Greenekay5763

Professional case management's career path offers countless opportunities to pursue, from attainment of the highest levels of licensure and credentialing to education, and that terminal degree. Defining each point of the journey and individual milestones warrants keen attention to a number of areas. All of these decisions and options evolve in response to the industry landscape, as well as professional and personal development. Five key lessons provide case managers clear starting points to consider the most appropriate career path to travel amid a landscape marked by constant change.Purpose High-impact physical activity is associated with bone health, but higher volumes of lower intensity activity may also be important. The aims of this study were to 1) investigate the relative importance of volume and intensity of physical activity accumulated during late adolescence for bone health at age 23; and 2) illustrate interpretation of the results. Methods This is a secondary analysis of data from the Iowa Bone Development Study, a longitudinal study of bone health from childhood through to young adulthood. The volume (average acceleration) and intensity distribution (intensity gradient) of activity at ages 17, 19, 21 and 23 were calculated from raw acceleration ActiGraph data and averaged across ages. Hip areal bone mineral density (aBMD), total body bone mineral content (BMC), spine aBMD and hip structural geometry (DXA, Hologic QDR4500A) were assessed at age 23. Valid data, available for 220 participants (124 females), were analysed with multiple regression. To elucidate significant effects, we predicted bone outcomes when activity volume and intensity were high (+1SD), medium (mean), and low (-1SD). Results There were additive associations of volume and intensity with hip aBMD and total body BMC (low-intensity/low-volume cf. high-intensity/high-volume = [INCREMENT]0.082g·cm and [INCREMENT]169.8g, respectively). For males' only spine aBMD intensity was associated independently of volume (low-intensity cf. high-intensity = [INCREMENT]0.049g.cm). For hip structural geometry, volume was associated independently of intensity (low-volume cf. high-volume = [INCREMENT]4.8-6.6%). Conclusion The activity profile associated with optimal bone outcomes was high in intensity and volume. The variation in bone health across the activity volume and intensity distribution suggests intensity is key for aBMD and BMC, while high volumes of lower intensity activity may be beneficial for hip structural geometry.Introduction Post-menopausal women have lower resting cardiac function than pre-menopausal women, but whether the menopause influences maximal cardiac output and hence exercise capacity is unclear. read more It is possible that pre- and post-menopausal women achieve similar improvements in maximal aerobic capacity (V[Combining Dot Above] O2max) and cardiac output with exercise training via different regional left ventricular muscle function ("LV mechanics"), as suggested by in vitro and animal studies. The aim of this study was to investigate the effects of the menopause on LV mechanics and adaptations to exercise training. Methods Twenty-five healthy untrained middle-aged women (age 45-58 years; 11 pre-menopausal, 14 post-menopausal) completed 12 weeks of exercise training. Before and after exercise training, (i) V[Combining Dot Above]O2max and blood volume were determined, and (ii) LV mechanics were assessed using echocardiography at rest and during two submaximal physiological tests - lower body negative pressure (LBNP) and supine cycling. Results The increase in V[Combining Dot Above]O2max after exercise training was 9% smaller in post-menopausal than pre-menopausal women, concomitant with a smaller increase in blood volume (P 0.05) despite altered regional LV muscle function, as indicated by higher basal mechanics in pre-menopausal women during the physiological tests after exercise training (P less then 0.05). Conclusion These findings are the first to confirm altered LV mechanics in post-menopausal women. In addition, the reduced aerobic adaptability to exercise training in post-menopausal women does not appear to be a central cardiac limitation, and may be due to altered blood volume distribution and lower peripheral adaptations.Background Postpartum depression (PPD) affects 10 to 15% of women and is associated with socio-economic burden and maternal morbidity. Recent studies showed that epidural analgesia may be associated with the development of PPD, although this association remains inconclusive. Objective To investigate the role of perinatal demographic, analgesic and psychological factors that may be related to PPD. Design Data were obtained from the Growing Up in Singapore Towards Healthy Outcomes, a prospective, longitudinal multiethnic cohort study. Setting Singapore's two major public maternity institutions. Patients Pregnant women recruited during antenatal consultation and with follow-up 3 months postdelivery at Singapore hospitals with maternity services. Intervention None. Main outcome measures The primary outcome of PPD was assessed 3 months postdelivery using the Edinburgh Postnatal Depression Scale to investigate an association with the use of labour epidural analgesia. The associations between PPD and anxiety and depression at 26 weeks' gestation predelivery were also evaluated. Demographic, analgesic, psychological factors and intrapartum data were analysed. Results There were 651 women with 152 cases (23.3%) of PPD and 499 controls (76.7%) at 3 months after childbirth. There was no significant difference between women who received labour epidural analgesia (95 of 385, 24.7%) and those who did not receive epidural analgesia (57 of 266, 21.4%) (unadjusted odds ratio 1.20, 95% confidence interval 0.83 to 1.75, P = 0.3361) in the incidence of PPD 3 months postdelivery. Predelivery anxiety and depression were positively associated with PPD 3 months postdelivery. Conclusion Our study did not demonstrate an association between PPD at 3 months postdelivery and labour epidural analgesia. Trial registration NCT01174875.Background Ultrasound has increased the efficacy of femoral nerve catheters but their postoperative dislocation still remains a common problem. Although catheter placement parallel to the nerve seems to reduce dislocation rates in other nerves and plexuses, the possible advantage for femoral nerve catheter placement remains unclear. Objective To compare the dislocation rates of femoral catheters when placed perpendicular or parallel to the femoral nerve. Design Randomised controlled study. Setting University orthopaedic hospital. Duration of study October 2018 to June 2019. Patients Eighty patients scheduled for major knee surgery with femoral catheter were enrolled and randomly allocated in two groups. Data from 78 patients could be analysed. Interventions The femoral nerve catheters was placed perpendicular to the nerve in Group 1 (n=40), whereas in Group 2 (n=38) parallel to it. For Group 1 the short-axis view of the nerve and an in-plane puncture was used. For Group 2 we used the short-axis view of the nerve and an out-of-plane puncture technique combined with rotation of the transducer to the long-axis view with the needle in-plane.