Higher psychological distress in patients seeking care for a knee disorder is associated with diagnostic discordance between health care providers: a secondary analysis of a diagnostic concordance study

Background Knee disorders are highly prevalent and may be a disabling condition. An accurate diagnosis is necessary to guide toward a rapid and efficient management of knee disorders. However, the ability to make a valid diagnosis is often complex for clinicians and evidence is mainly focused on clinician cognitive biases or errors produced during clinical reasoning. The aim of this secondary exploratory analysis is to identify patient-specific characteristics associated with diagnostic discordance between health care providers in making a diagnosis for a new knee disorder. Methods We performed a secondary analysis of a diagnostic study comparing the diagnostic ability of a physiotherapist to medical musculoskeletal specialists. Patients’ socio-demographic, psychosocial and clinical characteristics were compared between the concordant and discordant diagnostic groups. Psychosocial symptoms were evaluated using the validated Kessler 6 (K6) questionnaire. We performed multivariable logistic regressions using the Bayesian Information Criterion to identify the most probable model including patients’ characteristics associated with diagnostic discordance. Overall probability of identified variables to explain diagnostic discordance and associated odd ratios (OR) with 95% credibility intervals (95% CrI) were calculated. Results Overall, 279 participants were evaluated by a physiotherapist and medical musculoskeletal specialists. The mean age of the participants was 49.1 ± 15.8 years and 57.7% were female. The most common disorder was osteoarthritis (n = 117, 18.8% of cases were discordant). The most probable model explaining diagnostic discordance (11.13%) included having depressive symptoms, which was associated with an increased probability of diagnostic discordance (OR: 3.9; 95% CrI: 1.9 – 8.0) and having a higher number of comorbidities, which was associated with a decreased probability of diagnostic discordance (OR: 0.6; 95% CrI: 0.5 – 0.9). The depression item of the K6 questionnaire had a 99.4% chance to be included in a model explaining diagnostic discordance. Other variables taken separately had less than 50% chance to be included in a model explaining diagnostic discordance and cannot be considered significant. Conclusion Our results suggest that depressive symptoms may increase the risk of knee diagnostic discordance. Clinicians may be more likely to make diagnostic errors and should be more cautious when evaluating patients with knee disorders suffering from psychological distress.

Missional metanoia: Missional spirituality in holistic theological education

Theological education is in crisis having lost an important dimension with its main focus on quality academics often abstracted from real life. This study aimed to propose that the formation of spirituality is fundamental to theological education and that theological education should be a holistic formation. The setting of this study is re-imaging theological education in the Dutch Reformed Church (DRC), a denomination in the process of missional transformation, but it is also applicable to theological education in general. This study focused on the relation between theology and spirituality, the significance of missional spirituality in theological education and a probable model for the formation of a missional spirituality. The study found that theology and spirituality are interdependent, and theological education should thus focus on all the different areas of learning and formation, that is, minimum knowledge base, pass-on-able habits and skills, and attitudes and beliefs. Theological education should ultimately cultivate a missional spirituality, forming missional leaders for the church. Leaders who are equipped are able to equip others for God’s mission. Theological education is not about obtaining a degree but in essence a process of formation and transformation. Wright asks: if the gospel is not transforming you, will it transform anything else? Transformation to be able to transform – a missional metanoia.Contribution: This study provides a probable model for holistic theological education and the formation of a missional spirituality.

Time-dependent spectral-feature variations of stars displaying the B[e] phenomenon

We present an alternative model of V2028 Cyg, a B[e] star of FS CMa type. The star V2028 Cyg is atypical among FS CMa stars due to its composite spectra of B4III and K2II-Ib type. Our modelling of the temporal variability of the Hα line bisectors indicates as the most probable model a geometrically and optically thick disc, which is surrounded by a dusty ring seen almost edge-on. This provides a possibility that the K-spectral component is formed in the disc.

White-Collar Crime: Ukrainian Experience of Searching for Optimal Model of Criminal Liability

The Professor of the Law Institute of Poltava Nataliya O. Gutorova analyses quite a sensitive issue for society – white-collar crime in Ukraine, defining the optimally probable model of criminal liability. The white-collar shadow economy level is rather high in Ukraine – 45.96 % of the GDP and correlates with the respective data of Nigeria. The author’s approach can be related to two aspects: first, prevent excessive criminalization activities; second, effectively punish white-collar criminals. Poltavas Tiesību institūta profesore Natālija Gutorova (Nataliya O. Gutorova) analizē sociāli visai sensitīvu problēmu – t. s. balto apkaklīšu noziedzību Ukrainā, izzinot iespējamo kriminālatbildības optimālo modeli. Ar baltajām apkaklītēm saistītais ēnu ekonomikas līmenis Ukrainā ir visai augsts – 45,96 % no IKP un ir tuvs atbilstošam Nigērijas rādītājam. Autores pieeja ir attiecināma uz diviem aspektiem: pirmkārt, novērst darbību pārlieku kriminalizāciju; otrkārt, efektīvi sodīt baltās apkaklītes par noziegumiem.

Sporadic ovarian cancer: the probable model of pathogenesis

This article in question dwells on a possible pathogenetic model ovarian cancer, it’s histogenesis speciality, the role of ovulation, chronic inflammation and stem cells. The scheme of two variant of avarian cancer progress and possible ways of prevention it are represented as well