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We found generalization for the different shoulder orientation and reach distance/speed as measured by a reliable reduction in shoulder activity in these situations but no generalization for the different elbow orientation. In our fourth experiment, we found that generalization is also transferred to feedback control by applying mechanical perturbations and observing reflex responses in a distinct shoulder orientation. These results indicate that partial learning of new intersegmental dynamics is not sufficient for modifying a general internal model of arm dynamics.NEW & NOTEWORTHY Here we show that partially learning to reduce shoulder muscle activity following shoulder fixation generalizes to other movement conditions, but it does not generalize globally. These findings suggest that the partial learning of new intersegmental dynamics is not sufficient for modifying a general internal model of the arm's dynamics.PURPOSE Oncologists and fellows in hematology/oncology (HO) training programs report high levels of burnout. The Accreditation Council for Graduate Medical Education requires accredited programs to have a mechanism to foster well-being among fellows. METHODS Through an iterative process involving a multidisciplinary committee, we created a 3-year longitudinal Art of Oncology (AOO) curriculum intended to address burnout and foster solidary among HO fellows. Sessions used narratives to promote the formation of a shared mental model through discussion of the mutual experience of caring for patients with cancer. We tested the feasibility, acceptability, and initial effectiveness of implementing the curriculum into traditional didactic lectures as a pilot intervention from 2018 to 2019. Eight sessions were completed. RESULTS Sixteen fellows participated. Most were married (63%) and planned on pursuing careers in academic medicine (75%). The sample was racially and ethnically diverse (31% minority representation). Thirty-eight percent of fellows reported burnout symptoms. AOO sessions had higher attendance than didactic lectures (P = .04). Of 14 fellows who completed all follow-up assessments (87.5% response rate), 93% (13 of 14 fellows) felt the sessions were very or somewhat helpful and that sessions improved solidarity. Preparedness in managing work-life balance significantly improved (paired t test, mean difference, 0.53; P = .04). Measured levels of burnout did not significantly improve from baseline (mean difference, -0.133; P = .67). Work-life balance was associated with burnout on multivariable analysis (coefficient, 0.40; P = .03). CONCLUSION The implementation of a dedicated AOO curriculum is feasible and viewed as helpful by HO fellows. Larger studies are needed to assess the efficacy of this curricular intervention.Oral mucositis can be caused by chemotherapy and can affect a patient's quality of life. Nowadays, to prevent chemotherapy-induced oral mucositis (CIOM) is a crucial point in palliative care centers. This trial aimed to assess the effectiveness of aloe-vera in that concept. The trial was accomplished at Hematology Department of Hospital of Children of Damascus University, Syria. Acute lymphoblastic leukemia (ALL) children were the population from which 26 children were enrolled in the study. 2-NBDG nmr They were aged between 3 and 6 years old and were randomly referred according to the intervention into two groups, Aloe-vera (AV) and sodium bicarbonate 5% (13 each). Spongeous sticks were used to help in applying the material on tongue, labial and buccal mucosa, lips, floor of the mouth, and hard palate. Two blinded external examiners evaluated oral mucosa weekly for up to 2 months using the World Health Organization grading scale. Mann-Whitney U test was used to analyze data. According to the observed findings, CIOM degrees were less severe in the aloe-vera group than in the sodium bicarbonate group. Statistically significant difference of occurrence of different CIOM degrees between groups was recorded in the 2nd, 3rd, 4th, and 7th weeks of follow-up period. Moreover, Mann-Whitney U test indicated that patients in the sodium bicarbonate group began CIOM sooner than those in the aloe-vera group with a statistically significant difference (p = .001). These findings show that topical application of aloe-vera solution is effective in the prevention of CIOM in ALL children.The execution of activities of daily living requires the generation of three-dimensional shoulder torques through the coordinated activations of twenty shoulder muscles. Changes in shoulder posture can influence the contributions of individual shoulder muscles to shoulder torque generation, but it is unclear how the coordinated activity of shoulder muscles changes with shoulder plane of elevation and elevation angle. The purpose of this study was to characterize how neuromuscular coordination underlying three-dimensional shoulder function varies with arm posture. Muscle activations were obtained using surface electromyography from sixteen shoulder muscles as twelve healthy participants repeated eight three-dimensional isometric shoulder torques in twenty arm postures. Non-negative matrix factorization revealed the muscle synergies underlying shoulder torque generation across each of the experimental postures while the normalized similarity index assessed changes in overall synergy structure and linear mixed effects models assessed changes in the weighted contributions of individual muscles to each synergy. Our analysis revealed three distinct muscle synergies underlie healthy three-dimensional shoulder function. The overall structure of these synergies remained more similar than is expected by chance despite changes in shoulder posture. However, the weighted contributions of five muscles comprising the first synergy were influenced by changes in shoulder plane of elevation angle and six muscles comprising the second synergy were influenced by elevation angle. The weighted contributions of individual muscles comprising the third synergy were unaffected by posture. These findings suggest that the neuromuscular control plan for healthy shoulder function consists of three distinct synergies, whose overall structure is fixed across shoulder posture.

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