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Food literacy (FL) is a crucial need encompassing basic literacy and fundamental movement skills. The present study aimed to investigate the FL level in pre-schoolers and to evaluate the effect of potential predictors and the associations with gross motor and emergent literacy skills.
Cross-sectional study conducted within the Training-to-Health Project.
Kindergartens (n 21) in the Palermo City Council, Italy.
Pre-school children aged 3–6 years (n 921) followed education sessions on nutritional topics, practical activities and compiled prearranged sheets. FL was assessed by the five-domain toolkit ‘preschool-FLAT’; gross motor and emergent literacy skills were assessed by the Italian version of the gross motor development test and the PRCR-2/2009, respectively. Correlation and regression analyses were performed to assess relationships between FL scores and gender, age, weight, height, BMI, gross motor and emergent literacy skills.
Independent predictors (β, se) of higher FL were female gender (1·06, 0·315, P < 0·01), older age (0·08, 0·019, P < 0·001) and greater height (0·13, 0·03, P < 0·001). The adjusted coefficients were significant for quotient of gross motor development and in particular for the locomotor component (0·03, 0·01, P < 0·01 and 0·16, 0·046, P < 0·001, respectively). Almost all associations with the emergent literacy skills were significant (β = −0·02 to 0·47).
The study suggests that children raised in an environment where both cognitive and motor skills are enhanced can have better chances of increasing FL and success at school. Thus, the need for monitoring FL and its predictors since early age is highlighted.
Methane contributes substantially to global warming as the second most important anthropogenic greenhouse gas. Radiocarbon (14C) measurements of atmospheric methane can be used as a source apportionment tool, as they allow distinction between thermogenic and biogenic methane sources. However, these measurements remain scarce due to labor-intensive methods required. A new setup for the preparation of atmospheric methane samples for radiocarbon analysis is presented. The system combines a methane preconcentration line with a preparative gas chromatography technique to isolate pure methane samples for a compound-specific radiocarbon analysis. In order to minimize sample preparation time, we designed a simplified preconcentration line for the extraction of methane from 50 L atmospheric air, which corresponds to 50 µg C as required for a reliable 14C analysis of methane-derived CO2 gas measurement with accelerator mass spectrometry (AMS). The system guarantees a quantitative extraction of methane from atmospheric air samples for 14C analysis, with a good repeatability and a low processing blank. The setup was originally designed for the measurement of samples with low methane concentrations, but it can also be adapted to apportion sources from environmental compartments with high methane levels such as freshwaters or wetlands.
Introduction: Procedural skills training varies significantly across Canadian medical schools, and there is currently no standardized assessment tool to evaluate its benefits. This project aims to develop a curriculum that teaches 2nd-year medical students to perform and evaluate procedural skills. The goals of this program include decreasing anxiety, increasing confidence, and achieving competence for students and also allowing staff to judge the appropriate level of supervision when delegating learners to perform basic procedures in the team setting. Our curriculum incorporates, near-peer teaching as well as near peer formative assessment. Methods: Each of the twelve 2nd year participants completed a State Trait Anxiety Inventory and self-reported confidence questionnaire related to procedural skills. Students participated in four sessions taught by expert physicians over a five month period. A new skill was taught at each monthly workshop and an opportunity to practice previously taught skills was provided. Skills were assessed in a skills integration simulation OSCE, and the anxiety and confidence questionnaire was repeated. Results: Students who completed this pilot program showed a significant decrease in mean anxiety state (2.48 vs 1.74, p-value <0.001), while the control group did not (p-value = 0.408). When assessing confidence, students who completed this program showed increased self-assessed knowledge and confidence in each of the program's assessed skills. An increased level of competency was achieved in each skill by each student as assessed by the expert physicians. Conclusion: There is evidence to suggest that implementation of this procedural skills training model within the Canadian medical school curriculum may improve student anxiety, confidence, and competency for success in clerkship and could be the foundation for developing milestones for EPAs.
Introduction: In order to better characterize procedural skills curricula in Canada, a national survey was conducted. The objectives of the survey were: (i) to characterize procedural skills education currently employed in pre-clerkship and clerkship curricula; (ii) to determine what skills physician-educators think medical students should know upon graduation; and (iii) to identify physician-educator perceptions regarding the development of pre-clerkship procedural curriculum. Methods: A web-based survey was distributed to 201 clinician-educators across Canada's 17 medical schools. Respondents were directed to an individualized survey based on their self-identified roles at their institution. Respondents were asked demographic questions, what procedural skills are being taught and in what setting at their institution, and their opinions on the value of a pre-clerkship procedural curriculum. Results: From the 17 school's surveyed, 12 schools responded, with 8 schools responding “yes” that they had a clerkship procedural curriculum. For a pre-clerkship procedural curriculum, only 4 schools responded “yes”. The 5 of the top 10 procedurals skills identified that medical students should know upon graduation, in order, are: IV Access, Airway Management/Ventilator Management, Local anesthesia/field block, Casting, Spontaneous Vaginal Delivery. On a Likert scale, clinician-educators strongly supported a pre-clerkship procedural curriculum (median = 4.00/5.00, mode = 5.00/5.00), and they believed it would decrease anxiety (median = 4.00/5.00), increase confidence (median = 4.00/5.00), and increase technical ability (median = 3.00/5.00) in incoming clerks. Conclusion: Across Canada, the state of undergraduate medical education procedural skills education is inconsistent. With the identification of the Top 10 procedural skills medical students should know upon graduation, the learning objectives of a formal curriculum can be developed. With overwhelming support from physician-educators, a formal pre-clerkship procedural curriculum is poised to redefine the landscape of procedural care for a whole new generation of physicians.
The study of dwarf spheroidal galaxies (dSph) is of great importance to understand galaxy evolution at the low-mass end. In the Local Group the majority of them are found to be satellites of the Milky Way or M31. The closest ones have been studied in great detail, however it is hard to constrain if their present-day observed properties are mainly caused by internal or environmental mechanisms. In order to minimize these effects and gain an insight into their intrinsic properties, we are studying two of the three isolated dSph galaxies in the Local Group, i.e. Cetus and Tucana, located far beyond the virial radius of the Milky Way and M31. We present here results from our recently published analysis of Cetus (Taibi2018) and preliminary results for Tucana (Taibi et al. in prep.).
Understanding the peculiar properties of Ultra Diffuse Galaxies (UDGs) via spectroscopic analysis is a challenging task that is now becoming feasible. The advent of 10m-class telescopes and high sensitivity instruments is enabling the gathering of high quality spectra even for the faintest systems. In addition, advances in the modelling of stellar populations, stellar libraries, and full-spectral fitting codes are allowing the recovery of the stellar content shaping those spectra with unprecedented reliability. In this contribution we report on the extensive tests we have carried out using the inversion code STECKMAP. The similarities between the Star Formation Histories (SFH) recovered from STECKMAP (applied to high-quality spectra) and deep Colour-Magnitude diagrams fitting (resolved stars) in two Local Group dwarf galaxies (LMC and LeoA) are remarkable, demonstrating the impressive performance of STECKMAP. We exploit the capabilities of STECKMAP and perform one of the most complete and reliable characterisations of the stellar component of UDGs to date using deep spectroscopic data. We measure radial and rotation velocities, SFHs and mean population parameters, such as ages and metallicities, for a sample of five UDG candidates in the Coma cluster. From the radial velocities, we confirm the Coma membership of these galaxies. We find that their rotation properties, if detected at all, are compatible with dwarf-like galaxies. The SFHs of the UDG are dominated by old (∼ 7 Gyr), metal-poor ([M/H] ∼ -1.1) and alpha-enhanced ([Mg/Fe]∼ 0.4) populations followed by a smooth or episodic decline which halted ∼ 2 Gyr ago, possibly a sign of cluster-induced quenching. We find no obvious correlation between individual SFH shapes and any UDG morphological properties. The recovered stellar properties for UDGs are similar to those found for DDO 44, a local UDG analogue resolved into stars. We conclude that the UDGs in our sample are extended dwarfs whose properties are likely the outcome of both internal processes, such as bursty SFHs and/or high-spin haloes, as well as environmental effects within the Coma cluster.
Radiocarbon (14C) measurements of foraminifera often provide the only absolute age constraints in marine sediments. However, they are often challenging as their reliability and accuracy can be compromised by reduced availability of adequate sample material. New analytical advances using the MIni CArbon DAting System (MICADAS) allow 14C dating of very small samples, circumventing size limitations inherent to conventional 14C measurements with accelerator mass spectrometry (AMS). Here we use foraminiferal samples and carbonate standard material to assess the reproducibility and precision of MICADAS 14C analyses, quantify contamination biases, and determine foraminiferal 14C blank levels. The reproducibility of conventional 14C ages for our planktic (benthic) foraminiferal samples from gas measurements is 200 (130) yr, and has good precision as illustrated by the agreement between both standards and their reference values as well as between small gas- and larger graphitized foraminiferal samples (within 100±60 yr). We observe a constant contamination bias and slightly higher 14C blanks for foraminifera than for carbonate reference materials, limiting gas (graphite) 14C age determinations for foraminifera from our study sites to ~38 (~42) kyr. Our findings underline the significance of MICADAS gas analyses for 14C on smaller-than-conventional sized foraminiferal samples for paleoclimate reconstructions and dating.
Palatal reconstruction following maxillectomy is a surgical challenge, and a nasoseptal flap is a feasible approach. This paper reports the first known successful clinical case of a nasoseptal pedicle flap applied for the reconstruction of maxillary bone following hemi-maxillectomy.
This report describes hemi-maxillectomy in a 60-year-old Italian male diagnosed with stage IV squamous cell carcinoma of the left maxilla. Endoscopic transnasal extended medial maxillectomy was performed, followed by a transoral modified midfacial degloving technique for removal of the maxillary bone. The contralateral nasoseptal pedicle flap was used to reconstruct the defect. The case was followed up prospectively for the assessment of flap reception and healing.
The locally accessible nasoseptal flap is a viable alternative for palatal reconstruction; therefore, a second surgical procedure with its associated donor site morbidity can be avoided. Large-scale studies may help in establishing the cosmetic and functional outcomes.
We agree with Lake and colleagues on their list of “key ingredients” for building human-like intelligence, including the idea that model-based reasoning is essential. However, we favor an approach that centers on one additional ingredient: autonomy. In particular, we aim toward agents that can both build and exploit their own internal models, with minimal human hand engineering. We believe an approach centered on autonomous learning has the greatest chance of success as we scale toward real-world complexity, tackling domains for which ready-made formal models are not available. Here, we survey several important examples of the progress that has been made toward building autonomous agents with human-like abilities, and highlight some outstanding challenges.
An efficient breast-feeding monitoring system should be in place in every country to assist policy makers and health professionals plan activities to reach optimal breast-feeding rates.
From March to June 2015, breast-feeding rates at 3 and 5 months of age were monitored in Emilia-Romagna, an Italian region, using four questions added to a newly developed paediatric immunization database with single records for each individual. Data were collected at primary-care centres. Breast-feeding definitions and 24 h recall as recommended by the WHO were used. Direct age standardization was applied to breast-feeding rates. Record linkage with the medical birth database was attempted to identify maternal, pregnancy and delivery factors associated with full breast-feeding rates at 3 and 5 months of age.
Data on breast-feeding were collected for 14044 infants. The mean regional full breast-feeding rate at 3 months was 52 %; differences between local health authorities ranged from 42 to 62 %. At 5 months of age, the mean regional full breast-feeding rate dropped to 33 % (range between local health authorities: 26 to 46 %). Record linkage with the birth certificate database was successful for 93 % of records. Total observations more than doubled with respect to the previous regional survey.
The new monitoring system implemented in 2015 in Emilia-Romagna region, totally integrated with the immunization database, has proved to be feasible, sustainable and more efficient than the previous one. This system can be a model for other regions and countries where the vast majority of mothers obtain vaccinations from public health facilities and that already have an immunization database in place.
Faint dwarf galaxies such as those found around the Milky Way (MW) display the largest known dynamical mass-to-light ratios (up to several 100s M⊙/L⊙). However, tidal interaction with the MW may impact the dynamical equilibrium in the outer parts of some of these objects, and partly affect the derived dynamical M/L. Assessing this is crucial for the study of the dark matter content of these galaxies. A clear sign of ongoing tidal disturbance would be the presence of tidal tails. These are expected to be low surface brightness features, hence difficult to detect from star counts in systems where contamination is also present, e.g. from foreground MW stars. At present we have searched for these sorts of tidal features in the Sextans dwarf spheroidal galaxy (dSph), by adopting the Matched Filter Method (e.g. Rockosi et al. 2002), a very efficient technique to decontaminate stellar density maps with a high ratio of contamination versus source density (dwarf galaxies outer regions or ultra faint dwarf galaxies). We also calculate structural parameters from the position of stars without requiring spatial binning (Richardson et al. 2011), through a Bayesian MCMC (Foreman-Mackey et al. 2013).
Understanding the properties of dwarf galaxies is important not only to put them in their proper cosmological context, but also to understand the formation and evolution of the most common type of galaxies. Dwarf galaxies are divided into two main classes, dwarf irregulars (dIrrs) and dwarf spheroidals (dSphs), which differ from each other mainly because the former are gas-rich objects currently forming stars, while the latter are gas-deficient with no on-going star formation. Transition types (dT) are thought to represent dIs in the process of losing their gas, and can therefore shed light into the possible process of dwarf irregulars (dIrrs) becoming gas-deficient, passively evolving galaxies. Here we present preliminary results from our wide-area VLT/FORS2 MXU spectroscopic survey of the Phoenix dT, from which we obtained line-of-sight velocities and metallicities from the nIR Ca II triplet lines for a large sample of individual Red Giant Branch stars.
The University of Bern has set up the new Laboratory for the Analysis of Radiocarbon with AMS (LARA) equipped with an accelerator mass spectrometer (AMS) MICADAS (MIni CArbon Dating System) to continue its long history of 14C analysis based on conventional counting. The new laboratory is designated to provide routine 14C dating for archaeology, climate research, and other disciplines at the University of Bern and to develop new analytical systems coupled to the gas ion source for 14C analysis of specific compounds or compound classes with specific physical properties. Measurements of reference standards and wood samples dated by dendrochronology demonstrate the quality of the 14C analyses performed at the new laboratory.
Ca2MnO4 nanoparticles were prepared by the Pechini method and acid treated to extract Ca2+ ions. Structural, morphological and spectroscopic analyses by XRD, SEM/EDX, TEM/EDS and Raman revealed the formation of an amorphous outer layer at the particles surface with a preserved inner crystalline bulk. Thanks to the outer layer, which is electrochemically active, the acid-treated compounds showed capacity up to 150 Ah/kg. The crystalline bulk improved cycling stability, allowing reaching capacity retention up to 70% after 30 cycles.
In this review I will discuss the current status on determinations of the dark matter content and distribution in Milky Way dwarf spheroidals, for which the available data-sets allow the application of sophisticated mass modeling techniques.
This paper provides for the first time data on age and growth of Remora osteochir, also describing its sagittal otolith together with other biological and ecological aspects. Overall, 236 individuals of marlin sucker were collected in the southern-central Mediterranean Sea, from 2008 to 2009. All samples were hosted by the Mediterranean spearfish, Tetrapturus belone, caught by surface longline and harpoon. Analysis of gonads identified a reproductive peak during June and July. The estimated growth parameters according to the von Bertalanffy equation were: L∞ = 27.37 cm TL, k = 0.248 year−1, t0 = −1.36 year. The length-weight relationship, computed by using eviscerate weight, highlighted an isometric growth for both sexes, as supported by the other results: similar sizes, growth curves and disc length-total length relationship.
Acute agitation is a common psychiatric emergency often treated with intramuscular (IM) medication when rapid control is necessary or the patient refuses to take an oral agent. Conventional IM antipsychotics are associated with side effects, particularly movement disorders, that may alarm patients and render them unreceptive to taking these medications again. Ziprasidone (Geodon®) is the first second-generation, or atypical, antipsychotic to become available in an IM formulation. Ziprasidone IM was approved by the Food and Drug Administration in 2002 for the treatment of agitation in patients with schizophrenia. In October 2004, a roundtable panel of physicians with extensive experience in the management of acutely agitated patients met to review the first 2 years of experience with this agent. This monograph, a product of that meeting, discusses clinical experience to date with ziprasidone IM and offers recommendations on its use in various settings.
In clinical trials, patients treated with ziprasidone IM demonstrated significant and rapid (within 15-30 minutes) reduction in agitation and improvement in psychotic symptoms, agitation, and hostility to an extent greater than or equal to that attained with haloperidol IM. Tolerability of ziprasidone IM was superior to that of haloperidol IM, with a lower burden of movement disorders. Clinical trials have also shown that ziprasidone IM can be administered with benzodiazepines without adverse consequences. Transition from IM to oral ziprasidone has been well tolerated, with maintenance of symptom control. The most common adverse events associated with ziprasidone IM were insomnia, headache, and dizziness in fixed-dose trials and insomnia and hypertension in flexible-dose trials. No consistent pattern of escalating incidence of adverse events with escalating ziprasidone doses has been observed. Changes in QTc interval associated with ziprasidone at peak serum concentrations are modest and comparable to those seen with haloperidol IM. Results of randomized clinical trials of ziprasidone IM have been corroborated in studies in real-world treatment settings involving patients with extreme agitation or a recent history of alcohol or substance abuse. In these circumstances, clinically significant improvement was seen within 30 minutes of ziprasidone IM administration, without regard to the suspected underlying etiology of agitation. Agents with a good safety/tolerability profile, such as ziprasidone IM, may be more cost effective long term than older agents, due to reduced incidence of acute adverse effects (eg, acute dystonia) that often require extended periods of observation. Additional trials of ziprasidone IM in agitated patients in a variety of clinical settings are warranted to generate comparative risk/benefit data with conventional agents and other second-generation antipsychotics.
Acute agitation is a nonspecific term applied to an array of syndromes and behaviors. It is frequently defined as an increase in psychomotor activity, aggression, disinhibition/impulsivity, and irritable or labile mood. Etiologies of acute agitation include medical disorders, delirium, substance intoxication or withdrawal, psychiatric disorders, and medication side effects. Treatment of acute agitation requires both environmental and pharmacologic intervention. Patients should be calmed with sedating agents early in the course of treatment, allowing for diagnostic tests to take place. Failure to correctly diagnose causes of agitation may lead to delayed treatment for serious conditions, and can even exacerbate agitation.The most common cause of agitation in patients with schizophrenia is psychotic relapse due to medication nonadherence. Pharmacologic treatment options for these patients include lorazepam and antipsychotic agents. Lorazepam causes nonspecific sedation and treats some substance withdrawal, but has little effect on psychosis. First-generation antipsychotics treat psychosis and, at high enough doses, cause sedation, but may induce extrapyramidal side effects (EPS). Some second-generation antipsychotics have been approved for the treatment of agitation in schizophrenia. These agents treat psychosis with a favorable EPS profile, but are comparatively expensive and cause risks such as hypotension. However, avoiding EPS may reduce patients' resistance to antipsychotic treatment.
In this expert roundtable supplement, Joseph Battaglia, MD, provides an overview of the definition of acute agitation. Next, Delbert, G. Robinson, MD, outlines evaluation methods for actue agitation. Finally, Leslie Citrome, MD, MPH, reviews interventions for acute and ongoing management of agitation.