Difficulties In Scale Research Articles

Chronic traumatic encephalopathy in former college football playing brain donors

AbstractBackgroundChronic traumatic encephalopathy (CTE) is neurodegenerative disease associated with a history of repetitive head impacts (RHI). The majority of CTE cases have been reported in former contact sport athletes, including American football players. In 2017, a case series from the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank reported that 48 of the first 53 donors with college football as their highest level of play had CTE. Here we present updated numbers of former college football players with CTE in the UNITE Brain Bank and compare them to former college football players without CTE. We hypothesized that increasing CTE stage would be associated with dementia and increasing scores on clinical scales of informant reported symptoms.MethodBrain donors from the UNITE Brain Bank with college football as their highest level of play were included. CTE neuropathological diagnosis and staging (0‐IV; 0 = no CTE, IV = most severe) were assessed using validated criteria. Informants completed standardized scales of cognition (Cognitive Difficulties Scale, CDS), activities of daily living (Functional Activities Questionnaire, FAQ), and neurobehavioral dysregulation (BRIEF‐A Behavioral Regulation Index, BRI). Consensus dementia diagnoses were made by expert clinicians. Multivariable regression models examined associations between CTE stage, dementia, and each clinical scale, controlling for age at death, racial identity, education, and duration of football play in years.ResultAmong 319 donors with college football as their highest level of play (median age at death = 64.0; IQR = 47‐77), 222 (69.5%) had CTE. Among those with CTE, 44 (19.8%) were stage I, 47 (21.2%) were stage II, 79 (35.6%) were stage III and 52 (23.4%) were stage IV. Among those with CTE, 122 (55.0%) were demented and 123 (61.5%) and 131 (70.8%) had clinically meaningful elevations on the FAQ and BRI respectively. CTE stage was significantly associated with having dementia (OR = 1.37; 95%CI:1.08‐1.72) and with more symptoms on the CDS (beta = 5.04; 95%CI:1.41‐8.66) and FAQ (beta = 1.12; 95%CI:0.38‐1.86), but not the BRI. Effect estimates were larger after removing donors with non‐CTE neurodegenerative pathology.ConclusionAmong former college football playing brain donors, CTE pathology was very common. CTE stage was significant associated with dementia history and symptoms on clinical scales.

Comparison of intubating conditions in supine (sniffing) and 25° back-up position using channelled and non-channelled video laryngoscopes - A randomised controlled study.

The 25°back-up position is proposed to increase the efficacy of preoxygenation and provide better tracheal intubating conditions when using a direct laryngoscope. This study aimed to compare the ease of tracheal intubation between supine and 25° back-up positions when using two video laryngoscopes (VLS). One hundred adults with normal airways and belonging to the American Society of Anesthesiologists physical status classes I and II, requiring general anaesthesia, were randomised in groups K and M. The trachea was intubated using King Vision and McGrath VLS in either supine (groups K1 and M1) or 25° back-up (groups K2 and M2) positions. The 25° backup position was given by raising the operating table from the horizontal position by flexing the torso at the hips so that an imaginary line connected the patient's external auditory meatus to the sternal notch. Modified Intubation Difficulty Scale (mIDS) was the primary outcome, and intubation time, the number of intubation attempts, vital parameters, and complications were compared secondarily. Statistical analysis was done using MedCalc software by applying an independent t-test for parametric data and a Chi-square test for categorical data and finding the risk ratio. Mean (Standard deviation) mIDS was significantly reduced using both VLS in the 25° back-up position [0.92 (0.75) versus 0.48 (0.58), P = 0.025, degree of freedom (DF): 48, mean difference (95% confidence interval [CI]):-0.44 (-0.821 to - 0.059) in group K1 versus group K2 and 0.76 (0.59) versus 0.36 (0.48), P = 0.012, DF: 48, mean difference (95% CI): -0.40(-0.706 to - 0.094) in group M1 versus group M2, respectively]. The risk ratio comparing both the positions for the total number of patients requiring manoeuvres during intubation using both the VLS was 0.48 with P = 0.0004 and 95% CI = 0.305 - 0.765. Intubation time was shorter in the 25° backup position by using King Vision (P = 0.005) and McGrath (P = 0.042) VLS. The 25° backup position helps provide ease of intubation using both the channelled (King Vision) and non-channelled (McGrath) VLS.

SWSSL: Sliding Window-Based Self-Supervised Learning for Anomaly Detection in High-Resolution Images.

Anomaly detection (AD) aims to determine if an instance has properties different from those seen in normal cases. The success of this technique depends on how well a neural network learns from normal instances. We observe that the learning difficulty scales exponentially with the input resolution, making it infeasible to apply AD to high-resolution images. Resizing them to a lower resolution is a compromising solution and does not align with clinical practice where the diagnosis could depend on image details. In this work, we propose to train the network and perform inference at the patch level, through the sliding window algorithm. This simple operation allows the network to receive high-resolution images but introduces additional training difficulties, including inconsistent image structure and higher variance. We address these concerns by setting the network's objective to learn augmentation-invariant features. We further study the augmentation function in the context of medical imaging. In particular, we observe that the resizing operation, a key augmentation in general computer vision literature, is detrimental to detection accuracy, and the inverting operation can be beneficial. We also propose a new module that encourages the network to learn from adjacent patches to boost detection performance. Extensive experiments are conducted on breast tomosynthesis and chest X-ray datasets and our method improves 8.03% and 5.66% AUC on image-level classification respectively over the current leading techniques. The experimental results demonstrate the effectiveness of our approach.

Relative Contributions of Mixed Pathologies to Cognitive and Functional Symptoms in Brain Donors Exposed to Repetitive Head Impacts.

Exposure to repetitive head impacts (RHI) is associated with later-life cognitive symptoms and neuropathologies, including chronic traumatic encephalopathy (CTE). Cognitive decline in community cohorts is often due to multiple pathologies; however, the frequency and contributions of these pathologies to cognitive impairment in people exposed to RHI are unknown. Here, we examined the relative contributions of 13 neuropathologies to cognitive symptoms and dementia in RHI-exposed brain donors. Neuropathologists examined brain tissue from 571 RHI-exposed donors and assessed for the presence of 13 neuropathologies, including CTE, Alzheimer disease (AD), Lewy body disease (LBD), and transactive response DNA-binding protein 43 (TDP-43) inclusions. Cognitive status was assessed by presence of dementia, Functional Activities Questionnaire, and Cognitive Difficulties Scale. Spearman rho was calculated to assess intercorrelation of pathologies. Additionally, frequencies of pathological co-occurrence were compared to a simulated distribution assuming no intercorrelation. Logistic and linear regressions tested associations between neuropathologies and dementia status and cognitive scale scores. The sample age range was 18-97 years (median = 65.0, interquartile range = 46.0-76.0). Of the donors, 77.2% had at least one moderate-severe neurodegenerative or cerebrovascular pathology. Stage III-IV CTE was the most common neurodegenerative disease (43.1%), followed by TDP-43 pathology, AD, and hippocampal sclerosis. Neuropathologies were intercorrelated, and there were fewer unique combinations than expected if pathologies were independent (p < 0.001). The greatest contributors to dementia were AD, neocortical LBD, hippocampal sclerosis, cerebral amyloid angiopathy, and CTE. In this sample of RHI-exposed brain donors with wide-ranging ages, multiple neuropathologies were common and correlated. Mixed neuropathologies, including CTE, underlie cognitive impairment in contact sport athletes. ANN NEUROL 2024;95:314-324.

A Novel Methodology Analyzing the Influence of Micro-Stresses on Human-Centric Environments

This article offers experimental studies and a new methodology for analyzing the influence of micro-stresses on human operator activity in man–machine information and search interfaces. Human-centered design is a problem-solving technique that puts real people at the center of the design process. Therefore, mindfulness is one of the most important aspects in various fields such as medicine, industry, and decision-making. The human-operator activity model can be used to create a database of specialized test images and a computer for its implementation. The peculiarity of the tests is that they represent images of real work situations obtained as a result of texture stylization and allow the use of an appropriate search difficulty scale. A mathematical model of a person who makes a decision is built. The requirements for creating a switch to solve the given problem are discussed. This work summarizes the accumulated experience of such studies.

Hope and life satisfaction in Palestinian children victim of military violence: The predictive role of agency, potentially traumatic experiences and symptoms of trauma

BackgroundChildren exposed political violence deploy resources to maintain functioning, hope and life satisfaction. ObjectiveWe sought to explore whether or not children promote hope and life satisfaction trough agency, psychological difficulties, potentially traumatic experiences and symptoms in Palestine. Participants and setting965 children (494 males and 471 females) in multiple geographical contexts, and areas were involved. MethodsWe administered the War Child Agency Assessment Scale, Child Hope Scale, Multilevel Students'Life Satisfaction Scale-Bref, the Strength and difficulties scale, the Child Revised Impact of events Scale, and Trauma Checklist, and performed regression analysis; hope and life satisfaction were dependent and agency, strength and difficulties, trauma symptoms and traumatic events independent variables. ResultsSpecific forms of agency predicted life satisfaction (β = 0.219; ** p < .01, social agency; β = 0.11; ** p < .01, with agency in education) and hope (β = 0.07; ** p < .05, agency on free movement), while mental difficulties (conduct problems, β = −0.09; ** p < .01; hyperactivity, β = −0.07; ** p < .05; β = −0.15; ** p < .01 with life satisfaction) (conduct problems, β = −0.06; ** p < .05, and difficulties in pro-social behaviour, β = −0.21; ** p < .01 with hope), traumatic events (β = −0.16; ** p < .01, with life satisfaction; β = −0.15; ** p < .01, with hope) and trauma symptoms (β = −0.09; ** p < .05, with hope) were negatively associated with the dependents variables. ConclusionsWe found a positive role of social, educational, and freedom of movement agentic behaviours in fostering hope and life satisfaction.

Psychometric Evaluation of the PNH Symptom Questionnaire (PNH-SQ) Among Patients with Paroxysmal Nocturnal Hemoglobinuria from Three Phase 2 Clinical Trials with Pozelimab Monotherapy or in Combination with Cemdisiran

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, life-threatening disease caused by chronic dysregulation of the complement system. PNH has a high symptom burden with significant impacts on the life of a patient. The PNH Symptom Questionnaire (PNH-SQ) is a PNH-specific patient-reported outcome (PRO) questionnaire designed to assess daily symptom severity in patients with PNH. The objective of this current study was to evaluate PNH-SQ psychometric properties among patients with PNH from three phase 2 clinical trials with pozelimab monotherapy or in combination with cemdisiran. Methods: PRO data from three phase 2 PNH clinical trials, study 1852 (NCT03946748; pozelimab monotherapy; n=24), study 2092 (NCT04811716; combination therapy; n=24), and study 20105 (NCT04888507; combination therapy; n=6), were used for analysis. The PNH-SQ is a patient-reported daily diary that assesses 10 core symptoms of PNH using a five-point severity scale (none; very mild; mild; moderate; severe; very severe) for fatigue, shortness of breath, muscle weakness, headaches, abdominal pain, pain in back or legs, and chest discomfort, and a five-point difficulty scale (none, not at all, a little bit, somewhat, quite, very) for difficulty sleeping, difficulty thinking clearly, and difficulty swallowing. Prespecified psychometric analyses were performed after study database lock using blinded data. Analyses included quality of completion (ie ePRO prevented item-level missingness) and item responses over time. Reliability and validity of daily assessments with classical test theory (internal consistency and test-retest reliability, construct validity by observing correlations between pairs of PNH-SQ items and of the PNH-SQ daily score with other PRO scores from the EORTC QLQ-C30, FACIT-Fatigue and EQ-5D) and Rasch measurement theory (RMT) analyses were conducted. Test-retest reliability (within stable patients 4 weeks apart) and construct validity of various exploratory methods for aggregating daily scores over time were assessed. Results: Completion rates of PNH-SQ items were higher in studies 20105 and 2092 (at Day 1: 54.2% in 1852 vs 83.3% in 20105 and 91.7% in 2092). Fatigue was consistently the most experienced symptom at baseline of the three studies, while difficulty swallowing was not experienced by any patient. A high proportion of ‘none’ responses were observed across all assessments. Cronbach's alpha calculated using all daily assessments was 0.75, indicating modest reliability. The correlation between each pair of items at Day 1 ranged between 0.11 and 0.93, with the lowest correlations being observed between pain items and sleep/cognitive items, and between abdominal pain and fatigue/dyspnea. At Day 1, PNH-SQ daily score trended higher according to the Patient Global Impression of Severity (PGIS)-symptoms categories and showed moderate correlations in expected direction with fatigue and pain, as assessed by FACIT-Fatigue and EORTC QLQ-C30, and lower correlations with dyspnea and overall health status (EQ-5D visual analog scale). RMT analyses of the daily PNH-SQ data highlighted that for response options “Very mild” for severity/“Not at all” for difficulty did not provide any useful information. RMT also uncovered a meaningful hierarchy of symptoms ranging from fatigue to difficulty swallowing. A fixed 7-day average led to the best test-retest reliability (intraclass correlation coefficient, 0.76). Conclusions: Our analyses documented the PNH-SQ as an instrument to capture symptoms of PNH. The most frequent symptoms reported in our sample using the PNH-SQ, fatigue, dyspnea, and headaches, were aligned with observational study data. The sample of observations from the three trials was strongly skewed towards absence of symptoms, probably reflecting the low symptomatic severity of patients included in the study. Despite this restriction, early supportive data for the scoring of the PNH-SQ from a sample of patients with PNH were obtained, generating useful insights into the function of the response scales, opportunities for the creation of daily assessments of symptom severity, and for the creation of a measure reflecting severity over a longer period, for which a fixed 7-day average appeared as a potential good scoring approach. Generating further evidence, especially in a sample of more symptomatic patients, is recommended to substantiate these results.

Self-reported and parent-reported mental health in children from low-income families in Agder, Norway: results from baseline measurements of New Patterns project participants

BackgroundPoverty may pose risks to child and adolescent mental health, but few studies have reported on this association among children and adolescents in low-income families in Norway.MethodsBased on a sample...

Traffic light alarming signs are indispensable prerequisites for fruitful endoscopic third ventriculostomy

BackgroundEndoscopic third ventriculostomy (ETV) is a satisfying neuro-endoscopic journey in candidates with preoperatively predicted higher success rates. Alarming cases require extra care to avoid serious complications, predict/identify failure and offer reasonable intra-/postoperative decisions.PurposeTo create easily interpretable traffic light alarming signs to increase the awareness level for neurosurgeons regarding ETV difficulty/failure.MethodsA 3-year-retrospective study of postoperative ETV infants of both sexes with obstructive hydrocephalus and preoperative ETV success score ≤ 70, age ≤ 12 months, and follow-up for ≥ 6 months with a postoperative radiological evaluation of the ETV patency and cerebrospinal fluid dynamics. The ETV difficulty scale (ETV-DS) was designed as an intraoperative monitor for surgical/anatomical difficulties. And the ETV failure threshold (ETV-FT) was offered for postoperative evaluation to identify cases that are mistakenly interpreted as failure.ResultsAmong our 159 case series, 54 infants were involved. Patients’ demographics, age: ≤ 28 days, > 28 days to 6 months, and >6 to 12 months, were 5.5%, 70.3%, and 24.2%, respectively. Postoperatively, the outcome based on ETV-FT color scale was dark green (ETV-FT=0), light green (ETV-FT=1), yellow (ETV-FT=2), orange (ETV-FT=3), red (ETV-FT=4) in 29%, 14%, 20%, 10.3%, and 26.7%, respectively. Actual failure is identified as ETV-FT=4 based on clinical/radiological data. The failure rate was significantly attributed to inadequate communication with the basal cistern due to difficult/unsafe perforation of the thick/dense Liliequist membrane (87%) (P = 0.001).ConclusionThe traffic light alarming signs (ETV-DS and ETV-FT) can warn neurosurgeons to recognize critical cases that necessitate ultra-precautions to navigate safely through landmines for worthy outcomes.

An evaluation of the psychometric properties of the strengths and difficulties scale in Turkey: Implications for other non‐WEIRD countries

AbstractThe Strengths and Difficulties Questionnaire (SDQ) is a very widely used scale in which parents, teachers or the child rate various aspects of the child's well‐being. It is widely used in the Western world and is translated into 80+ languages. It is also used in countries that do not classify as WEIRD (Western, educated, industrialized, rich and democratic). However, unlike WEIRD countries, some studies indicate that the psychometric properties of the SDQ when used in non‐WEIRD countries are questionable. Therefore, we gave the SDQ to the mothers and teachers of 310 3‐ to 5‐year‐olds in urban centres of Turkey and examined its psychometric properties. Turkey is not a WEIRD country because it is not Western, although the participants in our study were well educated, living in an industrialized area, rich relative to others in Turkey (although poor relative to Westerners) and democratic. As such, it is not drastically different from WEIRD countries and our question was whether even relatively small deviations from standard WEIRD criteria could result in questionable psychometric properties for the SDQ.

Evaluation and comparison of sonographic difficult airway assessment parameters with clinical airway predictors.

None of the clinical difficult airway predictors are 100% sensitive and specific. Ultrasound is being used for airway assessment, but there is still no established parameters or model to predict difficult laryngoscopy. This observational study was planned to determine the predictive ability of clinical and sonography-based airway assessment parameters for difficult laryngoscopy and intubation. A total of 130 patients of 18-60 years of age undergoing elective intubation were included. The distribution of Cormack-Lehane (CL) grade and intubation difficulty scale (IDS) was correlated with the clinical and sonographic screening parameters for difficult airways. The prevalence of difficult laryngoscopy and difficult intubation in our study was 17.6% and 11.5%, respectively. Mallampati grade (MMG), upper lip bite test (ULBT), neck circumference, hyomental distance ratio (HMDR), tongue thickness (TT), skin to epiglottis/epiglottis to vocal cord distance (SED/E-VC), and mandibular condylar mobility (MCM) had significant association with the difficult laryngoscopy and MMG, neck circumference, SED, SED/E-VC; MCM had significant association with the difficult intubation. The combination of these predictors showed better diagnostic ability for difficult airways. Model 1 based on ultrasound parameters showed an area under the curve (AUC) of 0.848 (CI- 0.748-0.947, P value < 0.0001) and model 2 based on combined clinical and ultrasound parameters showed an AUC of 0.755 (95% CI- 0.631-0.879, P value < 0.0001). Ultrasound-based airway predictors can help in predicting difficult laryngoscopy and intubation along with the clinical parameters. Individual sonographic predictors have moderately satisfactory diagnostic profiles. The models based on combined tests have better diagnostic value.

Examining the effect of the future readiness psychoeducation program on gifted students' career decision-making competencies and future expectations

There is a great need for intervention programs related to career studies in today's world where the importance of career studies is increasing day by day. Gifted children also feel necessary to career guidance more due to many factors such as their special talents, multi-potentials and early career awareness. The purpose of this study is to examine the effect of the "Turkish Science and Art Centers (SAC) Future Readiness Psychoeducation Program" developed for gifted middle school students who also continuing education in SAC. The aims of program are increasing career awareness, decreasing career decision making difficulties and effecting positively to future expectations. Thirty-two 7th grade students who were identified as gifted in Kilis province participated in the study. The study was designed in a pre-test post-test one-group quasi-experimental design. The data were analyzed using Mann Whitney U and Wilcoxon Signed Ranks Test from non-parametric techniques according to group structure. Career Decision Difficulties Scale (CDDS), Adolescent Future Expectations Scale (FESA) and program evaluation form were used as data collection tools. When the results of the study were evaluated, it was seen that the career development program prepared for gifted students reduced their career decision-making difficulties and positively affected their future expectations. It was observed that gifted female students had higher career decision-making difficulties than male students, while there was no significant difference in terms of future expectations. When the evaluation form data and opinions of the participants were examined, it was seen that the satisfaction with the program was high, the activities could be enriched in terms of practice, and it would be more beneficial to spread the activities over a wider period of time and implement them as a single activity in each session.

Sorry About the Connection: Client-Reported Telehealth Technology Competency and Difficulties

The growing body of research on telehealth services provides evidence of the efficacy of services and the possibility for greater accessibility of counseling services for hard-to-reach clients. However, less is known how clients think about the process of telehealth for mental health services. This study focused on two dimensions of client perception: telehealth difficulties and telehealth technology competency. This study examined the factor structure of two client-reported new measures, the Telehealth Difficulties Scale and the Telehealth Technology Competency Scale, through exploratory factor analyses. Results found that both measures had a one-factor structure with a high degree of reliability. Implications for these results are discussed, and future directions are given.

The Policing of Berlin as a Post-Conflict City

The essay explores the difficult transition from war to peace in the defeated capital of Hitler’s Third Reich. Not only did Soviet forces exact terrible revenge on the civilian population, but conditions of desperation and hunger led to a spike in blackmarket activity and crime. The Unconditional Surrender, ratified by Potsdam, set up a significant imbalance of power between the occupiers and the occupied. Amid conditions of continued hunger, in the sheets as well as on the streets, such a blatant asymmetry encouraged exploitation and immorality. As a wounded and postconflict city, Berlin posed special problems for the police authorities. With many policemen having tainted themselves through participation in illegitimate oppression and war crimes, policing had to be begun again from scratch. Although the Allies had lofty ideals of how to reform policing (reflecting their national traditions, but also progressive ideas about the employment of women), their lack of unity, together with the scale of the practical difficulties the city faced, meant that such reforms became watered down and ineffectual. The former capital’s need to regenerate and heal was sacrificed to the needs of the cold war. Women and antiNazis were increasingly marginalized, while former Gestapo men found favour.

Disability and caregiver burden: Unique challenges in a developing country.

This study aimed to identify factors, including degree of disability, that contribute to the caregiver burden of raising children with cerebral palsy in Sri Lanka. Participants were caregivers of children with cerebral palsy attending the pediatric neurology clinic of the only tertiary care center in southern Sri Lanka. The locally validated Caregiver Difficulties Scale (CDS) was administered, and demographic information was obtained in a structured interview. Disability data was accessed through the medical record. Of 163 caregivers who participated in this study, 133 (81.2%) demonstrated a moderate to high level of burden, and 91 (55.8%) were at high risk for psychological burden. In the bivariate analysis, caregiver burden significantly correlated with degree of physical disability based on the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS), the presence of medical co-morbidities, and having two or more children. However, only the GMFCS level and number of children remained significant predictors of caregiver burden after controlling for confounding effects. Raising a child with cerebral palsy in Sri Lanka is likely to cause caregiver burden, particularly if they have a high level of disability or one or more siblings. Monitoring caregiver burden as part of routine cerebral palsy management is important, which allows targeting psychosocial support to families most in need.

Reliability and validity of the Chinese post-discharge coping difficulty scale-parent form in parents of premature infants: a multicenter cross-sectional study.

The measurement of the coping difficulties of parents of premature infants after discharge provides objective data for nurses to prepare infants for discharge. However, no Chinese scale has been developed to measure parents' coping difficulties after their premature infants are discharged. To translate the parent version of the Post-Discharge Coping Difficulty Scale (Ped-PDCDS) from English to Chinese and test the reliability and validity of the Chinese version in parents of premature infants. A multicenter cross-sectional study of 356 parents of premature infants was conducted. The scale was symmetrically translated. Validity was evaluated in terms of content, construct, discriminant, and convergent validities. Reliability was assessed in terms of internal consistency, split-half reliability, and test-retest reliability. The Chinese Ped-PDCDS finally contained 11 items. Exploratory and confirmatory factor analyses results showed that the Chinese Ped-PDCDS had three dimensions, and the convergent and discriminant validities of the scale was satisfactory. The overall reliability, split-half reliability, and test-retest reliability of the scale was 0.85, 0.92, and 0.84, respectively. The Chinese Ped-PDCDS has adequate psychometric properties, and is an easy and appropriate instrument for measuring parents' difficulty in coping with premature infants.

Functional and Sport-Specific Outcome Following Traumatic First-Time Shoulder Dislocation and Arthroscopic Surgical Repair in Rock Climbers.

Traumatic shoulder dislocations rank among the most common shoulder injuries in climbers, with rising numbers over the last years. The objective of this study was to analyze the outcome following traumatic first-time shoulder dislocation and subsequent surgical treatment in this population. In a retrospective study, climbers who experienced a traumatic shoulder dislocation were treated with an arthroscopic repair of the labrum-ligament complex (LLC). The functional outcome was assessed with a standardized questionnaire and clinical examination, including the Constant Murley and Single Assessment Numeric Evaluation scores. The sport-specific outcome was analyzed using the Union Internationale des Associations d'Alpinisme (UIAA) scale of difficulty and a sport-specific outcome score. The functional and sport-specific outcome for 27 climbers (20 men; 7 women; 3 with bilateral injuries; age, 34±11 [17-61] y; data presented as mean±SD [range]) was assessed 53±29 (12-103) mo after surgery. The postoperative Constant Murley score was 95±8 (67-100) points. At follow-up, 93% (n=25) of patients had started climbing again. Twenty-one climbers (78%) reached a climbing level within the range of ±0.33 UIAA grades of their initial capability or even exceeded their preinjury grade. Only 7% (n=2) of the patients had a recurrent shoulder dislocation, leading to a secondary surgery, and, therefore, required ongoing postoperative treatment at the time of follow-up. Arthroscopic repair of the LLC following first-time traumatic shoulder dislocation in climbers shows a good outcome and a low recurrence rate. After surgery, most patients are able to regain a high level of rock-climbing ability.

The Link Between Teacher Emotional Regulation and Maladaptive Behavior of Pre-School Student

Maladaptive behavior often appears in preschool-aged children as form of child adjustment to wider social environment. Maladaptive behavior that is not managed early on will have negative impact on child development. Intervention is needed so that maladaptive behavior is not attached to the child's character. Teachers are social agents who play an important role in changing children's behavior, high teacher emotional regulation is needed to weaken children's maladaptive behavior . This study aims to determine the link between teacher emotional regulation and maladaptive behavior of preschoolers. This research is correlational quantitative research. The data collection technique used questionnaire using Emotional Regulation Questionnare scale with reliability of 0.783 and Strength and Difficulty scale with reliability of 0.756. The subjects of this study were 200 ‘Aisyiyah Sidoarjo KB/TK teachers. The sampling technique uses quota sampling technique and data analysis uses Spearman Rho Correlation. The results of this study indicate the value of the correlation coefficient r = -0.54 with significance value of 0.001 (P &lt;0.05). This shows that there is negative link between teacher emotional regulation and maladaptive behavior of pre-school in 'Aisyiyah Sidoarjo KB/TK students. The higher the teacher's emotional regulation, the lower the maladaptive behavior raised by 'Aisyiyah Sidoarjo KB/TK students.

Medcaptain® video laryngoscope improves nasotracheal intubation in maxillofacial surgery: A randomized clinical trial

BackgroundNasotracheal intubation may be required to secure the airway in oral and maxillofacial surgery. AimTo evaluate the effectiveness of the video laryngoscope compared with the Macintosh laryngoscope for nasotracheal intubation in maxillofacial surgery. MethodsThis prospective, randomized, single-blind trial compared the video laryngoscope with the Macintosh laryngoscope for nasotracheal intubation in the adult population.The patients were randomized into two groups: Group M, which underwent intubation with a Macintosh laryngoscope; and Group V, which underwent intubation with a video laryngoscope (Medcaptain®), using an adapted blade (no. 3 for women and no. 4 for men). The modified nasotracheal intubation difficulty scale (NIDS), the three-step evaluation of nasotracheal intubation, the Cormack–Lehane score, the percentage of glottic opening (POGO) scale, and complications were compared. ResultsIn total, 62 patients (31 in each group) were included in the study. The total intubation duration, oropharynx–glottis time, and glottis–trachea time were significantly lower in Group V compared with Group M (p = 0.001, p = 0.007, and p = 0.008, respectively). Group V also had a significantly lower NIDS score (p = 0.001), a higher POGO score (p = 0.002), and a lower Cormack–Lehane score (p = 0.034) compared with Group M. The use of Magill forceps was less frequent in Group V (p = 0.002). The two groups showed comparable results for nose–oropharynx time, epistaxis, and hoarseness (p = 0.068, p = 0.43, and p = 0.74, respectively). ConclusionVideo laryngoscopy appears to provide easier and faster nasotracheal intubation in maxillofacial surgery. Clinical trial registrationThis study was registered in the Pan African Clinical Trials Registry (PACTR) under the reference PACTR202303563303199.

Lowered Delta Activity in Post-COVID-19 Patients with Fatigue and Cognitive Impairment.

In post-COVID-19 syndrome (PCS), neurocognitive symptoms and fatigue are often associated with alterations in electroencephalographic (EEG) activity. The present study investigates the brain source activity at rest in PCS patients (PCS-pts) perceiving cognitive deficits and fatigue. A total of 18 PCS-pts and 18 healthy controls (HCs) were enrolled. A Montreal Cognitive Assessment (MoCA), Perceived Cognitive Difficulties Scale (PDCS) and Fatigue Severity Scale (FSS) were administered for assessing the symptoms' severity. Brain activity at rest, both with open (OE) and closed eyes (CE), was recorded by high-density EEG (Hd-EEG) and localized by source estimation. Compared to HCs, PCS-pts exhibited worse performance in executive functions, language and memory, and reported higher levels of fatigue. At resting OE state, PCS-pts showed lower delta source activity over brain regions known to be associated with executive processes, and these changes were negatively associated with PDCS scores. Consistent with recent literature data, our findings could indicate a dysfunction in the neuronal networks involved in executive functions in PCS-pts complaining of fatigue and cognitive impairment.