Differences In Average Scores Research Articles

Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery

Background: Multimodal pain management within enhanced recovery after surgery (ERAS) protocols is designed to decrease opioid use, promote mobilization, and decrease postoperative complications. Objectives: To evaluate the role of intravenous (IV) versus oral (PO) acetaminophen within an established ERAS protocol in colorectal surgery. Study Design: This was a retrospective observational study. Setting: This research took place within an established perioperative colorectal surgery protocol. Methods: A total of 91 consecutive elective colorectal resections performed according to an ERAS protocol using only IV acetaminophen (IV group) were compared with 84 consecutive resections performed using one dose of IV acetaminophen followed by subsequent administration of oral acetaminophen (PO group). Our multimodal pain management strategy also included transverse abdominis plane blocks, celecoxib, and ketorolac medications for both groups. Opioid requirements, maximum and average daily pain scores by the Visual Analog Scale, and postoperative outcomes were compared between groups. Results: There were no differences in maximum or average pain scores on postoperative days 0-3 or at time of discharge between IV and PO groups. Compared with the IV acetaminophen only group, the PO group received significantly more perioperative opioids through 72 hours postoperatively (68.8 oral morphine equivalents [OME] IV group vs. 93.7 OME PO group; P < 0.0001), were more likely to require opioid patient-controlled analgesia (8.9% IV group vs. 46.4% PO group; P < 0.0001), and were more likely to experience postoperative nausea and vomiting (33.0% IV group vs. 48.8% PO group; P = 0.0449). Limitations: Significant limitations include the studies’ retrospective nature and that it was performed at a single institution. Conclusions: Restriction of IV acetaminophen within an ERAS protocol in colorectal surgery was associated with increased opioid use, greater need for opioid patient-controlled analgesia, and increased incidence of postoperative nausea and vomiting. IV acetaminophen may be superior to oral acetaminophen in the early postoperative setting. Key words: Perioperative pain management, enhanced recovery after surgery, acetaminophen, multimodal pain control, nonopioid

Patient-related factors may influence nursing perception of sleep in the Intensive Care Unit.

ObjectiveThere exist conflicting data regarding the accuracy of ICU nurses accurately assessing patient sleep using validated questionnaires. Using the Richards-Campbell Sleep Questionnaire (RSQ), we hypothesize that patient factors might influence nursing perception of their sleep.MethodsPatients in the ICU who met the inclusion criteria were asked to complete the sleep questionnaire, as were their nurses and intraclass correlation analysis was done.Results38 paired patient-nurse surveys were included for analysis. The mean difference in total average score of the RSQ was not significantly different between patients and nurses. There was fair intraclass correlation by patient age, black race, and admission for respiratory illnesses. A good intraclass correlation existed for non-blacks and admission for non-respiratory reasons. Most striking was the intraclass correlation by sex, with poor intraclass correlation for women compared to an excellent correlation for men.ConclusionThe results of our study confirm that patients in our ICU have poor sleep with a fair intraclass correlation. When examined by patient related factor, the greatest divergence between patient and nursing perception of sleep in the ICU using the RCSQ was patient female sex. More research is needed in this area to better understand the divergence and improve sleep in the ICU.

EFEKTIFITAS GAME POWERPOINT DALAM MENGEMBANGKAN KEMAMPUAN MATEMATIKA PERMULAAN DI TK ASYOFA PADANG

This study aims at determining the effectiveness of powerpoint games in developing initial mathematical abilities. The approach used was quantitative with a quasi experimental method type pretest-posttest group design. The population of this study was all of the group B early young learners in Koto Tangah Subdistrict, Padang City 2018/2019 academic year. The sampling technique used was simple random sampling with a total sample of 30 children. The data were collected by using an initial mathematical ability test adopted from REMA the Research Based Early Mathematics Assessment. Data analysis technique was an independent t-test, seeing a comparison of differences in average scores. The result shows that powerpoint games were effective in developing early mathematical abilities in the experimental group compared to the control group. The use of powerpoint games can be an alternative learning media in developing other aspects of development.

Application of agar thickener in dysphagia after radiotherapy for nasopharyngeal carcinoma

Objective To compare a new agar thickener with xanthan gum as a thickener in treating dysphagia patients with nasopharyngeal carcinoma after radiotherapy. Methods Twenty nasopharyngeal carcinoma patients with dysphagia after radiotherapy were asked to swallow moderately and extremely thick liquids thickened with the agar and xanthan gum, and their swallowing was recorded with a videofluoroscope. Results The average pharyngeal constriction ratio when swallowing agar thickener was significantly lower than when swallowing the traditional thickener. The average oral transit time, the initiation of pharyngeal swallowing were both significantly quicker. There was no significant difference in the average penetration aspiration scale scores between the two thickeners. In the subjective evaluation, the agar thickener was adjudged smoother and with better residual mouthfeel than the xanthan gum, but the scent of the xanthan gum was preferred. Conclusion The new agar thickener is smooth and not sticky. It produces faster transport with less oropharyngeal residue. It can be widely used among nasopharyngeal carcinoma patients with dysphagia after radiotherapy. Key words: Thickeners; Nasopharyngeal carcinoma; Dysphagia; Agar; Xanthan gum

The impact of modeling-eliciting activities on high school student design performance

Modeling allows students to become more effective designers. High school technology and engineering students engage in engineering design challenges as part of traditional instructional practices. Model-eliciting activities (MEA) present students with opportunities to elicit mathematical thinking that facilitates modeling. Students (n = 266) from four high schools completed a MEA and design challenge procedure. The research design utilized a quasi-experimental method, post-test only, with homogenous matching comparison groups based on possible confounding variables. A rubric was used to measure student design performance. Students in the comparison group (n = 124) completed a traditional design challenge and were assessed on their design performance. Students in the treatment group (n = 142) completed a MEA, a traditional design challenge and were assessed on their design performance. An analysis of covariance (ANCOVA) was used in order to discover if the difference in average design challenge rubric score from comparison group (42.56) to the treatment group (45.18) was statistically significant. A one-way multiple analysis of covariance (MANCOVA) was used to indicate if the differences in student average scores in each rubric category were significant. The ANCOVA did not reveal evidence supporting the research question with regard to overall design performance. The Pillai’s Trace MANCOVA test results were significant. Four design rubric categories were found to be significantly different: Criteria, Proposal, Test/Evaluate, and Communicate. The findings in this study suggest that MEAs significantly support design-based classroom activities. While overall student design performance was reported to show no significant increase, aspects of design displayed significant improvement. Technology and engineering teachers should examine MEAs as potential curriculum enhancements in their design-based classrooms.

Brief counseling by pharmacists enhances the knowledge, perceptions, and compliance of first and second-trimester pregnant women consuming ferrous fumarate at Jetis Community Health Center of Yogyakarta

In Indonesia, the prevalence of anemia during pregnancy increased from 37.1% in 2013 to 48.9% in 2018. It plays a significant part in elevated maternal mortality and perinatal rates. This research aimed to determine the influence of a brief counseling intervention by pharmacists based on the ‘5A’ strategy that had been modified to include the knowledge, perceptions, and compliance of pregnant women with the recommended consumption of ferrous fumarate as anemia treatment and prevention. It is a quasi-experimental study with a pretest-posttest control group design. The data were collected prospectively from December 2018 to February 2019. The sample consisted of 26 respondents, divided into a control group and an intervention group. Each group comprised 13 pregnant women in their first and second trimester (ranging from 12 to 27 weeks). The knowledge, perceptions, and compliance in each group were measured on the first day of visit (Day 1; pretest) and Day 31 (posttest) after the intervention. The results showed a significant difference in average scores between the pretest and posttest in the intervention group (p<0.001 for knowledge, perceptions, and compliance parameters) but an insignificant difference in the control group (p=0.185, p=0.366, and p=0.111, respectively). Score difference or improvement was determined from the relative risk (RR) values of the three parameters (4.55, 4.54, and 10.29, respectively, with p<0.50). As a conclusion, a brief counseling intervention based on the modified ‘5A’ strategy can enhance the knowledge, perceptions, and compliance of first and second-trimester pregnant women at Jetis Community Health Center with the proper consumption of Fe fumarate as an iron supplement.

HEARING IMPAIRMENT, COGNITIVE PERFORMANCE, AND BETA-AMYLOID DEPOSITION IN THE ARIC-PET AMYLOID IMAGING STUDY

Hearing impairment is a risk factor for dementia but the mechanism underlying this association is unknown. We investigated the relationship between hearing and cognitive performance and brain β-amyloid deposition in 252 adults aged 67-88 years (37% black race) without dementia from three U.S. communities. Global cortical standardized uptake value ratios (SUVRs) were calculated from florbetapir-positron emission tomography scans, with elevated SUVR defined as >1.2 (the median value). Air conduction hearing threshold levels for the frequencies of 0.5, 1, 2 and 4 kHz were obtained by pure tone audiometry and averaged for the better-hearing ear to yield a pure tone average (PTA) in decibels hearing level (dB). A composite cognitive score was created from ten neuropsychological tests summarized using latent variable methods. Multivariable-adjusted linear and Poisson regression with robust standard errors were used to estimate the average difference in cognitive scores and prevalence of elevated SUVR, respectively, by hearing impairment status. In analyses adjusted for age, sex, education and APOE ε4 status, hearing was not associated with elevated SUVR [prevalence ratio per 10 db increase (worse hearing) = 0.94 (95% CI: 0.84, 1.04)]. Results did not differ by race. In contrast, each 10 db increase in hearing impairment was associated with 0.08 standard deviation (95% CI: 0.02, 0.15) lower cognitive score, after adjustment for demographic and cardiovascular factors. Poorer hearing is associated with poorer cognitive performance but not with amyloid deposition, suggesting that the mechanism underlying the relationship between hearing and cognition may be independent of Alzheimer’s-related pathologic brain changes.

Interaction between apolipoprotein E genotype and hypertension on cognitive function in older women in the Nurses' Health Study.

ObjectiveTo examine the interaction between APOE genotypes and both treated and untreated hypertension on cognitive function in an updated analysis of Nurses’ Health Study (NHS) data.DesignAt baseline (1995–2001) and 3 biennial follow-up assessments over ~6 years, cognitive function was assessed.Setting and participants8300 NHS participants aged 70+ years underwent a cognitive battery, which comprised 6 tests including the Telephone Interview for Cognitive Status (TICS) and tests of verbal memory, category fluency, and working memory.MeasuresWe estimated the mean differences in average cognitive scores across up to 4 assessments using multiple linear regression. We also tested for interaction between APOE e4 allele carrier status and hypertension overall, as well as for apparently untreated and treated hypertension.ResultsWe confirmed that, compared with those with APOE e3/3 genotype, APOE e4 allele carriers scored lower by 0.55 units on the average TICS score (95%CI:-0.67,-0.43). We also observed a significantly worse average TICS score among women with untreated hypertension compared with women without hypertension (difference = -0.23, 95%CI:-0.37,-0.09), while no significant difference was observed for women with treated hypertension. Significant interaction was detected between the APOE e4 allele and untreated hypertension (p-int = 0.02 for the TICS; p-int = 0.045 for global score), but not with treated hypertension. Specifically, compared with normotensive women with the APOE e3/3 genotype, APOE e4 allele carriers with treated hypertension scored lower by 0.50 units (95%CI:-0.69,-0.31); however, the APOE e4 allele carriers with untreated hypertension scored lower by 1.02 units on the TICS score (95%CI:-1.29, -0.76). This interaction of APOE e4 and untreated hypertension was also consistently observed for the global score.ConclusionsWomen with hypertension and at least one APOE e4 allele had worse average cognitive function compared with women without hypertension with the e3/3 genotype; this difference was amplified among APOE e4 allele carriers with untreated hypertension.

Preemptive Oral Compared With Intravenous Acetaminophen for Postoperative Pain After Robotic-Assisted Laparoscopic Hysterectomy: A Randomized Controlled Trial.

To compare pain after robotic-assisted laparoscopic hysterectomy when giving preoperative oral compared with intravenous acetaminophen. This double-blind randomized trial included women undergoing robotic-assisted laparoscopic hysterectomy for benign indications. Participants received either acetaminophen 1 g orally then normal saline 100 mL intravenously before surgery, or a placebo orally then acetaminophen 1 g intravenously. The primary outcome measured was difference in pain between the groups 2 hours postoperatively. A sample size of 74 participants (37/group) was needed to achieve 80% power to detect noninferiority using a one-sided, two-sample t-test with an alpha of 0.025 and a noninferiority margin of 10 mm. From April 2016 through August 2017, 77 patients were enrolled, with 75 participants included in the final analysis. Characteristics were similar between groups. No difference in average pain score was noted 2 hours after surgery, nor at any of the measured time points. Average scores for the oral and intravenous group, respectively, at 2 hours were 35 and 36 mm (P=.86), at 4 hours 36 and 37 mm (P=.96), and at 24 hours 35 and 36 mm (P=.79). Thirty-eight percent of participants in the oral group and 19% of participants in the intravenous group experienced nausea (P=.12). The oral group used 9.7 morphine equivalents in the recovery room, and the intravenous group used 9.5 morphine equivalents (P=.9). The oral group requested analgesia in 45 minutes on average, and the intravenous group requested analgesia in 43 minutes (P=.79). No difference in pain was observed 2 hours postoperatively when comparing preoperative administration of oral compared with intravenous acetaminophen. Given the ease of administration and lower cost of oral dosing, this study supports the oral route as part of the enhanced recovery after surgery protocol for minimally invasive gynecologic surgery. ClinicalTrials.gov, NCT03391284.

أحلام الیقظة وعلاقتها بالتفکیر التأملی لدى الطالبات الموهوبات بمرحلتی المتوسطة والثانویة فی التعلیم بمدینة جدة Daydreams and It's Relation with Reflective Thinking of Gifted Middle and High School Students in Education in Jeddah

هدفت هذه الدراسة إلى التعرف على العلاقة بين أحلام اليقظة والتفکير التأملي لدى الطالبات الموهوبات بمدينة جدة، وفيما إذا کانت تختلف تبعا لمتغيرات (نوع التعليم، والمرحلة التعليمية). ووفقا لذلک، تم بناء مقياس أحلام اليقظة، واستخدام مقياس مستويات التفکير التأملي من إعداد کيمبر، وآخرون Kember et al. (2000) والمعرب من قبل ريان (2010)، وطبقت على عينة 96 طالبة تم اختيارهم بالطريقة العشوائية في مدارس التعليم بمدينة جدة. وأسفرت وجود علاقة ارتباطيه بين أحلام اليقظة الإيجابية، والتفکير التأملي لدى الطالبات الموهوبات بمدارس التعليم بجدة، کما أظهرت النتائج عن وجود فروق ذات دلالة إحصائية في متوسطات الدرجات لدى الطالبات الموهوبات علي مقياس أحلام اليقظة ذات المحتوى الإيجابي تبعا لمتغير نوع التعليم، ولصالح طالبات المدارس الحکومية، في حين لم تظهر فروق ذات دلالة إحصائية في متوسطات الدرجات لدى الطالبات الموهوبات علي مقياس أحلام اليقظة تبعا لمتغير المرحلة التعليمية، ولم توجد فروق ذات دلالة إحصائية في متوسطات الدرجات لدى الطالبات الموهوبات علي مقياس مستوى التفکير التأملي تبعا لمتغير المرحلة (متوسط- ثانوي)، کما لم توجد فروق ذات دلالة إحصائية في متوسطات الدرجات لدى الطالبات الموهوبات علي مقياس مستوى التفکير التأملي تبعا لمتغير نوع التعليم. This study aimed to identify the relationship between daydream and Reflective Thinking among female students gifted in Jeddah، and whether they differ according to the variables (a type of education، educational stage). Accordingly، the measure of daydreams and the use of the measure of reflective thinking levels was developed by Kimber، et al. (2000) and by Ryan (2010)، and was applied to a sample of 96 randomly selected students in the Jeddah schools of education. The results showed that there were statistically significant differences in the average scores of female students gifted on the scale of daydreams with positive content according to the variable of the type of education، and in favor of female students in public schools، While there were no statistically significant differences in the average scores of female students gifted on the scale of daydreams according to the variable of the educational stage. There were no statistically significant differences in the average scores of the female students gifted on the scale of thinking level depending variable the stage (secondary- middle School)، ​​and there were no statistically significant differences in average scores among female students gifted on a scale level of reflective thinking depending variable the type of education differences

A comparative study of combining intra-articular injection of platelet-rich plasma or sodium hyaluronate with isotonic muscle strength training in treating knee osteoarthritis

Objective To compare the efficacy of intra-articular injection of autologous platelet-rich plasma (PRP) with that of sodium hyaluronate for patients with knee osteoarthritis (KOA). Methods Fifty KOA patients were randomly divided into a PRP group (n=25) and a sodium hyaluronate group (n=25). Those in the PRP group were injected intra-articularly with 5 ml of autologous PRP every 2 weeks for 6 consecutive weeks, while the sodium hyaluronate group was given intra-articular injections of 2 ml of sodium hyaluronate once a week for 6 weeks. Both groups performed isokinetic strength training three times a week for 6 weeks. Before as well as 6 weeks, 3 months, 6 months and 12 months after the treatment, both groups were followed and evaluated using the Western Ontario and McMaster University osteoarthritis index (WOMAC). A Biodex System 4 isometric muscle strength testing system was used to evaluate the knees′ peak torque (PT) in flexion and extension, total power (TW), and average power (AP). Results Before the treatment there were no significant differences in pain, stiffness or average WOMAC score between the two groups. Afterward significant improvement was observed in the pain, stiffness and WOMAC scores of both groups. Compared with the sodium hyaluronate group, significantly greater decreases in the average WOMAC pain score were observed in the PRP group after the different intervals. That was also true of the average stiffness scores and the overall average WOMAC scores after 6 and 12 months. The flexor and extensor PT, TW and AP at the angular velocities of 60°/s and 90°/s also improved significantly in both groups after 6 weeks and 12 months, with the improvement of the PRP group significantly greater than that in the control group at the same time points. Conclusion Intra-articular injection of either autologous PRP or sodium hyaluronate can effectively alleviate the clinical symptoms of KOA when combined with isokinetic strength training. However, PRP is the more effective. Its use is worthy of clinical application and promotion. Key words: Knees; Osteoarthritis; Plasma; sodium hyaluronate; Isokinetic strength

Video-Based Pairwise Comparison: Enabling the Development of Automated Rating of Motor Dysfunction in Multiple Sclerosis

ObjectivesTo examine the feasibility, reliability, granularity, and convergent validity of a video-based pairwise comparison technique that uses algorithmic support to enable automated rating of motor dysfunction in patients with multiple sclerosis (MS). DesignFeasibility and larger cross-sectional cohort study. SettingThe outpatient clinic of 2 specialist university medical centers. ParticipantsSelected sample from a cohort of patients with MS participating in the Assess MS study (N=42). Videos were randomly drawn from each strata of the ataxia severity-degrees as defined in the Expanded Disability Status Scale (EDSS). In Basel: 19 videos of 17 patients (mean age, 43.4±11.6y; 10 women). In Amsterdam: 50 videos of 25 patients (mean age, 50.0±10.0y; 15 women). InterventionsNot applicable. Main Outcome MeasuresIn each center, neurologists (n=13; n=10) viewed pairs of videos of patients performing standardized movements (eg, finger-to-nose test) to assess relative performance. A comparative assessment score was calculated for each video using the TrueSkill algorithm and analyzed for intrarater (test-retest; ratio of agreement) and interrater reliability (intraclass correlation coefficient [ICC] for absolute agreement) and convergent validity (Spearman ρ). Granularity was estimated from the average difference in comparative assessment scores at which 80% of neurologists considered performance to be different. ResultsIntrarater reliability was excellent (median ratio of agreement≥0.87). The comparative assessment scores calculated from individual neurologists demonstrated good-excellent ICCs for interrater reliability (0.89; 0.71). The comparative assessment scores correlated (very) highly with their Neurostatus-EDSS equivalent (ρ=0.78, P<.001; ρ=0.91, P<.05), suggesting a more fine-grained rating. ConclusionsVideo-based pairwise comparison of motor dysfunction allows for reliable and fine-grained capturing of clinical judgment about neurologic performance, which can contribute to the development of a consistent quantified metric of motor ability in MS.

Battlefield Acupuncture and Physical Therapy Versus Physical Therapy Alone After Shoulder Surgery.

Objective: Opioid pain medications are commonly prescribed postsurgically for pain. Few studies have investigated the effects of Battlefield Acupuncture (BFA) on postsurgical pain and pain-medication use. To date, no studies have investigated BFA's effectiveness for reducing postoperative shoulder pain and pain-medication use post surgery. The objective of this study was to determine if adding BFA to a rehabilitation protocol was effective for reducing pain and use of prescribed pain medications, compared to that protocol alone after shoulder surgery. Materials and Methods: Forty Department of Defense beneficiaries (ages 17-55) were randomized to either a standard-of-care group or a standard-of-care + BFA group prior to shoulder surgery. The standard BFA protocol was administered with semipermanent acupuncture needles emplaced on the subjects' ears for 3-5 days within 24 hours after shoulder surgery in an outpatient physical therapy setting. BFA was reapplied, as needed, up to 6 weeks postsurgically for pain management in the intervention group. The primary outcomes were visual analogue scale (VAS) pain rating and daily pain medication use by each subject. Secondary outcome measures were the Global Rating of Change and Patient Specific Functional scale. Outcome measures were obtained at 24 hours, 72 hours, 1 week, 2 weeks, and 6 weeks post surgery. Results: Significant differences in average and worst VAS pain change scores were noted between baseline and 7 days (P < 0.05). The main effect for time was significant (average and worst VAS pain) at all timepoints (P < 0.05), without time-group interactions seen. No significant differences between the groups in pain-medication use were observed (P > 0.05) Conclusions: BFA reduced postsurgical shoulder pain significantly between the groups' average and worst pain change scores between baseline and 7 days despite similar opioid and nonsteroidal anti-inflammatory drug use between the groups.

Residency and Fellowship Program Administrator Burnout: Measuring Its Magnitude

Little is known about the level of burnout among program administrators (PAs) working in graduate medical education. We created a national database with baseline burnout data for PAs from residency and fellowship programs, including intention to leave their current positions. A cross-sectional study was conducted in July 2017 to assess levels of burnout in a national cohort of PAs, who were largely members of online specialty forums. The Copenhagen Burnout Inventory (CBI) was used to measure burnout. Univariate analysis produced descriptive statistics for CBI. We performed a 2-sample t test to measure differences in average burnout scores for those who had thoughts of resigning from their positions and those who had not. Of the approximately 10 205 national PAs, we sampled 1126 (11%). Of the 1126 individuals who received the study information, 931 (83%) completed the baseline survey. Total mean scores for all subscales were elevated (personal: 53.7, SD 21.4; work-related: 52.0, SD 22; and client-related: 30.6, SD 20.8; each scale ranged from 0, low, to 100, high). Burnout scores differed between those contemplating leaving their jobs and those who were not, across all subscales of CBI, including personal (64.2 versus 42.4, -24.18 to -19.44 confidence interval [CI]), work-related (63.5 versus 39.7, -26.12 to -21.35 CI), and client-related (36.6 versus 24.2, -14.95 to -9.84 CI; P < .0001 for all). In this national survey of PAs, burnout scores measured by the CBI were higher among those who had considered leaving their positions.

The effects of low-frequency transcranial magnetic stimulation combined with hyperbaric oxygen in the treatment of non-fluent aphasia

Objective To investigate the effect of repeated application of low-frequency transcranial magne-tic stimulation (rTMS) when combined with hyperbaric oxygen (HBO) in the treatment non-fluent aphasia after a stroke. Methods Forty-eight stroke survivors with non-fluent aphasia were randomly assigned to a control group, an HBO group or an observation group, each of 16. All received conventional rehabilitation therapy consisting of drug therapy, speech training and conventional physical exercises, while the HBO and observation groups were additionally given HBO and rTMS combined with HBO respectively. The 1 Hz rTMS was applied over the Broca′s homologues of the unaffected hemisphere. Before and after 4 weeks of treatment, the Western Aphasia Battery (WAB) was used to evaluate the subjects′ language function and the Modified Barthel Index (MBI) was used to assess their ability in the activities of daily living. Results There was no significant difference in the average WAB scores among the three groups before the treatment. After 4 weeks of treatment the average WAB and MBI scores of the HBO group and the observation group had improved significantly, and there was then a significant difference among the three groups. The observation group was performing significantly better than the HBO group and the control group in spontaneous speech, auditory comprehension, repetition, naming, AQ score and MBI score. Pairwise comparisons showed that the observation group′s average WAB score, spontaneous speech, auditory comprehension, repetition, naming, AQ score and MBI score were the best, followed by those of the HBO group and then those of the control group. All of the differences were statistically significant. Conclusions Low-frequency rTMS combined with HBO can significantly improve the language function and the quality of life of patients with non-fluent aphasia. Such combined therapy is worthy of clinical promotion and application. Key words: Transcranial magnetic stimulation; Hyperbaric oxygen; Stroke; Non-fluent aphasia

Analysis on the current situation of psychological stress of residents in the standardized training base

Objective To analyze the status of psychological stress of trainees in the standardized cooperation training base for municipal hospital residents, and to discuss their mental health problems. Methods Cluster random sampling method was used to select the standardized training trainees of resident physicians in a municipal cooperative base as the research object. Self-made psychological stress evaluation scale was divided into two dimensions: psychological stress and emotion. The emotional dimension was given 1 to 10 points respectively. Descriptive statistics and analysis of variance were used to evaluate the general situation and stress status of residents in standardized training. Results The psychological stress of trainees is prominent, and the employment pressure is the biggest source of stress (4.583±2.939). Other source are work pressure (4.269±2.791), study pressure (3.398±2.782), economic pressure (3.167±2.715), interpersonal pressure (1.222±2.088), environmental pressure (1.065±1.906), and emotional pressure (0.824±1.723). There are significant differences between different types of stress (F=44.68, P=0.000). Trainees' mental health problems are quite serious. 59.26% of the standardized training students occasionally feel pressure, 35.19% often feel pressure, and 4.63% always feel pressure. The detection rate of anxiety, depression and inferiority is 64%, 26% and 26%, respectively. There are significant differences in the average scores of various emotions (F=24.19, P=0.000). Conclusion The psychological stress and mental health problems of residents in standardized training are prominent. Positive measures should be taken to deal with the mental health problems in prospective doctors groups in their transformation stage of development. Key words: Standardized training residents; Psychological pressure; Affecting factors

A Development of Integrative Thematic Textbook with Problem-Based Learning to Improve the Critical-Thinking Ability of Elementary Students at Grade IV

This research aimed (1) to produce an integrative thematic textbook with Problem-&#x0D; Based Learning that is appropriate to improve the critical-thinking ability of elementary&#x0D; students at grade IV and (2) to examine the effectiveness of the textbook. The design&#x0D; of the research was R&amp;D by Borg and Gall. The product tests were limited test,&#x0D; expanded test, and operational test. The researches were conducted at SDN Semanu&#x0D; II, SDN Karangrejek II, and SDN Gombang II in Gunungkidul District. The subjects of&#x0D; the research were 110 students and 4 teachers of grade IV. The instruments of data&#x0D; collection were interview guidelines, observation sheets, and expert validation sheets,&#x0D; questionnaires of teachers’ response, students’ response scale, and test of criticalthinking&#x0D; ability. The effectiveness of the product was tested using quasi experiment.&#x0D; The data were analyzed descriptive qualitatively and quantitatively through the test of&#x0D; difference with significance level 0.05. The result of this research was in the form of&#x0D; appropriate textbook based on the assessment from media expert and material expert&#x0D; that categorized the textbook as “very good”. The developed product was effective to&#x0D; improve the students’ critical-thinking ability. The average post-test score proved it, in&#x0D; which experimental classes 1 and 2 gained 80.48 and 80.39. The average post-test&#x0D; score in control class was only 67.73. The difference of average scores was significant&#x0D; at calculated t score 5.579 and two-tails significance at 0.000 for the difference test&#x0D; between the post-test of experimental class 1 and the control class. Meanwhile, the&#x0D; difference of average scores was significant at calculated t score 5.845 and two-tails&#x0D; significance was at 0.000 for the difference test between the post-test of experimental&#x0D; class 2 and the control class.

Emirati women's attitudes towards menopause: Implications for health care policy.

Objectives To investigate the attitudes of Emirati women aged 30–64 years towards menopause and determine the relationships between these attitudes and their sociodemographic and reproductive characteristics. Study design A community-based cross-sectional study was conducted with 497 Emirati women attending five primary health care centres in Dubai using a multistage stratified and clustered random sampling technique. Emirati women were interviewed face-to-face via a structured questionnaire with two parts: sociodemographic and reproductive characteristics and the attitudes towards menopause scale. Results The mean ± S.D. of age was 42.06 years ± 8.716 (median 40 years). Mean age at menopause for the study sample (N = 436) was 49.94 years ± 4.593 (median 50 years). Of the respondents, 36.6% had completed high school, and 41.4% had graduated from university. Approximately, 70.8% of the women were premenopausal, 13.1% were perimenopausal and 16.1% were postmenopausal. Sixty-four percent of the respondents had never used oral contraceptive pills, while 32.9% were past users; 44.6% were employed outside the home. Mean average attitudes score ± S.D. was 2.42 ± 0.26 (minimum score of 1 indicates very negative attitudes, maximum score of 4 indicates very positive attitudes). Statistically significant differences in mean average attitudes score were noted for employment and menopausal status, and mean average attitudes score was positively correlated with age. Premenopausal women held more positive attitudes towards menopause than peri- and postmenopausal women. Conclusions Emirati women displayed neutral to positive attitudes towards menopause and premenopausal women exhibited more negative attitudes towards menopause than postmenopausal women.

Associations Between Food Pantry Size and Foods Received by Clients in Baltimore City (P04-031-19)

ObjectivesFood pantries act as a supplementary food source for food-insecure households throughout the United States. Recent studies show that healthy food options in food pantries are limited. This may be related to food pantry capacity, suggesting that the size of a food pantry may contribute to the healthfulness of provided foods – an area yet to be studied. Therefore, we aim to examine the relationship between food pantry size and healthfulness of foods received by clients. MethodsWe categorized the Maryland Food Bank’s Baltimore-based partner food pantries (n = 102) as small, medium, or large based on the weight of food they distribute annually. From the pantries who were eligible and interested, we randomly selected 2 small, 2 medium, and 3 large pantries. In terms of food distribution methods, 3 used client-choice and 4 used pre-assembled bags. Food selection data was collected from a total of 74 clients (21 at small, 20 at medium, and 33 at large pantries) between September and October 2018. The Food Assortment Scoring Tool (FAST), a metric used to quantify the nutritional quality of food in pantries, was used to assess the healthfulness of client food bags, with higher scores indicating higher nutritional quality. The Gross Weight Share (GWS) of the food groups described in FAST was calculated to find the proportion of these foods to the total weight of food clients received. ResultsThere was no statistically significant difference in overall average FAST scores among clients of different sized pantries. However, among client choice pantries, clients of small pantries had FAST scores 9.23 points (P = 0.02) higher than clients of medium sized pantries. Small pantries’ clients had higher GWS of fresh fruits and vegetables compared to large (P = 0.002) and medium pantries (P = 0.03), while large pantry clients had higher GWS of sweet and salty snacks than medium pantry clients (P = 0.03). ConclusionsAlthough the average FAST scores across clients from pantries of different sizes did not show statistically significant differences, stratifying FAST scores by food distribution model and examining GWS of key food groups suggest that small food pantry clients receive the largest proportion of healthy foods. These findings suggest the need to prioritize large food pantries in future interventions to help enable clients to receive healthier food products. Funding SourcesJohns Hopkins University Lerner Center for Public Health Promotion.

EFEKTIVITAS BOOKLET TERHADAP PENGETAHUAN DAN SIKAP PEMELIHARAAN KESEHATAN GIGI MULUT PADA IBU HAMIL

Pregnancy causes physiological changes in the body and as well as in the oral cavity. Dental and oral diseases associated with pregnancy that is, gingivitis, periodontitis and pregnancy granuloma. Mouth dental disease during pregnancy is not only influenced by the pregnancy itself but rather the lack of knowledge about dental and oral health maintenance. Efforts to improve the knowledge of pregnant women about oral health is done by providing information, information necessary for health education media. In this case the media is created and used to improve the knowledge of pregnant women is the booklet. This study aimed to analyze the differences in knowledge and attitudes before and after maintenance booklet oral health in pregnant women. This study is a quasi experiment with one group pre and post test design. The sample is the first trimester pregnant women who come to the health center in Sentosa Baru Medan as many as 34 people. Analysis of the data forcompare the average difference in scores of knowledge and attitudes before and after the intervention used the Wilcoxon test. The results showed there is an increased knowledge and attitude maintenance of oral health in pregnant women after being given a booklet with a value of p &lt; 0.001, a percentage increase of 30% knowledge and attitudes percentage of 37%. The conclusions of this study is increased knowledge and attitude maintenance of oral health in pregnant women after being given a booklet.