Webbbondesen2574
Implications This study documented for the first time in Latin America dust loadings less than 10 micrometers, information that can be used to estimate resuspended particle matter emissions in the region. The influence of meteorology, traffic characteristics, road condition, and land-use variables was analyzed and quantified. The management of land-use variables could be as important as traffic control and road maintenance for road dust mitigation. Further research interests are discussed.Objective To investigate the effects of photobiomodulation therapy (PBMT) on resistance training volume and discomfort of well-trained adults. Background PBMT has been used to attenuate fatigue in several physical exercise topics. However, it is unclear if PBMT can increase volume and reduce discomfort in resistance training well-trained individuals. Methods Fourteen participants (women = 7, 27.7 ± 6.0 years and men = 7, 28.3 ± 5.7 years) visited the laboratory three times, 7 days apart. In the first visit, 12-repetition maximum (12-RM) test was performed unilaterally on the standing calf raise machine. In the second and third visits, subjects were randomly submitted to a PBMT (60 J per site, 6 sites per limb, total dose = 360 J) or placebo treatment on the gastrocnemius and soleus muscles with a randomized crossover design. Five minutes after the treatment, subjects began the resistance training session, performed unilaterally with six sets of repetitions to concentric failure. In addition, the rate of perceived exertion for discomfort (RPE-D) was asked after each set. Results After the training session, it was observed a similar force reduction of 10.0 ± 13.6% for placebo and 7.7 ± 7.3% for PBMT (p = 0.815). No differences between PBMT and placebo was observed for the repetitions fatigue index (53.4 ± 11.7% and 50.0 ± 11.6%; p = 0.325) and total repetitions volume (55.4 ± 10.9 and 54.8 ± 13.0 reps; p = 0.764), respectively. RPE-D presented large means for all sets representing a large discomfort during resistance training to concentric failure for both PBMT (7.3 ± 2.3) and placebo (7.5 ± 2.5). Conclusions The PBMT was not effective for increasing volume and reducing discomfort during resistance training performed to concentric failure by well-trained men and women.
Malignant bowel obstruction (MBO) is common in advanced GI cancer, and MBO management, including drainage percutaneous endoscopic gastrostomy (dPEG), is palliative. How patients understand the goals of dPEG and its impact on disease is inadequately understood in the literature. Therefore, we analyzed these issues in patients with GI cancer.
Demographics, clinical variables, and patient outcomes were abstracted from the medical record. Illness understanding and future expectations were retrieved from palliative care notes. We described additional treatment and outcomes after dPEG and estimated overall survival (OS).
From January 2015 to June 2017, 125 admitted patients with metastatic GI cancer underwent dPEG for MBO. Cancers were most commonly colorectal (34%) and pancreatic/ampullary (25%). During the dPEG admission, 32% (40 of 125) of patients had a palliative care consultation, and 22% (28 of 125) were asked about illness understanding and future expectations. All (28 of 28) reported good understandire expectations vary. This may be an opportunity for improved communication regarding palliative procedures in advanced cancer.
Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid stakeholder prioritization that will facilitate health system implementation in patients with advanced cancer.
We reviewed MEDLINE/PubMed-indexed articles for process quality measures related to palliative and end-of-life care for patients with advanced cancer, supplemented by expert input. Measures were inductively grouped into "measure concepts" and higher-level groups.
Literature review identified 226 unique measures from 23 measure sources, which we grouped into 64 measure concepts within 12 groups. Groups were advance care planning (11 measure concepts), pain (7), dyspnea (9), palliative care-specific issues (6), other specific symptoms (17), comprehensive assessment (2), symptom assessment (1), hospice/palliative care referral (1), spiritual care (2), mental health (5), information provision (2), and culturally appropriate care (1).
Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.
Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.
Provider burnout is a challenge adversely affecting the quality, safety, and cost of health care. We measured burnout among pediatric oncology providers in the St Jude Affiliate network and used a Plan-Do-Study-Act (PDSA) improvement cycle to address one of the factors contributing to burnout.
Within the framework of the ASCO Thematic Quality Training Program, we sent the Mini Z 2.0 Survey to 47 pediatric oncology providers. Applying a fishbone diagram and Pareto chart, we analyzed potential causes of provider burnout. On the basis of the analysis, we used a PDSA approach to address documentation of oral chemotherapy adherence for children with acute lymphoblastic leukemia to mitigate burnout among providers.
The burnout survey response rate was 44.6%. Burnout was identified in 42.9% of providers. Remdesivir nmr Documentation in the electronic medical record (EMR) was cited as the second most common contributor to burnout, and it was this issue we chose to address according to a priority matrix. We improved the completeness of oral chemotherapy documentation from a baseline of 13% compliance to 87% compliance within 3 months. The improved compliance was achieved by standardizing the documentation process in the EMR for content and location.
The EMR was one of the contributing factors in the burnout survey of the pediatric oncology providers in the St Jude Affiliate network. A PDSA improvement model to improve clinical research documentation was successful in addressing one of several contributing factors to provider burnout.
The EMR was one of the contributing factors in the burnout survey of the pediatric oncology providers in the St Jude Affiliate network. A PDSA improvement model to improve clinical research documentation was successful in addressing one of several contributing factors to provider burnout.Zebrafish are an important and expanding experimental system for brain research. We describe a noninvasive electrophysiology technique that can be used in living larvae to measure spontaneous activity in the brain and spinal cord simultaneously. This easy-to-use method uses a commercially available multielectrode array to detect local field potential parameters, and allows for relative coordinated (network) measurements of activity. We demonstrate sensitivity of this system by measuring activity in larvae treated with the antiepileptic drug valproic acid. Valproic acid decreased larval movement and startle response, and decreased spontaneous brain activity. Spinal cord activity did not change after treatment, suggesting valproic acid primarily affects brain function. The observed differences in brain activity, but not spinal cord activity, after valproic acid treatment indicates that brain activity differences are not a secondary effect of decreased startle response and movement. We provide a step-by-step protocol for experiments presented that a novice could easily follow. This electrophysiological method will be useful to the zebrafish neuroscience community.The spray formation and breakup process in an open-end swirl injector were studied through experiments and numerical simulations. A high-speed shadowgraph system and a high-speed backlight system were adopted to record the spray. Volume of fluid was used as the interface tracking method to capture the evolution process. The filling process of the liquid film inside the injector was captured. The air core formation process as observed in the experiments differed from that depicted by the numerical simulation results. The results revealed that the spray pattern of the cross-section at the tangential inlets also varied during the filling process. The evolution of the holes on the liquid film and ligaments was observed. It was determined that the liquid sheet repeatedly exhibited thinning, instability, shedding, breakup, and coalescence in the spray formation and breakup process. The spray pattern underwent the distorted pencil stage, onion stage, tulip stage, and fully developed stage with the increased injection pressure drop. The formation process of the open-end swirl injector also underwent these four stages under an injection pressure drop of 0.5 MPa.
Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking.
To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature.
A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases PubMed and Scopus.
Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis.
Systematic review.
Level 3.
Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score.
Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries.
Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.
Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.
