scholarly journals Symptomatic fever management in children: A systematic review of national and international guidelines

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0245815
Author(s):  
Cari Green ◽  
Hanno Krafft ◽  
Gordon Guyatt ◽  
David Martin
Keyword(s):  
The Body ◽  
Healthcare Organizations ◽  
Level Of Evidence ◽  
Low Level ◽  
Pediatric Society ◽  
Age Related ◽  
Symptomatic Management ◽  
Guideline Quality ◽  
High Level ◽  
Grade Assessment

Introduction Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out. Methods Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country (with date coverage from January 1995 to September 2020). Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis. Methods and results are reported according to the PRISMA statement. Results 74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3–4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis. Conclusion There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence–this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.

scholarly journals Symptomatic fever management in children: A systematic review of national and international guidelines

2021 ◽  
Author(s):  
Cari Green ◽  
Hanno Kraft ◽  
Gordon Guyatt ◽  
David Martin
Keyword(s):  
The Body ◽  
Level Of Evidence ◽  
Low Level ◽  
Pediatric Society ◽  
Age Related ◽  
Guideline Quality ◽  
Level 3 ◽  
Grade Assessment ◽  
Based Medicine ◽  
Fever Management

AbstractIntroductionA comprehensive assessment of the recommendations made by clinical practice guidelines (CPGs) on symptomatic fever management in children has not been carried out.MethodsSearches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country. Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis.Results74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3-4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis.ConclusionThere is no recommendation on which all guidelines agree, and many are inconsistent with the evidence – this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.

The effects of genotype and post-weaning nutrition on compensatory growth in cattle reared as singles or twins

1987 ◽  
Vol 45 (3) ◽  
pp. 423-432 ◽  
Author(s):  
I. A. Wright ◽  
A. J. F. Russel ◽  
E. A. Hunter
Keyword(s):  
Body Composition ◽  
Live Weight ◽  
The Body ◽  
Equal Weight ◽  
Low Level ◽  
Limited Opportunity ◽  
Similar Weight ◽  
Grazing Period ◽  
And Performance ◽  
High Level

ABSTRACTThirty-five Charolais × Blue-Grey and Charolais × (Hereford × Friesian) weaned suckled calves which had been reared as either singles or twins and 19 single-reared Luing and Charolais × Luing weaned suckled calves were given silagead libitumsupplemented with either 0·75 or 2·5 kg rolled barley per day during the post-weaning winter. During summer the cattle continuously grazed perennial ryegrass swards. The high level of barley supplementation increased winter live-weight gain by 0·25 kg/day (P< 0·001). During summer the cattle from the low level of feeding gained weight at 0·09 kg/day (P< 0·05) faster than those from the high level of feeding. However, by the end of the summer grazing period the cattle on the low level of feeding were proportionately only 0·97 the weight of the animals on the high level of feeding.During winter the performance of all genotypes was similar, but at pasture the Luing cattle gained less weight (P< 0·01) than the single-reared Charolais-cross genotypes.Twin-reared cattle took 55 days longer to reach slaughter condition, but produced carcasses of equal weight and fatness to those from single-reared cattle.The twin-reared cattle on the high level of feeding and the single-reared cattle on the low level of feeding attained a similar weight, body condition and ultrasonic backfat at turn-out. Thereafter, their herbage intakes and live-weight gains were identical suggesting that previous level of feeding per se is unimportant in determining an animal's subsequent intake and performance. Rather it is the body composition at a given age, irrespective of the pathway followed to attain that composition, that determines performance thereafter. It is also suggested that the inability of cattle to compensate for a reduction in level of nutrition during the first 3 to 4 months of life is due to the lack of potential for fat deposition, and there is thus limited opportunity for nutritional manipulation of body composition at that age.

scholarly journals The high-level basis of body adaptation

2018 ◽  
Vol 5 (6) ◽  
pp. 172103 ◽  
Author(s):  
Kevin R. Brooks ◽  
Colin W. G. Clifford ◽  
Richard J. Stevenson ◽  
Jonathan Mond ◽  
Ian D. Stephen
Keyword(s):  
The Body ◽  
Minor Role ◽  
Low Level ◽  
Visual Exposure ◽  
Object Based ◽  
High Level ◽  
A Minor

Prolonged visual exposure, or ‘adaptation’, to thin (wide) bodies causes a perceptual aftereffect such that subsequently seen bodies appear wider (thinner) than they actually are. Here, we conducted two experiments investigating the effect of rotating the orientation of the test stimuli by 90° from that of the adaptor. Aftereffects were maximal when adapting and test bodies had the same orientation. When they differed, the axis of the perceived distortion changed with the orientation of the body. Experiment 1 demonstrated a 58% transfer of the aftereffect across orientations. Experiment 2 demonstrated an even greater degree of aftereffect transfer when the influence of low-level mechanisms was reduced further by using adaptation and test stimuli with different sizes. These results indicate that the body aftereffect is mediated primarily by high-level object-based processes, with low-level retinotopic mechanisms playing only a minor role. The influence of these low-level processes is further reduced when test stimuli differ in size from adaptation stimuli.

scholarly journals Guidelines in Gastroenterology: Careful Interpretation Is Essential

2021 ◽  
pp. 1-7
Author(s):  
Catarina Correia ◽  
Nuno Almeida ◽  
Pedro Narra Figueiredo
Keyword(s):  
Clinical Practice ◽  
Expert Opinion ◽  
North American ◽  
Clinical Judgment ◽  
Scientific Evidence ◽  
Improve Patient Care ◽  
Level Of Evidence ◽  
Low Level ◽  
High Level ◽  
Improve Patient

<b><i>Introduction:</i></b> Clinical practice guidelines (CPG) contain recommendations that aim to guide physicians in the diagnosis of and therapeutic approach toward patients affected by gastrointestinal (GI) pathologies. These CPG systematically combine scientific evidence and clinical judgment, culminating in recommendations that have been shown to improve patient care. <b><i>Material and Methods:</i></b> European and North American guidelines published in the area of gastroenterology in 2018 and 2019 were considered for inclusion. To standardize the results, only guidelines that used GRADE as an evidence system were included. Thus, in the end, 1,233 recommendations from 29 guidelines published between 2018 and 2019 were analyzed. <b><i>Results:</i></b> Of the 1,233 recommendations collected, 324 (26.3%) had a low level of evidence and 127 (10.3%) had a very low level of evidence, indicating little evidence or expert opinion. Of the 29 publications analyzed, 14 (48.3%) did not present any recommendation with a high level of evidence. Regarding the 1,233 individual recommendations expressed in these 29 publications, only 336 (27.25%) assumed a high level of evidence, with 277 (82.44%) referring to liver pathology. Of the recommendations evaluated, 77 were from North American societies and the remaining 1,156 were European recommendations. In relation to the first group, only 3 (3.9%) had a high level of evidence belonging to the Guidelines for Sedation and Anesthesia in GI Endoscopy. <b><i>Conclusions:</i></b> More than 25% of all recommendations currently accepted to guide patients with gastroenterological disorders are based on low-quality evidence or expert opinion. Thus, these documents should guide our performance, but clinical sense and multidisciplinarity must not be overlooked in dubious cases and with weak scientific evidence. Research should focus on the development of randomized controlled trials and systematic reviews to improve the evidence supporting the guidelines that guide clinical practice.

scholarly journals Corporate Governance Mechanisms, Whistle-Blowing Policy and Real Earnings Management

2019 ◽  
Vol 10 (6) ◽  
pp. 265 ◽  
Author(s):  
Mujeeb Saif Mohsen Al-Absy ◽  
Ku Nor Izah Ku Ismail ◽  
Sitraselvi Chandren
Keyword(s):  
Corporate Governance ◽  
Earnings Management ◽  
Resource Dependence ◽  
The Body ◽  
Real Earnings Management ◽  
Ownership Concentration ◽  
Whistle Blowing ◽  
Low Level ◽  
High Level

The purpose of this study is to investigate whether the mechanisms of corporate governance (CG) in firms that have a policy of whistle-blowing (WBP) are more effective in mitigating real earnings management (REM) than those without WBP. To achieve this objective, the sample of the study, 288 Malaysian firms for the years 2013 to 2015, have been grouped into firms with and without WBP. In addition, the Roychowdhury Models were used to determine the abnormal levels of the REM. The results show that most of the CG mechanisms, i.e., audit committee (AC) size, AC meetings, AC independence and auditor size in firms with WBP are found to be significantly associated with low level of REM which supporting agency and resource dependence theories. However, only board independence and ownership concentration are found to be significantly associated with high level of REM. Regarding firms without WBP, most of the CG mechanisms, i.e., AC size, women in the AC, AC accenting expertise and ownership concentration, are found to be significantly associated with high level of REM. However, only board meetings, AC multiple directorships and auditor size are found to be significantly associated with low level of REM. The finding of this study suggests that having WBP in a firm could improve the monitoring role of the CG mechanisms towards mitigating REM. However, strengthening the role of WBP is still necessary to improve the efficiency of the monitoring role of CG mechanisms. Hence, there is a need for more policy and law that could encourage whistle-blowers to disclose any misconducts in firms and at the same time, prevent management from undermining the effectiveness of the whistle-blowing policy. The findings of this study will enrich the body of literature where there is no previous study has been done in respect of REM.

Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings

Cephalalgia ◽  
2014 ◽  
Vol 35 (3) ◽  
pp. 271-284 ◽  
Author(s):  
Serena L Orr ◽  
Michel Aubé ◽  
Werner J Becker ◽  
W Jeptha Davenport ◽  
Esma Dilli ◽  
...  
Keyword(s):  
Task Force ◽  
Practice Variation ◽  
Moderate Level ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Low Level ◽  
Lysine Clonixinate ◽  
High Level ◽  
Meta Analyses ◽  
Quality Evidence

Background There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line. Methods A peer-reviewed search of databases (MEDLINE, Embase, CENTRAL) was carried out to identify randomized and quasi-randomized controlled trials of interventions for acute pain relief in adults presenting with migraine to emergency settings. Where possible, data were pooled into meta-analyses. Results Two independent reviewers screened 831 titles and abstracts for eligibility. Three independent reviewers subsequently evaluated 120 full text articles for inclusion, of which 44 were included. Individual studies were then assigned a US Preventive Services Task Force quality rating. The GRADE scheme was used to assign a level of evidence and recommendation strength for each intervention. Interpretation We strongly recommend the use of prochlorperazine based on a high level of evidence, lysine acetylsalicylic acid, metoclopramide and sumatriptan, based on a moderate level of evidence, and ketorolac, based on a low level of evidence. We weakly recommend the use of chlorpromazine based on a moderate level of evidence, and ergotamine, dihydroergotamine, lidocaine intranasal and meperidine, based on a low level of evidence. We found evidence to recommend strongly against the use of dexamethasone, based on a moderate level of evidence, and granisetron, haloperidol and trimethobenzamide based on a low level of evidence. Based on moderate-quality evidence, we recommend weakly against the use of acetaminophen and magnesium sulfate. Based on low-quality evidence, we recommend weakly against the use of diclofenac, droperidol, lidocaine intravenous, lysine clonixinate, morphine, propofol, sodium valproate and tramadol.

scholarly journals Assessment of market parameters of multiple age groups of the galician carp

2017 ◽  
Vol 19 (74) ◽  
pp. 29-32
Author(s):  
I. I. Hrytsyniak ◽  
V. V. Gurbyk
Keyword(s):  
Age Groups ◽  
Morphometric Parameters ◽  
The Body ◽  
Normative Values ◽  
Fish Products ◽  
Edible Part ◽  
Age Related ◽  
Productive Potential ◽  
High Level ◽  
Edible Parts

Purpose: To assess the productive potential of the Galician carp taking into account its morphometric parameters. To assess the market parameters of the Galician carp produced in the conditions of commercial aquaculture in ponds of the Subcarpathian region. To determine the output of fish products depending on fish age-related differences. Task: to determine major morphometric parameters in age-2 and age-3 cap produced at the end of the culture season in ponds of the Subcarpathian region; to assess the output of edible and non-edible parts of the body of the Galician carp. Methodology: The study was carried out in 2016 at the fish farm «Korop», Lviv region. The object of the study were age-2 and age-3 Galician carp produced at the end of the culture season. Fish were investigated according to methodical guidelines. The largest part of the body weight of the examined Galician carp was filet with skin. The smallest part in both age groups was scales that is due to the framed type of their scale covering. The quantity of edible parts in age-3 fish was 4.3% higher than in age-2 fish. The parameter of potentially edible parts in age-2 and age-3 fish was at the same level and did not exceed 32%. The non-edible part of the body in both age groups did not exceed 16%. In age-2 Galician carp, the edible part was 1.5% larger than in carp of the Lubin type of Ukrainian framed strain. In age-3 fish, the percent ratio of the head was 4.45% lower than in the Lubin type.  After analyzing the obtained experimental  data, a conclusion can be drawn that the output of edible parts in both age groups of the Galician carp from the marketable fish mass exceeded the normative values. At the same time, age-3 fish had 4% more filet than the age-2 fish. The Galician carp have a high level of the output of high quality market products compared to fish of the Lubin type of Ukrainian framed strain. An assessment of market parameters of the Galician carp produced during commercial culturing in ponds of the Subcarpathian region. The quantities of edible and non-edible parts in age-2 and age-3 fish of the examined array were determined.

scholarly journals Análisis antropométrico y de somatotipo en jugadores de pádel en función de su nivel de juego (Anthropometric and somatotype analysis between padel players according to their level of play)

Retos ◽  
2020 ◽  
pp. 285-290
Author(s):  
Diego Muñoz Marín ◽  
Víctor Toro Román ◽  
Francisco Javier Grijota Pérez ◽  
Javier Courel Ibañez ◽  
Alejandro Sánchez Pay ◽  
...  
Keyword(s):  
Body Composition ◽  
Muscle Mass ◽  
The Body ◽  
The Other ◽  
Low Level ◽  
First Category ◽  
Other Hand ◽  
Anthropometric Characteristics ◽  
Para Determinar ◽  
High Level

  El objetivo de este estudio fue analizar la composición corporal y el somatotipo en jugadores de pádel en función de la categoría de juego. La muestra incluyó a 40 jugadores masculinos de pádel distribuidos en 2 grupos: 20 jugadores de primera categoría (alto nivel, edad: 28.3 ± 8.3 años) y 20 de tercera categoría (bajo nivel, edad: 30.5 ± 7.5 años). Se tomaron medidas de peso, altura, pliegues, diámetros y perímetros para determinar la composición corporal y somatotipo. Los jugadores de bajo nivel (tercera categoría) mostraron un mayor IMC (23.8 ± 2.4 vs 25.7 ± 2.3 kg/m2) y mayores valores de pliegues abdominal y subescapular, en comparación con los de alto nivel (p <.05). Por el contrario, los jugadores de primera categoría presentaron mayor porcentaje muscular y menor porcentaje graso en comparación con los jugadores de tercera categoría, resultando en un somatotipo ectomorfo de los jugadores de alto nivel (p <.05). En conclusión, los jugadores de pádel presentan unas características antropométricas y de somatotipo diferentes según la categoría de juego, con una notable mejor composición corporal en los jugadores de mayor nivel.  Abstract. This study aimed to analyse the body composition and somatotype in padel players according to their playing category. The sample comprised 40 male padel players divided into two groups: 20 players of first category (high level, age: 28.3 ± 8.3 years) and 20 padel player of third category (low level, age: 30.5 ± 7.5 years). Weight, height, skin folds, diameters and perimeters were measured to determine the body composition and somatotype. Low level players showed higher BMI (23.8 ± 2.4 vs 25.7 ± 2.3 kg/m2) and higher abdominal and subscapular skin folds compared to high level players (p < .05). On the other hand, the first category players had higher muscle mass and lower fat percentages than third category players, resulting in an ectomorphic somatotype in high level players (p <.05). In conclusion, padel players present different anthropometric characteristics and somatotype regarding their level of play, with a notably better body composition in players from a higher level.

“Think of the Children!”

2019 ◽  
pp. 235-254
Author(s):  
Hsiu-Feng Wang
Keyword(s):  
Visual Complexity ◽  
Learning Motivation ◽  
Older Children ◽  
Aesthetic Preference ◽  
Low Level ◽  
Visual Aesthetics ◽  
Age Related ◽  
Medium Level ◽  
High Level ◽  
Different Levels

This experiment examined children's visual aesthetics and learning motivation with regard to websites. It applied Berlyne's theory of aesthetic preference to these websites. The experiment explored the relations between visual complexity, visual aesthetics, learning motivation, and children's age, and their effect on websites. A total of 150 children between 10 and 12 years old were involved. The children were asked to rate websites of different levels of perceived visual complexity in terms of visual aesthetic and learning motivation. The results showed that the children preferred websites that displayed a medium level of perceived visual complexity to those that displayed a high or low level of perceived visual complexity. Thus, the results supported Berlyne's theory. However, when aesthetic preference was analyzed with respect to age-related differences, it was found that older children preferred a medium level of perceived visual complexity and younger children preferred a high level of perceived visual complexity.

scholarly journals Use it or lose it: tonic activity of slow motoneurons promotes their survival and preferentially increases slow fiber-type groupings in muscles of old lifelong recreational sportsmen

2016 ◽  
Vol 26 (4) ◽  
Author(s):  
Simone Mosole ◽  
Ugo Carraro ◽  
Helmut Kern ◽  
Stefan Loefler ◽  
Sandra Zampieri
Keyword(s):  
Motor Neurons ◽  
Fiber Type ◽  
Functional Decline ◽  
Muscle Fibers ◽  
Motor Units ◽  
The Body ◽  
Age Related ◽  
Immuno Histochemistry ◽  
High Level ◽  
And Function

Histochemistry, immuno-histochemistry, gel electrophoresis of single muscle fibers and electromyography of aging muscles and nerves suggest that: i) denervation contributes to muscle atrophy, ii) impaired mobility accelerates the process, and iii) lifelong running protects against loss of motor units. Recent corroborating results on the muscle effects of Functional Electrical Stimulation (FES) of aged muscles will be also mentioned, but we will in particular discuss how and why a lifelong increased physical activity sustains reinnervation of muscle fibers. By analyzing distribution and density of muscle fibers co-expressing fast and slow Myosin Heavy Chains (MHC) we are able to distinguish the transforming muscle fibers due to activity related plasticity, to those that adapt muscle fiber properties to denervation and reinnervation. In muscle biopsies from septuagenarians with a history of lifelong high-level recreational activity we recently observed in comparison to sedentary seniors: 1. decreased proportion of small-size angular myofibers (denervated muscle fibers); 2. considerable increase of fiber-type groupings of the slow type (reinnervated muscle fibers); 3. sparse presence of muscle fibers co-expressing fast and slow MHC. Immuno-histochemical characteristics fluctuate from those with scarce fiber-type modulation and groupings to almost complete transformed muscles, going through a process in which isolated fibers co-expressing fast and slow MHC fill the gaps among fiber groupings. Data suggest that lifelong high-level exercise allows the body to adapt to the consequences of the age-related denervation and that it preserves muscle structure and function by saving otherwise lost muscle fibers through recruitment to different slow motor units. This is an opposite behavior of that described in long term denervated or resting muscles. These effects of lifelong high level activity seems to act primarily on motor neurons, in particular on those always more active, i.e., on the slow motoneurons. The preferential reinnervation that follows along decades of increased activity maintains neuron and myofibers. All together the results open interesting perspectives for applications of FES and electroceuticals for rejuvenation of aged muscles to delay functional decline and loss of independence that are unavoidable burdens of advanced aging. Trial Registration: ClinicalTrials.gov: NCT01679977.

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