Regular Monthly Research Articles

Who Volunteers? Results From an Internet-Based Cognitive Monitoring Study of Community-Based Older Adults.

Objectives. Volunteering promotes well-being and may provide added purpose to life after retirement. Limited evidence exists regarding the characteristics and study adherence among those who participate in longitudinal studies while also volunteering outside the study. We assessed characteristics and adherence of older adults who volunteered outside of participation in a regular monthly cognitive monitoring study. Method. All 124 participants with complete data were included. Participants were from a regular cognitive monitoring study that required completion of a 15-min monthly online cognitive assessment. Analysis of covariance and logistic regression analysis were performed to examine differences between volunteers and nonvolunteers. Results. Those who volunteered outside the study were significantly less likely to be college-educated (although all participants were highly educated) but the two groups were cognitively similar. Volunteers had significantly lower scores for neuroticism. Those who volunteered also were significantly less likely to drop out but had poorer study adherence. The most frequent type of volunteering was religious activities. Volunteers were motivated mainly by altruism, although most reported multiple reasons. Conclusion. Older adults who enroll in a longitudinal research study and volunteer outside the study have similar personal characteristics as those who opt out of additional volunteering, with somewhat less education and more favorable personality traits. However, they may be more likely to drop out and need more reminders. Therefore, those who volunteer outside a study may need more attention from study administrators and potentially a more individualized schedule that works around their volunteer obligations.

Overspending on smartphone purchases among Swedish young adults

In the Nordic countries with growing markets for consumer credit, a concern is that consumption desires in conjunction with easily accessible credit make financially constrained young adults vulnerable to problem debt and over-indebtedness. In addressing this concern empirically, we investigate whether retail offers of instalment payments of discounted cash prices tempt young adults to finance purchases of more expensive premium smartphones than they would purchase by cash payment. Descriptions of smartphones ranging from budget to latest premium models are in an online experiment presented to 152 Swedish young adults between 18 and 25 years. We employ a within-group design requiring the participants in counterbalanced order to choose a preferred smartphone twice, either if the default choice is paying the regular cash price or two-year monthly instalments with a 20% discount on the cash price. Although a majority chose the same smartphone twice seemingly not influenced by the retail offer, this was not the case for about one third of the young adults who despite a negative attitude to borrowing choose instalment payments of more expensive premium smartphones, and more than half of them at a price exceeding the regular cash price they choose to pay for a cheaper smartphone. Instalment payments as well as rental contracts are penetrating many consumer markets in which young adults are large segments. These new forms of accessible credit should be particularly attractive to those who are financially constrained with potentially negative consequences for their solvency. Our results suggest that regulation policies may need to be considered.

Importance of Seasonal Variation in Hawaiian Mushroom (Agaricomycetes) Basidiomata Production for Biodiversity Discovery and Conservation.

The Hawaiian Islands have a relatively well-known funga for a tropical location, yet there are over 400 species of mushrooms (Agaricomycetes) in the archipelago that remain to be documented. Importantly, the International Union for Conservation of Nature (IUCN) recently evaluated six mushrooms endemic to the islands as threatened with extinction. To improve detection of mushrooms for biodiversity discovery and better monitor threatened species in the archipelago-where many localities lack strong annual precipitation patterns associated with an obvious season for increased mushroom basidiomata production-we examined the phenology of Hawaiian mushrooms. Monthly richness was determined from a literature review and abundance from online data repositories. Phenological patterns were separately explored for native species and differing elevation and annual precipitation categories. Despite relatively consistent monthly temperatures and areas with regular monthly rainfall, we found Hawaiian mushrooms generally exhibit uneven temporal patterns in basidiomata production: richness and abundance are generally highest in January and lowest from February to April, then usually increase from May to July and remain at elevated levels through December. This pattern does not occur when considering native species richness only, nor when examining abundance data stratified by elevation and annual rainfall categories. Increased monthly basidiomata abundance in low elevation (<1,000 m), dry (<1,000 mm rainfall/year) locations on O'ahu and low, mesic (1,000-2,500 mm rainfall/year) locations on O'ahu and Kaua'i are positively correlated with increased monthly rainfall. Phenology of macrofungal sporocarp production should potentially be included in species threat assessments by the IUCN to increase detection via traditional surveying methods.

Insights into the Usefulness of a New Extreme Weather Guidance Tool: The Long-Range Tropical Cyclone Outlook for the Southwest Pacific (TCO-SP)

Abstract Tropical cyclones (TCs) produce extreme winds, large waves, storm surges, intense rainfall, and flooding and account for almost 75% of natural disasters across the southwest Pacific (SWP) region. The island nations and territories across the SWP rely on seasonal TC outlooks for insights into possible risks for the coming TC season. Launched in July 2020, the Long-Range Tropical Cyclone Outlook for the Southwest Pacific (TCO-SP) provides deterministic (frequency) and probabilistic (likelihood) TC outlooks for 12 subregional and island-scale locations up to 4 months (July) before the start of the SWP TC season (November–April). Following TCO-SP’s first season of operation, this study (i) outlines the process of generating and communicating TCO-SP outlooks, (ii) provides a postseason validation of TCO-SP performance on the 2020/21 SWP TC season, and (iii) reports on the results of a questionnaire used to determine end-user needs and user-perceived usefulness of TCO-SP. Postseason validation indicates that TCO-SP successfully predicted a near-normal SWP TC season. Island- and regional-scale guidance also performed well, with an average skill score of 54% across all regions. Analysis of responses to a TCO-SP questionnaire revealed a diverse and global user base that indicate the core features of TCO-SP (island-scale/regional-scale outlooks, regular monthly updates, and an outlook lead time up to 4 months before the start of the TC season) are particularly useful. TCO-SP will continue to innovate to deliver reliable and trusted TC outlooks with a goal to reduce disaster risk and increase resilience across the SWP region.

Effects of a remote patient monitoring system for patients on automated peritoneal dialysis: a randomized crossover controlled trial.

PurposeRemote patient monitoring (RPM) has contributed to improved patient-centered outcomes and prognosis in patients with end-stage renal disease on automated peritoneal dialysis (APD). However, evidence from prospective trials is lacking.MethodsThe participants (n = 15; median age: 65 years; males: 10; peritoneal dialysis vintage: 6.4 ± 3.5 years) randomly received APD therapy using the Kaguya® APD system either with or without the connective use of the cloud-based RPM software Sharesource® for 12 weeks. The primary outcome was patient satisfaction assessed using a modified nine-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) questionnaire. The secondary outcomes were healthcare resource consumption, the health-related quality of life (HRQOL) subscales assessed with the Kidney Disease Quality of Life-Short Form questionnaire, and clinical laboratory parameters.ResultsSignificant improvements were observed in the TSQM-9 subscales of Effectiveness (64.4 ± 18.8 vs. 57.8 ± 18.8; P = 0.006) and Convenience (76.3 ± 15.4 vs. 63.3 ± 17.3; P < 0.001) in patients on Sharesource®. Moreover, Sharesource® reduced the total amount of healthcare resource consumption (0.80 ± 1.32 vs. 1.87 ± 2.39 times/12 weeks; P = 0.02) and consultation time during regular monthly visits (813 ± 269 vs. 1024 ± 292 s; P < 0.001). A significant increase in ultrafiltration volume was found associated with more frequent modification of APD prescription in patients with Sharesource®. Sharesource® also improved the HRQOL subscale of General Health and Vitality.ConclusionSharesource® can improve patient-centered outcomes in patients on APD while reducing the treatment burden for both patients and medical staff.Trial registration: The study was registered in the Japan Registry of Clinical Trials (jRCT Number: jRCTs032190005).Supplementary InformationThe online version contains supplementary material available at 10.1007/s11255-022-03178-5.

The Effect of Menstrual Cycle Physiological Changes on Physical Fitness Patterns in Middle School Students Aged 12-14 Years

The purpose of this study was to determine the effect of the physiological changes associated with the menstrual cycle on some aspects of physical fitness, specifically speed, agility, and flexibility, among middle school students in Beirut aged 12 to 14 years old. To accomplish this, the study was conducted on a sample of 21 female students who were in good health and had a regular monthly cycle, and the descriptive approach was used to suit the nature of the study. Time and speed during the slalom and 30-meter sprint tests, as well as distance achieved during the trunk flexion test, were measured before and after menstruation. The study's findings revealed statistically significant differences at the level (0.05) in all variables: time, speed, and distance. This demonstrates the effect of the menstrual cycle on the elements of physical fitness, which is the focus of our research. The researchers recommended that physical education programs for girls be aligned with menstrual cycle requirements, taking into account the importance and necessity of exercising and not stopping during this time.

The Female Athlete Triad-the impact of running and type of diet on the regularity of the menstrual cycle assessed for recreational runners.

BackgroundThe Female Athlete Triad (FAT) included three interrelated conditions including disordered eating, amenorrhea, and osteoporosis. The American College of Sports Medicine updated the definition of FAT to reflect the interdependence of low energy availability with or without eating disorders. The main aim of the study was to assess the impact of recreational running on potential disturbances in the regularity of women’s menstrual cycles. Additionally, this work compared differences in the menstrual cycle between women runners and women who did not regularly practice sports. The respondents were also asked about the type of diet they consumed.MethodsA total of 360 women took part in the research. This group included 217 runners and 143 control. The authors’ questionnaire was used in the research.ResultsWhen compared to the control group, the runners had an increased frequency of menstrual cycles of <24 days (10.14% vs. 3.50%), fewer typical cycles of 25–31 days (75.58% vs. 86.71%), had fewer regular cycles per year (9.62 vs. 11.22), shorter duration of bleeding (4.79 vs. 5.27 days), and an increased frequency of painless menstruation (23.96% vs. 7.69%). A positive predictor of menstrual cycle disorders was the use of a ‘special diet’ (R:1.67; 95% C:0.47–2.87).ConclusionsThe runners had shorter and less regular monthly cycles and shorter and more often painless menstrual bleeding when compared to the control group. The frequency of menstrual disorders in runners was increased by following a ‘special diet’. The frequency of menstrual cycle disorders in runners, however, did not differ significantly from the control group.

Improvement of Hygiene Practices and Milk Hygiene Due to Systematic Implementation of Preventive and Corrective Measures

Abstract The Total Bacterial Count (TBC) and the Somatic Cells Count (SCC) in the milk are important indicators of its hygiene and quality. Hygienic conditions in barns, milking procedures, udder hygiene before, during and after milking, milking machine hygiene, as well as milk cooling procedures immediately after milking, have direct or indirect influences on milk hygiene indicators. Poor results of milk hygiene quality, when it comes to SCC and TBC, which are often seen in dairy cattle farms in our country, indicate numerous omissions before and during milking. To determine the possibility of improving milk hygiene quality, training of extension service professionals and farmers was conducted, corrective and preventive measures were determined and the achieved state was monitored on 128 dairy farms where SCC and TBC were observed at regular monthly intervals for 6 months. The results showed a continuous statistically very significant improvement in hygienic conditions in barns, milking procedures, udder hygiene before, during and after milking, milking machine hygiene, as well as milk cooling procedures. This has contributed to a statistically very significant improvement in the hygienic quality of milk, both in SCC and TBC indicators, continuously from month to month, with a visible improvement at the end related to the beginning of the study period. At the begining and the end of survey 19.7% and 50.0% of milk samples belong to 1st class of milk quality, respectively, indicating a significant improvement after implementation of corrective measurements.

The Burden of Surgical Cancellations: A Quality Improvement Study on the Importance of Preoperative Assessment.

BackgroundThe operating room (OR) is a critical facility that consumes a significant percentage of the hospital's resources, so it must be used judiciously. Surgical cancellation is a chief cause of OR underutilization. The purpose of this study was to hold medical concerns accountable for surgical cancellations at a large tertiary care hospital in Maharashtra, India.MethodsThe Plan, Do, Study, and Act (PDSA) cycle is a tool for analyzing change and learning via action. We used this method to determine the origins of errors, identify key points, and test change interventions such as an individually tailored anesthetic plan, provision of a pre-anesthesia evaluation clinic in the outpatient department, reevaluating patients, and rechecking the preoperative checklist. This study was undertaken as a part of a quality improvement project at our hospital in India. All elective surgical operations scheduled between January and November 2020 were included, and canceled procedures were investigated to identify potential reasons.ResultsDuring the auditing period, 7,709 elective operations were scheduled; 68 (0.88%) of them were canceled. After piloting interventions, the rate of cancellations dropped from 1.08% to 0.67% in the succeeding cycle. A root cause analysis of the data revealed that there was a 7.1% decrease in cancellations due to hypertension, a 3.8% decrease due to insufficient routine blood tests, and a 1.9% decrease in the inappropriate preoperative workup, while we saw an increase in fever (5.5%) and blood sugar level (1.9%) discrepancies.ConclusionsDr. D. Y. Patil Hospital & Research Centre in Pune, India, had cancellations in scheduled ORs due to associated medical co-morbidity that were potentially reducible post-intervention and could be replicated for application in various tertiary care hospitals. Regular monthly audits, quality improvement projects, and the designation of an organized system may enhance the proper utilization of the OR which could potentially save funds, preserve resources, alleviate the burden of patients, and reduce cancellations to a minimum.

A qualitative examination of the benefits and challenges of a psychosocial screening intervention in pediatric oncology: "Support comes to us".

Pediatric cancer diagnosis and treatment can have detrimental mental health effects on parents (caregivers) and their children/adolescents (youth). Psychosocial screening and intervention have been recognized as standards of care in pediatric oncology. The most effective psychosocial interventions to support those in need post screening have not been determined. This qualitative study aimed to investigate the perceived benefits and challenges for caregiver and youth participants in the screening-intervention arm of an Enhanced Psychosocial Screening Intervention (EPSI) pilot study. EPSI consists of a psychosocial navigator (PSN) who shares screening results conducted near diagnosis (T1) and monthly for 1year (T2) with treating teams and families. All 17 caregiver-youth dyads who had completed EPSI were invited to participate in a semi-structured interview. Ten caregivers and nine youth participated. Identified themes were grouped into benefits and challenges of EPSI: feeling supported and cared for (support comes to us regularly, having someone to talk to); and feeling empowered through knowledge of resources and services were perceived as benefits. Caregivers were challenged by feeling overwhelmed, and youth by screening questions perceived as too repetitive. Regular monthly contacts for a year by the PSN with screening results and recommendations were perceived as beneficial by youth newly diagnosed with cancer and their caregivers who participated in EPSI. Feeling that support came to them and they had someone to talk to was a critical component. While information about psychosocial resources was not always used right away, it did evoke feelings of being empowered.

HUBUNGAN STRES TERHADAP SIKLUS MENSTRUASI PADA SISWI PONDOK PESANTREN PUTRI UMMU SULAIM PEKANBARU TAHUN 2018

Background: Menstrual cycle is the time since the first day of menstruation until the arrival of next menstrual period. Menstrual cycle ideally regular every month with a span of time between 21 to 35 days each time the menstrual period and menstrual cycle can vary in women during different times of life depending on various things, one of which in the stress factor. In it’s effect on the menstrual cycle, stress involves the neoro-endocrinological system as a large system of it’s role in female reproduction. This menstrual cycle disorder involves an integrative regulatory mechanism that affects the body biochemical and cellular processes including the brain and psychological. Purpose: The pupose of this study was determine the relationship of stress to the menstrual cycle for students of Islamic Boarding School of Ummu Sulaim Pekanbaru Year 2018. Method: This research uses quantitative analytic research type, with cross sectional design using questionnaire as a measuring tool as well as sampling was stratified random sampling. Results: The results of this study indicate that moderate stress with irregular menstrual cycles that have equal to 57,1% p value 0,001 &gt; ? 0,005 means there is a relationship of stress to the menstrual cycle on students. Conclusion: The researcher’s suggestion is expected for students of Islamic Boarding School of Ummu Sulaim Pekanbaru in order to make good time management so that all activities, duties and memorization do not accumulate so it does not become burden which make student stress and consequently will affect the cycle of menstruation. Keyword : Stres, Menstrual cycle

Study of Waste Management in Solid Waste Collection and Evacuationin Delta State of Nigeria

Waste management has been a problem in Delta State even with the presence of government agencies saddled with the responsibility of waste management. The Research objective of this paper is to study the role of Delta State Waste Management Agency in solid waste collection and evacuation. The authors used a descriptive research design for the collection of quantitative data in the study area. The paper used the quantitative method that made use of a survey design. This was done through the questionnaire that was used to collect data from a sample consisting of 290 respondents. A simple random sampling method was used to select the respondents that participated in the survey. The study made use of an analysis of variance to test the hypothesis formulated for the research. A t-test calculated value of (4.447&gt;3.182) established that solid waste collection, Delta State Waste Management Agency under the board does not have a coordinated approach to waste management across the state. Based on the findings of the study, researchers concluded that there are variations in the management of waste in the study areas. It was recommended that there should be a time-tested approach to waste management by the agency to find out what works and thereafter derive a policy framework to enforce its implication alongside the regular monthly environmental sanitation.

Patient-Reported Pulmonary Symptoms, Exacerbations, and Management in a Cohort of Patients With Alpha-1 Antitrypsin Deficiency.

Identifying pulmonary exacerbations in patients with alpha-1 antitrypsin deficiency (AATD) is critical as they are associated with disease progression and poor health-related quality of life. Not all changes in usual respiratory symptoms will be identified as exacerbations by patients with AATD. Data collected via regular monthly telephone calls during the first year of the AlphaNet Step Forward Study were analyzed. AlphaNet subscribers were asked about changes in their usual respiratory symptoms, whether they considered changes in symptoms to be pulmonary exacerbations, and their management. Participants who reported changes in their usual respiratory symptoms throughout the year were included in the study. Per-patient and per-event analyses were performed. Participants (n=316, age 58±10 years, 53% female) reported 797 events of changes in their usual respiratory symptoms in 1 year. Almost half (48%) of these symptom events were identified as pulmonary exacerbations by the study participants. The average number of symptoms was higher in events recognized by participants as exacerbations than those not identified as exacerbations (3.3±1.5 versus 1.8±1.1, respectively). A greater proportion of the exacerbation events were managed by taking antibiotics or corticosteroids or both (81%, 53%, and 41% of the events, respectively). With exacerbations, participants mainly spoke to the pulmonary specialist (39%) or went to the doctor's office (37%). Symptom events not recognized as exacerbations were mostly self-treated (56%). Changes in usual pulmonary symptoms are not universally recognized as exacerbations. Patients' perspectives in recognizing changes in pulmonary symptoms as exacerbation events are critical.

PENGARUH BUDAYA ORGANISASI DAN KOMITMEN ORGANISASI TERHADAP LOYALITAS ANGGOTA BUMDES DI DESA KUKUH WINANGUN

BUMDes is a vehicle for running businesses in the village, the problem that occurs in BUMDes in Kukuh Winangun Village is that the lack of member loyalty is caused by other choices that they think are better than BUMDes. The formulation of the problem and the purpose of this research is to determine the effect of organizational culture and organizational commitment on member loyalty. This research was conducted at BUMDes, Kukuh Village, Marga District, Tabanan Regency. The population in this study was the total number of BUMDes members in Kukuh Winangun Village, Marga District, Tabanan Regency, which amounted to 1,166 members consisting of 8 official banjars, 12 traditional villages, then a sample of 93 respondents was determined. The data analysis technique used is validity test, reliability test, classical assumption test, multiple linear regression analysis test, determination, partial (t) and simultaneous (f) significant test. Based on the results of the analysis, it was found that partially organizational culture (X1) has a positive and significant effect on member loyalty (Y). Partial organizational commitment (X2) has a positive and significant effect on member loyalty (Y). There is a simultaneous influence of organizational culture and organizational commitment variables on member loyalty. Suggestions that can be given to BUMDes in Kukuh Winangun Village are to improve and strengthen communication patterns between village institutions by holding regular monthly or quarterly meetings to discuss the development of BUMDes so that the development of BUMDes can be known by all parties in Kukuh Winangun Village.

Regular feedback on inter-hospital transfer improved the clinical outcome and survival in patients with multiple trauma: a retrospective cohort study

BackgroundUndertriage of major trauma patients is unavoidable, especially in the trauma system of rural areas. Timely stabilization and transfer of critical trauma patients remains a great challenge for hospitals with limited resources. No definitive measure has been proven to improve the outcomes of patients transferred with major trauma. The current study hypothesized that regular feedback on inter-hospital transfer of patients with major trauma can improve quality of care and clinical outcomes.MethodThis retrospective cohort study retrieved data of transferred major trauma patients with an injury severity score (ISS) > 15 between January 2010 and December 2018 from the trauma registry databank of a tertiary medical center. Regular monthly feedback on inter-hospital transfers was initiated in 2014. The patients were divided into a without-feedback group and a with-feedback group. Demographic data, management before transfer, and outcomes after transfer were collected and analyzed.ResultsA total of 178 patients were included: 69 patients in the without-feedback group and 109 in the with-feedback group. The with-feedback group had a higher ISS (25 vs. 27; p = 0.049), more patients requiring massive transfusion (14.49% vs. 29.36%, p = 0.036), and less patients with Glasgow Coma Scale ≤8 (30.43% vs. 23.85%, p < 0.001). After adjusting for confounding factors, the with-feedback group was associated with a higher rate of blood transfusion before transfer (adjusted odds ratio [aOR]: 2.75; 95% confidence interval [CI]: 1.01–7.52; p = 0.049), shorter time span before blood transfusion (− 31.80 ± 15.14; p = 0.038), and marginally decreased mortality risk (aOR: 0.43; 95% CI: 0.17–1.09; p = 0.076).ConclusionThis study revealed that regular feedback on inter-hospital transfer improved the quality of blood transfusion.

Knowledge and Practice of Iraqi Women Regarding Breast Self-Examination

Background: Women around the world are suffering from breast cancer (BC) which is considering the commonest cancer affecting them. Even, the mortality rate can be decreased with a continuous and regular screening of the breast especially by Breast Self-Examination (BSE). Objectives: The main objective of this study was to assess the knowledge level, attitude level, and practice of Iraqi women living in Baghdad city regarding BSE. Secondly, to assess the presence of an association between knowledge and practice. Methods: This is an analytic cross-sectional study conducted on a non-random sample of 657 participant women attending primary healthcare centers (PHCCs) for different reasons. The average age was between (20-59) years. All consented women filled a specially designed questionnaire for the research purpose through a face-to-face interview. Results: The result showed only 75.5% of women were heard about BSE and there was a significant difference (p<0.001) in age between women heard about BSE and those never heard it. In addition to the significant association (p<0.001), (p<0.001), and (p<0.001) of being aware of BSE with educational level, employment status, and social class respectively. The mean knowledge score and standard deviation (SD) for BSE were (45.2±34.8). Only 33(5%) of women performed regular monthly BSE. A significant difference (P<0.001) in the knowledge of women who practicing BSE adequately and those with non-adequate practice. Conclusion: Women with the adequate practice of BSE had a higher knowledge level than those inadequately practiced. The practice of BSE was inadequate in a majority of participants and needs to be improved by educational programs.

The influence of subject learning on the skills of decoding autofluorescent images of the oral mucosa

Background. Despite the ease of implementation, harmlessness, painlessness and speed of the study, the method of autofluorescence does not belong to the routine and often used because of the dependence on the skill of the dentist in interpretation of the resulting visualization. Foreign and domestic researchers speak about the need for thematic training of dentists for the widespread introduction of the autofluorescence method into practice. There is no data proving the influence of training on the skill of interpretation autofluorescence images and showing the dependence of the skill on the duration of training and its frequency.The aim of the study was to conduct a comparative analysis of the results of interpreting autofluorescence images of the oral mucosa by dentists before and after thematic training.Methods. 308 dentists interpreted 20 images of autofluorescence of the oral mucosa before and after the thematic training, 10 of them were of potentially malignant diseases of the oral mucosa, 10 – of benign lesions and paraphysiological anomalies. Correctly identified mucosal changes presented in the autofluorescence image were considered positive results of decoding. The results were evaluated relative to the duration of training and its frequency, taking into account the duration of breaks, according to the average number of positive results.Results. Before the thematic training, dentists on average decoded 8.41 ± 4.89 images, after training – 12.11 ± 3.12 images. The difference before and after the thematic training between the number of positive results of interpretation autofluorescence images is statistically significant (t = –14.1, p˂ 0.001). There was no significant difference in the results of interpretation potentially malignant oral diseases (F = 1.67; p = 0.190) and benign lesions and conditions (F = 0.647; p = 0.524) between the three groups that studied for 6, 12 and 18 hours. There is a correlation to the duration of the interruption of training with positive results of decoding (r = –0.3376; p˂ 0.001). The positive results of interpretation of autofluorescence with regular monthly 6-hour training had significant increasing trends (12.11 ± 3.12 and 13.22 ± 1.76, t = –3.41, p = 0.001; 13.22 ± 1.76 and 14.40 ± 1.81, t = –4.74, p˂ 0.001).Conclusion. Thematic training improves the skill of interpretation autofluorescence images in dentists. The regularity of short-term training is more important for maintaining the interpretation skill than the duration of training.

Robotic-assisted laparoscopic cervicouterine anastomosis in a patient with agenesis of the uterine isthmus

To demonstrate the surgical management of agenesis of the uterine isthmus. Stepwise description of robotic-assisted laparoscopic cervicouterine anastomosis. Academic medical center. A 27-year-old nulligravida with primary amenorrhea and cyclic pelvic pain. The patient underwent a robot-assisted cervicouterine anastomosis using the following surgical steps: adhesiolysis of the right ovary from the rudimentary uterine horn; vesicouterine peritoneal fold dissection and mobilization of the cervical canal; the opening of the cervical canal and dilatation with Hegar dilators; longitudinal incision of the lower third of the anterior uterine wall up to the endometrial cavity; insertion of a 14 Ch Foley catheter, not inflated, fixed to the cervix with a suture and removed after 7 days; and closure of the cervicouterine breach with a double-layer Vicryl suture. Informed consent was obtained from the patient for the use of video and images. After 3 months, the patency of the anastomosis site was assessed via hysteroscopy. Subsequent follow-up was performed by referring physicians. Postoperatively, anatomic continuity was restored and the patient was menstruating with regular monthly cycles; furthermore, cyclic pelvic pain was relieved. Few cases of this condition have been reported in the literature and, currently, surgical treatment of agenesis of the uterine isthmus is controversial, with some treatments including laparoscopic-assisted uterocervical anastomosis using a stent to prevent restenosis, primary cervicouterine anastomosis by laparotomy performed with a Foley catheter in the cervical canal, and anastomosis of the uterine isthmus agenesis. However, to our knowledge, we are the first to use a robotic approach. Preservation of reproductive function and symptom relief represent the goals of the surgery. Therefore, hysterectomy cannot be considered as a treatment option. However, after a cervicouterine anastomosis procedure, the normal uterine morphology cannot be achieved; cyclic abdominal pain may remain after surgical treatment. In this case, an alternative surgical approach, such as hysterectomy, can be considered. Robotic-assisted treatment of this uncommon müllerian anomaly is feasible and may be an alternative to hysterectomy in individuals who wish to preserve fertility. Follow-up is needed to evaluate fertility and reproductive function.

Parkinson’s disease treatment with shockwaves

Abstract Shockwaves have been first successfully used for extracorporeal kidney stone disintegration in 1980. Meanwhile, low intensity shockwaves proved to be efficient for the treatment of non-unions, tendon- and muscular pain, wound healing, heart insufficiency, erectile dysfunction and aesthetics. Spasticity is treated since 1990, followed by the treatment of spinal cord injuries and unresponsive wakefulness. The working principle is the mechanical activation of biological processes called mechanotransduction resulting in anti-inflammatory effect, increased cell metabolism, release of nitric oxide (eNO) and of numerous growth factors. From 2010 to 2013, 18 patients with Parkinson’s disease were off-label treated. First, in order to determine an appropriate treatment rhythm and the energy dosage. A further 3 patients followed in 2017. The treatment was performed with focused shockwave generator and consisted of 6 approximately 30 minutes sessions within two weeks. 6000 pulses with energy flux density of 0.2mJ/mm2 at 5Hz were applied during each session in the region of interest of the brain. After the initial treatment block, the disease symptoms assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) improved by over 50%. The symptomatic improvements remained stable to date by regular monthly re-treatments (1 session) in one of the patients for 8 years and in the 3 other patients over 3 years. The UPDRS, motoric part decreased by more than 50% within the treatment period. The UPDRS, all 3 items, was reduced by 44%. There were no negative side effects. Parkinson’s disease treatment with shockwaves is safe and effective. The broad scope of shockwave stimulated biological effects in the brain seems to be an interesting and promising option as an extension to the established treatments. Further clinical trials with larger number of patients are necessary for regulatory clearance. A placebo controlled, randomized trial is ongoing. Keywords: Parkinson' disease, shockwaves, mechanotransduction, brain

Kesan Variasi Harga Minyak Terhadap Corak Perjalanan Pelajar Institusi Pengajian Tinggi

In Malaysia, most of the studies conducted on the effects of increase in fuel prices have focused on a group of people who have a regular monthly income. Little attention is given to the younger generation without income, especially among students in higher education. Malaysian students are also among the highest group of people who make daily trips. The increase in fuel prices has also increased the daily cost of students and can affect their daily commute. This study aims to examine the specific effects of the increase in the prices of fuel on the travel patterns of young people in higher education institutions. A total of 596 respondents among university students were involved in this study, which selected randomly from public and private universities in Malaysia. By focusing on the patterns of travel before and after the increase in fuel prices, the respondents were asked to fill out a questionnaire related to their weekly trip activities. From the survey conducted, there are variations in the choice of transport mode for educational purposes and personal activities of the respondents. Among the preferred mode of transport include driving cars, riding bikes, walking and taking public services. However, the highest mode of transport of the movement of respondents from residential areas to campus based on the weekly frequencies are walking and driving cars. Whereas, for personal purposes, students are most likely to prefer driving cars. Research shows, the rise in fuel prices do not provide a significant change to the travel patterns of the respondents. However, slight changes in the pattern of respondents’ travel have occurred, such as the reduction in the frequency of personal vehicle used and the increase in the frequency of sharing the vehicle.