Background: In the absence of uniform European regulations, there have been many differences in the training of perfusionists across Europe. Furthermore, there has been no uniform or single European accreditation of the profession. One of the objectives of The European Board of Cardiovascular Perfusion (EBCP) is to standardise and monitor training of perfusionists across Europe whilst offering support in accordance with national regulations. This goal is particularly imminent as there have been numerous newly founded National perfusion societies, particularly from Eastern European countries, which are now established members of EBCP.Purpose: In this article, we provide an updated overview or 'snapshot' of current European perfusion training programs that were accessible in 2022. Nationally acquired data refers to 2022 unless stated otherwise. The last overview of Perfusion education in Europe was reported over 15 years ago including 20 countries.Research Design: For this report thirty-two national EBCP delegates plus representatives from Austria were contacted at the beginning of 2023 to complete a pro forma questionnaire about their national perfusion training programmes. The data has been summarized in this article and five additional derived parameters were calculated.Results: We received responses from 31 countries, providing specific national training characteristics which are summarized, listed and benchmarked by country in this article.Conclusion: There have been several national and supranational initiatives towards the recognition of perfusion as a profession in Europe, however so far without success for the majority of countries. For this reason, it remains essential for EBCP, as the only European professional perfusionist body, to define education standards and competencies for perfusionists and to monitor training by accreditation of dedicated perfusion schools across Europe.
Postižení ledvin v rámci Light Chain Depositon Disease (LCDD) je velmi vzácně diagnostikovanou jednotkou. Popisuje- me případ, kdy tato diagnóza byla morfologicky stanovena až v biopsii transplantované ledviny a retrospektivně byla dohledána i v předchozí biopsii ledvin, kde však změny nebyly správně klasifikovány. Biopsie transplantované ledviny byla provedena pro postupně se horšící funkce štěpu. Následné vyšetření, cílené na monoklonální gamapatii, prokázalo zvýšenou sérovou koncentraci volných lehkých řetězců kappa (free light chain – FLC) s maximální hodnotou FLC kappa 226 mg/l a FLC lambda jen 6 mg/l. Poměr FLC kappa / FLC lambda byl jasně patologický, 37 (normalní rozmezí 0,26–1,65). Imunofixační elektroforéza séra a moče byla opakovaně negativní. Cytologické vyšetření kostní dřeně popsalo 8 % patolo- gických plazmatických buněk. Flow-cytometrické vyšetření kostní dřeně prokázalo 0,7 % plazmocytů ze všech jaderných buněk kostní dřeně. Tyto plazmocyty byly ve 100 % klonální, abnormálního fenotypu kappa+. Diagnóza byla uzavřena jako nemaligní gamapatie typu „monoklonální gamapatie renálního významu“ s poškozením ledvin v morfologické formě odpovídající LCDD. Pro léčbu byla zvolena kombinace daratumumabu, bortezomibu, cyklofosfamidu a dexametazonu. Současně pacientka dostávala imunosupresivní léčbu nutnou k zachování funkce transplantované ledviny. Sérová hladina volných lehkých řetězců kappa v průběhu prvních dvou měsíců léčby poklesla pod dolní hranici normy. LCDD je jednou z mnoha forem poškození ledvin, k němuž může dojít při nemaligních gamapatiích. Proto by vyšetření FLC mělo být provedeno vždy v rámci diferenciální diagnostiky každého renálního selhání. Pro poškození ledvin mono- klonálním imunoglobulinem byla akceptována klasifikace vytvořená mezinárodní skupinou The International Kidney and Monoclonal Gammopathy Research Group. Morfology, hodnoticí biopsie ledvin, je vhodné informovat o případné přítomnosti patologické koncentrace FLC anebo M-Ig, aby
Light Chain Deposition Disease (LCDD) is a very rarely diagnosed condition affecting the kidneys. We describe a case where this diagnosis was morphologically confirmed in a biopsy of a transplanted kidney, and retrospectively identified in a previous kidney biopsy where the changes were not correctly classified. The biopsy of the transplanted kidney was performed due to worsening graft function. Subsequent testing focused on monoclonal gammopathy, revealing elevated serum concentrations of free kappa light chains (FLC) with a maximum FLC kappa value of 226 mg/l and FLC lambda at only 6 mg/l. The FLC kappa / FLC lambda ratio was clearly pathological at 37 (normal range 0.26-1.65). Serum and urine immunofixation electrophoresis were repeatedly negative. Bone marrow cytology described 8% pathological plasma cells, and flow cytometry demonstrated 0.7% plasma cells among all nuclear bone marrow cells. These plasma cells were 100% clonal, of the abnormal kappa + phenotype. The diagnosis was thus concluded as a non-malignant gammopathy of the type "monoclonal gammopathy of clinical significance" with renal damage in a morphological form corresponding to LCDD. A combination of daratumumab, bortezomib, cyclophosphamide and dexamethasone was chosen for treatment LCDD. Free light kappa chains decreased below the lower limit of the norm during the first two months of anti-CD38 therapy. LCDD is one of the many forms of kidney damage that can occur in non-malignant gammopathies. Therefore, FLC testing should always be performed as part of the differential diagnosis of renal failure. For kidney damage by monoclonal immunoglobulin, a classification created by The International Kidney and Monoclonal Gammopathy Research Group was accepted. It is advisable to inform the evaluating morphologists of the possible presence of pathological concentrations of FLC and/or M-Ig so that they can focus the diagnosis in this direction, otherwise these rare forms of kidney injury may remain unrecognized.
- Keywords
- daratumumab,
- MeSH
- Bortezomib administration & dosage therapeutic use MeSH
- Cyclophosphamide administration & dosage therapeutic use MeSH
- Dexamethasone administration & dosage therapeutic use MeSH
- Immunoglobulin Light Chains blood MeSH
- Humans MeSH
- Antibodies, Monoclonal administration & dosage therapeutic use MeSH
- Paraproteinemias diagnosis pathology therapy MeSH
- Immunoglobulin Light-chain Amyloidosis * diagnosis drug therapy MeSH
- Renal Insufficiency etiology MeSH
- Aged MeSH
- Kidney Transplantation MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
The Satisfaction With Life Scale (SWLS) is a widely used self-report measure of subjective well-being, but studies of its measurement invariance across a large number of nations remain limited. Here, we utilised the Body Image in Nature (BINS) dataset-with data collected between 2020 and 2022 -to assess measurement invariance of the SWLS across 65 nations, 40 languages, gender identities, and age groups (N = 56,968). All participants completed the SWLS under largely uniform conditions. Multi-group confirmatory factor analysis indicated that configural and metric invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional SWLS model has universal applicability. Full scalar invariance was achieved across gender identities and age groups. Based on alignment optimisation methods, partial scalar invariance was achieved across all but three national groups and across all languages represented in the BINS. There were large differences in latent SWLS means across nations and languages, but negligible-to-small differences across gender identities and age groups. Across nations, greater life satisfaction was significantly associated with greater financial security and being in a committed relationship or married. The results of this study suggest that the SWLS largely assesses a common unidimensional construct of life satisfaction irrespective of respondent characteristics (i.e., national group, gender identities, and age group) or survey presentation (i.e., survey language). This has important implications for the assessment of life satisfaction across nations and provides information that will be useful for practitioners aiming to promote subjective well-being internationally.
- MeSH
- Adult MeSH
- Factor Analysis, Statistical MeSH
- Gender Identity * MeSH
- Language MeSH
- Quality of Life MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Personal Satisfaction * MeSH
- Surveys and Questionnaires MeSH
- Psychometrics methods MeSH
- Aged MeSH
- Age Factors MeSH
- Self Report MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Strokes after left atrial appendage closure (LAAC) prophylaxis are generally less severe than those after warfarin prophylaxis-thought to be secondary to more hemorrhagic strokes with warfarin. Hemorrhagic strokes are similarly infrequent with direct oral anticoagulant (DOAC) prophylaxis, so the primary subtype after either LAAC or DOAC prophylaxis is ischemic stroke (IS). OBJECTIVES: The purpose of this study was to compare the severity of IS using the modified Rankin Scale in atrial fibrillation patients receiving prophylaxis with DOACs vs LAAC. METHODS: A retrospective analysis was performed of consecutive patients undergoing LAAC at 8 centers who developed an IS (ISLAAC) compared with contemporaneous consecutive patients who developed IS during treatment with DOACs (ISDOAC). The primary outcome was disabling/fatal stroke (modified Rankin Scale 3-5) at discharge and 3 months later. RESULTS: Compared with ISDOAC patients (n = 322), ISLAAC patients (n = 125) were older (age 77.2 ± 13.4 years vs 73.1 ± 11.9 years; P = 0.002), with higher HAS-BLED scores (3.0 vs 2.0; P = 0.004) and more frequent prior bleeding events (54.4% vs 23.6%; P < 0.001), but similar CHA2DS2-VASc scores (5.0 vs 5.0; P = 0.28). Strokes were less frequently disabling/fatal with ISLAAC than ISDOAC at both hospital discharge (38.3% vs 70.3%; P < 0.001) and 3 months later (33.3% vs 56.2%; P < 0.001). Differences in stroke severity persisted after propensity score matching. By multivariate regression analysis, ISLAAC was independently associated with fewer disabling/fatal strokes at discharge (OR: 0.22; 95% CI: 0.13-0.39; P < 0.001) and 3 months (OR: 0.25; 95% CI: 0.12-0.50; P < 0.001), and fewer deaths at 3 months (OR: 0.28; 95% CI: 0.12-0.64; P < 0.001). CONCLUSIONS: Ischemic strokes in patients with atrial fibrillation are less often disabling or fatal with LAAC than DOAC prophylaxis.
- MeSH
- Anticoagulants adverse effects MeSH
- Stroke * epidemiology etiology prevention & control MeSH
- Atrial Fibrillation * complications drug therapy surgery MeSH
- Hemorrhagic Stroke * chemically induced complications drug therapy MeSH
- Ischemic Stroke * chemically induced complications drug therapy MeSH
- Hemorrhage chemically induced MeSH
- Middle Aged MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Left Atrial Appendage Closure MeSH
- Treatment Outcome MeSH
- Warfarin adverse effects MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
The traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be experts in their own lives based on their lived experiences. Improving healthcare safety, quality, and coordination, as well as quality of life, is an important aim in the care of patients with chronic conditions. Person-centered care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (1) digital care pathways for rhinitis and asthma multimorbidity and (2) digitally enabled, person-centered care.1 It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally enabled, patient-centered care. The paper includes (1) Allergic Rhinitis and its Impact on Asthma (ARIA), a 2-decade journey, (2) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (3) mHealth impact on airway diseases, (4) From guidelines to digital care pathways, (5) Embedding Planetary Health, (6) Novel classification of rhinitis and asthma, (7) Embedding real-life data with population-based studies, (8) The ARIA-EAACI (European Academy of Allergy and Clinical Immunology) strategy for the management of airway diseases using digital biomarkers, (9) Artificial intelligence, (10) The development of digitally enabled, ARIA person-centered care, and (11) The political agenda. The ultimate goal is to propose ARIA 2024 guidelines centered around the patient to make them more applicable and sustainable.
Východiská: Motivácia pri výbere zdravotníckeho po- volania zdravotnícky záchranár je kľúčová z viacerých dôvodov, ktoré ovplyvňujú nielen samotných študen- tov, ale aj následnú kvalitu starostlivosti, ktorú budú poskytovať. Cieľom prieskumu bolo zistiť, aké moti- vačné determinanty ovplyvnili výber povolania zdra- votnícky záchranár u študentov v študijnom programe urgentná zdravotná starostlivosť. Súbor a metódy: v prieskume sa zúčastnilo 61 štu- dentov denného štúdia v študijnom programe urgent- ná zdravotná starostlivosť z oslovených vysokých škôl na Slovensku. Online dotazník pozostával z 5 soci- odemografických a 19 prieskumných položiek austrál- skeho dotazníka MPCC (Motivating Factors in Paramedic Career Choice). Distribúcia dotazníka pre- biehala cez emailové adresy študentov v mesiacoch december 2023 a január 2024. výsledky sme vyhod- notili formou tabuliek a určili absolútnu a relatívnu početnosť. Výsledky: Medzi najčastejšie motivačné determinanty pri výbere povolania zdravotnícky záchranár patrí: „Túžba zachrániť ľudský život“ (96,7 %), „vzrušujúce povolanie“ (96,7 %), „Túžba pomôcť druhým ľuďom“ (93,4 %) a „Byť prítomný na mimoriadnych udalos- tiach (napr. dopravná nehoda)“ (90,2 %). Medzi naj- menej ovplyvňujúce motivačné determinanty patrí „vplyv rodiny“ (75,4 %), „vplyv priateľov pracujúcich v zdravotníctve“ (68,9 %), „Platové / finančné ohod- notenie“ (59 %) a „Čítanie novín/kníh so zameraním na zdravotnícke prostredie“ (57,4 %). Záver: Z analýzy výsledkov vyplýva, že podobne, ako v zisteniach v iných štúdiách, tak aj u našich respon- dentov ovplyvňuje vnútorná motivácia „chcieť pomá- hať ľuďom“, a „vzrušujúca kariéra“ vybrať si povola- nie zdravotnícky záchranár.
Backgrounds: Motivation in choosing the profession of a paramedic is crucial for several reasons, which affect not only the students themselves but also the quality of care they will provide in the future. The aim of the survey was to find out what motivational determinants belong to the choice of the profession of paramedic among students in the emergency me- dical care study program. File and methods: In the survey participated 61 full time students in the study programme emergency medical care from the selected universities in Slovakia. The online questionnaire consisted of 5 sociodemo- graphic and 19 survey items of the Australian MPCC (Motivating Factors in Paramedic Career Choice) qu- estionnaire. The distribution of the questionnaire took place via the email addresses of the students in the months of December 2023 and January 2024. We evaluated the results in the form of tables and determined the absolute and relative frequency. Results: We found that among the most common motivational determinants when choosing the profes- sion of paramedic are: „The desire to save human life“ (96.7%), „Exciting career“ (96.7%), „The desire to help people“ (93.4% ) and „Being present at extra- ordinary events (e.g. traffic accident)“ (90.2%). Among the least influential motivational determinants are „ Influence of family „ (75.4%), „Influence of friends working in the health sector“ (68.9%), „Salary / financial reward“ (59%) and „Reading newspapers / books with a focus on health environment„ (57.4%). Conclusion: The analysis of our empirical results shows that, similar to the findings in other studies, the internal motivation of „wanting to help people“ and „exciting career“ influences the choice of the profession of a paramedic.
The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset - with data collected between 2020 and 2022 - to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.
- MeSH
- Factor Analysis, Statistical MeSH
- Gender Identity * MeSH
- Language MeSH
- Humans MeSH
- Body Image * psychology MeSH
- Surveys and Questionnaires MeSH
- Psychometrics MeSH
- Reproducibility of Results MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Barakatov syndróm, tiež známy aj ako HDR syndróm, je klinicky heterogénne, extrémne zriedkavé, autozómovo dominantne dedičné ochorenie, ktorého frekvencia výskytu nie je známa. Primárne je spôsobený deléciou chromozómu 10p14 alebo mutáciou GATA3 génu, ktorý je umiestnený na 10. chromozóme. Hoci fenotypovo je definovaný triádou HDR: hypoparatyreóza (H), hluchota (deafness; D), postihnutie obličiek (renal involvement; R), v dostupnej literatúre boli identifikované aj prípady pozostávajúce z jeho jednotlivých komponentov HD, DR, HR (1). Syndróm bol prvýkrát opísaný Amin J. Barakatom v r. 1977 u súrodencov s hypokalciémiou a proteinúriou (2). Podľa dostupných údajov bolo doposiaľ v medicínskej literatúre publikovaných okolo 180 prípadov tohto ochorenia celosvetovo (3). V tomto článku prezentuje- me vlastnú kazuistiku pacienta s Barakatovým syndrómom s hypoparatyreózou, unilaterálnou hluchotou a obličkovým postihnutím.
Barakat syndrome, also known as HDR syndrome, is a clinically heterogenous, autosomal dominant rare genetic disease, which frequency is unknown. It is primarily caused by deletion of chromosome 10p14 or mutation of GATA3 gene, located on chromosome 10. Although this syndrome is phenotypically defined by its triad of HDR: hypoparathyroidism (H), deafness (D), renal disease (R), the literature identifies cases with different components, consisting of HD, DR, HR (1). The syndrome was first described by Amin J. Barakat et al. in 1977 in siblings with hypocalcemia and proteinuria (2). So far, about 180 cases have been reported in the worldwide medical literature (3). In this report we present our own case report of patient with Barakat syndrome with hypoparathyrodism, unilateral deafness and renal impairment.
- Keywords
- Barakatův syndrom,
- MeSH
- Adult MeSH
- Genetic Diseases, Inborn * diagnosis genetics MeSH
- Deafness diagnosis etiology MeSH
- Hypoparathyroidism diagnosis etiology therapy MeSH
- Humans MeSH
- Kidney Diseases diagnosis etiology genetics MeSH
- Hearing Loss, Sensorineural diagnosis etiology genetics MeSH
- GATA3 Transcription Factor MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Cieľom príspevku je zistiť výskyt funkčných porúch pohybového systému u detí s vynechanou fázou motorického vývinu lozenia po štyroch a porovnať ich s deťmi, ktoré túto fázu nevynechali. Výskumný súbor tvorili žiaci prvého ročníka základnej školy (n=38) vo veku (6,59±0,09). 19 probandov tvorilo súbor s vynechanou fázou motorického vývinu (E1-NCC) a 19 probandov túto fázu nevynechalo (E2-CC). Svalovú nerovnováhu sme hodnotili pomocou štandardizovaných testov. V testoch svalovej nerovnováhy boli zaznamenané signifikantné rozdiely u m. iliopsoas a dolných fixátorov lopatiek. Ostatné svalové testy s tendenciou k skráteniu neboli štatisticky významné, aj keď sme zistili rozdiely v prospech probandov (CC). Aj napriek tomu, že sme iba v dvoch testoch zaznamenali štatisticky významné rozdiely, vo všetkých testoch svalového skrátenia, v jednom teste svalového oslabenia a v dvoch testoch porušenia pohybových stereotypov vykazoval vyššiu frekvenciu výskytu svalovej nerovnováhy súbor detí, ktoré neštvornožkovali (NCC) v porovnaní so súborom detí, ktoré štvornožkovali (CC).Uvedený príspevok vznikol s podporou grantu MŠ VVS SR KEGA 020UKF-4/2021 Zdravie, s ním súvisiace správanie adolescentov a možnosti prevencie pred civilizačnými ochoreniami.
The aim of this contribution is to find out the incidence of motor sytem functional disorders in children who have missed crawling on all fours and to compare them with children who have not missed this phase. The research sample was formed by first grade elementary school pupils (n = 38) with a decimal age (6,59 ± 0,09). 19 of the probands formed a set with the missing motor development phase of crawling on all fours ( E1) and 19 did not omit this phase (E2.) We evaluated the muscle imbalance using standardised tests. There were some significant differences recorded related to m. iliopsoas and lower fixators of spatulas in muscke imbalance tests. Other muscle tests with a tendency to shorten were not statistically significant, although we found differences in favour of crawling on all four probands. Although there were significant differences in only two of the tests, in all of the muscle shortening tests, in one of the muscle weakness tests and in two of the impaired movement patterns tests, there was a higher incidence muscle imbalance of non-crawling children (NCC) on all fours compared to crawling children on all fours (CC). Acknowledgements: The contribution is a part of the grant project: ME SRS SR KEGA 020UKF-4/2021 Health, related behavior of adolescents and prevention options for diseases of civilization.
- Keywords
- lezení po čtyřech,
- MeSH
- Child MeSH
- Humans MeSH
- Motor Skills MeSH
- Musculoskeletal System MeSH
- Musculoskeletal Development MeSH
- Motor Skills Disorders * etiology MeSH
- Surveys and Questionnaires MeSH
- Child Development * physiology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: Identifying modifiable risk factors for cognitive decline can reduce burden of dementia. OBJECTIVE: We examined whether homocysteine was associated with memory performance, mediated by entorhinal volume, hippocampal volume, total gray matter volume, or white matter lesions, and moderated by APOE ɛ4 allele, B vitamins, creatinine, total cholesterol, or triglycerides. METHODS: All 204 members of the Czech Brain Aging Study with subjective cognitive decline (SCD; n = 60) or amnestic mild cognitive impairment (aMCI; n = 144) who had valid data were included. Linear regression was used, followed by conditional process modeling to examine mediation and moderation. RESULTS: Controlling for age, sex, and education, higher homocysteine was related to poorer memory performance overall (b = -0.03, SE = 0.01, p = 0.017) and in participants with SCD (b = -0.06, SE = 0.03, p = 0.029), but less so in aMCI (b = -0.03, SE = 0.02, p = 0.074); though sensitivity analyses revealed a significant association when sample was reduced to aMCI patients with more complete cognitive data (who were also better functioning; b = -0.04, SE = 0.02, p = 0.022). Results were unchanged in fully adjusted models. Neither mediation by markers of brain integrity nor moderation by APOE ɛ4, B vitamins, creatinine, and cardiovascular factors were significant. Memory sub-analyses revealed that results for SCD were likely driven by non-verbal memory. The homocysteine-memory relationship was significant when hippocampal volume was below the median (b = -0.04, SE = 0.02, p = 0.046), but not at/above the median (p = 0.247). CONCLUSION: Higher homocysteine levels may adversely influence memory performance, which appears particularly apparent in those without cognitive impairment. Results appear to be independent of brain health, suggesting that homocysteine may represent a good target for intervention.
- MeSH
- White Matter diagnostic imaging MeSH
- Hippocampus diagnostic imaging MeSH
- Homocysteine blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Neuropsychological Tests MeSH
- Memory physiology MeSH
- Gray Matter diagnostic imaging MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Organ Size physiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
