-
Neurotherapeutics : the Journal of the... Jul 2023Hippocratic Medicine revolved around the three main principles of patient, disease, and physician and promoted the systematic observation of patients, rational... (Review)
Review
Hippocratic Medicine revolved around the three main principles of patient, disease, and physician and promoted the systematic observation of patients, rational reasoning, and interpretation of collected information. Although these remain the cardinal features of clinical assessment today, Medicine has evolved from a more physician-centered to a more patient-centered approach. Clinical assessment allows physicians to encounter, observe, evaluate, and connect with patients. This establishes the patient-physician relationship and facilitates a better understanding of the patient-disease relationship, as the ultimate goal is to diagnose, prognosticate, and treat. Biomarkers are at the core of the more disease-centered approach that is currently revolutionizing Medicine as they provide insight into the underlying disease pathomechanisms and biological changes. Genetic, biochemical, radiographic, and clinical biomarkers are currently used. Here, we define a seven-level theoretical construct for the utility of biomarkers in neurodegenerative diseases. Level 1-3 biomarkers are considered supportive of clinical assessment, capable of detecting susceptibility or risk factors, non-specific neurodegeneration or dysfunction, and/or changes at the individual level which help increase clinical diagnostic accuracy and confidence. Level 4-7 biomarkers have the potential to surpass the utility of clinical assessment through detection of early disease stages and prediction of underlying pathology. In neurodegenerative diseases, biomarkers can potentiate, but cannot substitute, clinical assessment. In this current era, aside from adding to the discovery, evaluation/validation, and implementation of more biomarkers, clinical assessment remains crucial to maintaining the personal, humanistic, and sociocultural aspects of patient care. We would argue that clinical assessment is a custom that should never go obsolete.
Topics: Humans; Biomarkers; Physician-Patient Relations; Risk Factors
PubMed: 37594658
DOI: 10.1007/s13311-023-01410-3 -
JDS Communications Jul 2023Pasture-based dairy herds continue to grow around the world as demand increases for sustainable farming practices. Grazing dairy farmers may benefit from the utilization... (Review)
Review
Pasture-based dairy herds continue to grow around the world as demand increases for sustainable farming practices. Grazing dairy farmers may benefit from the utilization of precision dairy technologies because these technologies have the potential to improve animal welfare, increase farm efficiency, and reduce costs. Precision dairy technologies have provided novel information about activity, rumination, and grazing behavior of various breeds in pasture-based systems. Previous research with wearable technologies has indicated that rumination, eating, and no activity have moderate to high correlations (r = 0.65 to 0.88) with visual observation; however, activity may be difficult to record in grazing herds. However, many grazing dairy farmers around the world are using activity monitors with generally positive success. Grazing is a complex behavior to define because cows may walk to an area and stop to eat or continuously walk and take bites of grass from the pasture. Wearable technologies can detect whether a cow is grazing with reasonable accuracy. However, the challenge is to determine pasture intake as bite rate and bite size because these can vary as the pasture is grazed to a low residual height. Nevertheless, grazing behavior data collected with wearable technologies was highly correlated (r = 0.92 to 0.95) with visual observations. Grazing is a behavior that should continue to be explored, especially with precision dairy technologies. As healthy and productive pastures are integral to grazing systems, accurate forage biomass measurements can improve efficiency and production of pastured dairy cows. However, few farms use technology to determine forage availability. Therefore, using dairy technologies to monitor forage dry matter from pasture may provide a potential benefit for grazing-based dairy farms. Current satellite technology with the normalized difference vegetation index and electronic rising plate meters may provide new technologies for farms to monitor forage biomass and fine-tune grazing within pastures. In the future, pasture-based dairy farms may rely on virtual fencing, drones to detect animal health issues and forage availability, and autonomous vehicles to move cattle and to detect weeds on pasture.
PubMed: 37521056
DOI: 10.3168/jdsc.2022-0308 -
European Urology Aug 2023Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology. (Review)
Review
CONTEXT
Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology.
OBJECTIVE
To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS.
EVIDENCE ACQUISITION
A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations.
EVIDENCE SYNTHESIS
The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities.
CONCLUSIONS
The guidelines provide an evidence-based approach for the management of male LUTS.
PATIENT SUMMARY
A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications.
Topics: Humans; Male; Urology; Lower Urinary Tract Symptoms; Nocturia; Urinalysis; Prostatic Neoplasms; Prostatic Hyperplasia
PubMed: 37202311
DOI: 10.1016/j.eururo.2023.04.008 -
Frontiers in Psychology 2023In this paper we argue that the quality of early education programs or classrooms can be defined in terms of features of teachers' interactions with students observed... (Review)
Review
In this paper we argue that the quality of early education programs or classrooms can be defined in terms of features of teachers' interactions with students observed using the Classroom Assessment Scoring System, or CLASS. We present evidence suggesting that dimensions of teacher-student interactions can be described, observed, and measured consistently across cultures and countries and that such dimensions also have modestly positive influence student development and learning. Evidence is summarized indicating that interactions can also be improved systematically through professional development interventions. The paper relies on a framework that describes core features of effective teacher-student interactions present across countries' highly varied settings and cultural contexts. Limitations of the study include exclusive reliance on the CLASS and that most countries were not low or middle income. We discuss the cross-cultural applicability of the framework and outline suggestions for education policy and practice and future directions for research.
PubMed: 37519392
DOI: 10.3389/fpsyg.2023.1110419 -
Journal of Clinical Ultrasound : JCU Sep 2023Echogenic fetal bowel (EB) is a prenatal ultrasound finding (0.2%-1.4% of all pregnancies) defined as bowel of similar or greater echogenicity than surrounding bone. In... (Review)
Review
Echogenic fetal bowel (EB) is a prenatal ultrasound finding (0.2%-1.4% of all pregnancies) defined as bowel of similar or greater echogenicity than surrounding bone. In fact, the ultrasound assessment is strongly subjective with inter-observer variability. The pathophysiology depends on the underlying condition, apparently related with meconium stasis and hypercellularity. It is often an isolated finding, with possible association with other structural anomalies. About the origin, it was observed in fetuses with cystic fibrosis, congenital infections, thalassemia, intraamniotic bleeding, fetal growth restriction. Fetuses with EB are at increased risk of adverse perinatal outcome, such as intrauterine growth restriction, placental dysfunction and perinatal death, highlighting the need for a thorough antenatal management and post-natal follow-up. It seems to be associated with a plenty of conditions, such as a poor fetal outcome, fetal growth restriction and placental dysfunction. Therefore management requires a multidisciplinary approach with different specialties' involvement and the prognosis is influenced by the underlying pathophysiology. In this complex scenario, the present review aims to define the clinical pathway which should be offered to pregnant women in case of finding of fetal EB ultrasound marker, to rule out any suspected pathological cause.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Fetal Growth Retardation; Ultrasonography, Prenatal; Placenta; Prenatal Diagnosis; Echogenic Bowel; Fetus
PubMed: 37553773
DOI: 10.1002/jcu.23528 -
Sports Medicine - Open Jun 2024Deceptive movements occur when an actor seeks to fake, hide or delay kinematic information about their true movement outcomes. The purpose of deceptive movements is to... (Review)
Review
BACKGROUND
Deceptive movements occur when an actor seeks to fake, hide or delay kinematic information about their true movement outcomes. The purpose of deceptive movements is to impair the perception of opponents (the 'observer') to gain an advantage over them. We argue though that a lack of conceptual clarity has led to confusion about what deception is and in understanding the different approaches by which an actor can deceive their opponent. The aim of this article is to outline a conceptual framework for understanding deceptive movements in sport.
MAIN BODY
Adopting Interpersonal Deception Theory from the field of communication, we define deception as when an actor deliberately alters their actions in an attempt to impair the ability of an observer to anticipate their true action outcomes. Further, deception can be achieved either by what we define as deceit, the act of providing false information, or disguise, the act of concealing the action outcome. Skilled athletes often have actions that are difficult to anticipate, but an action is only classified as containing deception if the actor has explicit intent to deceive an observer. Having outlined the conceptual framework, we then review existing empirical findings on the skilled perception of deceptive movements considering the framework. This approach includes a critical evaluation of the mechanisms known to facilitate the perceptual ability to prevent being deceived, including a consideration of visual search strategies, confidence, the contribution of visual and motor experiences, and the influence of response biases and action capabilities on perceptual performance.
CONCLUSION
The distinction between deceit and disguise particularly helps to show that most research has examined deceit, with little known about how an actor can more effectively disguise their action, or about how an observer can improve their ability to anticipate the outcome of disguised actions. The insights help to identify fruitful areas for future research and outline implications for skill acquisition and performance enhancement.
PubMed: 38861037
DOI: 10.1186/s40798-024-00730-8 -
PNAS Nexus Oct 2023The spatial distribution of covert visual attention following an exogenous cue is often described as a spotlight, which disregards depth. Here, we study the orienting of...
The spatial distribution of covert visual attention following an exogenous cue is often described as a spotlight, which disregards depth. Here, we study the orienting of attention across binocular disparity, a key depth cue in primates. A small Gabor patch target was displayed at ±12-arcmin horizontal offset in each eye independently, resulting in four possible 3D locations. With some latency relative to target onset (0-300 ms), an attentional cue was displayed at one of five binocular locations, resulting in various combinations of relative azimuth (horizontal position) and disparity (depth). Observers' task was to discriminate the orientation of the target. Observers' performance decreased as the relative azimuth between the cue and the target increased. Performance also decreased with the difference in disparity, even when the azimuth remained constant. Performance varied with the delay between the cue and the target and was maximal between 100 and 150 ms. The orienting of attention in azimuth and depth followed the same time course. We mapped the 3D shape of attentional focus over time and found that the spatial envelope was approximately a Gaussian modulated in time. These results could not be explained by monocular confounds nor by eye movements. We conclude that exogenous cues direct attention not only to their visual direction but also to their depth and that binocular disparity is sufficient to define that depth. The identical time course and interaction between azimuth and depth suggest a shared mechanism, and therefore that visual attention to spatial location is an intrinsically 3D process.
PubMed: 37822768
DOI: 10.1093/pnasnexus/pgad314 -
Cureus Feb 2024Extended wrist rotation provides a simple clinical measure of rigidity in movement disorders. The supinator-pronator muscles of the forearm form an agonist-antagonist...
Extended wrist rotation provides a simple clinical measure of rigidity in movement disorders. The supinator-pronator muscles of the forearm form an agonist-antagonist pair that can be isolated for diagnosis and monitoring. Patients rarely can isolate these muscles without extraordinary training and body awareness. Clinicians may find documenting the impact of the shoulder girdle, wrist, and hand movements overburdensome. A preliminary study shows that restricting the olecranon and keeping the wrist in line with the hand can provide a simple, reproducible measure of rigidity. We study a two-handed "handshake" examination and the use of a pulley-based goniometer. This preliminary analysis indicates that both offer the same observer and between-observer reliability. Two-way analysis of variance showed no statistical differences or outliers.
PubMed: 38371435
DOI: 10.7759/cureus.54319 -
Biomedicines Oct 2023The expression of CD4 and CD8 co-receptors defines two distinct T cell populations with specialized functions. While CD4 T cells support and modulate immune responses... (Review)
Review
The expression of CD4 and CD8 co-receptors defines two distinct T cell populations with specialized functions. While CD4 T cells support and modulate immune responses through different T-helper (Th) and regulatory subtypes, CD8 T cells eliminate cells that might threaten the organism, for example, virus-infected or tumor cells. However, a paradoxical population of CD4CD8 double-positive (DP) T cells challenging this paradigm has been found in the peripheral blood. This subset has been observed in healthy as well as pathological conditions, suggesting unique and well-defined functions. Furthermore, DP T cells express activation markers and exhibit memory-like features, displaying an effector memory (EM) and central memory (CM) phenotype. A subset expressing high CD4 (CD4) and intermediate CD8 (CD8) levels and a population of CD8CD4 T cells have been identified within DP T cells, suggesting that this small subpopulation may be heterogeneous. This review summarizes the current literature on DP T cells in humans in health and diseases. In addition, we point out that strategies to better characterize this minor T cell subset's role in regulating immune responses are necessary.
PubMed: 37893076
DOI: 10.3390/biomedicines11102702