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Thus, we may tentatively conclude that mindful practice appears promising as a method of improving diagnostic accuracy, but that further definitive studies of efficacy are required. We identified a taxonomy of 71 terms related to mindful practice, 7 of which were deemed core terms due to being each cited 5 times or more. The 7 core terms appear to be sufficient to describe the findings at higher levels of evidence in our evidence synthesis, suggesting that future definitive studies of mindful practice should focus on these common core terms in order to promote more generalisable findings.Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced education in the Family Medicine residency. We aimed to test whether alerts to encourage spaced education can improve clinical knowledge as measured by scores on the Canadian Family Medicine certification examination.

We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. read more At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada.

Over 67weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points.

Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.

Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.Soil and water are vital natural resources. However, due to their indiscriminate use, these resources are being seriously threatened. Therefore, it is essential to manage them in a sustainable way and leave them for future generations. Population and agricultural areas have expanded, deforesting native landscapes for cultivation and pastures. As a result, soil loss from agricultural areas is increasing the amount of sediment transport in water courses. The objective of this study was to quantify soil loss and sediment yield from the Corrente dos Matões sub-basin (CMSB). These measurements are essential to quantify the environmental impact of advancing agricultural frontiers. The Universal Soil Loss Equation (USLE) was applied due to its wide use, compatibility with GIS, and data availability. The suspended sediment transport was calculated by collecting samples with DH-48 sampler. From the application of USLE, the average soil erosion contributed very little to sediment delivery in the watercourse, with a magnitude of only 0.37 t ha-1 year-1. The highest soil loss was associated with greater slope and was observed in areas with agriculture or under the absence of vegetation cover. The low transport of suspended sediments in CMSB is due to the existence of preserved sites. About 99% of the sub-basin had a low degree of erosion. The high degree of soil loss was attributed to the cliffs and the development of agricultural activities leaving the soil uncovered. This work will help identify the most susceptible areas to water erosion for optimizing the allocation of financial resources for the preservation of this natural resource.We investigated the effect of paravertebral muscle (PVM) on poor prognosis in osteoporotic vertebral fracture (OVF) and remaining lower back pain (LBP) in the thoracolumbar and lower lumbar regions. Additional OVF occurrence in the thoracolumbar and remaining LBP in the lumbar region was significantly related to PVM fat infiltration percentage.

Paravertebral muscle (PVM) is an important component of the spinal column. However, its role in the healing process after osteoporotic vertebral fracture (OVF) is unclear. This study aimed to clarify the effect of PVM in thoracolumbar and lower lumbar regions on OVF clinical and radiological outcomes.

This was a multicenter prospective cohort study from 2012 to 2015. Patients ≥ 65 years old who presented within 2 weeks after fracture onset were followed up for 6 months. PVM was measured at the upper edge of the L1 and L5 vertebral body in the magnetic resonance imaging (MRI) T2-axial position at registration. The cross-sectional area (CSA), relative CSA (rCSA), and Physicians should be aware that patients with such fatty degeneration shown in acute MRI may require stronger treatment.Vulnerability assessment and mapping is a significant tool for sustainable management of the precious natural groundwater resources. DRASTIC is an extensively used index model to map groundwater vulnerable zones. However, the original DRASTIC model rates and weights used in most of the research depict the poor correlation between nitrate concentration and groundwater vulnerability index. Wilcoxon test and five population-based metaheuristic (MH) algorithms, namely, firefly algorithm (FA), invasive weed optimization (IWO), teaching learning-based optimization (TLBO), shuffled frog leaping algorithm (SFLA), and particle swarm optimization (PSO), were used to optimize the rates and weights of the DRASTIC model to improve its accuracy. The performance of all the employed metaheuristic algorithms converges to a global optimal solution at different iterations, and to choose the best algorithm for DRASTIC weights optimization, a ranking methodology was proposed. The algorithms were ranked by calculating the relative closeness of alternatives with computational speed and the number of iterations as attributes in the TOPSIS method. This study identifies FA as the outperforming algorithm among the employed for this specified weight optimization problem based on ranking. The result of the optimization model proposed depicts significant improvement in the correlation coefficient between the groundwater vulnerability index and nitrate concentration from 0.0545 for the original DRASTIC model to 0.7247 for the Wilcoxon-MH- DRASTIC. Hence, this ranking approach can be adopted when global optimal solution is found by all employed algorithms in DRASTIC weight optimization.Coronavirus disease 2019 (COVID-19) pandemic has struck many countries and caused a great number of infected cases and death. Healthcare system across all countries is dealing with the increasing medical, social, and legal issues caused by the COVID-19 pandemic, and the standards of care are being altered. Admittedly, neurology units have been influenced greatly since the first days, as aggressive policies adopted by many hospitals caused eventual shut down of numerous neurologic wards. Considering these drastic alterations, traditional ethical principles have to be integrated with state-of-the-art ethical considerations. This review will consider different ethical aspects of care in neurologic patients during COVID-19 and how this challenging situation has affected standards of care in these patients.

Monoclonal antibodies targeting the calcitonin gene-related peptide, including erenumab, are migraine-specific preventive treatments, whose long-term effectiveness has still to be evaluated in real-life settings. We assessed early outcomes of erenumab discontinuation after a 52-week treatment in patients with a continuous positive response to the drug.

We evaluated the early outcomes after treatment completion in migraineurs from a real-life multicenter register. All patients received monthly erenumab for 52weeks and attended a 8-week follow-up after treatment completion. Primary outcomes were responder rates and changes in monthly migraine days (MMDs), acute medications days (AMDs), and pain intensity on a Numerical Rating Scale (NRS score) during weeks 1-4 after erenumab treatment completion.

The 32 included patients reported a decrease in MMDs, AMDs, and NRS score during the last 4weeks of treatment compared with baseline (P<0.001). During weeks 1-4 after treatment completion, all the outcome measures increased compared with the last 4weeks of treatment (P < 0.001) despite staying lower than baseline (MMDs and AMDs P < 0.001, NRS score P = 0.005). Over the same time frame, 18 (56%) patients maintained a ≥ 50% reduction from baseline in MMDs. At week 4 after treatment completion, 10 (31%) patients restarted treatment due to disease rebound to baseline levels.

More than half patients had an early disease worsening, while the remaining patients maintained their responder status during weeks 1-4 after treatment completion. Further studies might identify predictors of prolonged response to erenumab and define the optimal treatment duration according to patients' characteristics.

More than half patients had an early disease worsening, while the remaining patients maintained their responder status during weeks 1-4 after treatment completion. Further studies might identify predictors of prolonged response to erenumab and define the optimal treatment duration according to patients' characteristics.High-rise residential developments are rapidly increasing in urban areas. Smaller residential units in this high rise bring a reduction in windows, resulting in poor indoor air ventilation. In addition, materials used in interiors can emit volatile organic compounds (VOCs), which can significantly affect human health. Since people spend 90% of their time indoors, an evaluation of indoor air quality is especially important for high-rise residential buildings with an analysis of determining factors. This study aims to measure the concentrations of VOCs, formaldehyde, and particulate matter (PM2.5 and PM10) in 9 high-rise residential buildings in Bangkok by using the accidental sampling method (n = 252) and to investigate possible important determining factors. The results show that the average concentrations of VOCs, formaldehyde, PM2.5, and PM10 in 9 high-rise residential buildings were at good to moderate levels in the indoor air quality index (IAQI) and that high pollutant concentrations were rarely found except in new constructions. Moreover, it was found that the age of buildings shows strong correlations with all pollutants (p value less then 0.0001). Old buildings showed significantly lower pollutant concentrations than new and under-construction buildings at a 95% confidence level. The findings from this investigation can be used as part of sustainable well-being design guidelines for future high-rise residential developments.The aim of present study was to evaluate the feasibility of a naringenin-hydroxypropyl-β-cyclodextrin (naringenin-HPβCD) inhalation solution for pulmonary delivery. Naringenin, a flavanone derived from citrus fruits, has been proven to exhibit excellent peripheral antitussive effect. To address the limitation of its poor oral bioavailability and low local concentration in the lung, a naringenin-HPβCD inhalation solution was prepared for pulmonary delivery. The aerosolization performance of formulation was evaluated by next generation impactor (NGI). Both dose-dependent and time-dependent antitussive effects of naringenin-HPβCD inhalation solution on acute cough induced by citric acid in guinea pigs were investigated. In vitro toxicity of naringenin-HPβCD inhalation solution in pulmonary Calu-3 cells was evaluated by MTS assay, and in vivo local toxicity investigation was achieved by assessing bronchoalveolar lavage (BALF) and lung histology after a 7-day inhalation treatment in guinea pigs. Fine particle fraction (FPF) of the formulation was determined as 53.