Kidney and urogenital abnormalities in Down syndrome: a meta-analysis.

BACKGROUND: Reviews on Down syndrome do not or only marginally address the issue of kidney and urogenital tract abnormalities, and lower urinary tract dysfunctions. Hence, we performed a meta-analysis of the literature.  METHODS: A literature search was undertaken in the Library of Medicine, Web of Science and Excerpta Medica. The search algorithm combined various keywords: (Down syndrome OR trisomy 21 OR mongolism) AND (kidney OR urinary tract OR bladder) AND (malformation OR dysfunction OR anomaly OR abnormality OR size). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used. RESULTS: Eight case-control studies were retained for the final analysis. Three studies addressed the prevalence of kidney and urogenital tract abnormalities: an increased pooled relative risk of 5.49 (95%-CI: 1.78-16.93) was observed in Down syndrome. Penile malformations, obstructive malformations (including urethral valves), dilated urinary tract system, and kidney hypodysplasia were especially common. Three reports addressed the prevalence of lower urinary tract dysfunction: an increased pooled relative risk of 2.95 (95%-CI: 1.15-7.56) was observed. Finally, an autoptic study and an ultrasound study disclosed a reduced kidney size in Down syndrome. CONCLUSIONS: This meta-analysis indicates that abnormalities of the kidney and urogenital tract, lower urinary tract dysfunctions, and a reduced kidney size present with an increased frequency in individuals with Down syndrome.

Clinical effectiveness of pit and fissure sealants in primary and permanent teeth of children and adolescents: an umbrella review.

PURPOSE: This umbrella review aimed to critically appraise the evidence published in systematic reviews (SRs) on the clinical effectiveness of sealants compared with each other/the non-use in primary/permanent teeth of children and adolescents with at least 12-month follow-up. METHODS: A systematic literature search on 4 electronic databases was conducted up to January 18th, 2023. Following handsearching, two review authors independently screened retrieved articles, extracted data, and assessed the risk of bias (RoB) using the risk of bias in systematic reviews (ROBIS) tool. Based on a citation matrix, the overlap was interpreted by the corrected covered area (CCA). RESULTS: Of 239 retrieved records, 7 SRs met the eligibility criteria with a moderate overlap among them (CCA = 7.4%). For primary molars, in 1120 1.5- to 8-year-old children, data on the clinical effectiveness of sealants were inconclusive. For permanent molars, 3 SRs found a significant caries risk reduction for sealants versus non-use (≤ 36-month follow-up). There was insufficient evidence to proof superiority of sealants over fluoride varnish for caries prevention (3 SRs), and to rank sealant materials according to the best clinical effectiveness in permanent molars. One study was rated at low and 6 at high RoB, which did not allow for a valid quantitative synthesis. CONCLUSION: Considering the limitations of this umbrella review, sealants are more effective for caries prevention in children's permanent molars compared to no treatment. Future well-implemented RCTs are needed to draw reliable conclusions on the clinical effectiveness of sealants in primary and permanent teeth of children and adolescents.

Determinants of intention to leave among nurses and physicians in a hospital setting during the COVID-19 pandemic: A systematic review and meta-analysis.

BACKGROUND: The global outbreak of COVID-19 has brought to light the profound impact that large-scale disease outbreaks can have on healthcare systems and the dedicated professionals who serve within them. It becomes increasingly important to explore strategies for retaining nurses and physicians within hospital settings during such challenging times. This paper aims to investigate the determinants of retention among nurses and physicians during the COVID-19 pandemic. METHOD: A systematic review of other potential determinants impacting retention rates during the pandemic was carried out. Secondly, a meta-analysis on the prevalence of intention to leave for nurses and physicians during the COVID-19 pandemic. FINDINGS: A comprehensive search was performed within four electronic databases on March 17 2023. Fifty-five papers were included in the systematic review, whereas thirty-three papers fulfilled the eligibility criteria for the meta-analysis. The systematic review resulted in six themes of determinants impacting intention to leave: personal characteristics, job demands, employment services, working conditions, work relationships, and organisational culture. The main determinants impacting the intention to leave are the fear of COVID-19, age, experience, burnout symptoms and support. Meta-analysis showed a prevalence of intent to leave the current job of 38% for nurses (95% CI: 26%-51%) and 29% for physicians (95% CI: 21%-39%), whereas intention to leave the profession for nurses 28% (95% CI: 21%-34%) and 24% for physicians (95% CI: 23%-25%). CONCLUSION: The findings of this paper showed the critical need for hospital managers to address the concerning increase in nurses' and physicians' intentions to leave during the COVID-19 pandemic. This intention to leave is affected by a complex conjunction of multiple determinants, including the fear of COVID-19 and the confidence in and availability of personal protective equipment. Moreover, individual factors like age, experience, burnout symptoms, and support are maintained in this review. Understanding the influence of determinants on retention during the COVID-19 pandemic offers an opportunity to formulate prospective strategies for retaining nurses and physicians within hospital settings.

Evaluating the Tobii Pro Glasses 2 and 3 in static and dynamic conditions.

Over the past few decades, there have been significant developments in eye-tracking technology, particularly in the domain of mobile, head-mounted devices. Nevertheless, questions remain regarding the accuracy of these eye-trackers during static and dynamic tasks. In light of this, we evaluated the performance of two widely used devices: Tobii Pro Glasses 2 and Tobii Pro Glasses 3. A total of 36 participants engaged in tasks under three dynamicity conditions. In the "seated with a chinrest" trial, only the eyes could be moved; in the "seated without a chinrest" trial, both the head and the eyes were free to move; and during the walking trial, participants walked along a straight path. During the seated trials, participants' gaze was directed towards dots on a wall by means of audio instructions, whereas in the walking trial, participants maintained their gaze on a bullseye while walking towards it. Eye-tracker accuracy was determined using computer vision techniques to identify the target within the scene camera image. The findings showed that Tobii 3 outperformed Tobii 2 in terms of accuracy during the walking trials. Moreover, the results suggest that employing a chinrest in the case of head-mounted eye-trackers is counterproductive, as it necessitates larger eye eccentricities for target fixation, thereby compromising accuracy compared to not using a chinrest, which allows for head movement. Lastly, it was found that participants who reported higher workload demonstrated poorer eye-tracking accuracy. The current findings may be useful in the design of experiments that involve head-mounted eye-trackers.

Pharmacy students' perceptions and attitudes toward face-to-face vs. virtual team-based learning (TBL) in the didactic curriculum: A mixed-methods study.

INTRODUCTION: Virtual TBL is an online adaptation of the team-based learning (TBL) instructional strategy, emphasizing collaborative learning and problem-solving. The emergency shift to virtual TBL during the COVID-19 pandemic presented unique challenges. This study aims to 1) compare overall pharmacy students' perceptions and attitudes toward face-to-face (FTF) TBL vs. virtual TBL in the didactic curriculum and stratify their perceptions and attitudes by various students' characteristics; 2) evaluate students' perceptions of the strengths and weaknesses of virtual TBL. METHODS: This mixed-methods, pre-post, cross-sectional study utilized an anonymous survey to collect the data. Pharmacy students completed a survey to compare their perceptions and attitudes toward learning, class experience, learning outcomes achieved, and satisfaction with FTF TBL vs. virtual TBL using a 5-point Likert-type scale. Additionally, the survey included two open-ended questions to gather students' perceptions of the strengths and weaknesses of virtual TBL. Quantitative survey data were analyzed using the Wilcoxon matched-pairs signed rank exact test, while qualitative survey data were analyzed using thematic analysis. RESULTS: A total of 117 students (response rate of 59.4%) completed the study survey. Pharmacy students perceived FTF TBL to be superior to virtual TBL in their attitudes toward learning, class experience, learning outcomes achieved, and overall satisfaction across various students' characteristics. While the students identified some unique strengths of using virtual TBL, they also highlighted several weaknesses of using this learning modality compared to FTF TBL. CONCLUSIONS: Pharmacy students perceived FTF TBL to be superior to virtual TBL across various students' characteristics. These findings can be helpful to pharmacy programs considering the implementation of virtual TBL in their didactic curricula. Future research should explore whether a purposefully designed virtual TBL environment, as opposed to the pandemic-driven emergency TBL planning, can influence students' perceptions and attitudes toward virtual TBL.

[What do parents know of patient rights of minors in the Netherlands?] / Wat weten ouders over de patiëntenrechten van kinderen?

INTRODUCTION: In the Netherlands, medical decision-making without parental permission is allowed from the age of 16. The aim of this study was to examine parents' knowledge of this age-based framework to discover potential knowledge gaps that hinder the communication between doctors, parents, and their children. METHODS: Survey-based research was conducted to examine parents' knowledge of the age-based framework that applies to minors in Dutch healthcare. The survey was based on 5 topics: medical diagnosis and treatment, medical advice, reproductive and sexual health services, abortion, and euthanasia. The survey was sent to 1,010 Dutch parents, aged 35-55 years, with at least one child. The data were analysed using SPSS. Percentages and means were calculated. RESULTS: Parental knowledge of the age-based framework varied depending on the topic. CONCLUSION: This study provides insights into parents' current level of knowledge of the age-based framework that applies to minors in Dutch healthcare. This information is useful in the conversation between health care professional, parents, and their children.

Clinical practice - latest insights in optimizing the care of children with Down syndrome.

An essential part of the care of children with Down syndrome is secondary screening for comorbidity. It is well known that comorbidity frequently occurs in these children. A new update of the Dutch Down syndrome medical guideline was developed to create a sound evidence base for several of these conditions. We present the latest insights and recommendations from this Dutch medical guideline which are based on the most relevant literature currently available and developed with rigorous methodology. The main focus of this revision of the guideline was on obstructive sleep apnea and other airway problems and hematologic disorders, such as transient abnormal myelopoiesis, leukemia, and thyroid disorders. Conclusion: This is a short summary of the latest insights and recommendations from the updated Dutch medical guideline for children with Down syndrome.

On Senders's Models of Visual Sampling Behavior.

OBJECTIVE: We review the sampling models described in John Senders's doctoral thesis on "visual sampling processes" via a ready and accessible exposition. BACKGROUND: John Senders left a significant imprint on human factors/ergonomics (HF/E). Here, we focus on one preeminent aspect of his career, namely visual attention. METHODS: We present, clarify, and expand the models in his thesis through computer simulation and associated visual illustrations. RESULTS: One of the key findings of Senders's work on visual sampling concerns the linear relationship between signal bandwidth and visual sampling rate. The models that are used to describe this relationship are the periodic sampling model (PSM), the random constrained sampling model (RCM), and the conditional sampling model (CSM). A recent replication study that used results from modern eye-tracking equipment showed that Senders's original findings are manifestly replicable. CONCLUSIONS: Senders's insights and findings withstand the test of time and his models continue to be both relevant and useful to the present and promise continued impact in the future. APPLICATION: The present paper is directed to stimulate a broad spectrum of researchers and practitioners in HF/E and beyond to use these important and insightful models.

Shared control versus traded control in driving: a debate around automation pitfalls.

A major question in human-automation interaction is whether tasks should be traded or shared between human and automation. This work presents reflections-which have evolved through classroom debates between the authors over the past 10 years-on these two forms of human-automation interaction, with a focus on the automated driving domain. As in the lectures, we start with a historically informed survey of six pitfalls of automation: (1) Loss of situation and mode awareness, (2) Deskilling, (3) Unbalanced mental workload, (4) Behavioural adaptation, (5) Misuse, and (6) Disuse. Next, one of the authors explains why he believes that haptic shared control may remedy the pitfalls. Next, another author rebuts these arguments, arguing that traded control is the most promising way to improve road safety. This article ends with a common ground, explaining that shared and traded control outperform each other at medium and low environmental complexity, respectively. Practitioner summary: Designers of automation systems will have to consider whether humans and automation should perform tasks alternately or simultaneously. The present article provides an in-depth reflection on this dilemma, which may prove insightful and help guide design. Abbreviations: ACC: Adaptive Cruise Control: A system that can automatically maintain a safe distance from the vehicle in front; AEB: Advanced Emergency Braking (also known as Autonomous Emergency Braking): A system that automatically brakes to a full stop in an emergency situation; AES: Automated Evasive Steering: A system that automatically steers the car back into safety in an emergency situation; ISA: Intelligent Speed Adaptation: A system that can limit engine power automatically so that the driving speed does not exceed a safe or allowed speed.

Approaches to decolonising forensic curricula.

Forensic science in UK Higher Education involves a constellation of subdisciplines, each with a biography shaped by a colonial past. Deeper examinations of the structures of curriculum design allow educators to address where colonial assumptions may reside and the impact of these legacies on the present. One process to assist this endeavour is Decolonising the Curriculum (DtC), which seeks to question and dismantle colonial structures of knowledge and support contextualisation to broaden, rather than narrow, the curricula. DtC toolkits, like those developed at the University of Winchester in the south of England, may provide practical support to programme teams to reflect on how colonial attitudes shape new and existing curricula. DtC may be seen as supporting existing quality processes that are part of the reflection cycle and tested through institutional and other accreditation quality procedures. Toolkits support programme teams to identify existing good practices and areas requiring further reflection and development. We offer perspectives on areas that would benefit from critical evaluation when teaching subjects with foundations in race science, colonial attitudes, and social injustice. The paper focuses on three main approaches to support decolonial discourse: sustained historical inquiry, questioning ethnic classifications and identity, and the presentation of international forensic work. Rather than seeing DtC as a threat to educational quality, it may be more constructively seen as an integral part of quality processes in curriculum design to support more diverse, inclusive, and authentic learning in forensic Higher Education.

The potential of a light spot, heat area, and novel object to attract laying hens and induce piling behaviour.

Piling behaviour of laying hens often results in smothering or death due to suffocation. Mechanisms leading to piling are not yet understood though various potential factors have been suggested. In this experimental study, we predicted that the presence of a light spot, a novel object (metal foil), or a heat area within animal pens would increase animal numbers around the stimulus leading to piling behaviour. We presented the cues in a 4 × 2 Latin-square design in eight identical experimental pens including each 55 Lohmann Selected Leghorn hens. The cues were presented in two test areas per pen, at two bouts per day in the morning, consecutively for 5 days, over four periods (age: 20, 22, 24, 26 weeks). Each pen received a cue and control condition simultaneously (test areas without cue presentation) once. For a bout, each cue was presented for 35 min except for the light spot where the duration was 10 min. Birds' responses to the cues during bout and non-bout times were video recorded and analysed for the first bout of each period. To assess the cues' attractiveness, the number of hens during bout times was counted at predefined times within the test and control areas. To assess the cues' effects on piling, we described piling behaviour (pile number, duration, animal numbers, trigger) in control and test areas during bout times. Furthermore, we described piling behaviour during bout times and non-bout times on the first day of the first period and fourth period. The best model explaining the number of hens included the interactions of treatment and bout time, and treatment and area. Over the bout's time course, more hens were attracted to the light spot compared to the control condition, and more to test areas compared to control areas. In the novel object condition, more hens were drawn to the test areas compared to the control areas. Hens were not attracted to the heat area. Piling in bout times was observed twice when hens pecked at the novel object. During non-bout times, piling behaviour occurred frequently at midday and in the late morning compared to the afternoon, mostly in corners and mainly preceded by the mutual attraction of hens. Overall, hens were attracted to light spots and less so to the novel object though neither reliably induced piling behaviour. The occurrence of piling behaviour in non-bout times shows that more work is needed to understand mechanisms eliciting piling behaviour.

Management of proximal metaphyseal curvilinear tibial fractures in 25 skeletally immature dogs (2009 to 2020).

OBJECTIVES: To describe the occurrence, management and outcome of proximal metaphyseal curvilinear tibial fractures in skeletally immature dogs. MATERIALS AND METHODS: A multi-centre retrospective review was conducted, searching for skeletally immature dogs presenting with proximal metaphyseal curvilinear tibial fractures between January 2009 and September 2020. Signalment, fracture description and case management data were retrieved. Outcome was assessed by retrospectively evaluating follow-up radiographs, hospital records and an owner questionnaire. RESULTS: Twenty-five dogs met the inclusion criteria. All but one fracture was a result of minimal trauma. Twenty fractures were managed with internal fixation, two with external fixation and three conservatively. All 25 fractures healed. Eight major complications occurred in seven of 25 (28%) dogs. Twelve minor complications occurred in 10 of 25 (40%) dogs. Owner questionnaire data were available for 12 of 25 dogs; 11 of 12 were reported as having full function and one of 12 as having acceptable function at the time of questioning (median 34.5 months following presentation). At final follow-up, either by clinical examination or owner questionnaire, full function was achieved in 22 of 25 patients and acceptable function in three of 25. CLINICAL SIGNIFICANCE: This study reported a series of proximal metaphyseal tibial fractures in skeletally immature dogs. The most common fixation method was internal fixation, which frequently resulted in full limb function at final follow-up. Owners reported outcome as fully functional in all dogs that underwent surgery at first presentation and had owner follow-up available, though positive outcomes may have been affected by participation bias.