Higher Levels Of Discomfort Research Articles

Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition.

Facial emotion recognition is a key component of human interactions, and in clinical relationships contributes to building and maintaining the therapeutic alliance with patients. The introduction of facemasks has reduced the availability of facial information in private and professional relationships. This study aimed to assess the impact of facemasks on clinicians' perception of clinical interactions as well as their ability to read facial expressions. In this cross-sectional study, a purposive sample of 342 clinical psychologists or psychotherapists completed an online survey including the assessment of burnout, alexithymia, emotion dysregulation, and self-perceived ability to build effective relationships and communication with patients with/without facemasks. Participants were randomly assigned to the standardized facial emotion recognition task Diagnostic Analysis of Nonverbal Accuracy FACES 2-Adult Faces including 24 faces representing anger, fear, sadness, and happiness. Facemasks impaired the self-perceived ability of clinicians to build effective relationships and communicate with patients and reduced satisfaction in clinical encounters. The ability of clinicians to recognize facial emotions is significantly reduced for masked happy and angry faces, but not for sad and afraid ones. The perceived difficulty in building good relationships and communication with patients had a positive correlation with alexithymia and emotion dysregulation; higher levels of discomfort when wearing facemasks had a positive correlation with burnout and emotion dysregulation. Facemasks reduced clinicians' self-confidence in clinical encounters with patients wearing facemasks, but their facial emotion recognition performance was only partially impaired.

Deep learning framework for congestion detection at public places via learning from synthetic data

Congestion in public places is one of the major problems in public transportation systems and causes a high level of discomfort for the commuters. Traditionally, overcrowding is detected by manually monitoring and analyzing the video streams from the surveillance cameras, which might lead to errors due to limited human activity. On the other hand, current machine learning models for automatic congestion detection require a massive amount of labeled data to train the network. These models suffer from the over-fitting problem and cannot be generalized to novel scenes. First, we propose a novel synthetic dataset for congestion detection in public places to address these problems. Secondly, we propose a Bidirectional Long-short-term-memory (Bi-LSTM) model that exploits synthetic datasets to boost the performance of congestion detection in the wild. We adopt a domain adaptation strategy to bridge the gap between the real and synthetic data by pre-train the model on the synthetic dataset and then fine-tuning the model on real data. From experiment results, we observe that the proposed framework achieves a significant performance boost on the real datasets after training on the synthetic dataset.

Commercial Question Banks Present a Limited Scope of Sickle Cell Disease

INTRODUCTION Question banks are the most widely used educational resource for medical students and graduate medical trainees studying for professional licensing exams and are the preferred platform both for learning new material and for review. Trainees who use question banks to prepare for these critical exams achieve higher scores on their United States Medical Licensing (USMLE) Steps 1-3, which in turn predict success in residency clinical performance and ultimately, board certification. The content of question banks can therefore be regarded as a strong predictor of the clinical knowledge medical trainees are expected to master. This foundational knowledge base plays an important role in the formation and reinforcement of "illness scripts” that unconsciously drive real-life clinical decision-making. Sickle cell disease (SCD) is an underserved area of healthcare with large disparities between research-proven interventions and clinical practice. In particular, the growing population of adults with SCD suffer high morbidity and mortality due to insufficient access to SCD specialists and comprehensive SCD care. Most patients with SCD seek care from centers without important clinical expertise. Family physicians, internists, and ED physicians are primarily responsible for the treatment of many with SCD. When surveyed, these physicians report high levels of discomfort with SCD management due to lack of specialized knowledge and training. Our study is the first to examine SCD content in commercial question banks and determine how the disease is portrayed to medical trainees. We hypothesize that the pathophysiologic and clinical scope of SCD portrayed by question banks does not reflect the true epidemiology or scope of this complex disease. METHODS Nine of the most widely used commercial question banks for undergraduate and graduate medical trainees were accessed and searched for questions related to SCD. Inclusion criteria consisted of questions in which SCD was intended as the educational objective as featured in the question stem only. Questions were excluded if they featured SCD among the answer choices only, answer explanations only, or if sickle cell trait was intended as the primary educational objective. Questions that met all criteria were transcribed into RedCap software and three reviewers independently coded questions for content. Code book variables like sickle cell disease clinical complications were compiled using the 2014 NHLBI evidence-based guidelines for management of SCD. Questions coded with unique or discrepant entries were examined individually and final coding was determined by consensus. RESULTS A total of 22,152 questions were screened for inclusion from question banks listed in Table 1. Seventy unique questions featured SCD as the primary educational objective and were included in the analysis. Children aged 10 and younger formed the largest proportion of patients presented in questions (n=32, 45.7%). In contrast, data from the CDC Sickle Cell Data Collection Program shows healthcare utilization is lowest in children younger than 10 and increases with age [Green line in Figure 1]. The oldest patient in our dataset was 37 years old and there were two questions in which no patient age was mentioned. Clinical complications presented in questions were almost always acute (89%). The most common complications were acute pain, acute infection, and acute anemia presented in 42%, 41%, and 23% of questions, respectively. Only 4 patients (5.9%) presented in questions were taking hydroxyurea (HU). CONCLUSION Our novel study suggests that commercial question banks portray the patient with SCD as predominantly young and presenting with acute complaints. There is little focus on the multi-system organ dysfunction that ultimately drives the high morbidity and mortality associated with SCD. Disease-modifying treatments like hydroxyurea are rarely mentioned and evidence- based preventative care measures are not emphasized. Future research is needed to determine how this narrow portrayal of SCD risks reinforcing an overly simplistic "illness script” or narrative that may influence the clinical decision-making of practicing physicians. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The activity of the speech therapist at the time of COVID 19: survey of the Campania region

Our government has enacted restrictive and isolation measures, also in the field of rehabilitation, to combat andcontain the spread of the SARS-CoV-2 virus. These have had a major impact on the working methods and activitiesperformed by the Speech Therapist. The Board of Speech Therapists of the Interprovincial Order of NA-AV-BN-CEconducted an anonymous survey to observe the phenomenon.The study aimed to assess how and to what extent the health measures in place influenced occupational activities andwork-related discomfort.A questionnaire was structured to investigate, anonymously, different areas of professional interest (how therapeuticactivities are carried out, work-related stress management, changes in human relations, specific needs), disseminatedvia the web thanks to the Google platform, and available from 15/06/2020 to 15/11/2022 for all speech therapistsbelonging to the interprovincial order of NA-AV-BN-CE.161 Speech Therapists, aged between 21 and 40 years (73.9 per cent), took part in the survey. They worked mainly ina combined telerehabilitation and outpatient setting (64.12 per cent), and were provided with appropriate PPE for thetreatment (65.8 per cent). Speech and language therapists reported a low to medium level of frustration (63.9%) andwork-related stress (63.4%) for telerehabilitation treatment, to a high level for outpatient or home treatment (69.6%).Medium to high values (81.4%) of anxiety, worry and work-related distress are reported, favoured by social isolationand a perception of less support among colleagues, with a perceived need for psychological support from specialisedfigures to manage the emotional burden.The results suggest a medium to high level of work-related discomfort during the pandemic period, mainly for speechtherapists who performed outpatient/domiciliary activities, entailing the risk of developing psychological distress.Further research should be undertaken, with multicentre and larger sample size studies, to define the relationshipsbetween the working methods promoted, work-related stress and the need to manage it.

Child temperament and child-teacher relationship quality: Implications for children's emotional functioning during preschool period.

Although, in the last years several studies have moved beyond analyzing the role of mother-child relationship in the association between child temperament and child emotional functioning, our knowledge is still limited about which fine-grained temperamental components of child reactivity and self-regulation are associated with child-teacher relationship quality. Also, fewer studies have looked at the moderating role of child-teacher relationship in the association between child temperament and child internalizing/externalizing problems during early childhood. The present study examined the relation between components of child temperamental Negative Affectivity, Surgency, and Effortful Control and child-teacher relationship quality (i.e., closeness, conflict) in preschool children. In addition, our aim was to test the moderating effect of the child-teacher relationship on the association between temperament and internalizing and externalizing problems. One hundred Romanian preschoolers (55 boys, mean age = 4.04 years) participated in this study. Mothers assessed their child's temperament by completing the Children's Behavior Questionnaire and externalizing and internalizing problems with the Child Behavior Checklist. Child-teacher relationship quality was evaluated by children's teachers using the Student-Teacher Relationship Scale. Our results revealed that teachers rated their relationship as less conflictual with children who were assessed by their mothers as better in shifting and focusing attention, enjoying situations involving low stimulus intensity and displaying higher levels of Shyness, Sadness and Activity Level. Moreover, higher levels of Discomfort were associated with more conflict and less closeness while emotional reactivity such as Sadness, Fearfulness, and Activity Level were positively associated with closeness. Teacher-child closeness was associated with three temperamental self-regulation factors in the expected direction, except inhibitory control. Furthermore, results revealed a statistically significant interaction between child temperamental Shyness and child-teacher closeness in the prediction of child internalizing problems. Thus, when child-teacher closeness was low, there was a significant and positive relationship between child temperamental Shyness and child internalizing problems. Results highlight the importance of child-teacher relationship quality in relation to child temperament and social-emotional development during preschool period.

Doświadczenia rodziców i dzieci podczas pandemii COVID-19

The study, which included a total of 1,122 Italian parents (96.5% female; 3.5% male) of children with an average age of 7.56 years (N = 1,461, SD = 2.03), explores how parents with children (5–11 years old) represent changes in their daily habits as well as their own and children’s experiences in relation to the impact caused by the health emergency. The study also investigates how work, family life, contextual factors and media exposure associated with information regarding COVID-19 have contributed to influencing emotional states and behavioural patterns. The research programme was carried out by an online questionnaire in June 2020. The pandemic was experienced in a variety of ways across four clusters. The highest levels of discomfort can be observed among those parents who have experienced isolation and the fear of contagion with higher levels of anxiety, which have been intensified by the perception of change and the deterioration in working conditions. Parents with higher emotional instability have found a low emotional stability and high depressive tones in their children. Results suggest that the capacity of parents to process and mentalise emotions by facing the difficulties and stress caused by the situation can act as a protective factor in contrasting any emotional instability in children.

Comprehensive analysis of thermal stress over northwest India: Climatology, trends and extremes

Heat waves are quite frequent over the Indian subcontinent during the summer season (April–July) owing to an increase in anthropogenic activities and global temperatures. These extreme heat conditions induce a high level of outdoor discomfort, adverse health effects and mortality, depending on the degree of thermal stress. The present study investigates the climatology of thermal stress and its trends over northwest (NW) India during the summer. The Universal Thermal Climate Index (UTCI) derived from Human thErmAl comforT (ERA5-HEAT) dataset was used for the period of 1981–2019. The monthly and seasonal climatological mean of UTCI exhibits moderate to strong thermal stress over NW India (ranges from 27 to 34.5 °C) than in the rest of the country (below 25.5 °C), with a peak during the months of June (34.5 °C) and July (33.5 °C) months. The seasonal mean UTCI shows significant rising trends (0.9 °C per 39 years) over NW India and entire India (0.6 °C per 39 years), indicating that the thermal discomfort amplifies at a faster pace compared to the rest of India. Similar rising trends are also noticed in the major cities of the study region. Surface temperature and relative humidity also exhibit a substantial increasing trend, which resulted in the intensification of thermal discomfort over NW India. Furthermore, the number of thermal discomfort days over NW India exhibits an increasing trend during 1981–2019. The composite analysis of UTCI greater than 32 °C (referred to as strong heat stress) depicts the highest thermal discomfort conditions in NW India. During summer, strong soil temperatures and high sensible heat fluxes over the study region may enhance the warming at the surface during UTCI (> 32 °C) days as it depends on surface radiative fluxes through the mean radiant temperature. In addition to high temperatures, a substantial amount of moisture transported by strong westerly wind from the Arabian Sea towards the NW India during strong thermal stress days seems to have contributed to high thermal stress conditions in the region.

Evaluation of the Levels of Pain, Discomfort, Functional Impairments and Satisfaction With the Periodontally Accelerated Osteogenic Orthodontics (PAOO) When Leveling and Aligning Crowded Teeth: A Prospective Cohort Study.

BackgroundOnly a few studies have reported levels of pain, discomfort, functional impairments, and patients' satisfaction after undergoing periodontally accelerated osteogenic orthodontics (PAOO). Therefore, the objectives were to evaluate postoperative pain, discomfort, functional impairments, and satisfaction following this surgical intervention.MethodsA prospective cohort study was undertaken at the Department of Orthodontics, University of Damascus Dental School, between August 2018 and November 2020. The sample consisted of 16 patients (4 males, 12 females, mean age: 21±3.05 years) with moderately crowded lower anterior teeth who underwent full-thickness vestibular flap elevation followed by cortical cuts using piezosurgery. Then a bovine xenograft was applied before reflecting the flap and suturing. Fixed orthodontic therapy was then initiated. Questionnaires were administered to assess the levels of pain, discomfort, and oral functional problems using a visual analog scale (VAS) at one day, seven days, 14 days, and 28 days after surgery. The level of satisfaction was also assessed at 28 days postoperatively. Friedman's test was employed, and Wilcoxon signed-rank tests were used for post-hoc tests with an adjusted alpha level.ResultsOn the first day following the PAOO, the mean values of perceived pain, discomfort, swelling, mastication difficulties, swallowing problems, limitation in jaw movements were 80.00, 80.63, 68.13, 78.13, 55.00, and 64.38, respectively. These mean values dropped significantly in the following assessment times (P<0.001). At 28 days following the PAOO, the mean satisfaction score was 84.94±22.46. All patients mentioned that they took painkillers after the surgical intervention.ConclusionsOn the first day following surgery, patients perceived high levels of pain and discomfort, moderate to severe levels of swelling and chewing difficulties, and suffered from restricted jaw movement. These levels decreased significantly in the following assessment times. Patients' satisfaction with the PAOO procedure was high.

Almost a year in: Virtual offices remained an ergonomic trouble spot.

Many individuals continued to work from home even after nearly 9 months since the COVID-19 pandemic started in spring of 2020. To conduct a follow-up survey of the faculty and staff of a large Midwest university to determine whether there had been any changes to their home work environment and health outcomes since a prior survey conducted at the start of the pandemic in spring of 2020. An electronic survey was sent out to all employees, staff, and administration (approximately 10,350 individuals) and was completed by 1,135 individuals. It was found that not much had changed after nearly 9 months of working at home. Faculty and staff continued to primarily use laptops without an external keyboard, monitor or mouse. Few participants reported using chairs with adjustable armrests. These conditions continued to result in high levels of body discomfort (49% neck and head, 45% low back, and 62% upper back and shoulders having moderate to severe pain). If workers are going to continue to work from home, companies will need to accommodate them with more than a laptop, and should include an external keyboard, monitor, and mouse.

Sexual Functioning in Women with Breast Cancer: Role of Depression, Anxiety and Coping Styles

Sexual dysfunction encompasses a broad spectrum of issues, all of which are susceptible to insult after treatment for cancer. Sexual dysfunction affects up to 90% of women treated for breast cancer, and sexual quality of life is a significant concern for breast cancer survivors. This study investigated role of depression, anxiety and coping styles in developing sexual dysfunctions in 210 women with breast cancer, one year after diagnosis. The median age was 58. Female Sexual Functioning Index (FSFI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Coping Inventory for Stressful Situations (CISS) were used for this purpose. All women stated that before breast cancer they did not have significant sexual problems that would interfere with sexual pleasure. It is noticeable that women included in this study report high levels of pain and discomfort during and after vaginal penetration have low levels of sexual arousal and have significant difficulty achieving orgasm and lubrication, which is significantly associated with high levels of anxiety and moderate to high levels of depression. They are more likely to use a task-oriented coping strategy, and within avoidance as a coping strategy, they are more likely to use a distraction. More frequent use of avoidant strategies and less propensity for emotion-oriented strategies is associated with greater sexual desire. Women who used emotion-oriented coping strategies have more pronounced symptoms of depression and anxiety. Lower levels of overall sexual function were found in women who had a mastectomy (total and partial). Breast reconstruction after mastectomy has a positive influence on sexual functioning, especially on sexual arousal and pleasure, and women who have not had a mastectomy report greater sexual desire and arousal, and less pain during sexual intercourse. Participants who were not exposed to radiotherapy during treatment expressed greater satisfaction with achieving orgasms and lubrication during sexual intercourse. Hierarchical regression analysis indicated that depression, anxiety and coping styles significantly contribute to all domains of sexual functioning. These results add to growing evidence that sexual quality of life is a multidimensional construct with aspects differentially affected by variables related to cancer survivorship.

Psychological Discomfort in Nursing Degree Students as a Consequence of the COVID-19 Pandemic.

Students are a population at risk of developing psychological complications, such as psychological discomfort, stress, and anxiety, among other problems, especially during the current health crisis due to the COVID-19 pandemic. The present study’s objective was to analyze the effects of the COVID-19 pandemic on the psychological discomfort of final-year nursing students. A cross-sectional descriptive observational study was carried out. To analyze the psychological discomfort of the participants, the Kessler test (previously validated) was used. The results of this test were divided into two levels (High ≥ 21/Low < 21), showing high sensitivity as a screening method for anxiety and depression. Questionnaires were sent via email to final-year nursing students of Spanish and South American universities, inviting them to participate voluntarily. The sample consisted of 400 students, with an average age of 23.29 years and a sex proportion of 82.75% women and 17.28% men. Almost all participants (n = 396) belonged to Spanish universities, and the greatest participation corresponded to Andalusian universities (64.5%). The average psychological discomfort was high (M = 27.94). Statistically significant relationships were detected between age, sex, and feeling ready for the world of work, observing no relationships with the rest of the studied variables. The sample of 4th-year students of the Degree of Nursing presented a high level of psychological discomfort. This pathology does not seem to be related to having suffered from COVID-19 or being in contact with infected people during the practicum and is more strongly related to personal sociodemographic variables and students’ preparation for the world of work.

Computational Bioprospecting of Andrographolide Derivatives as Potent Cyclooxygenase-2 Inhibitors

Background: Inflammation is a protective response of the human body that still causes a high level of discomfort because of the associated pain and other inflammatory reactions. Nonsteroidal anti-inflammatory drugs (NSAIDs) have certain associated severe side-effects such as hepatotoxicity. Thus, there is an urgent need to develop a novel anti-inflammatory agent to counter the associated problems with the existing NSAIDs. Methods: The herbal sources are a very vast treasure for exploring potential leads for the development of novel therapeutic agents to counter the existing healthcare problems for the welfare of humankind. Thus, in the current experimental study, the author has tried to develop some of the novel andrographolide analogs as cyclooxygenase-2 (COX-2) inhibitors by using bioisosteric substitutions. Results: The newly developed andrographolide derivatives have a high affinity for the human COX-2 enzyme, an optimized pharmacokinetic profile as well as being free from any associated toxic effects. Conclusion: The andrographolide derivatives as COX-2 inhibitors are supposed to be free from the side effects associated with NSAIDs with an optimized pharmacokinetic profile.

Impact of Covid-19 on the Use of Laptops by College Students and the Effects on Posture and Discomfort

Over the past year, the Covid-19 pandemic has led to a switch from a majority of classes being taught in-person to a majority being taught online. The switch has led to an increase in the amount of time students are utilizing technology for learning purposes. This study assessed how technology use has changed during the pandemic, particularly related to laptop use, and the postures students work in and the discomfort they’re experiencing while participating in online learning. The results of the survey (n=1,074) found that laptop use is up significantly (used the majority of the time by 70.2% of students), students are working in poor postures (up to 80% working with deviated neck postures), and are experiencing high levels of discomfort (up to ~60% reporting moderate/extreme discomfort in their upper extremities). The results bring to light the urgent need to provide ergonomics education and training for designing good work environments.

Forehead temperatures as an indicator of outdoor thermal comfort and the influence of tree shade

Due to climate change and a growing urban population worldwide, cities as heat islands are of increasing concern for the health and living comfort of urban populations. Accordingly, thermal comfort is an important element of bioclimatic design within cities, and areas with an abundance of hard surfaces, and a lack of tree shade, can become uncomfortably hot in summer periods, which can negatively alter usage patterns of these spaces and even become an issue of human health. In this context, a pilot study was undertaken to assess if thermal photography of the forehead of an individual can be a reliable, non-invasive, rapid tool to predict outdoor thermal comfort. A combination of street interviews, micrometeorological measurements and facial thermography was used with 775 volunteers on warm summer days in the city of Bolzano (N Italy). Two locations were chosen with contrasting sky view factors and tree shade amounts. A large difference in the mean radiant temperature, and Universal Thermal Comfort Index (UTCI), between the two locations resulted in higher thermal sensation votes and higher levels of discomfort in the space without tree shade. The mean average forehead temperature was 1.5 °C higher in the treeless space (35.2 °C) compared to the shaded space (33.7 °C). Forehead temperatures correlated significantly positively with UTCI (treeless: r = 0.30, p < 0.001; shaded: r = 0.21, p < 0.001) and air temperature (treeless: r = 0.28, p < 0.001; shaded: r = 0.22, p < 0.001). Thermal comfort was successfully predicted from forehead temperatures in the treeless space using a logistic regression model, however low R2 values limit the predictive power of these models. Facial thermography shows promise as a proxy for thermal comfort in thermally stressful spaces.

Psychological Distress and Psychosocial Factors in the Non-Formal Context of Basketball Coaches in Times of the COVID-19 Pandemic.

Psychological distress and psychosocial factors are studied in the sports context in players of various specialties, but are only little studied with coaches who carry out their work with these athletes; that is where we put the emphasis, trying to determine the perception of coaches on psychological distress and psychosocial risk factors that may influence their sports work in times of a pandemic. It is an ex post facto study with a single-group retrospective design, with a representative sample of 94 coaches out of a possible 109. The Kessler Psychological Distress Scale and the short version of the ISTAS21 Psychosocial Risk Assessment at Work Questionnaire were adapted to the sports context. The results show that the youngest, those with the least experience and level 1 and level 2 coaches show the highest levels of stress. According to the psychosocial risk assessment, level 1 and 2 coaches, with experience between 6 to 10 years, are in the risk zone. Therefore, it is important to work with a group of coaches who are in the psychosocial risk zone and with high levels of psychological discomfort in order to avoid mental, emotional and physical stress, for the good performance of their work in the best possible conditions.

Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours.

Simple SummaryThere is growing international interest in adopting a risk-based approach to breast cancer screening, where an individual’s risk would inform screening practices. It has been suggested that primary care will contribute to the delivery of this service by conducting risk assessment and providing primary prevention advice. The aim of our review was to understand what primary care providers think and feel about performing these tasks by examining their attitudes and typical activity in clinical practice (routine behaviours). The results suggest that primary care providers mainly assess breast cancer risk by collecting family history information but feel less comfortable advising on risk-reducing medications. Primary care will need to proactively assess breast cancer risk for women to get the most benefit from risk-based screening and prevention. To promote risk assessment and prevention activities, improved education/training and changes to resources (integrated risk assessment tools, better patient materials etc.) will be necessary.Implementing risk-stratified breast cancer screening is being considered internationally. It has been suggested that primary care will need to take a role in delivering this service, including risk assessment and provision of primary prevention advice. This systematic review aimed to assess the acceptability of these tasks to primary care providers. Five databases were searched up to July–August 2020, yielding 29 eligible studies, of which 27 were narratively synthesised. The review was pre-registered (PROSPERO: CRD42020197676). Primary care providers report frequently collecting breast cancer family history information, but rarely using quantitative tools integrating additional risk factors. Primary care providers reported high levels of discomfort and low confidence with respect to risk-reducing medications although very few reported doubts about the evidence base underpinning their use. Insufficient education/training and perceived discomfort conducting both tasks were notable barriers. Primary care providers are more likely to accept an increased role in breast cancer risk assessment than advising on risk-reducing medications. To realise the benefits of risk-based screening and prevention at a population level, primary care will need to proactively assess breast cancer risk and advise on risk-reducing medications. To facilitate this, adaptations to infrastructure such as integrated tools are necessary in addition to provision of education.

Geocaching in Texas state parks: a technology readiness analysis

德州州立公园地理藏宝：一项科技准备度的分析研究研究目的本研究旨在运用科技三角模型以及科技准备度指数（TRI）以定性研究为方法来探索地理藏宝这一现象。研究设计/方法/途径本研究为探索公园, 地理藏宝以及访客的三角结构关系提出了理论框架。研究对德克萨斯州立公园行政人员进行了12项半结构化访谈。主题分析发进行了访谈数据分析。研究结果研究发现了三种形式的互动：公园访客, 访客科技装备, 和公园的科技装备。尽管地理藏宝活动提高了公园访客的体验, 本研究通过公园人员的视角也发现访客的热情有所降低。研究结果发现德州州立公园在科技准备度意义来说仍处于“回避”阶段, 基于较低的积极度和创新意识, 以及对地理藏宝活动表现较高的不适以及不安。研究原创性/价值本研究为已有的文献增添了有关州立公园地理藏宝的新发现。本研究是首次运用科技三角模型来研究公园, 地理藏宝和访客之间的三边关系。本论文也创新性的在定性研究中运用了TRI对州立公园科技准备度进行研究。

The effect of fertility-sparing surgery on sexuality and global quality of life in women with malignant ovarian germ cell and sex cord stromal tumors: an analysis of the CORSETT database of the AGO study group

PurposeMalignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) are ovarian neoplasms that affect disproportionally young women. Little is known about the impact of surgical and adjuvant management of these patient’s sexual life. This study investigated the effect of fertility-sparing surgery on sexual activity and global quality of life (gQoL) in women with MOGCT and SCST.MethodsCORSETT was an observational, multicenter, mixed retrospective/prospective cohort study of the AGO study group. Women of any age who had been diagnosed with MOGCTs and SCSTs between 2001 and 2011 were asked to complete the Sexual Activity Questionnaire (SAQ) and the EORTC QLQ-C30.ResultsIn total, 355 patients were included. Of these, 152 patients with confirmed histological diagnosis had completed the questionnaires. A total of 106 patients were diagnosed with SCST and 46 with MOGCT.Totally, 83 women (55%) were sexually active. After fertility-sparing surgery, patients had a 2.6 fold higher probability for being sexually active than after non-fertility-conserving treatment (unadjusted odds ratio (OR) 2.6, p = 0.01). After adjustment for age, time since diagnosis, FIGO stage, histology and phase of disease, the OR dropped to 1.8 (p = 0.22).Of the sexually active patients, 35 (42%) reported high levels of discomfort during intercourse; 38% after fertility-sparing; and 58% after non-fertility-sparing surgery (adjusted OR 2.8, p = 0.18).Women with fertility-conserving treatment reported a significantly better global QoL (Fadj 2.1, 6.2 points difference, p = 0.03) but not more pleasure during intercourse than women without fertility-sparing surgery (Fadj 0.4, p = 0.52).ConclusionFertility preserving approaches should be offered to every patient, when oncologically acceptable.

Analysis of Outdoor Thermal Discomfort Over the Kingdom of Saudi Arabia.

In this study, the variability and trends of the outdoor thermal discomfort index (DI) in the Kingdom of Saudi Arabia (KSA) were analyzed over the 39‐year period of 1980–2018. The hourly DI was estimated based on air temperature and relative humidity data obtained from the next‐generation global reanalysis from the European Center for Medium‐Range Weather Forecasts and in‐house high‐resolution regional reanalysis generated using an assimilative Weather Research Forecast (WRF) model. The DI exceeds 28°C, that is, the threshold for human discomfort, in all summer months (June to September) over most parts of the KSA due to a combination of consistently high temperatures and relative humidity. The DI is greater than 28°C for 8–16 h over the western parts of KSA and north of the central Red Sea. A DI of >28°C persistes for 7–9 h over the Red Sea and western KSA for 90% of summer days. The spatial extent and number of days with DI > 30°C, that is, the threshold for severe human discomfort, are significantly lower than those with DI > 28°C. Long‐term trends in the number of days with DI > 28°C indicate a reduced rate of increase or even a decrease over some parts of the southwestern KSA in recent decades (1999–2018). Areas with DI > 30°C, in particular the northwestern regions of the Arabian Gulf and its adjoining regions, also showed improved comfort levels during recent decades. Significant increases in population and urbanization have been reported throughout the KSA during the study period. Analysis of five‐years clinical data suggests a positive correlation between higher temperatures and humidity with heat‐related deaths during the Hajj pilgrimage. The information provided herein is expected to aid national authorities and policymakers in developing necessary strategies to mitigate the exposure of humans to high levels of thermal discomfort in the KSA.

It's Getting Hot in Here: Piloting a Telemedicine OSCE Addressing Menopausal Concerns for Obstetrics and Gynecology Clerkship Students.

IntroductionAlthough menopause is a common condition, trainees still express high levels of discomfort with managing climacteric symptoms. Trainees also receive little preparation for conducting telemedicine visits, which have become increasingly important in clinical care. We present a formative standardized patient (SP) encounter to introduce medical students to the diagnosis and treatment of menopausal symptoms and the process of conducting a telemedicine visit.MethodsWe designed a virtual telemedicine encounter with an SP for medical students. Students received feedback via a post-encounter note on history taking, differential diagnosis, and diagnostics/management and an SP debrief. We collected student input on the experience at the midpoint and end of clerkship and analyzed it for recurring themes. We calculated summary statistics from student post-encounter notes.ResultsThirty-two OB/GYN students completed the menopause telemedicine SP encounter between April and June 2020. Students scored a median of 20 out of 45 (interquartile range: 18, 22) on the post-encounter note. All students correctly provided a diagnosis of perimenopause/menopause; however, 50% did not offer any strategy for counseling or managing menopausal symptoms. Students expressed discomfort with using a telehealth format (78%) but found it a useful skill to practice (47%). A majority (66%) found the educational encounter to be of excellent or above-average educational value.DiscussionWhile medical students demonstrated discomfort with both managing menopause and utilizing a telemedicine format, this SP case provided an opportunity for them to practice both skills in a safe learning environment. The majority of participants rated the learning experience highly.