Understanding Of Definition Research Articles

Knowledge, attitude, and beliefs of interns towards brain death diagnosis

Objective. To evaluate the knowledge and attitudes of interns regarding brain death diagnosis and organ donation. Methods. A cross-sectional survey was administered to 142 interns at Umm Al-Qura University to assess their understanding of the legal definitions, diagnostic criteria, procedures, and attitudes towards organ donation. Results. Significant knowledge gaps were identified, with many interns demonstrating a limited understanding of key aspects of brain death. While some expressed confidence in their diagnostic abilities, concerns about misdiagnosis and premature organ donation were also prevalent. Conclusion. Although limited by its single-center design, this study highlights the need for enhanced education on brain death in medical training programs. Further research, particularly multicenter studies, is necessary to validate these findings and develop targeted educational interventions to improve interns' comprehension and address their concerns.

Illuminating the shadows: the role of private supplementary tutoring on student math performance in PISA 2022

Recent decades have witnessed a global expansion of private supplementary tutoring, known as shadow education—additional support in academic subjects that takes place outside of regular school hours. Using the data of 55 countries from the Programme for International Student Assessment (PISA) 2022, this study examines the association between students’ participation in shadow education and their academic achievement in mathematics and how these relationships change for developed, developing, and East Asian regions. This study also sheds light on the moderating effect that socio-economic status has on the relationship between engagement in shadow education and math performance. Multilevel regression analyses revealed that, at the between-school level, only one of the five forms of shadow education, namely the degree to which students received asynchronous video-recorded instruction, was associated with improved math performance. Similarly, at the within-school level, only the degree to which students received video-recorded instruction was statistically significantly associated with improved mathematical outcomes. Incidentally, we find that institutional-related school-level factors such as the overall quality of student–teacher relationships, provision of math-related extra-curricular activities, and support in terms of peer-to-peer tutoring appear to be associated with improved school math performance, while the quality of student–teacher relationships and level of math teacher support also feature positively for students within-schools. Regarding differential effects by region, at the between-school level, only the degree to which students received large-group study or practice was associated with math performance in East Asian countries. With regards to the moderating effect of SES on the positive relationship between asynchronous shadow education and math performance, we find the effects to be negative, suggesting that asynchronous engagement might be more beneficial for students from lower SES backgrounds. Finally, while the overall negative relationships between synchronous forms of shadow education and math performance appear counter-intuitive, we speculate that this may reflect the use of such tutoring for remedial purposes. We suggest that further research into these “remedial reverse effects” in post-COVID AI-bot-capable educational contexts may provide a more definitive understanding of the role that student engagement in shadow education has on their academic performance.

Trace element contaminants and endocrine status of European brown bears assessed using blood as a matrix.

Bioaccumulation of trace element contaminants with endocrine disruptive (ED) potential has been noted in European brown bears, though evidence of their effects is lacking. Generalized linear models were employed to assess circulating levels of reproductive, stress, and thyroid hormones in relation to arsenic (As), cadmium (Cd), mercury (Hg), lead (Pb) and thallium (Tl) in 53 free-ranging brown bears (Ursus arctos) from two European populations (Carpathian and Dinara-Pindos). Other potential drivers of hormone variation, such as essential elements, ecological factors, physiological variables, and capture methods, were included as predictors. The models demonstrated a positive association between cortisol and Cd, and a negative association with Tl. In addition, Tl and Pb were identified as key factors in explaining variation in thyroid hormones (free triiodothyronine, fT3 and free thyroxine, fT4). Trap type was significant in explaining variation in fT3 concentrations, while sex was an important predictor of progesterone levels. The essential elements, cobalt (Co) and copper (Cu) accounted for 41% of testosterone variation, while Cu and selenium (Se) were negatively associated with fT4. Other notable predictors of investigated hormone variation included body condition index (important for cortisol), age (for fT4), year (for fT3), capture day (for fT4 and fT4:fT3 ratio) and population (fT4:fT3 ratio). This study evidenced trace elements as important factors to consider when studying hormonal variation in terrestrial wildlife (Tl for cortisol and fT3, Cd for cortisol, Cu for testosterone and fT4, Co for testosterone, Pb and Se for fT4). To gain a more definitive understanding of the effects of exposure to element contaminants on endocrine status, it is recommended to include more sensitive and specific endocrine disruption-related endpoints in a larger sample size. Doing so will further enhance our understanding of the potential adverse endocrine effects of environmental pollutants on these bear populations and other large mammalian wildlife species.

What, When, and How of Responsible Leadership: Taking Stock of Eighteen Years of Research and a Future Agenda

AbstractBecause research on responsible leadership has grown significantly in recent years, we conducted a systematic review of research on responsible leadership. Our overall goal was to establish a comprehensive understanding of alternative definitions of responsible leadership, its theoretical foundations, and distinctions from other moral leadership constructs. Drawing from 194 studies, we first clarify the conceptual underpinnings of responsible leadership, and how it differs from other constructs in the moral leadership domain, thus highlighting its value as a construct. Second, we identify and evaluate the prominent theoretical frameworks that underpin responsible leadership. Third, we conceptualize the antecedents, mediating factors, contingency variables and outcomes of responsible leadership. Fourth, we offer important recommendations for future research that will move the field forward. Overall, our review provides insights to advance an understanding of responsible leadership.

Penyuluhan Pemberian Edukasi Fisioterapi Mengenai Hipertensi Pada Komunitas Lansia di Posyandu Mawar Balai RW 03 Kelurahan Dinoyo Kota Malang

Introduction: Hypertension, often referred to as the silent killer, is a major risk factor for mortality worldwide, including in Indonesia. It affects all age groups, with the elderly being the most vulnerable. Hypertension is defined as a condition where systolic blood pressure exceeds 140 mmHg and diastolic blood pressure exceeds 90 mmHg. It is categorized into primary hypertension, with an unknown cause, and secondary hypertension, caused by kidney, endocrine, heart, or adrenal disorders. Research Method: Educational counseling and sports therapy were conducted on October 19, 2024, from 08.30 to 10.00 WIB at Posyandu Mawar, Balai RW.03, Dinoyo Village, Lowokwaru District, involving 30 elderly respondents. Posters and leaflets were used as health promotion tools, along with a questionnaire containing four questions, each worth 25 points. Results: Pretest results indicated understanding of hypertension definition (70%), breathing exercises (45%), benefits (67.4%), and application (0%). Posttest results showed a 100% improvement in all components after the intervention. Conclusion: Counseling and exercise therapy significantly increased understanding and implementation of hypertension management among the 30 elderly respondents, reducing the risk of death, the severity of hypertension, and the likelihood of complications.

Collaborative and interdisciplinary teaching in sport and exercise: Lessons from the development and delivery of an equity, diversity, and inclusion workshop

Training in sport and exercise that is collaborative and interdisciplinary allows for the delivery of key knowledge and skills that help shape trainees’ practice. Such training also demonstrates how collaborations can take shape and how individuals can work together in the future. We present an example of collaborative and interdisciplinary training used within an equity, diversity, and inclusion workshop that was provided to trainees enrolled on the Sport and Exercise Psychology Accreditation Route (SEPAR) training program offered through the British Association of Sport and Exercise Sciences. The SEPAR program was designed to allow trainees to gain knowledge, skills, and experience to apply and register as Practitioner Psychologists with the Health and Care Professions Council in the United Kingdom. The workshop was a collaboration between individuals trained in sport and exercise psychology and clinical social work. Overall, the workshop helped trainees gain an understanding of key terms and definitions concerning equity, equality, diversity, inclusion, and social justice as well as legal responsibilities. The workshop also demonstrated a variety of perspectives from sport and exercise psychology and clinical social work as to how inclusive and socially just approaches can be used to create safe environments that can foster strong therapeutic relationships with clients.

Individual factors that affect laypeople's understanding of definitions of medical jargon

ObjectivePatients have difficulty understanding medical jargon in electronic health record (EHR) notes. Lay definitions can improve patient comprehension, which is the goal of the NoteAid project. We assess whether the NoteAid definitions are understandable to laypeople and whether understandability differs with respect to layperson characteristics. MethodsDefinitions for jargon terms were written for laypersons with a 4th-to-7th-grade reading level. 300 definitions were randomly sampled from a corpus of approximately 30,000 definitions. 280 laypeople (crowdsource workers) were recruited; each layperson rated the understandability of 20 definitions. Understandability was rated on a 5-point scale. Using a generalized estimating equation model (GEE) we analyzed the relationship between understandability and age, sex, race/ethnicity, education level, native language, health literacy, and definition writer. ResultsOverall, 81.1 % (95 % CI: 76.5–85.7 %) of the laypeople reported that the definitions were understandable. Males were less likely to report understanding the definitions than females (OR: 0.73, 95 % CI: 0.63–0.84). Asians, Hispanics, and those who marked their race/ethnicity as “other” were more likely to report understanding the definitions than whites (Asians: OR: 1.43, 95 % CI: 1.17–1.73; Hispanics: OR: 1.86, 95 % CI: 1.33–2.59; Other: OR: 2.48, 95 % CI: 1.65–3.74). Laypeople whose native language was not English were less likely to report understanding the definitions (OR: 0.51, 95 % CI: 0.36–0.74). Laypeople with lower health literacy were less likely to report understanding definitions (health literacy score 3: OR: 0.51, 95 % CI: 0.43–0.62; health literacy score 4: OR: 0.40, 95 % CI: 0.29–0.55). ConclusionUnderstandability of definitions among laypeople was high. There were statistically significant race/ethnic differences in self-reported understandability, even after controlling for multiple demographics. Public interest summaryWe conducted a study to ensure that definitions written for the NoteAid EHR jargon identification tool are understandable. We recruited a diverse group of crowdsource workers and found that overall, the definitions were understandable, but understanding levels varied based on several demographic characteristics.

Understanding and Tuning the Effects of H2O on Catalytic CO and CO2 Hydrogenation.

Catalytic COx (CO and CO2) hydrogenation to valued chemicals is one of the promising approaches to address challenges in energy, environment, and climate change. H2O is an inevitable side product in these reactions, where its existence and effect are often ignored. In fact, H2O significantly influences the catalytic active centers, reaction mechanism, and catalytic performance, preventing us from a definitive and deep understanding on the structure-performance relationship of the authentic catalysts. It is necessary, although challenging, to clarify its effect and provide practical strategies to tune the concentration and distribution of H2O to optimize its influence. In this review, we focus on how H2O in COx hydrogenation induces the structural evolution of catalysts and assists in the catalytic processes, as well as efforts to understand the underlying mechanism. We summarize and discuss some representative tuning strategies for realizing the rapid removal or local enrichment of H2O around the catalysts, along with brief techno-economic analysis and life cycle assessment. These fundamental understandings and strategies are further extended to the reactions of CO and CO2 reduction under an external field (light, electricity, and plasma). We also present suggestions and prospects for deciphering and controlling the effect of H2O in practical applications.

Charge-transfer dipole low-frequency vibronic excitation at single-molecular scale.

Scanning tunneling microscopy (STM) vibronic spectroscopy, which has provided submolecular insights into electron-vibration (vibronic) coupling, faces challenges when probing the pivotal low-frequency vibronic excitations. Because of eigenstate broadening on solid substrates, resolving low-frequency vibronic states demands strong decoupling. This work designs a type II band alignment in STM junction to achieve effective charge-transfer state decoupling. This strategy enables the successful identification of the lowest-frequency Hg(ω1) (Raman-active Hg mode) vibronic excitation within single C60 molecules, which, despite being notably pronounced in electron transport of C60 single-molecule transistors, has remained hidden at submolecular level. Our results show that the observed Hg(ω1) excitation is "anchored" to all molecules, irrespective of local geometry, challenging common understanding of structural definition of vibronic excitation governed by Franck-Condon principle. Density functional theory calculations reveal existence of molecule-substrate interfacial charge-transfer dipole, which, although overlooked previously, drives the dominant Hg(ω1) excitation. This charge-transfer dipole is not specific but must be general at interfaces, influencing vibronic coupling in charge transport.

Best descriptors for predicting noise annoyance and spectrum-based penalty of steady-state wideband noise

Many objective descriptors (i.e., single-number quantities) are available in the literature for the objective assessment of noise annoyance of wideband, steady-state sounds. However, there is no definitive understanding of which descriptors best correspond to subjective annoyance. Our purpose is to assess how different descriptors correspond with differences in noise annoyance resulting from changes in A-weighted sound level and spectrum. This investigation is based on recently published results from a psychoacoustic experiment conducted by Kuusinen et al. [1]. They investigated 23 steady-state wideband noises with various spectral shapes within 32-48 dB LAeq, and participants rated them in terms of subjective annoyance. The study revealed that penalty due to spectrum shape could be even 10 dB. Here, we present a follow up analysis focusing on objective noise descriptors. The results indicate that many descriptors are strongly associated with noise annoyance ratings, while Spectral Centroid and Sharpness appear to be the best candidates to predict spectrum-based penalty.

Necrotizing Enterocolitis: A Current Understanding and Challenges for the Future.

This perspective reviews the definition and current understanding of necrotizing enterocolitis and evaluates a future prevention approach to this multifactorial disease. An overview of the prevention approach in general is presented, where key aspects and emerging criticisms are identified. In addition, key elements of early diagnosis and treatment are presented, together with some of their challenges and ambiguities. Moreover, it concludes with emerging questions from the global community to reach a consensus on the definition, diagnosis, and management of necrotizing enterocolitis disease.

The Clinical Characteristics, Treatment and Prognosis of Tuberculosis-Associated Chronic Obstructive Pulmonary Disease: A Protocol for a Multicenter Prospective Cohort Study in China.

Tuberculosis and chronic obstructive pulmonary disease (COPD) are significant public health challenges, with pulmonary tuberculosis recognized as a pivotal risk factor for the development of COPD. Tuberculosis-associated COPD is increasingly recognized as a distinct phenotype of COPD that potentially exhibits unique clinical features. A thorough understanding of the precise definition, clinical manifestations, prognosis, and most effective pharmacological strategies for tuberculosis-associated COPD warrants further investigation. This prospective, observational cohort study aims to enroll over 135 patients with tuberculosis-associated COPD and 405 patients with non-tuberculosis-associated COPD, across seven tertiary hospitals in mainland China. The diagnosis of tuberculosis-associated COPD will be established based on the following criteria: (1) history of pulmonary tuberculosis with standard antituberculosis treatment; (2) suspected pulmonary tuberculosis with radiological evidence indicative of tuberculosis sequelae; (3) no definitive history of pulmonary tuberculosis but with positive interferon-gamma release assay results and radiological signs suggestive of tuberculosis. At baseline, demographic information, medical history, respiratory questionnaires, complete blood count, interferon-gamma release assays, medications, spirometry, and chest computed tomography (CT) scans will be recorded. Participants will be followed for one year, with evaluations at six-month intervals to track the longitudinal changes in symptoms, treatment, lung function, and frequencies of COPD exacerbations and hospitalizations. At the final outpatient visit, additional assessments will include chest CT scans and total medical costs incurred. The findings of this study are expected to delineate the specific characteristics of tuberculosis-associated COPD and may propose potential treatment options for this particular phenotype, potentially leading to improved clinical management and patient outcomes.

Demographic, Environmental, and Psychosocial Influences on Resilience Toward Chronic Stress.

As studied previously, chronic stress environments lead to the formation of distinctive resilience groupings when related to individual outcomes among participants. The majority of the population has decreased mental and physical strength during prolonged periods of mental distress but returns to baseline status when those stressors are removed. Others have increased and decreased mental fortitude despite the removal of stressors. Our hypothesis is that certain demographic, environmental, and/or transgenerational aspects are associated with resilience or lack thereof in populations with a history of chronic stress. The end goal is the early identification of at-risk populations to decrease adverse outcomes and improve quality of life. In this review, we looked at 17 studies to gain a greater understanding of which factors influence individual resilience. The factors found to have a positive relationship with resilience were religion, cognitive function, socioeconomic status, marriage, psychological functioning, positive coping mechanisms, and relationships; the negative were medical diagnoses, violence exposure, female sex, stressors/trauma, disaster exposure, and negative coping mechanisms. During our research, we found that transgenerational aspects such as race/ethnicity, occupation, education, age, substance use, and physical location had mixed results across multiple studies. These findings suggest the need for future original research to allow for a definitive understanding of populations resilient to chronic stress.

Lunar simulant behaviour variability and implications on terrestrial based lunar testing

The detrimental effects and challenges of Lunar dust for Lunar exploitation were first identified during the Apollo missions. During the extra vehicle activities (EVAs) undertaken by astronauts, the dust clogged mechanisms, disrupted sensors, and caused several health issues for the astronauts. Despite numerous studies, there is no definite understanding as to why different Apollo missions experienced varying levels of dust disruptions. The variations in dust behaviour could be attributed to the amount of radiation the Lunar soil is exposed to, as well as mineralogy and particle sizes. To enhance our understanding of Lunar dust behaviour this study investigated Space Recourse Technologies, formally known as Exolith, simulant at different mineral compositions, and their surface detachment characteristics were measured. Experiments measuring the individual minerals and their mixed simulant-like counterparts were conducted using electrostatic fields. Inclusive to this, non-dried and dried samples were compared by measuring adhesion to target plates when subject to electrostatic forces. The results found that Highlands simulant exhibited a higher buildup on a target plate than its Mare counterpart by an average of 33% under the same conditions, likely due to particle size differences. In addition to these findings, evidence of particle reactivity decay was observed under repeated tests with up to 60% less Mare simulant and 36% Highlands deposition being measured compared to the first set of experiments. A possible explanation may be particle reactivity. Microscope images identified that particles are transported in groups as opposed to individual grains. These results will help researchers in tailoring dust mitigation solutions based on different regions on the Lunar surface and influence mission planning from the perspective of dust mitigation and contamination.

Intersystem Crossing Control of the Nb+ + CO2 → NbO+ + CO Reaction.

The transfer of an oxygen atom from carbon dioxide (CO2) to a transition metal cation in the gas phase offers atomic level insights into single-atom catalysis for CO2 activation. Given that these reactions often involve open-shell transition metals, they may proceed through intersystem crossing between different spin manifolds. However, a definitive understanding of such spin-forbidden reaction requires dynamical calculations on multiple global potential energy surfaces (PESs) coupled by spin-orbit couplings. In this work, we report global PESs and spin-orbit couplings for three low-lying spin (quintet, triplet, and singlet) states for the reaction between the niobium cation (Nb+) and CO2, which are used to investigate the nonadiabatic reaction dynamics and kinetics. Comparison with experimental data of kinetics and collision dynamics shows satisfactory agreement. This reaction is found to be very similar to that between Ta+ + CO2. Specifically, our theoretical findings suggest that the rate-limiting step in this reaction is intersystem crossing, rather than potential barriers.

Improvement in Adverse Drug Reaction (ADR) Knowledge: A Pre- and Post-video Intervention Study Among Doctors.

Background Adverse drug reactions (ADRs) represent a significant public health concern, contributing to mortality, morbidity, and healthcare costs worldwide. Healthcare practitioners especially doctors play a vital role in identifying and reporting ADR. This study investigates the prevalence of knowledge regarding ADR among doctors and enhances it with educational intervention. It also explores the association between demographic factors and baseline ADR awareness. Methods A prospective cross-sectional interventional study was conducted among doctors in Ahmedabad, India, to evaluate their knowledge of ADR reporting and the effectiveness of an educational video intervention. Pre- and post-intervention questionnaires were administered to assess knowledge improvement. Statistical analysis, including paired t-tests and chi-square tests, was performed to evaluate the intervention's impact and explore associations between demographic factors and ADR awareness. Results Analysis of pre- and post-intervention questionnaires revealed a significant increase in correct response rates post-intervention, indicating the effectiveness of the educational video intervention. Demographic factors, particularly age, were associated with ADR awareness. Following the intervention, participants demonstrated an improved understanding of ADR definitions, WHO causality assessment, reporting mechanisms, and challenges faced by pharmacovigilance programs. All participants found the video helpful and expressed intent to share their knowledge post-intervention. Conclusion The results of the study suggest that educational video intervention can serve as an effective tool for understanding ADRconcepts and pharmacovigilance practices. Moreover, the association of demographic factors, particularly age, with ADR awareness further emphasizes the importance of educational interventions in addressing specific population needs.

The Year Publication Rate of Presentations from the Inaugural Medical Student Orthopedic Society Research Symposium

Introduction Orthopaedic surgery is one of the most competitive residencies to match in medicine, the match rate has decreased to 63.1% in 2023.<sup>1,13</sup> Aspects of the application that are most in the control of applicants are their personal and research experiences in the field and their choice of acting internships. The Medical Student Orthopaedic Society (MSOS) hosted the first national, and virtual orthopaedic research symposium for medical students. This study aimed to examine the short-term publication rate of the research presented at the 2022 MSOS Research Symposium. Methods The titles of the articles and the names of the presenters from the MSOS program were used to search for publications via PubMed and Google Scholar search engines. If no matching result was found, the article was considered not published. If the presentation was published in a journal within our study period, the updated title, name and gender of the medical student and senior author, name of the journal, and date of publication were recorded. Demographic variables among presenters included gender, and current training status. These were determined via a Google search. Impact factors were extracted from the Web of Science (WoS) database for the year of 2023. Results For the 2022 MSOS Symposium, a total of 300 presentations were given. Nineteen publications had to be excluded. Of the 281 presentations included in this study, 129 were published in a peer-reviewed journal within 18-months after the symposium (45%). Presentations were published on average 165 days (~5.5 months) after the symposium. Of the journals that had an impact factor score, the average was 2.18. Categories with over 60% publication rate were Practice Management and Health Disparities, shoulder and elbow, and medical education. Among presenters whose projects were published, 74% identified as men and 26% as women. The papers’ senior authors were 85% men and 15% women. Of those that participated and published in the 18-month period, 22% of individuals matched into orthopedics the following year, 9% matched into another residency, 38% were still medical students, 30% statuses were unknown or could not be determined. Of those schools represented, 20 schools (35 participants) did not have a home program at their institution, also known as orphan programs. The presenter was the first author in 53% (69) of the published works. Discussion The Medical Student Orthopaedic Society (MSOS) touted a publication rate of 45% which is comparable to the rates of publication in less time than numerous other meetings (~5.5 months). This may be due to medical students’ finite amount of time to gain the experience necessary to apply, suggesting there is a higher motivation to get research out and published. However, further research into the participation levels of presenters would need to be studied directly to give a definitive understanding as to why first authorship was not provided to the presenter. Participants that published were majority male and attended allopathic schools. Most were still in medical school, while 21% have matched into an Orthopaedics program, 9% matched into another program and 30% could not be determined at this time. Conclusion As the goal for a medical student is to successfully match it is highly important that opportunities are not only accessible but allow for URiM and orphan medical schools to engage in a meaningful way.<sup>11</sup> The MSOS is hopeful that this virtual symposium can be beneficial in expanding exposure to orthopaedics through research opportunities and experiences. <sup>1</sup>

Exploring the intersections of frailty, sarcopenia, and cachexia with malnutrition.

This review examines our current understanding of consensus definitions for frailty, sarcopenia, and cachexia and their perceived overlap with malnutrition. Patients with these syndromes will often meet the criteria for malnutrition. It is common for these overlap syndromes to be misapplied by practitioners, and confusion has been further exacerbated by the lack of a common malnutrition language. To address the latter concern, we recommend using either the standalone Global Leadership Initiative in Malnutrition (GLIM) framework or the GLIM consensus criteria integrated with other accepted approaches as dictated by preference and available resources. Established care standards should guide the recognition and treatment of malnutrition to promote optimal clinical outcomes and quality of life. The effectiveness of nutrition interventions may be reduced in settings of severe acute inflammation and in end-stage disease that is associated with cachexia. However, such interventions may still assist patients to tolerate treatments that target the underlying etiology for an overlap syndrome, and they may help to improve select clinical outcomes and quality of life. Recent, large, well-designed randomized controlled trials have demonstrated the compelling positive clinical effects of medical nutrition therapy. The application of concurrent malnutrition risk screening and assessment is therefore a high priority. The necessity to deliver specific interventions that target the underlying mechanisms of these overlap syndromes and also diagnose and address malnutrition is paramount. It must be highlighted that securing beneficial outcomes for frailty, sarcopenia, and cachexia will also require nonnutrition interventions, like comprehensive care plans, pharmacologic agents, and prescribed exercise.

The impact of formative assessment on K-12 learning: a meta-analysis

ABSTRACT To facilitate a more definitive understanding of the usefulness of formative assessment, this meta-analysis examined the impact of formative assessment on student academic achievement in the K-12 classroom. The study analyzed 258 effect sizes from 118 primary studies published around the world. By applying a broad lens for defining and understanding formative assessment, the study confirmed the usefulness of formative assessment. The overall effect size was 0.25 (Hedges’ g) for all studies included, and 0.22 for studies conducted within the US. The effect size was similar across different types of formative assessments (e.g., self-assessment vs peer assessment) and content domains (e.g., English language, mathematics, science, etc.). The mean effect size was significantly larger for studies conducted outside North America and Western Europe, for formative assessments for high school students, and for studies using the quasi-experimental design. No publication bias was detected for studies conducted in North America and Western Europe.

A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic‐periodontal lesions? A case report

AbstractBackgroundThis study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis.MethodsClinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface.ResultsAt 6‐month and 1‐year follow‐ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4‐year follow‐up period.ConclusionsThe spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL.Key Points Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic‐periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic‐periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo‐periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.