Self-concept and facial appearance of individuals with an intellectual disability:A scoping review

This paper looks at how self-concept is related to facial appearance. Very little information can be found on how persons with intellectual disabilities think and feel about their own facial appearance. In this review 19 articles on subject of self-concept in people with intellectual disabilities were included. Results show that self-concept of individuals with intellectual disabilities is affected by the relationships they have (positively and negatively). The perceptions of caregivers, peers and their awareness of stigma effects self-concept. How facial appearance affects the self-concept of persons with intellectual disabilities remains unclear and should be a focus of research in future. Abstract: Background The mental health and well-being of individuals can be positively affected by improving facial appearance through orthodontic treatment. However, research is limited on the relationship between facial appearance and self-concept of individuals with intellectual disabilities. Materials and methods This scoping review includes 19 articles and is aimed to examine the self-concept of individuals with intellectual disabilities and determine how the self-concept might be impacted by facial appearance. Furthermore, this review is exploratory in the way that an attempt was made to extract constructs that contribute to the self-concept of persons with intellectual disabilities. Results Unfortunately, no articles were found on how individuals with intellectual disabilities think about their own facial appearance. However, the articles on self-concept in persons with intellectual disabilities do mention some interesting facts: social comparisons lead to social stigma that can contribute negatively to the self-concept of individuals with intellectual disabilities. Also, the ability to communicate and express oneself can contribute to one's self-esteem. Furthermore, parents/caregivers often influence the concept of oneself. Moreover, an individual's relationship with their social environment defines their self-concept. Conclusion It is currently unknown how individuals with intellectual disabilities view their own facial appearance and whether their self-concept is influenced by their appearance. Questionnaires which address attitudes on facial appearance could provide a deeper understanding of the self-concept of individuals with intellectual disabilities and possibly make way for orthodontic treatment. However, caution is needed concerning changing the physical appearance of persons with intellectual disabilities. One should also battle stigma by encouraging the social inclusion of persons with intellectual disability

Do malpractice claim clinical case vignettes enhance diagnostic accuracy and acceptance in clinical reasoning education during GP training?

Abstract Background Using malpractice claims cases as vignettes is a promising approach for improving clinical reasoning education (CRE), as malpractice claims can provide a variety of content- and context-rich examples. However, the effect on learning of adding information about a malpractice claim, which may evoke a deeper emotional response, is not yet clear. This study examined whether knowing that a diagnostic error resulted in a malpractice claim affects diagnostic accuracy and self-reported confidence in the diagnosis of future cases. Moreover, suitability of using erroneous cases with and without a malpractice claim for CRE, as judged by participants, was evaluated. Methods In the first session of this two-phased, within-subjects experiment, 81 first-year residents of general practice (GP) were exposed to both erroneous cases with (M) and erroneous cases without (NM) malpractice claim information, derived from a malpractice claims database. Participants rated suitability of the cases for CRE on a five-point Likert scale. In the second session, one week later, participants solved four different cases with the same diagnoses. Diagnostic accuracy was measured with three questions, scored on a 0–1 scale: (1) What is your next step? (2) What is your differential diagnosis? (3) What is your most probable diagnosis and what is your level of certainty on this? Both subjective suitability and diagnostic accuracy scores were compared between the versions (M and NM) using repeated measures ANOVA. Results There were no differences in diagnostic accuracy parameters (M vs. NM next step: 0.79 vs. 0.77, p = 0.505; differential diagnosis 0.68 vs. 0.75, p = 0.072; most probable diagnosis 0.52 vs. 0.57, p = 0.216) and self-reported confidence (53.7% vs. 55.8% p = 0.390) of diagnoses previously seen with or without malpractice claim information. Subjective suitability- and complexity scores for the two versions were similar (suitability: 3.68 vs. 3.84, p = 0.568; complexity 3.71 vs. 3.88, p = 0.218) and significantly increased for higher education levels for both versions. Conclusion The similar diagnostic accuracy rates between cases studied with or without malpractice claim information suggests both versions are equally effective for CRE in GP training. Residents judged both case versions to be similarly suitable for CRE; both were considered more suitable for advanced than for novice learners

Bilateral multiple coronary artery fistulae with angina pectoris and syncope

AbstractCoronary artery fistulae (CAF) are rare cardiac anomalies. They frequently arise from the right coronary artery (RCA) with fistulae originating from the left anterior descending artery (LAD) or from multiple arteries being less common. They do not usually cause symptoms and are incidentally diagnosed on routine cardiac imaging. We report a 70years old male patient presenting with chest pain and syncope during physical activity. Diagnostic coronary angiography revealed bilateral multiple CAF originating from both the LAD and RCA. As high blood flow output was recognized in these large vascular anomalies contributing to ‘steal phenomenon’ surgical intervention was planned. This manuscript aimed to present the case and review the current literature for the management and treatment of these coronary anomalies

Comparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery

To guide the selection of osteosynthesis systems, this study compared the mechanical properties of biodegradable and titanium osteosynthesis systems. SonicPins Rx and xG were subjected to pull-out tests. Additionally, 15 biodegradable (Inion CPS 2.0 and 2.5 mm; LactoSorb 2.0 mm; Macropore 2.0 mm; Polymax 2.0 mm; BioSorb FX 2.0 mm; ResorbX 2.1 mm; Osteotrans-MX 2.0 mm with plate thicknesses 1.0 and 1.4 mm; SonicWeld Rxplate/Rxpins, xGplate/Rxpins and xGplate/xGpins 2.1 mm without and with tapping the burr hole) and six titanium (CrossDrive (2006), CrossDrive (2018), MaxDrive; all 1.5 and 2.0 mm) straight, four-hole osteosynthesis systems were evaluated. All systems were subjected to tensile, bending and torsion tests. Pull-out loads of the SonicPins were comparable (P = 0.423). Titanium systems’ tensile loads were higher than biodegradable systems (P < 0.001). CrossDrive (2018) and MaxDrive systems’ tensile and torsional stiffness were lower, accompanied with higher ductility, than corresponding CrossDrive (2006) systems (P < 0.001). Bending stiffness of 1.5 mm titanium systems was comparable to, and of the 2.0 mm systems higher than, all biodegradable systems (P < 0.001). Regarding biodegradable systems, Inion CPS 2.5 mm had highest tensile load and torsional stiffness, SonicWeld 2.1 mm highest tensile stiffness, and BioSorbFX 2.0 mm highest bending stiffness (P < 0.001). On the basis of the results of this study, the CrossDrive (2018) and MaxDrive 1.5 mm titanium systems are recommended for midface fractures (e.g., zygomatic or maxillary fractures) and osteotomies (e.g., Le Fort I osteotomy), and the CrossDrive (2018) and MaxDrive 2.0 mm titanium systems for mandibular fractures and osteotomies when a titanium osteosynthesis system is used. When there is an indication for a biodegradable osteosynthesis system, the SonicWeld 2.1 mm or BioSorbFX 2.0 mm are recommended for midface fractures and osteotomies, and the Inion CPS 2.5 mm biodegradable system for mandibular osteotomies and non-load bearing mandibular fractures, especially when high torsional forces are expected (e.g., mandibular symphysis fractures)

Laboratory Demonstration of Spatial Linear Dark Field Control For Imaging Extrasolar Planets in Reflected Light

Imaging planets in reflected light, a key focus of future NASA missions and ELTs, requires advanced wavefront control to maintain a deep, temporally correlated null of stellar halo -- i.e. a dark hole -- at just several diffraction beam widths. Using the Ames Coronagraph Experiment testbed, we present the first laboratory tests of Spatial Linear Dark Field Control (LDFC) approaching raw contrasts ($\sim$ 5$\times$10$^{-7}$) and separations (1.5--5.2 $\lambda$/D) needed to image jovian planets around Sun-like stars with space-borne coronagraphs like WFIRST-CGI and image exo-Earths around low-mass stars with future ground-based 30m class telescopes. In four separate experiments and for a range of different perturbations, LDFC largely restores (to within a factor of 1.2--1.7) and maintains a dark hole whose contrast is degraded by phase errors by an order of magnitude. Our implementation of classical speckle nulling requires a factor of 2--5 more iterations and 20--50 DM commands to reach contrasts obtained by spatial LDFC. Our results provide a promising path forward to maintaining dark holes without relying on DM probing and in the low-flux regime, which may improve the duty cycle of high-contrast imaging instruments, increase the temporal correlation of speckles, and thus enhance our ability to image true solar system analogues in the next two decades.Comment: 13 pages, 7 figures, accepted for publication in Publications of the Astronomical Society of the Pacifi

Development of an international standard set of value-based outcome measures for patients with chronic kidney disease : a report of the International Consortium for Health Outcomes Measurement (ICHOM) CKD working group

Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support the shift toward value-based health care in chronic kidney disease (CKD), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use. The considered outcomes and patient-reported outcome measures were generated from systematic literature reviews. Feedback was sought from patients and health professionals. Patients with very high-risk CKD (stages G3a/A3 and G3b/A2-G5, including dialysis, kidney transplantation, and conservative care) were selected as the target population. Using an online modified Delphi process, outcomes important to all patients were selected, such as survival and hospitalization, and to treatment-specific subgroups, such as vascular access survival and kidney allograft survival. Patient-reported outcome measures were included to capture domains of health-related quality of life, which were rated as the most important outcomes by patients. Demographic and clinical variables were identified to be used as case-mix adjusters. Use of these consensus recommendations could enable institutions to monitor, compare, and improve the quality of their CKD care

Dermatofibrosarcoma Protuberans Re-excision and Recurrence Rates in the Netherlands Between 1989 and 2016

Dermatofibrosarcoma protuberans is a rare soft tissue tumour with a very low (less than 0.5%) rate of metastasis. Rates of re-excision and recurrence were determined using data from the Netherlands Cancer Registry between 1989 and 2016. Of the 1,890 instances of dermatofibrosarcoma protuberans included, 87% were treated with excision, 4% with Mohs micrographic surgery, and 9% otherwise or unknown. Linked pathology data were retrieved for 1,677 patients. Half of all excisions (847/1,644) were incomplete and 29% (192/622) of all re-excisions were incomplete. The cumulative incidence of a recurrence was 7% (95% confidence interval (CI) 6–8) during a median followup of 11 years (interquartile range (IQR) 6–17). AfterMohs micrographic surgery (n = 34), there were no recurrencesduring a median follow-up of 4 years (IQR 3–6). Due to the high rate of incomplete excisions and recurrences after excision, this study supports the European guideline, which recommends treating dermatofibrosarcoma protuberans with Mohs micrographic surgery in order to decrease the rate of recurrence

Effects of age, amyloid, sex, and APOE ε4 on the CSF proteome in normal cognition

Introduction: It is important to understand which biological processes change with aging, and how such changes are associated with increased Alzheimer's disease (AD) risk. We studied how cerebrospinal fluid (CSF) proteomics changed with age and tested if associations depended on amyloid status, sex, and apolipoprotein E Ɛ4 genotype. Methods: We included 277 cognitively intact individuals aged 46 to 89 years from Alzheimer's Disease Neuroimaging Initiative, European Medical Information Framework for Alzheimer's Disease Multimodal Biomarker Discovery, and Metabolic Syndrome in Men. In total, 1149 proteins were measured with liquid chromatography mass spectrometry with multiple reaction monitoring/Rules-Based Medicine, tandem mass tag mass spectrometry, and SOMAscan. We tested associations between age and protein levels in linear models and tested enrichment for Reactome pathways. Results: Levels of 252 proteins increased with age independently of amyloid status. These proteins were associated with immune and signaling processes. Levels of 21 proteins decreased with older age exclusively in amyloid abnormal participants and these were enriched for extracellular matrix organization. Discussion: We found amyloid-independent and -dependent CSF proteome changes with older age, perhaps representing physiological aging and early AD pathology

Abnormal septal convexity into the left ventricle occurs in subclinical hypertrophic cardiomyopathy.

BACKGROUND: Sarcomeric gene mutations cause hypertrophic cardiomyopathy (HCM). In gene mutation carriers without left ventricular (LV) hypertrophy (G + LVH-), subclinical imaging biomarkers are recognized as predictors of overt HCM, consisting of anterior mitral valve leaflet elongation, myocardial crypts, hyperdynamic LV ejection fraction, and abnormal apical trabeculation. Reverse curvature of the interventricular septum (into the LV) is characteristic of overt HCM. We aimed to assess LV septal convexity in subclinical HCM. METHODS: Cardiovascular magnetic resonance was performed on 36 G + LVH- individuals (31 ± 14 years, 33 % males) with a pathogenic sarcomere mutation, and 36 sex and age-matched healthy controls (33 ± 12 years, 33 % males). Septal convexity (SCx) was measured in the apical four chamber view perpendicular to a reference line connecting the mid-septal wall at tricuspid valve insertion level and the apical right ventricular insertion point. RESULTS: Septal convexity was increased in G + LVH- compared to controls (maximal distance of endocardium to reference line: 5.0 ± 2.5 mm vs. 1.6 ± 2.4 mm, p ≤ 0.0001). Expected findings occurred in G + LVH- individuals: longer anterior mitral valve leaflet (23.5 ± 3.0 mm vs. 19.9 ± 3.1 mm, p ≤ 0.0001), higher relative wall thickness (0.31 ± 0.05 vs. 0.29 ± 0.04, p ≤ 0.05), higher LV ejection fraction (70.8 ± 4.3 % vs. 68.3 ± 4.4 %, p ≤ 0.05), and smaller LV end-systolic volume index (21.4 ± 4.4 ml/m(2) vs. 23.7 ± 5.8 ml/m(2), p ≤ 0.05). Other morphologic measurements (LV angles, sphericity index, and eccentricity index) were not different between G + LVH- and controls. CONCLUSIONS: Septal convexity is an additional previously undescribed feature of subclinical HCM