Reasons for encounter and symptom diagnoses : a superior description of patients’ problems in contrast to medically unexplained symptoms (MUS)

This is a review of the literature on the role of symptoms in family practice, with a focus on the diagnostic approach in family medicine (FM). We found two, contrasting, approaches to reducing symptoms presented by patients in primary care, especially those which do not immediately allow the definition of a disease-label diagnosis. Years of research into ‘medically unexplained symptoms’ (MUS) has failed to support an international body of knowledge and cannot convincingly support the philosophy on which the reduction itself is based. This review supports the approach of researching reasons for encounter as they present to the family doctor, without artificial mind–body metaphors. The medical model is shown to be an incomplete reduction of FM, and the concept of MUS fails to improve this situation. A new model based on a substantial paradigm shift is needed. That model should be the biopsychosocial model, reflected in the philosophical concepts of the International Classification of Primary Care and the value of the patient’s ‘reason for encounter’. There is more to life than medicine may diagnose, and FM should strive to move closer to the lives of our patients than the medical model alone could allow.The European Union Financial Protocol 7 project ‘TRANSFoRm’ (www.transformproject.eu) (FP7 247787) supported part of the protected time of the authors in performing this study, through its partner the Mediterranean Institute of Primary Care (www.mipc.org.mt).peer-reviewe

Age-related changes in egg yolk composition between conventional and organic table eggs

The aim of this study was to investigate fatty acids, fat-soluble vitamins, malondialdehyde and cholesterol in conventional and organic eggs obtained from hens of different ages (30 and 60 weeks). A total of 360 egg yolks were used in this study. Polyunsaturated fatty acid, omega-3, and omega-6 levels were higher in the organic eggs from the 30-week-old hens. The monounsaturated fatty acid level was higher in the conventional eggs but was the same between the two age groups. Cholesterol and vitamin A levels were not influenced by either the rearing system or the age of the hens. The malondialdehyde, vitamin D2, and vitamin K2 were higher in the organic eggs; however, vitamin E was higher in the conventional eggs. The results showed that the rearing system and age, as well as the diet, had an impact on the composition of the egg. Total levels of polyunsaturated fatty acid, omega-3, and omega-6 are higher in organic eggs produced by younger hens

ICPC-2-E: the electronic version of ICPC-2. Differences from the printed version and the consequences.

peer reviewedaudience: researcher, professionalBACKGROUND: In 1998, ICPC-2 was published as a book. In the process of translating the book, and preparing an electronic version of chapter 10 (the actual classification), ICPC-2 proved to contain many errors and inconsistencies. Particularly, major problems were identified in the conversion between ICPC-2 and ICD-10, which could lead to major errors when used in electronic patient records. OBJECTIVES: We prepared an electronic version of chapter 10 of ICPC-2, ICPC-2-E, with all necessary corrections, to be published on the Oxford University Press web site as a part of this article. METHODS: Errors and inconsistencies were redressed, including particularly those in the con-version structure with all consequences on the level of inclusion and exclusion criteria, through a process of careful checking. RESULTS AND CONCLUSION: ICPC-2-E, the electronic version of chapter 10 of ICPC-2, is specifically to be used in an electronic patient record and for research purposes. It is to be used together with the first nine chapters of ICPC-2, since the book is indispensable to make a correct use of ICPC

Eficacia de los niveles séricos de S100B, TRAIL y adropina para predecir el resultado clínico, el núcleo del infarto final y los subtipos de ataque cerebrovascular de los pacientes con accidente cerebrovascular isquémico agudo

Objectives: To identify the significance of TRAIL and adropin release and the relative changes related to S100B levels and the relationship between these biomarkers with final infarct core, clinical outcome, and the presence of large artery atherosclerosis in acute stroke patients. Material and methods: Over a one-year period, demographic, clinical, and neuroimaging findings of 90 consecutive patients with acute ischemic stroke were evaluated. Results: Among our study population, the mean age was 69.28 ± 10 and 39 patients were female. The increased level of S100B and the decreased levels of sTRAIL with adropin were significantly associated with the moderate to the severe patient neurologic presentation (p=.0001, p=.002, p =.002, respectively). On control CT, a large infarct core was significantly associated with decreased serum level of sTRAIL and adropin (p=.001 and p=.000; respectively); however, the levels of S100B were not significantly associated with good ASPECT score (p=.684). Disability and unfavorable outcome were significantly related to the decreased level of sTRAIL and adropin (p=.001 and p=.000; respectively for THRIVE score>5). Decreased sTRAIL and adropin levels and increased S100B level were correlated with the presence of large artery atherosclerotic etiologic factor among the study population (p=.000, p=.000, p =.036, respectively). Conclusion: TRAIL and Adropin serum levels are associated with poor clinical outcome and greater infarcted area in acute ischemic stroke patients.Objetivo. Identificar la importancia de la liberación de TRAIL y adropin y los cambios relativos relacionados con los niveles de S100B y la relación entre estos biomarcadores con el núcleo final del infarto, el resultado clínico y la presencia de aterosclerosis de arterias grandes en pacientes con ataque cerebrovascular agudo. Materiales y métodos. Durante un período de un año, se evaluaron los hallazgos demográficos, clínicos y de neuroimagen de 90 pacientes consecutivos con ataque cerebrovascular isquémico agudo. Resultados. Entre la población de nuestro estudio, la edad media fue de 69,28 ± 10 y 39 pacientes eran mujeres. El aumento del nivel de S100B y la disminución de los niveles de sTRAIL con adropina se asociaron significativamente con la presentación neurológica del paciente de moderada a grave (p = ,0001, p = ,002, p = ,002, respectivamente). En la TC de control, un gran núcleo de infarto se asoció significativamente con una disminución del nivel sérico de sTRAIL y adropina (p = ,001 y p = ,000; respectivamente); sin embargo, los niveles de S100B no se asociaron significativamente con una buena puntuación ASPECT (p = ,684). La discapacidad y el resultado desfavorable se relacionaron significativamente con la disminución del nivel de sTRAIL y adropina (p = ,001 yp = ,000; respectivamente para la puntuación THRIVE> 5). La disminución de los niveles de sTRAIL y adropina y el aumento del nivel de S100B se correlacionaron con la presencia de un factor etiológico aterosclerótico de arterias grandes entre la población de estudio (p = ,000, p = ,000, p = ,036, respectivamente). Conclusiones. Los niveles séricos de TRAIL y Adropin se asocian con un resultado clínico deficiente y una mayor área infartada en pacientes con ataque cerebrovascular isquémico agudo

Extensive Reading: A study of Its Effects on Turkish EFL Learners' General Language Proficiency in an Input-Based Setting

Abstract This study explored the nature of the relationship between extensive reading and the improvements shown on the general proficiency level of learners of English as a foreign language. For this purpose, 60 college students were recruited whose proficiency levels were A1 according to CEFR (Common European Framework of Reference for Languages: Learning, Teaching, Assessment) or Novice according to the proficiency guidelines established by ACTFL (American Council for the Teaching of Foreign Languages). They were given a standardized pre-test at the beginning of the Fall 2015 semester as part of the institutional requirement. Then, the participants were provided with a large amount of written resources and asked to choose materials for extensive reading. At various degrees, all the participants did extensive reading activities throughout the experiment time. In the meantime, they received formal input-based instruction. The extensive reading activities took place outside of the class, during leisure times. The experiment took almost nine months. At the end of the experiment, they were given a post-test, which was the same as the pre-test, and completed a reading habits questionnaire. The questionnaire consisted of items seeking information about how much time they spent doing extensive reading, what materials were chosen in this process, how many pages were read on a daily basis, and so forth. The findings provided supporting evidence for extensive reading and pointed out that extensive reading activities can positively influence the improvements of learners’ global proficiency level. The results also indicated that there is a linear relationship between extensive reading and proficiency levels, namely, the more learners do extensive reading and the longer the length of the extensive reading program, the higher their proficiency level will be. All in all, this study revealed that extensive reading is an effective way to improve global target language skills

A Novel Design of Low-Voltage VDIBA and Filter Application

In this study, a low-voltage low-power design of previously introduced analog signal processing element called as Voltage Differencing Inverting Buffered Amplifier (VDIBA) is presented. Level shifter current mirrors are used in the circuit design in order to accomplish the low-voltage low-power operation. The configuration operates only with ±0.4 V supply voltages and consumes power 569 μW at the bias current 50 μA. Also, low-voltage transconductor which has highly linear gm is executed with the use of bulk-driven quasi-floating gate (BD-QFG) and source degeneration techniques. The simulations of the introduced circuit have been performed with 0.18 μm TSMC CMOS technology by SPICE. The theoretical approaches have been confirmed by the simulation results

The effect of erythropoietin on biomechanical properties of the Achilles tendon during the healing process: an experimental study

Tensile test data. (XLSX 10 kb

THE ANALYSIS OF SHEAR ZONES IN CALABRIA; IMPLICA TIONS FOR THE GEODYNAMICS OF THE CENTRAL MEDITERRANEAN

Systematic analysis of basement structures and Neogene morphotectonic elements -calibrated with research data on shear zones -has led to the construction of a new synthetic structural model for the Cala­brian Arc. Six fault systems can be distinguished which have generated various types of basins, such as piggy-back,pull-apart and complex oblique strike-slip basins. These systems are determined by three morphotectonic patterns: A) N130 trending segments separated by oblique transversal thrust zones. B) SW-NE trending thrust zones representing the most internal part of the Calabrian accretionary wedge system. C) Radial wedge-shaped segments confining the collapsed Southern Tyrrhenian Basin with accompanying concentric patterns of ten­sional faults internally and dome-shaped uplift centres situated externally, determining the actual arc. The pactterns A and B can be linked to the Serravallian-Early Pliocene development of crustal shear zones ("Strike-Slip Cycle") while pattern C can be linked to the Pleistocene development (extreme vertical tectonics). The Late Pliocene was characterised by a tensional regime. A scenario for the Neogene Central Mediterranean geodynamics has been developed by means of three mechanisms: 1) NE-SW compression (dextral shear along the N. African margin); 2) diapiric rise within the Tyrrhenian area and 3) roll-back and detachment of remnants of the subducted Ionian lithosphere ("passive subduction"). The interplay of these three mechanisms led to basal detachment and the gravitational displace­ment of che Calabrian Element to the SE, superimposed upon oblique overthrusting in the Apennines. A proto-Mediterranean shear zone pattern -evolved as a result of sinistral megatorsion of the northern hemisphere -controlled the development of the Central Medicerranean.

THE EFFECT OF PREOPERATIVE ANXIETY ON FETAL CORD BLOOD TUMOR NECROSIS FACTOR-ALPHA, INTERLEUKIN-6, AND NEONATAL OUTCOMES IN PREGNANT WOMEN

Backgrounds: In this study, we aimed to investigate the relationship in pregnant women who undergo elective cesarean section between the preoperative anxiety (POA) levels and neonatal results and TNF-alfa,IL-6 and IL-8 levels, the pro-inflammatory cytokines in cord blood. Subjects and methods: Sixty-six volunteer patients, aged 18 to 40, who underwent elective cesarean surgery were included in the study. Trait Anxiety Inventory (TAI) was evaluated at the anesthesia outpatient clinic and State Anxiety Inventory (SAI) was determined one hour before cesarean section. Plasma levels of TNF-alfa,IL-6 and IL-8 in the umbilical cord blood were determined using the ELISA method. Fetal cord blood gas, birth weight, and APGAR scores at the 1st and 5th minutes after birth were recorded. Results: The mean preoperative maternal SAI and TAI scores were 46,6+-10,9 and 41,4+-7,8, respectively. There was a significant correlation between POA and fetal birth weight and fetal cord blood TNF-alfa,IL-6 and IL-8 parameters. The inflammatory marker levels in the cord blood of fetuses in the high anxiety groups were significantly higher (p<0.001). Fetal birth weight was significantly lower in the high anxiety groups (p<0.05), whereas there was no significant difference in cord blood gas values. Conclusions: Our results show that an increase in the levels of TNF-alfa,IL-6, and IL-8 cytokines in fetal cord blood in pregnant women with high anxiety levels and this situation causes negative effects on the newborn