História da construção de saberes em enfermagem traumato-ortopédica / History of knowledge construction in trauma and orthopedic nursing care / Historia de la construcción del conocimiento en enfermería traumatológica ortopédica

Objetivo: analisar o desenvolvimento da enfermagem traumato-ortopédica a partir da primeira turma de residentes de um hospital especializado. Método: o estudo seguiu a metodologia histórica com abordagem qualitativa. As fontes foram documentos escritos e orais. Resultados: trabalhar em uma instituição especializada foi o ponto de partida para a busca por especialização de enfermeiras atuantes no cuidado traumato-ortopédico, que perceberam o saber/poder adquirido no trabalho assistencial, além da intenção de qualificar a assistência e elevar o hospital a instituto. Estratégias empregadas reúnem a busca por parcerias com instituições universitárias e associativas, além da criação de uma associação própria. Considerações finais: a enfermagem traumato-ortopédica ampliou seu espaço científico ao criar um curso de especialização com uma unidade acadêmica. Foi possível delimitar o poder acadêmico e institucional da enfermagem na instituição de saúde pela formação de enfermeiras especialistas constituindo um grupo de reconhecido pelo saber científico.

Objective: to analyze the development of trauma and orthopedic nursing care from the very first class of residents of a specialized hospital. Method: historical methodology study with a qualitative approach. The sources consisted of written and oral documents. Results: working in a specialized institution was the starting point for nurses who were seeking specialization in the field of trauma and orthopedic care as they noticed the power-knowledge acquired through care work, plus they were willing to improve assistance and take the hospital up to an institute level. Strategies used include the search for partnerships with universities and associative-type institutions, in addition to creating their own association. Final considerations: trauma and orthopedic nursing care expanded its scientific space by creating a specialization course together with an academic unit. It was possible to define the academic and institutional power of the nursing staff in the health institution by considering the training process of its nurse specialists, who consisted of a group recognized for their scientific knowledge.

Objetivo: analizar el desarrollo de la enfermería traumatológica ortopédica a partir del primer grupo de residentes de un hospital especializado. Método: estudio con metodología histórica con un enfoque cualitativo. Las fuentes fueron documentos escritos y orales. Resultados: el trabajo en una institución especializada fue el punto de partida para la búsqueda de la especialización de las enfermeras que trabajaban en la atención traumatológica ortopédica, quienes notaron el saber/poder adquirido en el trabajo asistencial, además de la intención de cualificar la atención y elevar el hospital al nivel de instituto. Las estrategias empleadas incluyen la búsqueda de alianzas con instituciones universitarias y asociaciones, y la creación de una asociación propia. Consideraciones finales: la enfermería traumatológica ortopédica amplió su espacio científico mediante la creación de un curso de especialización con una unidad académica. Se logró delimitar el poder académico e institucional de la enfermería en la institución de salud a través de la formación de enfermeros especialistas, que es un grupo reconocido por el conocimiento científico.

Lessons Pharmacy Practice in India Should Adopt From Advanced Nations: A Review.

In India, pharmacy practice is still at a developing stage with the majority of the graduates taking the industry pathway. Currently, there are only a few pharmacists who have been board-certified by the Board of Pharmacy Specialities (BPS), which is the most established pharmacist board certification program globally. Even though India is the largest global exporter of generic medications, pharmacy practice is yet to gain stronghold within its healthcare scenarios. In this article, we aim to examine the development of pharmacy practice from a global viewpoint and scale down to the recent modern practice, particularly in advanced nations. Furthermore, we assess the ways through which pharmacy practice can be enhanced in India. Notably, with several pharmacy practice graduates completing their studies in India yearly, pharmacy practice is projected to significantly grow in the coming years. Gaining a proper understanding of and embracing advanced clinical pharmacy practices will improve the domain of pharmacy practice among both junior and senior pharmacists. Moreover, enrolling in and receiving international accreditations such as the Board of Pharmacy Specializations (BPS) will validate the practice standards being offered in India as compared to other developed countries, i.e., the US. The main objective of this review is to assess various means through which pharmacy practice can be improved in India.

Turf Wars - Is It Necessary?

Privileging processes by an apex body such as National academy of Medical sciences(NAMS) or National Medical Commission (NMC) is the need of the hour to tackle unhealthy turf wars for medical sub-specialties among specialists.

Current and future perspectives for enhancing our understanding of the evolution of plant metabolism.

The special issue 'The evolution of plant metabolism' has brought together original research, reviews and opinions that cover various aspects from the full breath of plant metabolism including its interaction with the environment including other species. Here, we briefly summarize these efforts and attempts to extract a consensus opinion of the best manner in which to tackle this subject both now and in the future. This article is part of the theme issue 'The evolution of plant metabolism'.

Body size modulates the extent of seasonal diet switching by large mammalian herbivores in Yellowstone National Park.

Prevailing theories about animal foraging behaviours and the food webs they occupy offer divergent predictions about whether seasonally limited food availability promotes dietary diversification or specialization. Emphasis on how animals compete for food predominates in work on the foraging ecology of large mammalian herbivores, whereas emphasis on how the diversity of available foods generally constrains dietary opportunity predominates work on entire food webs. Reconciling predictions about what promotes dietary diversification is challenging because species' different body sizes and mobilities modulate how they seek and compete for resources-the mechanistic bases of common predictions may not pertain to all species equally. We evaluated predictions about five large-herbivore species that differ in body size and mobility in Yellowstone National Park using GPS tracking and dietary DNA. The data illuminated remarkably strong and significant correlations between body size and five key indicators of diet seasonality (R 2 = 0.71-0.80). Compared to smaller species, bison and elk showed muted diet seasonality and maintained access to more unique foods when winter conditions constrained food availability. Evidence from GPS collars revealed size-based differences in species' seasonal movements and habitat-use patterns, suggesting that better accounting for the allometry of foraging behaviours may help reconcile disparate ideas about the ecological drivers of seasonal diet switching.

Decreased inter-hemispheric connectivity predicts a coherent retrieval of auditory symbolic material.

Investigating the transmission of information between individuals is essential to better understand how humans communicate. Coherent information transmission (i.e., transmission without significant modifications or loss of fidelity) helps preserving cultural traits and traditions over time, while innovation may lead to new cultural variants. Although much research has focused on the cognitive mechanisms underlying cultural transmission, little is known on the brain features which correlates with coherent transmission of information. To address this gap, we combined structural (from high-resolution diffusion imaging) and functional connectivity (from resting-state functional magnetic resonance imaging [fMRI]) with a laboratory model of cultural transmission, the signalling games, implemented outside the MRI scanner. We found that individuals who exhibited more coherence in the transmission of auditory symbolic information were characterized by lower levels of both structural and functional inter-hemispheric connectivity. Specifically, higher coherence negatively correlated with the strength of bilateral structural connections between frontal and subcortical, insular and temporal brain regions. Similarly, we observed increased inter-hemispheric functional connectivity between inferior frontal brain regions derived from structural connectivity analysis in individuals who exhibited lower transmission coherence. Our results suggest that lateralization of cognitive processes involved in semantic mappings in the brain may be related to the stability over time of auditory symbolic systems.

Enhancing Traditional Chinese Medicine healthcare system in Taiwan post-COVID-19 pandemic: A strategic focus on specialization.

Despite the advancements in precision medicine, regenerative medicine, and smart healthcare, traditional Chinese medicine (TCM) remains vital in Taiwan, reflecting its cultural and historical heritage. TCM is commonly used in conjunction with or as an alternative to conventional medicine and is reimbursed by Taiwan's National Health Insurance, enabling the Taiwanese people to integrate traditional and modern treatments for comprehensive healthcare. This article explores the critical role of specialization in TCM amid evolving healthcare challenges. This highlights the need for specialized knowledge among TCM physicians to manage iatrogenic risks, such as drug-herb interactions, and to improve healthcare outcomes, particularly when integrating TCM with Western medicine. Specialization enhances treatment precision, patient outcomes, and clinical research quality. Drawing on South Korea's experience in establishing a specialist physician system for traditional Korean medicine, Taiwan's Ministry of Health and Welfare's initiatives to advance systematic TCM training and regulatory frameworks were examined, showcasing the development and implementation of a TCM specialist physician training program. In conclusion, specialized physician training in TCM improves patient care, optimizes healthcare utilization, and promotes long-term sustainability of the health insurance system by aligning TCM practices with modern healthcare needs.

Associations of Sport Participation and Training Volume With Overuse Injuries in Japanese Male Youth Soccer Players: Implications for Early Sport Specialization.

BACKGROUND: Sport specialization is associated with increased risk of overuse injuries. However, the effects of sport specialization on the risk of overuse injury may differ by specific sport and sociocultural parameters. This study aimed to determine the associations of sport participation and training volume with previous overuse injuries in Japanese male youth soccer players. HYPOTHESIS: Being highly specialized before the age of 12 years and high training volume relative to participant age would be associated with a history of serious overuse injury. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Survey data were collected from male youth soccer players (seventh-ninth grade) during midseason of the 2020-2021 academic year. Participants completed a questionnaire regarding their status of sport participation (single- and multisport athletes), weekly sports volume in first- sixth grade and injury history in the previous year. Odds ratio (OR) was calculated to identify associations of specialization and training volume with a history of serious overuse injury. RESULTS: A total of 841 players (mean age, 13.7 ± 0.9 years) participated; 11% reported serious overuse injury in the previous year, and 64% participated in other sports before the age of 12 years. Players who participated in other sports at <12 years old (OR, 1.79; 95% CI, 1.09-2.94; P = 0.02) and those who trained for more weekly hours than their age in fifth to sixth grade (OR, 1.70; 95% CI, 1.07-2.72; P = 0.03) had greater odds of reporting serious overuse injuries. CONCLUSION: Multisport athletes and high training volume in fifth-sixth grade were associated with previous serious overuse injuries. CLINICAL RELEVANCE: Coaches and parents of male youth soccer players should be aware of the increased risk of serious overuse injury participating in multiple sports simultaneously, and youth athletes should adhere to age-appropriate volume recommendations.

Super-Speciality in India: A Boon or Bane?

In the past few decades, super-specialization has gained popularity in many medical disciplines. It provides professionals with a sturdy platform for advanced research and helps to deliver focused and extensive care in the fields of trauma and critical care, which can translate into good clinical outcomes for patients. Although this drift may bring about novel research opportunities, it may limit the number of doctors attending to the basic healthcare needs of the population. India is still struggling to provide primary healthcare services to its population. Super-specialization is a highly technology-driven industry, the costs of which our public health system cannot endure in the present settings. The current demand in India, where basic priorities are yet to be met, is to increase health awareness, provide basic healthcare facilities, and generate interest among medical professionals in providing general health services, especially in rural areas.

Katanin regulatory subunit B1 (KATNB1) regulates BTB dynamics through changes in cytoskeletal organization.

In this study, we have explored the role of the KATNB1 gene, a microtubule-severing protein, in the seminiferous epithelium of the rat testis. Our data have shown that KATNB1 expressed in rat brain, testes, and Sertoli cells. KATNB1 was found to co-localize with α-tubulin showing a unique stage-specific distribution across the seminiferous epithelium. Knockdown of KATNB1 by RNAi led to significant disruption of the tight junction (TJ) permeability barrier function in primary Sertoli cells cultured in vitro with an established functional TJ-barrier, as well as perturbations in the microtubule and actin cytoskeleton organization. The disruption in these cytoskeletal structures, in turn, led to improper distribution of TJ and basal ES proteins essential for maintaining the Sertoli TJ function. More importantly, overexpression of KATNB1 in the testis in vivo was found to block cadmium-induced blood-testis barrier (BTB) disruption and testis injury. KATNB1 exerted its promoting effects on BTB and spermatogenesis through corrective spatiotemporal expression of actin- and microtubule-based regulatory proteins by maintaining the proper organization of cytoskeletons in the testis, illustrating its plausible therapeutic implication. In summary, Katanin regulatory subunit B1 (KATNB1) plays a crucial role in BTB and spermatogenesis through its effects on the actin- and microtubule-based cytoskeletons in Sertoli cells and testis, providing important insights into male reproductive biology.

Social wasp-associated Tsukamurella sp. strains showed promising biosynthetic and bioactive potential for discovery of novel compounds.

In the face of escalating antibiotic resistance, the quest for novel antimicrobial compounds is critical. Actinobacteria is known for producing a substantial fraction of bioactive molecules from microorganisms, nonetheless there is the challenge of metabolic redundancy in bioprospecting. New sources of natural products are needed to overcome these current challenges. Our present work proposes an unexplored potential of Neotropical social wasp-associated microbes as reservoirs of novel bioactive compounds. Using social wasp-associated Tsukamurella sp. strains 8F and 8J, we aimed to determine their biosynthetic potential for producing novel antibiotics and evaluated phylogenetic and genomic traits related to environmental and ecological factors that might be associated with promising bioactivity and evolutionary specialization. These strains were isolated from the cuticle of social wasps and subjected to comprehensive genome sequencing. Our genome mining efforts, employing antiSMASH and ARTS, highlight the presence of BGCs with minimal similarity to known compounds, suggesting the novelty of the molecules they may produce. Previous, bioactivity assays of these strains against bacterial species which harbor known human pathogens, revealed inhibitory potential. Further, our study focuses into the phylogenetic and functional landscape of the Tsukamurella genus, employing a throughout phylogenetic analysis that situates strains 8F and 8J within a distinct evolutionary pathway, matching with the environmental and ecological context of the strains reported for this genus. Our findings emphasize the importance of bioprospecting in uncharted biological territories, such as insect-associated microbes as reservoirs of novel bioactive compounds. As such, we posit that Tsukamurella sp. strains 8F and 8J represent promising candidates for the development of new antimicrobials.

The left-lateralized N170 for visual specialization in advanced L2 Chinese learners.

Visual word recognition is crucial for improving reading skills in second language learners (L2Ls). It is unclear whether L2Ls who are native speakers of languages that use alphabetic scripts can recognize Chinese characters at an early stage of visual processing and if their visual specialization can reach a level of word recognition comparable to that of native Chinese speakers. This study aims to uncover the visual specialization mechanism of Chinese L2Ls. A delayed-color matching task was carried out with participants who were Chinese first language speakers (L1Ss) and advanced Chinese L2Ls with Indonesian as their first language. The results of the event-related potentials (ERPs) indicated that L2Ls exhibited significant visual specialization with a predominant distribution of the left-lateralized N170, along with some activation in the right hemisphere. These findings suggest that the early processing stage of Chinese characters by advanced L2Ls is similar to that of adult native speakers, although it is still influenced by their first language and its writing system.

Veterinary students' attitudes toward anesthesiology as a specialty.

OBJECTIVE: To identify the perceptions of veterinary students interested in specialization regarding veterinary anesthesiology. STUDY DESIGN: Cross-sectional, multi-institutional, voluntary, anonymous, nonrandomized survey. POPULATION: Veterinary students (303 of 557 total respondents) from 10 veterinary schools. METHODS: Quantitative data were obtained via 5-point Likert scale questions about anesthesia-related topics. Open-ended questions were used to obtain qualitative data. A multivariate logistic regression model assessed the likelihood of choosing a career as an anesthesiologist. Spearman's rank correlation coefficient was used to assess the relationship between 'anesthesia is interesting' and other variables. RESULTS: Of the respondents, 14 (6%) indicated veterinary anesthesia as their chosen specialty. There was a significant positive relationship between 'anesthesia is interesting' and the following variables: age, enjoyment in anesthesia class, belief in the importance of anesthesia for their career, belief in the importance of analgesia for their career, belief that anesthesia and analgesia have a large impact on patient care, interest in pharmacology, interest in physiology, interest in learning technical skills, belief that anesthesiologists are respected by their colleagues and belief that anesthesiologists are an important part of the health care team. More weeks on the anesthesia clinical rotation was positively and significantly associated with increased rotation enjoyment. Enjoyment in the anesthesia class [p = 0.001, Exp(ß) = 2.1, 95% confidence interval (CI): 1.3-3.4] and belief that anesthesia is interesting [p = 0.013, Exp(ß) = 2.6, 95% CI: 1.2-5.4] were predictors that respondents would be more likely to consider a career as a veterinary anesthesiologist. CONCLUSIONS: Those veterinary students with an interest in pharmacology and who enjoyed their anesthesia course were more likely to consider a career as a veterinary anesthesiologist. If students indicated no interest in specializing in veterinary anesthesia, they appreciated the value the specialty brings to animal care and believed that veterinary anesthesiologists are respected by their peers.

Sour, but acceptable: Taste responsiveness to five food-associated acids in zoo-housed white-faced sakis, Pithecia pithecia.

White-faced sakis (Pithecia pithecia) are commonly considered as frugivores but are unusual among primates as they do not specialize on ripe fruits but rather include a high proportion of unripe fruits into their diet, even during seasons when ripe fruits are available. Using a two-bottle preference test of short duration we therefore assessed whether this dietary specialization affects the taste responsiveness and sour-taste tolerance of four adult white-faced sakis for five food-associated acids. We found taste preference thresholds of the sakis to be 1-10 mM for citric acid, 0.5-20 mM for ascorbic acid, 2-10 mM for malic acid, 0.1-1 mM for tannic acid, and 2-20 mM for acetic acid, respectively. When given the choice between a reference solution of 50 mM sucrose and mixtures containing varying concentrations of sucrose plus citric acid, the sakis displayed a high sour-taste tolerance and required only 100 mM of sucrose (when mixed with 10 mM citric acid) or 200 mM of sucrose (when mixed with 30 or 50 mM citric acid), respectively, to prefer the sweet-sour mixture over the purely sweet 50 mM sucrose reference solution. These results demonstrate that white-faced sakis have a well-developed taste sensitivity for food-associated acids which is not inferior to that of primates specializing on ripe fruits. Compared to other platyrrhine primates, the sakis displayed a markedly higher sour-taste tolerance. These results may therefore reflect an evolutionary adaptation to the dietary specialization of the white-faced sakis to sour-tasting unripe fruits.

[Looking back on 100 years of board certification for urology in Germany : Formation of a medical subject in the context of specialization and professionalization]. / 100 Jahre Facharzt für Urologie : Zur Ausbildung eines medizinischen Faches im Kontext von Spezialisierung und Professionalisierung.

This article examines the development of urology as an independent medical discipline in Germany, with a particular focus on professionalization and specialization in the 19th and 20th centuries. Based on historical sources, the text illuminates the importance of the German medical profession's further training regulations as an instrument of medical self-administration and the classification of urology as a medical specialty in the Bremen guidelines of 1924, which established board certification in diseases of the urinary organs (urology).

Encountering Bias: Examining Biases and Stereotypes in the Evaluation Process Among Expert Psychologists During Specialization Exams.

The study of cognitive biases in job interviews has garnered significant attention due to its far-reaching implications for the economy and society. However, little research has focused on the biases exhibited by expert psychologists serving on psychology specialization examination committees. As such, this study has conducted a comprehensive examination of biases within the specialization exam in Israel. One additional objective of the research is to assess the levels of distress experienced by examinees following the examination. Questionnaires were administered to 418 psychologists participating in the clinical and educational psychology specialization exams. The findings unveiled several noteworthy outcomes. Firstly, several biases were identified, including ethnic stereotypes, biases stemming from cognitive load, and more. Secondly, examinees who presented a cognitive-behavioral therapy (CBT) case experienced a higher failure rate. Thirdly, a positive association was found between exam failure and personal distress and this effect was stronger for educational examinees compared to clinical examinees. The most intriguing discovery was that all biases, without exception, occurred among clinical psychologists, whereas educational psychologists displayed no biases. This outcome contrasted with initial expectations. Consequently, the present study aims to expand the existing knowledge about psychological biases and stereotypes by elucidate the reasons behind this discrepancy between the two disciplines while considering the advantages and disadvantages associated with a sense of "expertise" in the realm of adult diagnostics.

Short-term dietary changes are reflected in the cerebral content of adult ring-billed gulls.

Omega-3 long-chain polyunsaturated fatty acids (n3-LCPUFAs) are produced primarily in aquatic ecosystems and are considered essential nutrients for predators given their structural role in vertebrates' cerebral tissues. Alarmingly, with urbanization, many aquatic animals now rely on anthropogenic foods lacking n3-LCPUFAs. In this study undertaken in Newfoundland (Canada), we tested whether recent or longer term diet explains the cerebral fatty acid composition of ring-billed gulls (Larus delawarensis), a seabird that now thrives in cities. During the breeding season, cerebral levels of n3-LCPUFAs were significantly higher for gulls nesting in a natural habitat and foraging on marine food (mean ± s.d.: 32 ± 1% of total identified fatty acids) than for urban nesters exploiting rubbish (27 ± 1%). Stable isotope analysis of blood and feathers showed that urban and natural nesters shared similar diets in autumn and winter, suggesting that the difference in cerebral n3-LCPUFAs during the breeding season was owing to concomitant and transient differences in diet. We also experimentally manipulated gulls' diets throughout incubation by supplementing them with fish oil rich in n3-LCPUFAs, a caloric control lacking n3-LCPUFAs, or nothing, and found evidence that fish oil increased urban nesters' cerebral n3-LCPUFAs. These complementary analyses provide evidence that the brain of this seabird remains plastic during adulthood and responds to short-term dietary changes.

Comparing physical therapist clinical specialists to experienced nonspecialists on physical activity education for patients with heart failure: A modified retrospective cohort study.

Background and Aims: The purpose of this study was to compare the knowledge and practices of specialist and experienced nonspecialist physical therapists in performing patient education about physical activity with patients with heart failure (HF). Methods: Responses on a nationwide anonymous online survey were used to compare specialist and experienced nonspecialist physical therapists on knowledge and frequency of providing physical activity related education to patients hospitalized with acutely decompensated HF. Responses to survey items were scored on 5-point scales ranging from "Strongly agree" to "Strongly disagree" or "Always" to "Never." Mann-Whitney U statistics were used to compare specialist and experienced nonspecialist responses and Wilcoxon signed-ranks tests were used to examine the gap between knowledge and practice. Results: Twenty-seven specialists and 43 experienced nonspecialists completed the survey. Both groups were similar in age, and experience treating patients hospitalized with acutely decompensated HF. Both groups "strongly agree" that they had the required knowledge and skills to educate patients with HF on the physical activity topics. However, specialists more often than experienced nonspecialists provided education on topics such as how to monitor vital signs during physical activity ("most of the time" vs. "about half of the time") that promoted patient confidence and safety during exercise. Specialists demonstrated a smaller gap between knowledge and frequency of providing patient education than experienced nonspecialists on three of the four patient education topics. Conclusion: Specialist physical therapists treating patients with HF in the inpatient hospital setting provided patient education on physical activity at a level more closely matching their skills and the clinical practice guideline than did experienced nonspecialists. Physical therapy clinical specialists practicing in the inpatient hospital setting may improve patient outcomes and lower costs to the health care system by improving physical activity adherence and thereby may reduce avoidable hospital readmissions.

[Reform proposal "Occasional surgical oncology" : Medical strategic analysis and ramifications of the draft bill within the framework of the Hospital Treatment Improvement Act (KHVVG) from the perspective of a university hospital]. / Reformvorhaben "Gelegenheits-Onkochirurgie" : Medizinstrategische Analyse und Auswirkungen der Gesetzesinitiative im Rahmen des Krankenhausversorgungsverbesserungsgesetzes (KHVVG) aus der Perspektive eines Universitätsklinikums.

BACKGROUND: Cancer remains the second most common cause of death in Germany. Performance management and specialization concepts in medicine have the potential to positively influence the care and chances of survival of patients. OBJECTIVE: From the perspective of the University Hospital Freiburg (UKF), the legislative initiative within the framework of the Hospital Treatment Improvement Act (KHVVG) results in a number of medical strategic implications. This article explains and discusses the background, objectives and contents of the reform project "Occasional surgical oncology" and provides perspectives on strategic fields of action. MATERIAL AND METHODS: Analysis and interpretation of the draft of the Act for improvement of the treatment quality in hospitals and on the reform of the remuneration structures (Federal Government draft act). RESULTS: From the point of view of the UKF hospitals should engage in cooperative discussions with neighboring hospitals at the earliest opportunity to shape regional healthcare with the goals of mapping the local allocation of oncology patients for optimal treatment, mitigating the loss of patients at affected locations and preparing for patient growth at facilities that will continue to provide treatment in surgical oncology. DISCUSSION: The ongoing legislative process and the fact that a reliable analysis of relevant treatment areas will be possible for hospitals in the first half of 2025, presents particular challenges for hospitals and the strategic planning of activities. The gaps in the bill presented in this article should be urgently addressed to avoid undermining the project's goals and to support the hospitals remaining in the healthcare system in their preparations.