Intersocietal survey on real-world asthma management in Italian children.

Pediatric asthma management is a compelling challenge for every pediatrician. Different aspects require attention and definition. The present Intersocietal Survey aimed to collect real-world experiences from a sample of Italian pediatricians. A web platform was used to collect anonymous answers to the survey questions.Four hundred four pediatricians participated in this initiative promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Society of Preventive and Social Pediatrics (SIPPS), and the Federation of Italian Pediatricians (FIMP).The results showed an extensive participation of primary care pediatricians (72%). There was a large consensus about diagnostic criteria and medication choice. However, treatment duration and device choice were various. Adherence to guidelines on general aspects of practical clinical management was high.In conclusion, the present Intersocietal Survey confirmed that pediatric asthma management is rather satisfactory, even if further improvement should concern a more widespread use of ICS for acute asthma/wheezing attacks, a better definition of the duration of ICS and bronchodilator use, and hospital-primary care integration.

The development of maxillofacial surgery in East Germany: From a municipal hospital to specialised department at the medical academy Dresden.

The transition of the Stomatology Clinic into the Department of Maxillofacial Surgery at the Medical Academy Carl Gustav Carus in Dresden shows how healthcare evolved in East Germany after the Second World War. Founded in 1954 to tackle medical staff shortages, the department grew and specialised over time, becoming a key hub for surgical dentistry in Saxony. Through structural changes, it became a semi-autonomous unit, emphasising patient care and research. By 1983, it evolved into a full Section of Stomatology, streamlining care and training, enhancing expertise and promoting collaboration. Overall, this transformation reflects a significant shift in dental healthcare and academic leadership, shaping surgical dentistry in the region.

Pediatric femoral shaft fractures: the American Academy of Orthopaedic Surgeons clinical practice guidelines versus actual management in a teaching hospital.

Background: In 2009, the clinical practice guidelines (CPG) were released by the American Academy of Orthopaedic Surgeons (AAOS), which outline an age-based approach for treating pediatric femoral shaft fractures (PFSF), both nonoperatively and operatively. The aim of the current study was to investigate potential disparities between the recommended treatments for PFSF based on the AAOS-CPG and the actual treatments administered in The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. Methods: A retrospective review was conducted on the medical charts and radiographs of all PFSF treated at The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2014 to January 2022. We identified 445 children who met our inclusion criteria and evaluated their treatments according to the AAOS-CPG. Actual treatments were then compared with the treatments recommended by the AAOS-CPG. Binomial and multivariate logistic regression was used to examine whether different factors could predict the choice between operative and nonoperative management. Results: Operative treatments were undertaken in 102 of 215 (47.4%) fractures in children younger than 6 years, in 102 of 122 (83.6%) fractures in those between 6 and 12 years of age, and in 107 of 108 (99.1%) fractures in those older than 12 years. Nonoperative management was conducted in 113 of 215 (52.6%) fractures in children younger than 6 years, in 20 of 122 (16.4%) fractures in those between 6 and 12 years of age, and in 1 of 108 (0.9%) fractures in those older than 12 years of age. Surgeon decisions for non-surgery were in agreement with the CPG 52.6% of the time, whereas agreement reached 90.9% for surgical choices. Predictors of actual operative management were age (P=0.01), patient weight (P<0.001), fracture pattern (P<0.001), presence of other orthopedic injuries requiring surgery (P=0.002), and polytrauma (P=0.02). Conclusions: There was limited concordance between actual treatments and CPG recommendations, particularly for the nonoperative management of fractures in children under 6 years old. Age, patient weight, fracture pattern, presence of other orthopedic injuries requiring surgery, and polytrauma were the main predictors of our operative decision-making process.

Nature in Seclusion. The Monastic Republic of Letters in Southern Germany.

Monasteries were famous for their extensive libraries and richly decorated churches. Less well known are their observatories and their mathematical-physical collections with telescopes, air pumps, and friction machines. But how did the way of life in the monastery and scientific practices influence each other? This paper examines the interaction of scientific practices and religious way of life using the example of southern German monasteries in the second half of the eighteenth century. It shows how the monks pragmatically linked monastic life and research practice, thereby forming their own specific scientific culture. This closes an important gap in the understanding of scholarship in the eighteenth century by foregrounding the monasteries as places of knowledge production, which have so far received little attention alongside universities and academies.

Vision, mission, goals, and objectives of the Academy of Family Physicians of India.

The role of the Academy of Family Physicians of India (AFPI) has been vital in promoting family medicine in India. Through its various initiatives, the AFPI has worked to enhance the quality of healthcare services, support the professional development of family physicians, and advocate for policies that recognize and strengthen the role of primary care in the healthcare system. By fostering education, research, and collaboration, the AFPI is working toward a healthcare system where everyone can access comprehensive and continuous primary care. This paper summarizes the vision, mission, goals, and objectives of AFPI.

Performance of three artificial intelligence (AI)-based large language models in standardized testing; implications for AI-assisted dental education.

INTRODUCTION: The emerging rise in novel computer technologies and automated data analytics has the potential to change the course of dental education. In line with our long-term goal of harnessing the power of AI to augment didactic teaching, the objective of this study was to quantify and compare the accuracy of responses provided by ChatGPT (GPT-4 and GPT-3.5) and Google Gemini, the three primary large language models (LLMs), to human graduate students (control group) to the annual in-service examination questions posed by the American Academy of Periodontology (AAP). METHODS: Under a comparative cross-sectional study design, a corpus of 1312 questions from the annual in-service examination of AAP administered between 2020 and 2023 were presented to the LLMs. Their responses were analyzed using chi-square tests, and the performance was juxtaposed to the scores of periodontal residents from corresponding years, as the human control group. Additionally, two sub-analyses were performed: one on the performance of the LLMs on each section of the exam; and in answering the most difficult questions. RESULTS: ChatGPT-4 (total average: 79.57%) outperformed all human control groups as well as GPT-3.5 and Google Gemini in all exam years (p < .001). This chatbot showed an accuracy range between 78.80% and 80.98% across the various exam years. Gemini consistently recorded superior performance with scores of 70.65% (p = .01), 73.29% (p = .02), 75.73% (p < .01), and 72.18% (p = .0008) for the exams from 2020 to 2023 compared to ChatGPT-3.5, which achieved 62.5%, 68.24%, 69.83%, and 59.27% respectively. Google Gemini (72.86%) surpassed the average scores achieved by first- (63.48% ± 31.67) and second-year residents (66.25% ± 31.61) when all exam years combined. However, it could not surpass that of third-year residents (69.06% ± 30.45). CONCLUSIONS: Within the confines of this analysis, ChatGPT-4 exhibited a robust capability in answering AAP in-service exam questions in terms of accuracy and reliability while Gemini and ChatGPT-3.5 showed a weaker performance. These findings underscore the potential of deploying LLMs as an educational tool in periodontics and oral implantology domains. However, the current limitations of these models such as inability to effectively process image-based inquiries, the propensity for generating inconsistent responses to the same prompts, and achieving high (80% by GPT-4) but not absolute accuracy rates should be considered. An objective comparison of their capability versus their capacity is required to further develop this field of study.

The Uniform Determination of Death Act is Not Changing. Will Physicians Continue to Misdiagnose Brain Death?

Efforts to revise the Uniform Determination of Death Act in order to align law with medical practice have failed. Medical practice must now align with the law. People who are not dead under the law that defines death should not be declared dead. There is no compelling reason to continue the practice of declaring legally living persons to be dead.

A Causality Assessment Framework for COVID-19 Vaccines and Adverse Events at the COVID-19 Vaccine Safety Research Center.

During the coronavirus disease 2019 (COVID-19) pandemic, conclusively evaluating possible associations between COVID-19 vaccines and potential adverse events was of critical importance. The National Academy of Medicine of Korea established the COVID-19 Vaccine Safety Research Center (CoVaSC) with support from the Korea Disease Control and Prevention Agency to investigate the scientific relationship between COVID-19 vaccines and suspected adverse events. Although determining whether the COVID-19 vaccine was responsible for any suspected adverse event necessitated a systematic approach, traditional causal inference theories, such as Hill's criteria, encountered certain limitations and criticisms. To facilitate a systematic and evidence-based evaluation, the United States Institute of Medicine, at the request of the Centers for Disease Control and Prevention, offered a detailed causality assessment framework in 2012, which was updated in the recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2024. This framework, based on a weight-of-evidence approach, allows the independent evaluation of both epidemiological and mechanistic evidence, culminating in a comprehensive conclusion about causality. Epidemiological evidence derived from population studies is categorized into four levels-high, moderate, limited, or insufficient-while mechanistic evidence, primarily from biological and clinical studies in animals and individuals, is classified as strong, intermediate, weak, or lacking. The committee then synthesizes these two types of evidence to draw a conclusion about the causal relationship, which can be described as "convincingly supports" ("evidence established" in the 2024 NASEM report), "favors acceptance," "favors rejection," or "inadequate to accept or reject." The CoVaSC has established an independent committee to conduct causality assessments using the weight-of-evidence framework, specifically for evaluating the causality of adverse events associated with COVID-19 vaccines. The aim of this study is to provide an overview of the weight-of-evidence framework and to detail the considerations involved in its practical application in the CoVaSC.

National Family Medicine Day.

The Academy of Family Physicians of India (AFPI) is a professional association of physicians promoting the knowledge domain, academic discipline, and medical specialty of family medicine in India. AFPI was founded on 27 September 2010. In 2022, 27 September, the foundation day of AFPI, was for formally launched as the National Family Medicine Day (NFMD). NFMD is a momentous occasion dedicated to recognising and celebrating the vital role of family medicine, the academic discipline of family physicians, within the healthcare delivery system. NFMD is a significant event that underscores the essential role of family physicians in providing accessible, comprehensive, and continuous healthcare. This article is an account of the inaugural and initial years of NFMD and AFPI foundation day celebrations.

American Academy of Pediatrics Recommended Cardiac Screening Questions in Preparticipation Physical Evaluation Forms.

To evaluate the utilization of the American Academy of Pediatrics' (AAP) cardiovascular screening questions within preparticipation physical evaluation forms from the 50 state high school athletic associations. We found that fewer than one-half of state forms incorporated all 10 AAP questions; moreover, a subset failed to adhere to criteria recommended by either the AAP or American Heart Association.

Setting the Agenda for Patient-Centered Research in Infant and Young-Child Feeding: Results from the Academy of Breastfeeding Medicine and Reaching Our Sisters Everywhere.

Background: Breastfeeding is critically important for optimal health of both birthing people and their infants. Shared, patient-centered goals of how health care team members, community groups, and families can help facilitate breastfeeding success are needed, as are ways to define and measure what breastfeeding success looks like from the patient's perspective. Methods: The Academy of Breastfeeding Medicine and Reaching Our Sisters Everywhere's collaborated in a multi-methods approach to identify breastfeeding priorities most important to parents. Results: We identified (1) Key components of a successful breastfeeding journey defined by parents and families, (2) Research priorities that will enable families to achieve breastfeeding. Conclusion: Dissemination of these findings can foster research efforts that are codesigned with birthing parents and families and reflect their priorities.

The birth of pediatric urology in the United States: From pioneers to subcertification.

INTRODUCTION: Pediatric urology is a subspecialty of urology that emerged from a culture in which children with urological disorders were cared for by general urologists and general pediatric surgeons. The development of pediatric urology as a subspecialty was years in the making, highlighted by individuals who recognized that children with urological conditions were not just "small adults," but required special experience and training. Subspecialization was initiated by persistent visionaries who recognized the need for a trained cadre of experts to provide better care for children. It took the coordinated effort of all subgroups and leaderships in pediatric urology to push these efforts over the goal line. The focus of this review is to highlight certain individuals who played major roles in this vision and to document the efforts of many to coordinate the pathways to sub-specialization. METHODS: The careers of Meredith F. Campbell and Frank B. Bicknell were researched to identify their rationale and roles in developing pediatric urology as a distinct medical specialty in the United States. In addition, the minutes of the meetings of the Pediatric Urology Advisory Council (PUAC) with the American Board of Urology (ABU) were reviewed. The origins of the Society for Pediatric Urology (SPU) and the American Academy of Pediatrics Section of Urology (AAP-SOU) were researched. The contributions of each to the certification of pediatric urology as a distinct subspecialty was delineated. RESULTS: Campbell was Chair of Urology at the New York University (NYU) School of Medicine and wrote prolifically about pediatric urology. He published one of the first practical textbooks in pediatric urology, almost completely self-written, in 1937. Bicknell, a general urologist in Michigan on the faculty at Wayne State University School of Medicine, led the initiative to create the Society for Pediatric Urology (SPU) that first met at the 1951 annual American Urological Association (AUA) meeting in Chicago and included nine attendees. Subsequently, John Lattimer (College of Physicians and Surgeons at Columbia University) organized a well-attended meeting of urologists interested in pediatrics at the 1964 annual AAP meeting in New York City. This led to the formation of the AAP Section on Urology. Integral to the justification for the development of a subspecialty was evidence of a published corpus of content. In addition to published textbooks devoted exclusively to pediatric urology, this was further fulfilled by the AAP Section on Urology Pediatric Supplement to the Journal of Urology, first published in 1986, and later with the Journal of Pediatric Urology in 2005. The SPU and the AAP Section on Urology came together to form the Pediatric Urology Advisory Council (PUAC) in 2000, which worked with the ABU to create subspecialty certification in pediatric urology with an independent exam, first administered in 2008 to 176 applicants. CONCLUSION: The metaphor "We have stood on the shoulders of giants" is apt for pediatric urology: Meredith Campbell, Frank Bicknell, David Innes Williams (Hospital for Sick Children, London), and J. Herbert Johnston (Alder Hay Hospital, Liverpool) come to mind among the first generation of pediatric urology pioneers, and others among their colleagues also had significant impact. Clearly this is a story of persistence and attention to detail on the part of those giants and those who followed. Pediatric urology became a distinct discipline after the SPU and AAP-SOU came together to create a robust cohort of pediatric urologists who through education and negotiation were able to help the ABU and the American Board of Medical Specialties (ABMS) recognize that subspecialization would lead to better care for children with urologic disorders. This benchmark set a high bar for future subspecialization in urology and other fields.

Exploring the Relationship of Declarative Tactical Knowledge With Participation, Football Competence, and Potentiality in a Professional Club (Real Sociedad).

We compared the declarative tactical knowledge (DTK) of 196 male and female players (16.9 ± 2.4 years) belonging to the academy of a Spanish professional football club with their participation (minutes played), football competence (coaching staff assessment), and future potential (technical direction prediction). The DTK had no correlation with the minutes played (%) by the participants during the 2021-22 season (r = -.162, p = .045). Student's t test for independent samples compared the football competence of the participants with high DTK (n = 74) and low DTK (n = 76), proving a small impact (p = .021, d = 0.39) in favor of the first group. Although the high-DTK group showed a better average of potentiality, the technical direction identified more potential players for the first team in the low-DTK group. In conclusion, no solid evidence was found to justify that participants with higher DTK in each team were those who played more minutes and showed greater football competence and potentiality.

World Federation of Neurology.

BACKGROUND AND PURPOSE: To acknowledge the occasion of the 10th anniversary of the formation of the European Academy of Neurology (EAN), the World Federation of Neurology was invited to contribute its perspective on the formation of the EAN and its activities over the past decade. METHODS: This article is based on the experiences of the author in several functions with the European Union of Medical Specialists, the European Federation of Neurology and the European Neurological Society and with the World Federation of Neurology as a trustee since 2009. This article is supported by the author's own archive as well as by several publications. RESULTS: The formation of the EAN was influenced by the activities of the two main predecessor societies, the European Neurological Society and European Federation of Neurology, which left an imprint on the structure of the EAN. The newly formed EAN underwent rigorous structural and organizational changes and has been acting as a successful and independent regional society, expanding increasingly in worldwide activities. CONCLUSION: The EAN, with its 47 member countries, strong democratic leadership and structure, is an excellent example of a regional society with expanding global influence that uses its advocacy skills to influence and improve the structure of neurology in Europe.

Dr. Prakash Chand (PC) Bhatla: Father of Family Medicine.

Dr. Prakash Chand (PC) Bhatla MBBS was one of the illustrious past presidents (1975-76) of Indian Medical Association (IMA). He was a General Practitioner by vocation and a towering professional leader. He made an immense contribution to the discipline of Family Medicine - the academic discipline, medical specialty, and the knowledge domain of Family Physicians/Family Doctors within India as well as the global level. He was a brilliant human being and professional par excellence. He was probably one of the greatest leaders of the medical profession in India and a rightful successor to Dr BC Roy's legacy. As a rare achievement, he received the Dr BC Roy National Award from the President of India twice. He received this prestigious recognition award in 1977 for socio-medical relief in India and again in 1982 for the promotion of Specialty of General Practice. He founded IMA CGP (Indian Medical College of General Practitioners), and his foundational work led to the recognition of Family Medicine as a specialty in India. Due to his efforts, Family Medicine was included in the list of recognized specialties by the National Board of Examinations (NBE) as well by the Medical Council of India (MCI). His contribution to medicine at a global level is also remarkable. He is also considered one of the founding forefathers of WONCA - World Organization of Family Doctors. He was associated with the foundation process of WONCA from the beginning (1964). The International Liaison Committee organized the first World meeting of General Practice in Montreal (Canada) in 1964 and the second meeting in Salsburg in 1966. Dr Bhatla was the convenor of the Third World Conference on General Practice in New Delhi, India, in 1968. A global representative body of Family Medicine/General Practice was launched in 1972 in Melbourne, Australia. Due to contribution to WONCA, he was elected for the first ever WONCA fellowship, the most prestigious global Family Medicine award. He was contemporary to other world leaders of Family Medicine and Primary Care such as Ian McWhinney and Barbara Starfeild. He is rightfully recognized and remembered as Father of Family Medicine. Dr Bhatla's intellectual, professional, and administrative contribution laid down the sound background for the foundation of a Specialty body of Family Medicine in India called the Academy of Family Physicians of India. Life and work of Dr PC Bhatla continues to inspire family doctors, family physicians, general practitioners, and Family Medicine specialists across India, South Asia, and the World in the 21st century.

Defining and Measuring the Scope of Atopic Dermatitis.

Atopic dermatitis (AD) has no definitive diagnostic test and has a large range of phenotypes, making it a difficult disease to assess and define. However, an agreed-upon definition of AD is important for clinical trials, population-based studies, and clinical practice. Several diagnostic criteria systems have been proposed to fill these needs, with none considered the gold standard. To further aid in standardized assessment of AD patients, numerous disease severity and quality-of-life measurement tools have been proposed. There is similarly no gold standard and efforts are ongoing to develop a single consensus scale. Finally, assessment of AD-associated comorbidities, including allergic/immunologic conditions, psychiatric disorders, and metabolic/cardiac conditions, is important when evaluating this patient population.

Atopic Dermatitis Disease Education.

There has been an influx of new educational resources for atopic dermatitis (AD) patients in recent years. The two primary organizations in the United States offering educational materials, online resources, and other forms of support include the National Eczema Association (NEA) and the American Academy of Dermatology (AAD). Educational workshops and interventions have emerged as tools that can deliver comprehensive information on AD, such as symptoms, treatments, and disease management. In regard to these workshops, studies have proven longer interventions to be more effective. Studies have also found multidisciplinary teams, including psychologists, dietitians, and AD specialists, to be more effective in AD treatment and education. Additionally, video-based education was found to be the most effective delivery medium compared to various written modes of education. Given the psychosocial impacts of AD, support groups have been found to improve life quality and decrease disease severity, with age-specific groups offering the greatest benefits. Technology such as social media and smartphones has also improved education. Social media has allowed the rapid exchange of information to wider audiences, but due to its unregulated nature, false information has also been disseminated. Despite this, web-based interventions have still been found to be satisfying, convenient, and effective in increasing treatment awareness. The advent of smartphone applications has provided patients with access to information on AD symptoms and treatment on demand. While the effectiveness of these promising applications hasn't been confirmed by studies, patient provider interactions via smartphone (teledermatology) have been found to be as effective as in-person appointments. This chapter will discuss these different types of emerging resources available to AD patients including educational materials, interventions, support groups, organizational support, and technological resources and their effectiveness.

Law enforcement recruit fitness: Changes across the fitness spectrum.

BACKGROUND: Law enforcement is a profession of sedentary physical activity interspersed with physically demanding activity that requires high levels of fitness. It is imperative that agencies training law enforcement recruits maximise their fitness during their time at the academy. OBJECTIVE: The aim of this study was to investigate changes in physical fitness during academy training. METHODS: Retrospective data for 10 academy recruit classes, totalling 715 participants, were collected from a US law enforcement agency. The change in performance on two standardised tests were used as outcome measures. Comparisons were made between percentiles utilising one-way ANOVA and a linear mixed model (LMM). RESULTS: Overall, higher percentiles were found to have smaller improvements in physical fitness than lower percentiles. The results of the LMM support this supposition, showing that lower physical fitness scores resulted in greater improvements in a generalised fitness assessment (value = -0.45, standard error 0.02, p <  0.001) and an occupational assessment (value = -0.49, standard error = 0.02, p <  0.001). CONCLUSION: The results of this study suggest that recruits with lower physical fitness will see greater improvements during academy training. This could be due to a ceiling effect for the more fit but may also be due to recruits of higher physical fitness being under trained during academy. Utilising ability-based training and prescribing an appropriate workload to recruits of higher fitness may improve overall recruit fitness upon graduation.

Advancing HIV cure research in low- and middle-income countries requires empowerment of the next generation of scientists.

While low- and middle-income countries (LMICs), especially in Southern and Eastern Africa, bear the largest burden of the HIV globally, investigators working on the front lines in these regions are leading a limited number of research efforts, particularly related to HIV cure. Conducting HIV cure research in high-burden HIV LIMCs provides an unparalleled opportunity to formulate innovative research strategies, design trials tailored to the local context, evaluate clinical outcomes within key and vulnerable populations, meaningful involvement of stakeholders, and to shape policies in areas where HIV prevention and cure interventions can yield the most significant impact. Further, the high prevalence of infection, with varied HIV strains affecting large diverse populations, creates a unique environment for studies that would not be feasible in any other part of the world. This underscores the critical importance of addressing obstacles to unlock the full potential of research efforts in these regions. In this viewpoint, we identify significant challenges facing early career investigators in LMICs, particularly in Africa, that hinder their full engagement in HIV cure research. Drawing examples from the International AIDS Society's Research-for-Cure Academy, we provide practical recommendations to overcome barriers that include limited access to funding, effective mentors, educational and career development opportunities, coupled with inadequate investment in infrastructure that contribute towards the limited number of investigators from high-burden HIV LIMCs who are spearheading cutting-edge cure research. Addressing these challenges is crucial to empower investigators who possess unique insights and expertise, and who are well positioned to lead HIV cure-related research efforts. We acknowledge and welcome initiatives that promote capacity building and knowledge exchange between early-career investigators in LMICs and their peers and scientific leaders from high-income countries (HICs). Prioritizing investment in global collaboration and partnership will play a pivotal role in empowering the next generation of African scientists and clinicians. To expedite advancements of cure-related strategies that will be effective in high-burden HIV LMICs, we endorse the sustainable expansion of these pivotal initiatives in these regions, to enhance their effectiveness and hasten progress in the pursuit of a global HIV cure.

A dual approach to addressing gaps in scholar diversity in aging research.

The number of people with Alzheimer's disease and related dementias (ADRD) in the United States is steadily increasing, with minoritized populations having a disproportionate burden of disease. One strategy to address the racial and ethnic disparities in aging is to diversify scholars in the field of aging, to increase dynamic solution development and create cultural congruence among researchers and participants. The National Institute on Aging has a committed effort to increase and diversify the number of scientists who conduct aging and ADRD research, placing a call for Centers to focus on this effort. In response to the National Institute on Aging call, the Carolina Center for Alzheimer's Disease and Minority Research, housed at the University of South Carolina, proposed a dual approach to addressing these gaps through a joint national conference and mentorship program for underrepresented minoritized faculty. After one year of the program, the participating scholars were surveyed, and successes and growth points of the program were identified to help guide the improvement of this dual approach to addressing gaps in scholar diversity in aging research.