Milnemorrison1890

nce thyroid hormone levels through induced oxidative/nitrosative stress. Regular active commuting, such as cycling and walking to and from the workplace, is associated with lower all-cause mortality through increased physical activity (PA). However, active commuting may increase intake of fine particles (PM2.5), causing negative health effects. The purpose of this study is to estimate the combined risk of PA and air pollution for all-cause mortality among active commuters who, on days with high PM2.5 levels, switch to commuting by public transportation or work from home. Towards this purpose, we developed a Health Impact Assessment model for six cities (Helsinki, London, Sao Paulo, Warsaw, Beijing, New Delhi) using daily, city-specific PM2.5 concentrations. For each city we estimated combined Relative Risk (RR) due to all-cause mortality for the PA benefits and PM2.5 risks with different thresholds concentrations. Everyday cycling to work resulted in annual all-cause mortality risk reductions ranging from 28 averted deaths per 1000 cyclists (95% confidence interval (CI) 20-38) in Sao Paolo to 12 averted deaths per 1000 cyclists (95% CI 5-19) in Beijing. Similarly, for everyday walking, the reductions in annual all-cause mortality ranged from 23 averted deaths per 1000 pedestrians (95 CI 16-31) in Sao Paolo to 10 averted deaths per 1000 pedestrians (95%CI 5-16) in Beijing. Restricting active commuting during days with PM2.5 levels above specific air quality thresholds would not decrease all-cause mortality risk in any examined city. On the contrary, all-cause mortality risk would increase if walking and cycling are restricted in days with PM2.5 concentrations below 150 μg/m3 in highly polluted cities (Beijing, New Delhi). In all six cities, everyday active commuting reduced all-cause mortality when benefits of PA and risk or air pollution were combined. Switching to working from home or using public transport on days with high air pollution is not expected to lead to improved all-cause mortality risks. OBJECTIVE To compare the efficacy of different radiofrequency techniques (thermal, pulsed, and cooled radiofrequency) for treating lumbar facet joint (LFJ) or sacroiliac joint (SIJ) pain. PATIENTS AND METHODS The inclusion criteria were as follows (1) age > 18 years; (2) patients suffering from LFJ or SIJ pain; and (3) patients receiving radiofrequency treatments. Four electronic databases, including Pubmed, Embase, Cochrane Library, and ISI Web of Knowledge were systematically searched from inception until December 2019 for relevant articles. The search was conducted on 2 January 2020. When the outcomes among articles showed heterogeneity, then a random-effects model was adopted to calculate the effect size; otherwise, a fixed-effects model was adopted. RESULTS All the three techniques showed significant improvements in LFJ or SIJ pain for up to 12 months compared with the baseline level. However, no significant differences among the three techniques were observed at any follow-up visits except for possibly a trend for variance in efficacy. For treating LFJ pain, cooled radiofrequency was the most effective, followed by thermal radiofrequency and then pulsed radiofrequency as the least respectively for the follow-up visit at 6 months. No serious complications were reported after receiving treatment using the three techniques. CONCLUSION Sequentially, cooled radiofrequency followed by thermal radiofrequency and then pulsed radiofrequency for treating LFJ pain were identified as most to least effective at the 6-month follow-up. OBJECTIVES Percutaneous tracheostomy (PT) is common on ICUs. An increase of intracranial pressure (ICP) can be observed in patients with acute cerebral diseases. Factors determining ICP increase remain unclear. PATIENTS AND METHODS Data for all PTs were collected prospectively. ICP, cerebral perfusion pressure (CPP), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), and heart rate (HR) were monitored continuously every minute. Primary outcome parameter was an increase of ICP during PT (ICP > 20 mmHg). Influencing factors were evaluated by the means of logistic regression analysis Body mass index (BMI), age, gender, physician performing the procedure (neurologist vs. neurosurgeon), duration of the procedure, underlying disease, duration of mechanical ventilation, and baseline ICP value before the procedure. RESULTS A total of 175 PTs were performed during the observation period between 2010 and 2013. Of these, 54 received ICP monitoring and were included into this study. Median initial ICP value was 10.4 mmHg and rose significantly to a median value of 18.4 mmHg (p  15 mmHg are at risk to develop harmful ICP crises. BACKGROUND Simulated practice using high fidelity has been shown to have significant benefits in the medical and nursing field. However, the benefits amongst paramedical and midwifery students are not well known. AIM The aim of this study was to explore and compare the impact of Immersive Simulation Training (IST) on midwifery and paramedic students' confidence to perform a skill (basic life support) in real-life stressful and life-threatening scenarios. DESIGN A mixed-method approach with an explanatory sequential design was used. SETTING AND PARTICIPANTS Seventeen first year student midwives and paramedics were recruited from one Higher Education Institution. find more MEASUREMENTS A validated confidence questionnaire and focus groups were used to collect data. FINDINGS Students' confidence following IST was significantly improved when compared to confidence following conventional simulation training (CST); a statistically significant increase of 6.71 (95% CI, 3.57 to 9.84), p  less then  0.001. Additionally, five themes were identified; 'Needing a solid foundation', 'The role of peer support' and 'It is just not real' following CST and 'A steep learning curve' and 'A whole new world' following IST. CONCLUSION The study identified the important role of CST to establish a foundation but the need for escalation to IST to ensure deeper learning and preparedness for real life scenarios and should both be integrated in curricula.