards, and metrics enable early problem detection and resolution during development. The proposed quality-in-use model provides an insightful and objective perspective on system capabilities, guiding development and ensuring stakeholder involvement. However, challenges such as shortening development cycles for early and regular stakeholder feedback and managing an increased number of system tests were noted. Our study makes a significant contribution to the field of Intelligent Environments by providing a structured approach to embedding and managing quality throughout the development lifecycle. The multiple case study offers empirical evidence of the effectiveness of the proposed approaches, with ongoing considerations for challenges in the development process.

Assessing Moroccan physician knowledge and practices regarding maternal obesity's impact on childhood obesity: Implications for prevention and intervention.

Childhood obesity is a growing global concern with far-reaching health implications. This study focuses on evaluating the knowledge and practices of physicians in Morocco regarding the link between maternal obesity and childhood obesity. Despite the increasing prevalence of childhood obesity worldwide, this issue remains inadequately addressed in the Moroccan context. To assess the awareness and practices of physicians in Morocco concerning the connection between maternal obesity and childhood obesity. The research encompasses a comprehensive survey of practicing physicians, revealing significant gaps in awareness and practices related to maternal obesity. Notably, a significant portion of doctors do not provide adequate guidance to overweight pregnant women, highlighting the urgency for targeted educational programs. In conclusion, this research illuminates critical areas for improvement in tackling childhood obesity in Morocco. By addressing these gaps, fostering awareness, and enhancing medical practices, the healthcare system can contribute significantly to preventing childhood obesity and improving the overall health of future generations.

Serial cardiac biomarkers, pulmonary artery pressures and traditional parameters of fluid status in relation to prognosis in patients with chronic heart failure: Design and rationale of the BioMEMS study.

Heart failure (HF), a global pandemic affecting millions of individuals, calls for adequate predictive guidance for improved therapy. Congestion, a key factor in HF-related hospitalizations, further underscores the need for timely interventions. Proactive monitoring of intracardiac pressures, guided by pulmonary artery (PA) pressure, offers opportunities for efficient early-stage intervention, since haemodynamic congestion precedes clinical symptoms. The BioMEMS study, a substudy of the MONITOR-HF trial, proposes a multifaceted approach integrating blood biobank data with traditional and novel HF parameters. Two additional blood samples from 340 active participants in the MONITOR-HF trial were collected at baseline, 3-, 6-, and 12-month visits and stored for the BioMEMS biobank. The main aims are to identify the relationship between temporal biomarker patterns and PA pressures derived from the CardioMEMS-HF system, and to identify the biomarker profile(s) associated with the risk of HF events and cardiovascular death. Since the prognostic value of single baseline measurements of biomarkers like N-terminal pro-B-type natriuretic peptide is limited, with the BioMEMS study we advocate a dynamic, serial approach to better capture HF progression. We will substantiate this by relating repeated biomarker measurements to PA pressures. This design rationale presents a comprehensive review on cardiac biomarkers in HF, and aims to contribute valuable insights into personalized HF therapy and patient risk assessment, advancing our ability to address the evolving nature of HF effectively.

Exploring brain plasticity in developmental dyslexia through implicit sequence learning.

Developmental dyslexia (DD) is defined as difficulties in learning to read even with normal intelligence and adequate educational guidance. Deficits in implicit sequence learning (ISL) abilities have been reported in children with DD. We investigated brain plasticity in a group of 17 children with DD, compared with 18 typically developing (TD) children, after two sessions of training on a serial reaction time (SRT) task with a 24-h interval. Our outcome measures for the task were: a sequence-specific implicit learning measure (ISL), entailing implicit recognition and learning of sequential associations; and a general visuomotor skill learning measure (GSL). Gray matter volume (GMV) increased, and white matter volume (WMV) decreased from day 1 to day 2 in cerebellar areas regardless of group. A moderating effect of group was found on the correlation between WMV underlying the left precentral gyrus at day 2 and the change in ISL performance, suggesting the use of different underlying learning mechanisms in DD and TD children during the ISL task. Moreover, DD had larger WMV in the posterior thalamic radiation compared with TD, supporting previous reports of atypical development of this structure in DD. Further studies with larger sample sizes are warranted to validate these results.

Social inclusion and values: a study from culture

Nowadays, studies in this area of ​​knowledge proliferate and the criteria in this regard are diverse. In this research, emphasis is placed on the main concepts, their importance and relationship from different points of view according to the authors. There is a series of deeply rooted values ​​in our society, shared values ​​that even make it difficult to accept it from a positive vision of diversity, and it is also recognized by some researchers that it does not have to be an obstacle for a group of people, with specific characteristics learn, but with the right and adequate guidance it can be a motivating and energizing factor for the development of learning of the specific group in question. In order to achieve the proposed objective, a theoretical and descriptive analysis is carried out that shows the different approaches and values ​​that highlight inclusion in accordance with the social demand of these times.