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Citizen science is spreading and numerous centres, services, or “hubs” within the field are manifesting themselves at European universities. Research libraries can potentially play a central role in advancing citizen science and open science. Building on a scoping literature review, a survey with 125 respondents, and an in-depth follow-up survey of 29 research libraries as part of the Citizen-enhanced Open Science in Southeastern Europe Higher Education Knowledge Hubs (CeOS_SE) project, this article outlines the current state and potential of citizen-enhanced open science (CE-OS) among European research libraries and presents a series of strategic and operational reflections for the future. Overall, research libraries report a high degree of understanding of both open science and citizen science and their applicability for society and research, but only few report the presence of services or infrastructure. Also, approximately half of the libraries engage in, or experiment with, citizen science. Common barriers exist such as resources, funding, strategy, and lack of policy. From these data, we present a typology to better understand how research libraries currently engage with citizen science and the steps that have been taken in this field. However, the overarching conclusion is that CE-OS with regards to European research libraries is contextual. There is no one size fits all.

Effective communication is necessary for the success of construction project performance. Due to its nature, effective communication is required to coordinate all parties involved in construction projects such as owners, project managers, engineers, subcontractors, etc. Few previous studies have addressed the issues of construction project communication, particularly in the communication planning stage. This paper aimed to investigate how far the communication planning has been effectively implemented in several construction projects in Jakarta and measure how big the influence to project performance. It adopts a quantitative method by distributing questionnaire surveys to contractors and consultants in Jakarta. Descriptive statistics were used to analyse the data which presents that communication planning has been implemented by 78.02 % of the responses and significantly impact the project performances. This paper offers useful implications for practitioners on how construction project teams (from contractors and consultants) should carefully manage the communication process particularly during its planning stage.

Non-linear electrical properties of a (biological) tissue can be revealed by non-linear electrical measurements, which means that the applied stimulus itself affects the measurement. If resulting voltage–current plots exhibit pinched hysteresis loops, the underlying tissue may be classified as a memristor, a state dependent resistor. The aloe vera plant and apples have been found to be memristors. However, polarization processes on the electrodes are also non-linear and may affect the measurement. Apples and aloe vera conduct electrical current very well and it is likely that the recordings are actually dominated by the polarization impedance of the electrodes. Here, we study the non-linear properties of aloe vera and apples with two different measurement electrode types. Furthermore, we measured also on the extracted liquids from one aloe vera leaf and one apple, leading to similar results. We concluded, unlike previous studies on these subjects, that the memristive properties originate from electrochemical reactions on the electrodes rather than the apples or aloe vera themselves.

OBJECTIVE: To describe population values in cardiovascular disease (CVD) risk factors such as blood lipids, fasting insulin and glucose and blood pressure in this young age group, and calculate associations to fitness and fatness. METHODS: Participants were 369 boys (6.8 +/- 0.4 years) and 327 girls (6.7 +/- 0.4 years) from preschool classes in Copenhagen. Peak VO2, blood pressure (BP), fat content and anthropometry were determined. A fasting blood sample was analysed for insulin, glucose and blood lipids. Physical activity was measured using accelerometry. RESULTS: Mean BMI, BP and blood lipids were not different between sexes. Fat percentage assessed from skinfolds was higher (21.5% vs. 16.5%) in girls than in boys (P < 0.001). Peak VO2 and physical activity were higher in boys than in girls (8% and 9%, respectively). Peak VO2 associated to fatness independent of body weight (r = 0.41; P < 0.001). Among the CVD risk factors, fitness was associated to high-density lipoprotein (HDL) (r = 0.14; P < 0.01) and physical activity (r = 0.12; P < 0.01). Fatness assessed by skinfold was associated to blood pressure (r = 0.19-0.28; P < 0.001), to fasting glucose (r = 0.11, P < 0.05) and insulin (r = 0.17; P < 0.001). CONCLUSIONS: Mean BP in 6-7-year-old Danish children has decreased since 1979 and BMI has increased modestly since 1986/1987. The lipid profile was similar compared with data from 1973 and 1978 in Danish children. Weak relationships were found between CVD risk factors, fitness and fatness. Copyright © 2004 by Elsevier Science (USA). [ABSTRACT FROM AUTHOR]

Infrastructure project selection and prioritization is a challenging decision-making problem. Thus, decision makers are required to develop and use a decision-making framework to evaluate the proposals. The first step in developing such framework is to establish the decision criteria. This research aims to identify these criteria based on a systematic review of literature. A total of 34 decision criteria for infrastructure project selection was identified. In addition, this research has also identified three major facts related to decision criteria and presented a structured model to integrate these decision criteria into a Decision-Making Framework. As a preliminary study, the findings from this research are expected to assist further research on developing a Decision-Making Framework for infrastructure project selection.

Child maltreatment poses not only immediate danger, but as a type of toxic stress, it creates higher risk of biologic dysfunction later in life. Pediatricians are in a unique position to diagnose child maltreatment, but they need evidence-based guidance for when to initiate screening when injury is occult. In this retrospective cohort study of 855 pediatric patients diagnosed with child maltreatment, researchers explored whether type or number of diagnoses was associated with abnormal pediatric weight in either direction. Diagnoses and weight assessed at intake were extracted from medical records for analysis. Statistically significant associations were found between weight classification and child maltreatment type as well as diagnosis count. Neglect was most frequently diagnosed, and children with ≥2 diagnoses were more likely to be classified as underweight, overweight, or obese. Findings support abnormal pediatric weight as a biologic signal of adversity that warrants safety screening in the clinical setting., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical DisclosureLehigh Valley Health Network Institutional Review Board determined that this study (#PRO00004403) met the requirements for approval of research under 45 CFR 46.111.

focused Rapid Assessment Process (fRAP) 2.0 is a community engagement approach combining geospatial mapping with rapid qualitative assessment in cyclical fashion within communities to capture multifactorial and multilevel features impacting primary care problems. fRAP 2.0 offers primary care researchers a methodology framework for exploring complex community features that impact primary healthcare delivery and outcomes. The fRAP 2.0 study design expands the fRAP from a sequential design to a cyclical process of geospatial mapping and rapid qualitative assessment in search of modifiable contextual factors. Research participants are stakeholders from various socioecological levels whose perspectives inform study outcomes that they may use to then become the agents of change for the very problems they helped explore. Here, we present a proof-of-concept study for fRAP 2.0 examining disparities in cervical cancer mortality rates among Hispanic women in Texas. The primary outcomes of interest are features at the community level, medical health system level and regional government policy levels that offer opportunities for collaborative interventions to improve cervical cancer outcomes. In this study, geospatial mapping of county and ZIP code-level variables impacting postdiagnosis cervical cancer care at community, medical and policy levels were created using publicly available data and then overlaid with maps created with Texas Cancer Registry data for cervical cancer cases in three of the largest population counties. Geographically disparate areas were then qualitatively explored using participant observation and ethnographic field work, alongside 39 key informant interviews. Roundtable discussion groups and stakeholder engagement existed at every phase of the study. Applying the fRAP 2.0 method, we created an action-oriented roadmap of next steps to improve cervical cancer care disparities in the three Texas counties with emphasis on the high disparity county. We identified local change targets for advocacy and the results helped convene a stakeholder group that continues to actively create on-the-ground change in the high-disparity county to improve cervical cancer outcomes for Hispanic women., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Premise: Species distribution models (SDMs) are widely utilized to guide conservation decisions. The complexity of available data and SDM methodologies necessitates considerations of how data are chosen and processed for modeling to enhance model accuracy and support biological interpretations and ecological applications., Methods: We built SDMs for the invasive aquatic plant European frog-bit using aggregated and field data that span multiple scales, data sources, and data types. We tested how model results were affected by five modeler decision points: the exclusion of (1) missing and (2) correlated data and the (3) scale (large-scale aggregated data or systematic field data), (4) source (specimens or observations), and (5) type (presence-background or presence-absence) of occurrence data., Results: Decisions about the exclusion of missing and correlated data, as well as the scale and type of occurrence data, significantly affected metrics of model performance. The source and type of occurrence data led to differences in the importance of specific explanatory variables as drivers of species distribution and predicted probability of suitable habitat., Discussion: Our findings relative to European frog-bit illustrate how specific data selection and processing decisions can influence the outcomes and interpretation of SDMs. Data-centric protocols that incorporate data exploration into model building can help ensure models are reproducible and can be accurately interpreted in light of biological questions., (© 2024 The Authors. Applications in Plant Sciences published by Wiley Periodicals LLC on behalf of Botanical Society of America.)

Objectives: To analyze adverse childhood experiences (ACEs) among mothers of newborns referred to a hospital's child protection team (CPT) for suspected substance exposure. Researchers hypothesized that a higher prevalence of these mothers have ≥ 4 ACEs than female counterparts in the general population. The study team also explored whether associations existed between type of maternal ACEs and substance use in pregnancy., Methods: Retrospective review of infant referrals to the CPT in the 3 years after adding an ACEs questionnaire to the consultation process. Bivariate analyses and multivariate logistic regression models examined associations between prenatal substance use and maternal ACEs prevalence, controlling for demographics., Results: Data from 222 infants (four sets of twins) and 218 mothers were analyzed. Half (50.0%) the infants had withdrawal symptoms. Most (67.0%) women had positive toxicology screens, while 85.0% reported prenatal substance use. Half (50.9%) the mothers reported ≥ 4 ACEs and these individuals had significantly higher odds of cannabinoid use [adjusted odds ratio (aOR), 3.7; 95%CI 2.0, 6.9, p < 0.001) than those with < 4 ACEs. A significant association was found between substance use and ACEs in the household challenges category (p = 0.03), especially parental separation/divorce (p < 0.001)., Conclusions for Practice: As hypothesized, a higher prevalence of mothers referred to the CPT had ≥ 4 ACEs than women in the general population (50.9% vs. 15.2%), and a large proportion had used substances while pregnant. Routine prenatal ACEs screening and universal, nonpunitive toxicology testing of infants and mothers at birth may provide opportunities for intervention while reducing the transgenerational impact of ACEs., (© 2023. The Author(s).)

We design and fabricate a grating coupler for interfacing suspended silicon photonic membranes with free-space optics while being compatible with single-step lithography and etching in 220 nm silicon device layers. The grating coupler design simultaneously and explicitly targets both high transmission into a silicon waveguide and low reflection back into the waveguide by means of a combination of a two-dimensional shape-optimization step followed by a three-dimensional parameterized extrusion. The designed coupler has a transmission of -6.6 dB (21.8 %), a 3 dB bandwidth of 75 nm, and a reflection of -27 dB (0.2 %). We experimentally validate the design by fabricating and optically characterizing a set of devices that allow the subtraction of all other sources of transmission losses as well as the inference of back-reflections from Fabry-Pérot fringes, and we measure a transmission of 19 % ± 2 %, a bandwidth of 65 nm and a reflection of 1.0 % ± 0.8 %.

Ultralow velocity zones (ULVZs) are the most anomalous structures within the Earth's interior; however, given the wide range of associated characteristics (thickness and composition) reported by previous studies, the origins of ULVZs have been debated for decades. Using a recently developed seismic analysis approach, we find widespread, variable ULVZs along the core-mantle boundary (CMB) beneath a largely unsampled portion of the Southern Hemisphere. Our study region is not beneath current or recent subduction zones, but our mantle convection simulations demonstrate how heterogeneous accumulations of previously subducted materials could form on the CMB and explain our seismic observations. We further show that subducted materials can be globally distributed throughout the lowermost mantle with variable concentrations. These subducted materials, advected along the CMB, can provide an explanation for the distribution and range of reported ULVZ properties.

Nanotechnology enables in principle a precise mapping from design to device but relied so far on human intuition and simple optimizations. In nanophotonics, a central question is how to make devices in which the light-matter interaction strength is limited only by materials and nanofabrication. Here, we integrate measured fabrication constraints into topology optimization, aiming for the strongest possible light-matter interaction in a compact silicon membrane, demonstrating an unprecedented photonic nanocavity with a mode volume of V ~ 3 × 10 -4  λ 3 , quality factor Q ~ 1100, and footprint 4 λ 2 for telecom photons with a λ ~ 1550 nm wavelength. We fabricate the cavity, which confines photons inside 8 nm silicon bridges with ultra-high aspect ratios of 30 and use near-field optical measurements to perform the first experimental demonstration of photon confinement to a single hotspot well below the diffraction limit in dielectrics. Our framework intertwines topology optimization with fabrication and thereby initiates a new paradigm of high-performance additive and subtractive manufacturing., (© 2022. The Author(s).)

Objectives: To determine whether there is an association between skeletal jaw position and perioral musculature, and if genotypes can predict skeletal growth., Materials and Methods: A prospective study on 42 patients over 1 year was performed. The study included 22 females and 20 males with and average age of 28.5 years. Lip strength was compared to radiographic cephalometric measurements. Allelic and genotypic frequencies from polymorphisms rs678397 and rs1815739 in ACTN3 and rs10850110 in MYO1H were compared to each variable. Chi-square and Fisher exact tests were used to determine if differences were statistically significant (alpha = 0.05)., Results: The data showed significant differences between rs678397 genotype and allele frequencies and SNA angle (P = .01; P = .003, respectively); between rs1815739 allele frequency and SNA angle (P = .01); between rs678397 allele frequency and ANB angle (P = .049); between rs678397 genotype and allele frequencies and lip strength in females (P = .045; P = .02); and between rs678397 allele frequency and overall lip strength (P = .049), after mean strength values used as cut off being customized by sex., Conclusions: Polymorphisms in ACTN3 are associated with weak lips and larger SNA and ANB angles., (© 0000 by The EH Angle Education and Research Foundation, Inc.)

Background: European frog-bit ( Hydrocharismorsus-ranae L.; EFB) is a free-floating aquatic plant invasive in Canada, the United States and India. It is native to Europe and northern and western Asia and is believed to have first been introduced to North America in Ottawa, Ontario in 1932. It has since spread by way of the St. Lawrence River and connected waterways to southern Ontario and Quebec and parts of the northern United States. Invasive European frog-bit occurs in freshwater coastal wetlands and inland waters, where it can form dense mats that have the potential to limit recreational and commercial use of waterways, alter water chemistry and impact native species and ecosystems. Data on the past and present distribution of this invasive species provide geospatial information that can be used to infer the pattern of invasion and inform management and monitoring targeted at preventing secondary spread. Our EFB dataset contains 12,037 preserved specimen and observation-based occurrence records, including 9,994 presence records spanning two Canadian provinces and ten U.S. states and 2,043 absence records spanning five U.S. states. The aggregated EFB dataset provides a curated resource that has been used to guide a Michigan management strategy and provide information for ongoing efforts to develop invasion risk assessments, species distribution models and decision-support tools for conservation and management., New Information: Specimen-based and observation-based occurrence data were accessed through nine digital data repositories or aggregators and three primary sources. Twenty-six percent of the data are new records not previously published to a data repository or aggregator prior to this study. We removed duplicate data and excluded records with incorrect species identifications. Occurrence records without coordinates were georeferenced from recorded locality descriptions. Data were standardised according to Darwin Core. This aggregated dataset is the most complete account of EFB occurrence records in its North American invasive range.

Background: Type 2 diabetes (T2DM) results in significant morbidity and mortality and is associated with disparities in prevalence, treatment, and outcomes. GIS can identify geographically based disparities. In the focused Rapid Assessment Process (fRAP)-a novel mixed-method study design-GIS is combined with qualitative inquiry to inform practice interventions and policy changes., Methods: Using fRAP, areas with poor T2DM outcomes (priority areas) as well as areas with positive T2DM outcomes (bright spots) were identified, focus groups were conducted, and responses analyzed for intervention opportunities. Focus group participants were English- and Spanish-speaking patients with T2DM living in one of the identified areas. Qualitative analysis consisted of initial coding with a priori themes from the focus group question guide, followed by identification of emergent themes within each defined category., Results: The a priori categories included Facilitators, Barriers, Strategies, and Impact of Diabetes Diagnosis. Emerging recurrent themes were Interactions with Medical Professionals, Medications, Lifestyle Management, Family Motivators and Support, Self-Efficacy, and Social Needs and Community Resources., Conclusions: Thematic results from focus groups can be used by practices to improve T2DM care through educating patients about chronic disease and nutrition, connecting them to diabetes-specific services, learning how diabetes fits in the context of patient lives, and eliciting patient values and motivations to improve diabetes self-management. Findings also may be used by health care professionals to inform community-based advocacy efforts, interventions, and future research.

Introduction: Self-determination theory (SDT), when applied to curricular construction, emphasizes curiosity, self-awareness, and resilience. Physicians need these qualities to face the challenges of clinical practice. SDT offers a lens for medical educators to track learner development toward sustainable, rewarding careers. This study describes the changes observed in learner communications about feelings of competence, relatedness, and autonomy across a 3-year family medicine training program designed to develop activated, lifelong learners., Methods: This retrospective, mixed-methods case study uses a phenomenological approach to explore how 51 learners described their experiences at various intervals in residency training. Data collected from 2009 to 2015 from resident focus groups, competency assessment meetings, and faculty assessment reports inform a 3-stage analysis process to determine learner motivation levels along the SDT continuum., Results: Aggregated qualitative and quantitative data show residents' progression from introjection (controlled motivation) in PGY1, to identification (autonomous motivation) in PGY2, and integration (autonomous) by the end of PGY3. The examination of a single learner's data set reveals an advanced motivation level in PGY1 (identification), followed by a period of retrograde in PGY2 (introjection), then rebounding in PGY3 (identification), which illustrates how motivation level can be affected by external competency requirements and challenges related to career transitions., Discussion: The examination of self-motivation in medical learners has implications for curriculum development, assessment, teaching and self-directed learning, and resilience training. Learner awareness of intrinsic motivation, and the curriculum designed around it, can better prepare residents for challenges during residency and help them flourish in twenty-first-century medicine., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© International Association of Medical Science Educators 2021.)

Monitoring patients' health, mobility, mentation, and ability to maintain social connections can help you promote healthy aging for your older patients.

Background and Objectives: As part of a national pilot, the Lehigh Valley Family Medicine Residency Program implemented curricular changes to emphasize family medicine identity. These changes included limiting first-year inpatient experiences, adding "interval" outpatient weeks, and increasing family physician mentorship. This study explores how postgraduate learners describe their professional identities within the context of their chosen specialty, as defined by Family Medicine for America's Health (FMAHealth)., Methods: This qualitative study approached family medicine identity formation from a social constructionist framework using evolved grounded theory. We performed a thematic analysis of focus groups conducted over 12 years with first-year residents (n=73). Then, utilizing a matrix analysis, articulations about professional identity were compared with structural components of the FMAHealth definition of the specialty. Three cohort groups (Preimplementation, Implementation, and Postimplementation) were defined to conduct a longitudinal comparison., Results: Six unique biosketches synthesizing the analyses emerged. Expansion in ability to articulate professional identity was evident not only across, but also within cohort groups. The Preimplementation cohort entered and left their first year identifying as relationship-centered generalists desiring guidance from role models. The Implementation learners used more FMAHealth language to describe their practice, later recognizing the potential it held for patient care. Similarly, the Postimplementation cohort entered with a broader view of family medicine and exited wondering how to help advance its reach., Conclusions: Curricular changes placing interns within specialty-relevant learning settings coincide with thematic differences in articulations in professional identity. These findings suggest that experiential learning and role modeling contribute to professional identity formation among graduate medical learners.

Statement of Problem: Identifying factors that affect the clinical outcomes of implant therapy is important., Purpose: The purpose of this retrospective study was to determine whether implant location was a factor affecting the complication and failure rates of single-tooth implant-supported restorations in a predoctoral setting., Material and Methods: The charts of 431 patients treated with a surgically placed dental implant and restored with a single crown in the predoctoral clinic were analyzed. Data on implant location, type of complication (surgical or prosthetic), and type of failure were collected and analyzed according to implant location using the Fisher Exact Test and Mantel-Haenszel Exact Chi Square Test analysis (α=.05)., Results: The charts revealed 158 complications (68 surgical and 90 prosthetic) in 110 patients, and 3.9% of the implants failed. No statistically significant difference was found between the number of surgical complications or prosthetic complications in the maxilla and the mandible (P=.469)., Conclusions: Jaw location (maxilla compared with mandible) of the implant had no statistically significant impact on the incidence of surgically or prosthetically related complications. No statistically significant difference was found in overall implant failures, surgical failures, and prosthetic failures between maxillary and mandibular implants., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Studies of drug permeability rate and localization in buccal mucosa are essential to gain new knowledge of means such as chemical enhancers or osmolality to enhance buccal drug transport in the development of new buccal drug products. The transport of caffeine, diazepam and mannitol across porcine buccal mucosa was studied in modified Ussing chambers with a hypotonic donor solution, in the presence of levulinic acid (LA), oleic acid (OA), propylene glycol (PG) as well as sodium dodecyl sulfate (SDS). Subsequently, matrix-assisted laser desorption ionization - mass spectrometry imaging (MALDI-MSI) was applied to image the spatial distribution of caffeine, mannitol and SDS in cross-sections of porcine buccal mucosa. The results revealed that none of the permeation enhancing strategies improved the permeability of caffeine or diazepam, despite impact on the tissue integrity by OA and SDS, as seen by an increased permeability of mannitol. Further studies are needed with OA since PG solvent may have concealed the possible impact of OA. SDS decreased the permeability of caffeine and diazepam, a decrease which can be explained by micellar lipid extraction and encapsulation in micelles. MALDI-MSI showed that SDS permeated into approximately one-third of the epithelium, and it therefore appears that the main permeability barrier for mannitol is located in the outer epithelium. MALDI-MSI was shown to be a useful method for imaging spatial distribution of drugs and permeations enhancers in buccal mucosa., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Diabetes and prediabetes are increasing in prevalence, corresponding to epidemic rates of obesity. Hispanic adults with prediabetes are 1.7 times more likely than non-Hispanic whites to progress to diabetes. We set out to understand health beliefs of Hispanic adults and, with that knowledge, facilitate tailored messaging to promote patient activation and lifestyle change. Using the Risk Perception Survey for Developing Diabetes along with demographic and lifestyle intervention interest questions, a 34-question survey was mailed to a registry of Hispanic adults with a diagnosis of prediabetes and an HbA1c between 5.7 and 6.4% (N = 414). Despite more than three-quarters of respondents (n = 92; 77%) indicating they had prior knowledge of their diagnosis, overall diabetes risk knowledge was low. A significant difference in diabetes risk knowledge was found between groups stratified by education level. High scores in personal control and worry were reported. Respondents overwhelmingly reported interest in exercise (n = 92; 77%) and healthy eating interventions (n = 60; 50%) over technology-based interventions. High levels of worry and personal control, combined with low to intermediate levels of risk knowledge, indicate an opportunity for education and activation in this community. Healthy eating and exercise programs are possible interventions that may slow the progression from prediabetes to diabetes.

Introduction: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA)., Methods: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L'Abbe Plots and trial sequential analysis., Results: The included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low., Conclusion: A low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA.

Introduction: Multidisciplinary rehabilitation has beneficial effects on health-related quality of life (HRQoL) in patients with chronic rheumatic diseases. However, whether this intervention benefits different age groups in women or men is largely unknown., Purpose: To investigate HRQoL in patients with chronic rheumatic disease after completion of a 3-week multidisciplinary treatment, with special focus on differences in effect between age and gender groups., Method: HRQoL was measured with SF-36. Mean scores for all SF-36 domains were compared before and after the 3-week regimen and again at 3-, 6-, and 12-month follow-ups. Multivariable linear regression models using generalized estimating equations to account for repeated measurement were employed. A weighting procedure to account for differential dropouts was applied., Results: Three hundred fifty-six women and 74 men with chronic rheumatic disease were included. There were short-term improvements in all SF-36 domains irrespective of age or gender. These effects persisted for up to 1 year in the psychological, social, and energy domains for women under 50. We found no lasting effects for men; however, young men showed similar trends., Conclusion: Inpatient multidisciplinary rehabilitation improves short-term HRQoL in all patients. Younger women maintain these beneficial effects for up to 1 year. Additional intervention should be considered for elderly women and for men in order to sustain rehabilitation effects.

Problem: To accurately determine one's ability in any clinical competency, an individual must be able to self-assess performance and identify personal limitations. Existing research demonstrates that physicians of all levels are unreliable self-assessors. This poses a concern in medical practice, which requires continuous updates to clinical competencies and awareness of personal limitations. Few published studies examine graduate medical education curricula designed to develop self-assessment skills., Intervention: Conceptual models, such as self-determination theory, suggest that self-assessment is most effectively learned through reflective processes. The Family Medicine Residency Program at Lehigh Valley Health Network developed a learner-centered competency assessment process that integrates advising and performance review. The multisource, observable behavior-based process encourages conversation between resident and advisor. Utilizing feedback from clinical preceptors and patient surveys, advisors guide residents in determining individual learning needs in core competency areas, including relationship-centered care. Development of medical learners' capacity to form relationships is one means to improving the patient experience., Context: This retrospective case study evaluates the accuracy of senior residents' self-assessment in relationship-centered care compared with that of junior residents. The study population includes the 34 residents enrolled from AY 2009-2012. Data sets represent specific 6-month periods and have 3 component scores-Self, Faculty, and Patient-which were triangulated to determine concordance rates by postgraduate year level., Outcome: The concordance rate among first-years was 26.7%, whereas third-years saw 60.0% concordance. A discordance analysis found the Patient score most often deviated from the other 2 scores, whereas the Faculty score was never the sole dissenter. When all 3 scores differed, the Self score frequently fell between the other 2 scores., Lessons Learned: The principles of self-determination theory provide a valuable framework for understanding the development of residents' intrinsic motivation to become lifelong learners. The trend in improved concordance rates among senior residents suggests that prompting learners to triangulate feedback from multiple sources can lead to a shift in perspective about competency. Further study is needed to determine whether our results are generalizable to other competencies and educational settings.

Background: Burnout continues to erode the physician workforce, and there are few effective intervention studies to guide educators., Objective: We explored residents' experience in a model environment emphasizing resident wellness, safety, and interpersonal skills., Methods: As 1 of 14 participants in the national Preparing the Personal Physician for Practice (P 4 ) project, the family medicine residency at Lehigh Valley Health Network implemented a series of curricular changes designed to transform the culture of education. This mixed-methods case study utilizes the results from 3 quantitative self-report instruments for well-being, along with content analysis of transcripts from 20 focus groups and 33 resident advising sessions to describe experiences of the residents enrolled between July 2007 and June 2012., Results: In the intervention, we found no statistically significant quantitative differences in the well-being of residents compared with the family medicine faculty and staff. Deductive (a priori and template) analysis and inductive thematic analysis of the residents' articulations of their experiences revealed 6 recurrent themes: naming/articulation of emotions, relationships, attitudes about self-care, self-reflection, delivery of learning experiences, and availability of resources., Conclusions: Quantitative measures of well-being did not capture the experiential value of the curricular innovations implemented by the residency program, while qualitative analysis highlighted themes important to residents. While not all residents in the intervention expressed support for the changes, repeated references to the nurturing educational environment indicate recognition of, and favorable responses to, the creation of an emotionally intelligent learning community., Competing Interests: The authors declare they have no competing interests.

The influence of fermentation temperatures (8°C, 16°C, and 32°C) and yeast levels (2%, 4%, and 6% of the flour) on the formation of volatile compounds in the crust of whole meal wheat bread was investigated. The fermentation times were regulated to optimum bread height for each treatment. The volatile compounds were extracted by dynamic headspace extraction and analyzed by gas chromatography-mass spectrometry. The results were evaluated using multivariate data analysis and ANOVA. In all crust samples 28 volatile compounds out of 58 compounds were identified and the other 30 compounds were tentatively identified. Higher fermentation temperatures promoted the formation of Maillard reaction products 3-methyl-1-butanol, pyrazine, 2-ethylpyrazine, 2-ethyl-3-methylpyrazine, 2-vinylpyrazine, 3-hydroxy-2-butanone, 3-(methylsulfanyl)-propanal, and 5-methyl-2-furancarboxaldehyde whereas at lower temperature (8°C) the formation of 2- and 3-methylbutanal was favored. Higher levels of yeast promoted the formation of 3-methyl-1-butanol, 2-methyl-1-propanol and 3-(methylsulfanyl)-propanal, whereas hexanal was promoted in the crust fermented with lower yeast level., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

At the end of the eighteenth century a scientific basis for medicine was called for. The Scottish physician John Brown proposed an all-comprising medical system in 1780. A surplus or lack of stimulating factors, the prime movers of life according to Brown, was supposed to explain all diseases and indicate their treatment. Individuals only subjected to a small degree of stimulation became affected by "asthenic diseases" which were the most frequent diseases. They should be treated with abundant food and wine, supplemented with camphor, opium, or other drugs considered to be stimulating. Conversely, individuals with "sthenic diseases" should reduce their intake of food and beverage. Brown's system was received with transient approval by some Danish physicians from the late 1790s. But it soon proved to be of no value in medical practice, and its success dwindled within academic medicine around 1814. On the other hand, it seemed to generate new ideas. It became linked with the German Romantic Movement and "Naturphilosophie." The widespread use of camphor and opium in both academic and folk medicine, continued throughout the nine- teenth century and into the twentieth century.

Purpose: Through this exploratory study, we sought to understand why group visit participation is low among adult patients with type 2 diabetes., Methods: Eligible study participants included adult patients with type 2 diabetes. After a pilot survey was sent to a random sample of 48 patients, the remaining 187 eligible patients were invited to complete a revised version of the survey., Results: Most frequently cited reasons for not attending group visits included diabetes under control, work and/or other responsibilities, and time barriers. There was variability in the desired time for the visits, though the majority of patients preferred evening visits. While some patients reported copays as a challenge, the likelihood of attending did not decrease for this subgroup. Most patients surveyed (54%) indicated interest in diabetes group visits., Conclusion: Implementing strategies to address the patient-identified system barriers (eg, time, transportation, and copays) may increase participation in diabetes group visits., (© The Author(s) 2015.)

A birth with fatal outcome for both the mother and the foetus was reported in the Danish medical journal, Bibliothek for Læger in 1868. Here, the article with its two illustrations is summarised because of the vivid description of the course together with the therapeutic considerations expressed by the obstetrician. Due to an earlier osteomyelitis the pregnant woman's spine was deformed and her pelvis was narrowed. The birth came to a standstill, and it became necessary to reduce the circumference of the foetus' cranium by perforation, after which the dead foetus could be delivered. The woman died of infection some days later. Afterwards her deformed lumbar spine and pelvis was removed, preserved and depicted in two lithographs. The preserved pelvis is still extant in the Saxtorphian obstetric collection in Medical Museion, Copenhagen.

A young Danish sailor died from yellow fever in Barbados in 1887. The Shipmaster's letter to the family with a description of the course of the disease, which has been preserved, is presented here together with a photo of the sailor and a painting of the Danish sailing-ship.

Ole H. Mynster (1772-1818) was a stepson of the leading physician at the Royal Frederik Hospital in Copenhagen. At an early age he became fond of zoology and mineralogy. He created "societies" in Enlightenment-style for boys and young people with lectures and collections. Later on a circle of talented young students, scientists and poets met in his small room at the hospital. Some of them with Ole Mynster as the head set up a modern scientific journal, Physicalsk, oeconomisk og medicochirurgisk Bibliotek for Danmark og Norge which encouraged the introduction of antiphlogistic chemistry. Ole Mynster became physician at the Royal Frederik Hospital and lecturer in clinical pharmacology. He wrote the first book in Danish on pharmacology based upon chemistry. In their memoirs, prominent members of his circle have told about him, and his son F.L. Mynster has written a draft for a biography. An overview of the activities within natural science and medicine of the young Ole Hieronymus Mynster is presented.

The starting point for Foucault's book was his wide reading of French medical literature from late 18th and early 19th centuries. He showed how the concept of disease changed profoundly during that period of great societal changes. Foucault's protagonists in the book were the French doctors Pinel, Bichat, Laënnec and Broussais. Here, short biographies and summaries of their works will be presented in the medical and historical context and together with extracts of Foucault's text.