To see, meet and adapt – an interview study about physiotherapists’ pedagogical approach to dementia

Background Physiotherapists need to use pedagogical approaches and strategies in their work. However, there is no previous definition of what a pedagogical approach in physiotherapy means neither in general nor specifically to dementia. The purpose of this study was therefore to gain greater insight into physiotherapists’ pedagogical approach to dementia by investigating physiotherapists’ views and working methods in contact with older people with dementia, relatives, and nursing staff in elderly care. Methods This was a qualitative study with an inductive approach. Semi-structured individual interviews were conducted with 15 physiotherapists with experience of working with older people with dementia in elderly care. The interviews were analyzed with qualitative content analysis. Results The term “pedagogical approach” could sometimes be experienced as “vague” or “hard to grasp”. Our research nonetheless identified one overarching theme To see, meet and adapt which is based on insights from the interviews grouped in to five categories. This theme can be seen as an expression of the physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff. It captures the participants’ desire to always see the person in front of them, meet them where they are and adapt their own way of working accordingly. Creating a trusting relationship was described as important and made it easier for the participants to adapt their working methods. The participants’ adaptations could apply to the way they communicated with people with dementia, and how they organized tutoring/education of relatives and nursing staff to maximize learning. Learning through experience and reflection was described as a key to advancing the pedagogical approach and the participants experienced their own learning as constantly ongoing. Conclusions This study provides increased understanding into physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff in elderly care and shows that learning through experience and reflection can contribute to the development of the pedagogical approach. Thus, opportunity for reflection should be accommodated in the physiotherapists’ work. The importance of more pedagogical education for physiotherapists both in bachelor and master level were also highlighted. Increasing mobility and physical activity in older people with dementia is important since physical inactivity and sedentary behavior is common. Future research may be directed at further exploring physiotherapists’ pedagogical approach in tutoring/education of nursing staff, with the aim of increasing physical activity among older people with dementia.

Emergence in Southern France of a new SARS-CoV-2 variant of probably Cameroonian origin harbouring both substitutions N501Y and E484K in the spike protein

SARS-CoV-2 variants have become a major virological, epidemiological and clinical concern, particularly with regard to the risk of escape from vaccine-induced immunity. Here we describe the emergence of a new variant. For twelve SARS-CoV-positive patients living in the same geographical area of southeastern France, qPCR testing that screen for variant-associated mutations showed an atypical combination. The index case returned from a travel in Cameroon. The genomes were obtained by next-generation sequencing with Oxford Nanopore Technologies on GridION instruments within approximately 8 h. Their analysis revealed 46 mutations and 37 deletions resulting in 30 amino acid substitutions and 12 deletions. Fourteen amino acid substitutions, including N501Y and E484K, and 9 deletions are located in the spike protein. This genotype pattern led to create a new Pangolin lineage named B.1.640.2, which is a phylogenetic sister group to the old B.1.640 lineage renamed B.1.640.1. Both lineages differ by 25 nucleotide substitutions and 33 deletions. The mutation set and phylogenetic position of the genomes obtained here indicate based on our previous definition a new variant we named 'IHU'. These data are another example of the unpredictability of the emergence of SARS-CoV-2 variants, and of their introduction in a given geographical area from abroad.

U-Shaped Association Between Serum Uric Acid and Short-Term Mortality in Patients With Infective Endocarditis

BackgroundIncreased uric acid (UA) levels have been reported to be associated with poor clinical outcomes in several conditions. However, the prognostic value of UA in patients with infective endocarditis (IE) is yet unknown.MethodsA total of 1,117 patients with IE were included and divided into two groups according to the current definition of hyperuricemia (UA>420 μmol/L in men and >360 μmol/L in women): hyperuricemia group (n=336) and normouricemia group (n=781). The association between the UA level and short-term outcomes were examined.ResultsThe in-hospital mortality was 6.2% (69/1117). Patients with hyperuricemia carried a higher risk of in-hospital death (9.8% vs. 4.6%, p=0.001). Hyperuricemia was not an independent risk factor for in-hospital death (adjusted odds ratio [aOR]=1.92, 95% confidence interval [CI]: 0.92-4.02, p=0.084). A U-shaped relationship was found between the UA level and in-hospital death (p<0.001). The in-hospital mortality was lower in patients with UA in the range 250–400 μmol/L. The aOR of in-hospital death in patients with UA>400 and <250 μmol/L was 3.48 (95% CI: 1.38-8.80, p=0.008) and 3.28 (95%CI: 1.27-8.51, p=0.015), respectively. Furthermore, UA>400 μmol/L (adjusted hazard ratio [aHR]=3.54, 95%CI: 1.77-7.07, p<0.001) and <250 μmol/L (aHR=2.23, 95%CI: 1.03-4.80, p=0.041) were independent risk factors for the 6-month mortality.ConclusionThe previous definition of hyperuricemia was not suitable for risk assessment in patients with IE because of the U-shaped relationship between UA levels and in-hospital death. Low and high levels of UA were predictive of increased short-term mortality in IE patients.

Neomisticius platypi n. sp. and N. variabilis n. sp. (Tylenchomorpha: Anguinidae) from dead oak trees in Japan

Summary Two new Neomisticius species, typologically and phylogenetically close to each other, are described and illustrated from dead Quercus trees and an ambrosia beetle, Platypus quercivorus. The two species share some stylet morphological characteristics, namely, they both possess a long conus occupying more than half of the total stylet length, a long crustaformeria composed of more than 160 cells (eight rows of more than 20 cells each), and a short and broad female tail with a digitate tip. They are distinguished from each other by N. variabilis n. sp. having a wide, spindle-shaped male bursa with a blunt terminus and N. platypi n. sp. having an oval bursa with a rounded terminus. In addition, the males and females of both species have three large rectal glands and the posterior end of the male testis (distal end of the vas deferens) bears three cells that seemingly function as a valve between the vas deferens and the cloacal tube. These characteristics have not been reported in other tylenchids. Currently, the genus contains only three species: the two new species and N. rhizomorphoides, which has a normal stylet with a short conus, a short crustaformeria, and lacks rectal glands and valve cells in the vas deferens. Therefore, the two new species are readily distinguished from N. rhizomorphoides and, based on the previous definition, may even represent a new genus. However, considering their phylogenetic closeness and biological similarities (e.g., association with ambrosia beetles), the generic definition of Neomisticius was emended to include these new species.

Impact of Three Different Algorithms for the Screening of SSc-PAH and Comparison with the Decisions of a Multidisciplinary Team

Background: to compare three existing screening algorithms of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) with the results of a multidisciplinary team (MDT) meeting from a tertiary center. Methods: we conducted a monocentric longitudinal study from 2015 to 2018. All patients with SSc according to LeRoy’s classification were eligible. Patients were excluded in the case of missing data required by any of the three screening algorithms. The algorithms were applied for each patient at inclusion. Right heart catheterization (RHC) was performed based on the MDT decision. MDT members were all blinded from the results of the three algorithms regarding RHC recommendations. The RHC recommendations of each algorithm were compared with the MDT decision, and the impact on diagnosis and management was evaluated. Results: 117 SSc patients were consecutively included in the study, and 99 had follow-up data over the three-year duration of the study (10 deaths). Among the 117 patients, the MDT suggested RHC for 16 patients (14%), DETECT algorithm for 28 (24%), ASIG for 48 (41%) and ESC/ERS 2015 for 20 (17%). Among the 16 patients who had RHC, SSc-PAH was diagnosed in seven. Among patients with an initial recommendation of RHC based on at least one algorithm but not according to the MDT meeting, no SSc-PAH was diagnosed during the three-year follow-up. Results were unchanged when the new 2018 definition of PAH was applied instead of the previous definition. Conclusion: a MDT approach appears interesting for the screening of SSc-PAH, with a significant reduction of RHC performed in comparison with dedicated algorithms. The specific relevance of a MDT for the management and follow-up of patients with RHC recommended by existing algorithms but with no PAH warrants further studies.

Análise dos Tensores Antropogênicos dos Mangues no Complexo Estuarino Real- Piauí-Fundo, sul de Sergipe

Os mangues do litoral sul de Sergipe sobrevivem em meio à presença de tensores antropogênicos comprometedores da existência do ecossistema manguezal. Objetiva-se analisar os tensores antropogênicos que afetam os mangues Avicennia schaueriana Stapf. & Leech, Laguncularia racemosa (L.) Gaertn.f. e Rhizophora mangle L. e os níveis de vulnerabilidade decorrentes da tensão, no complexo estuarino Real-Piauí-Fundo/ Sergipe. Mediante adaptações na metodologia de Laranjeira e de Oliveira com Melo e Souza, foram determinadas características definidoras da transformação dos mangues. Os tensores foram observados sistematicamente nos estuários inferior, médio e superior, com base na definição prévia de atributos de tensão. Para avaliação conjunta dos tensores, foram determinados pesos e calculado o reescalonamento da vulnerabilidade. Os dados expressos em quadros, gráficos e mapa produzido no ArcGis, revelam: o estuário médio constitui a área de menor tensão antrópica; e o superior a área de maior vulnerabilidade, com a maior parte da faixa de mangues fora dos limites do polígono da Área de Proteção Ambiental do Litoral Sul, quando visualizados os limites da APA e as localidades da pesquisa. A sensibilidade dos estuários inferior e médio, que estão dentro da APA, foi classificada como elevada e moderada, respectivamente, revelando que os mangues do complexo estuarino estão sujeitos aos riscos das ações humanas. Mesmo dentro de um complexo estuarino, os mangues apresentam capacidade de resposta distinta aos tensores antropogênicos e chances significativas de desaparecimento. Analysis of Mangrove Anthropogenic Tensors in the Real- Piauí-Fundo Estuarine Complex, south of Sergipe, Brasil ABSTRACTThe mangroves on the south coast of Sergipe survive amid the presence of anthropogenic tensors that compromise the existence of the mangrove ecosystem. The objective is to analyze the anthropogenic tensors that affect the Avicennia schaueriana (Stapf & Leech), Laguncularia racemosa (L.) C.F. Gaertn and Rhizophora mangle (L.) and the levels of vulnerability resulting from tension, in the Real-Piauí-Fundo/ Sergipe estuarine complex. The tensors were systematically observed in the lower, middle and upper estuaries, based on the previous definition of tension attributes. For the joint assessment of the tensors, weights were determined and the rescheduling of the vulnerability was calculated. The data expressed in charts, graphs and maps produced in ArcGis, reveal: the average estuary constitutes the area with the lowest anthropogenic tension; and the upper one, the most vulnerable area, with most of the mangrove strip outside the limits of the polygon of the Environmental Protection Area of the South Coast, when viewing the APA limits and the research locations. The sensitivity of the lower and middle estuaries, which are within the APA, was classified as high and moderate, respectively, revealing that the mangroves of the estuarine complex are subject to the risks of human actions. Even within an estuarine complex, the mangroves have a different response capacity to anthropogenic tensors and significant chances of disappearance.Keywords: mangrove vulnerability. environmental stressor. mangrove. anthropic actions.

Problematika Konsep Diskresi dalam Penyelenggaraan Administrasi Pemerintahan pasca Undang-Undang Cipta Kerja

Purpose: The enactment of Law No. 11 of 2020 on Job Creation has modified several provisions governing government administration, one of which concerns discretion. Discretion, defined as the freedom of action of government officials when acting or making decisions, is redefined in the Job Creation Law, as the previous definition was deemed to obstruct investment by defining discretion as limited discretion. The community criticizes discretion, but the Job Creation Law's discretion is due to the numerous problems associated with this concept. Research Methodology: The study's problem formulation is as follows: How is the concept of discretion applied to government administration following the Job Creation Act? What issues arise as a result of the Job Creation Act's change in the concept of discretion? This legal research employs a normative juridical research methodology that combines a statutory and conceptual approach to map the concept of discretion in the Law on Job Creation and the resulting problems. Results: The Employment Creation Act expanded the concept of discretion by eliminating discretionary requirements that are inconsistent with applicable laws and regulations, resulting in several issues, including the possibility of issuing unconstitutional discretion, discretion that is inconsistent with the AUPB, and a concept of discretion that is too broad, disproportionate to the supervision of discretionary officials.

On the α-q-Mutual Information and the α-q-Capacities

The measures of information transfer which correspond to non-additive entropies have intensively been studied in previous decades. The majority of the work includes the ones belonging to the Sharma–Mittal entropy class, such as the Rényi, the Tsallis, the Landsberg–Vedral and the Gaussian entropies. All of the considerations follow the same approach, mimicking some of the various and mutually equivalent definitions of Shannon information measures, and the information transfer is quantified by an appropriately defined measure of mutual information, while the maximal information transfer is considered as a generalized channel capacity. However, all of the previous approaches fail to satisfy at least one of the ineluctable properties which a measure of (maximal) information transfer should satisfy, leading to counterintuitive conclusions and predicting nonphysical behavior even in the case of very simple communication channels. This paper fills the gap by proposing two parameter measures named the α-q-mutual information and the α-q-capacity. In addition to standard Shannon approaches, special cases of these measures include the α-mutual information and the α-capacity, which are well established in the information theory literature as measures of additive Rényi information transfer, while the cases of the Tsallis, the Landsberg–Vedral and the Gaussian entropies can also be accessed by special choices of the parameters α and q. It is shown that, unlike the previous definition, the α-q-mutual information and the α-q-capacity satisfy the set of properties, which are stated as axioms, by which they reduce to zero in the case of totally destructive channels and to the (maximal) input Sharma–Mittal entropy in the case of perfect transmission, which is consistent with the maximum likelihood detection error. In addition, they are non-negative and less than or equal to the input and the output Sharma–Mittal entropies, in general. Thus, unlike the previous approaches, the proposed (maximal) information transfer measures do not manifest nonphysical behaviors such as sub-capacitance or super-capacitance, which could qualify them as appropriate measures of the Sharma–Mittal information transfer.

Abstract P533: Incidence and Outcomes of Thrombectomy Rescue Therapies in Acute Basilar Artery Occlusions

Background: Hematoma expansion (HE) is an important therapeutic target in intracerebral hemorrhage. Recently proposed HE definitions have not been validated, and no previous definition has accounted for withdrawal of care (WOC). Objective: To compare conventional and revised definitions of hematoma expansion (HE), while accounting for WOC. Methods: We analyzed data from the ATACH-2 trial, comparing revised definitions of HE incorporating intraventricular hemorrhage (IVH) expansion to the conventional definition of “≥6 mL or ≥33%”. The primary outcome was modified Rankin Scale of 4-6 at 90-days. We calculated the incidence, sensitivity, specificity, positive and negative predictive values, and c- statistic for all definitions of HE. Definitions were compared using non-parametric methods. Secondary analyses were performed after removing patients who experienced WOC. Results: Primary analysis included 948 patients. Using the conventional definition, the sensitivity was 37.1% and specificity was 83.2% for the primary outcome. Sensitivity improved with all three revised definitions (53.3%, 48.7%, and 45.3%, respectively), with minimal change to specificity (78.4%, 80.5%, and 81.0%, respectively). The greatest improvement was seen with the definition “≥6 mL or ≥33% or any IVH”, with increased c -statistic from 60.2% to 65.9% (p < 0.001). Secondary analysis excluded 46 participants who experienced WOC. The revised definitions outperformed the conventional definition in this population as well, with the greatest improvement in c -statistic using “≥6 mL or ≥33% or any IVH” (58.1% vs 64.1%, p < 0.001). Conclusions: HE definitions incorporating intraventricular expansion outperformed conventional definitions for predicting poor outcome, even after accounting for care limitations.

Abstract P406: Revised Intracerebral Hemorrhage Expansion Definitions and Relationship With Care Limitations

Background: Hematoma expansion (HE) is an important therapeutic target in intracerebral hemorrhage. Recently proposed HE definitions have not been validated, and no previous definition has accounted for withdrawal of care (WOC). Objective: To compare conventional and revised definitions of hematoma expansion (HE), while accounting for WOC. Methods: We analyzed data from the ATACH-2 trial, comparing revised definitions of HE incorporating intraventricular hemorrhage (IVH) expansion to the conventional definition of “≥6 mL or ≥33%”. The primary outcome was modified Rankin Scale of 4-6 at 90-days. We calculated the incidence, sensitivity, specificity, positive and negative predictive values, and c- statistic for all definitions of HE. Definitions were compared using non-parametric methods. Secondary analyses were performed after removing patients who experienced WOC. Results: Primary analysis included 948 patients. Using the conventional definition, the sensitivity was 37.1% and specificity was 83.2% for the primary outcome. Sensitivity improved with all three revised definitions (53.3%, 48.7%, and 45.3%, respectively), with minimal change to specificity (78.4%, 80.5%, and 81.0%, respectively). The greatest improvement was seen with the definition “≥6 mL or ≥33% or any IVH”, with increased c -statistic from 60.2% to 65.9% (p < 0.001). Secondary analysis excluded 46 participants who experienced WOC. The revised definitions outperformed the conventional definition in this population as well, with the greatest improvement in c -statistic using “≥6 mL or ≥33% or any IVH” (58.1% vs 64.1%, p < 0.001). Conclusions: HE definitions incorporating intraventricular expansion outperformed conventional definitions for predicting poor outcome, even after accounting for care limitations.