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9 ± 11.1% vs 40.2 ± 11.2%, P = .022 and 16.7 ± 6.8% vs 19.4 ± 6.8%, P = .016, respectively, for the left atrium, and 33.0 ± 10.6% vs 37.6 ± 11.2%, P = .011 and 15.2 ± 5.6% vs 18.0 ± 6.3%, P = .004, respectively, for the right atrium). CONCLUSION Even in apparently healthy people with no other cardiovascular risk factors, smoking is associated with impaired atrial and ventricular functions. © 2020 Wiley Periodicals, Inc.In this work, we utilized adsorbed bovine serum albumin and multi-walled carbon nanoparticles (BSA/MWCNTs) as a stationary phase in open tubular (OT) capillary for separation of chiral drugs. (3-Aminopropyl)triethoxysilane (APTES) was used to assist fabrication of BSA/MWCNTs coated OT column by covalent bonding. Incorporation of MWCNTs nanomaterials into a polymer matrix could increase the phase ratio and take advantage of the easy preparation of an OT-CEC column. Scanning electron microscopy (SEM) was carried out to characterize the BSA/MWCNTs OT columns. The electrochromatographic performance of the OT columns was evaluated by separation of ketoprofen, ibuprofen, uniconazole and hesperidin. The effects of MWCNTs concentration, background solution pH and concentration and applied voltage on separation were investigated. Chiral separations of ketoprofen, ibuprofen, uniconazole and hesperidin were achieved using the BSA/MWCNTs coated OT column with resolutions of 24.20, 12.81, 1.50 and 1.85, respectively. Their optimas were found in the 30 mM phosphate buffers at pH 5.0, 6.5, 7.0 and 6.5, respectively. In addition, the columns demonstrated good repeatability and stability with the run-to-run, day-to-day and batch-to-batch relative standard deviations of migration times less than 3.5%. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.BACKGROUND Patient and public engagement is gaining momentum across many domains of healthcare, inclusive of education and research. In this framing, engagement is offered as a solution to a myriad of problems. Yet, the way problems and solutions are linked together may be assumed, rather than made explicit. In the absence of clarity, there is a risk that solutions which may have worked in one domain of healthcare could falter - or even create new problems - in another. OBJECTIVE We use a model from organizational studies as a way to make sense of the relationships between the problems, solutions, and stakeholders operating in the name of patient and public engagement in healthcare. The "garbage can model" - is a playfully phrased but meaningful attempt to decipher the complex world of decision-making in organizations. We use this model to guide our framing of the solutions of patient engagement practice and the wide-range of problem statements that animate all of this activity. RESULTS Following a discussion of the complexity of the field of patient engagement, we identify strategies for educators to conceptually weave problem statements, solutions, and stakeholders together in mosaics of engagement activity. We further suggest a movement away from considering problems to be solved to thinking about polarities to be navigated. CONCLUSIONS As patient engagement becomes more embedded in decision making spaces in health professions education, we need a better understanding of how decisions are actually made in these organizations. We also need to consider that our most treasured solutions may have an uneasy fit - and some unintended consequences - as they enter new domains of healthcare. Finally, we advocate for critical approaches not just to the solutions of patient engagement, but to understand problem statements as they are defined, upheld, and disrupted through all of this work. This article is protected by copyright. All rights reserved.BACKGROUND Tongue lift movement (TLM) is used as a therapy to improve tongue pressure against the hard palate for dysphagic patients. OBJECTIVE The present study aimed to characterize the time-dependent endurance changes of hyoid muscle activity and hyoid-laryngeal displacement during TLM in different ways. METHODS Sixteen young healthy volunteers were instructed to perform TLM at maximum effort (100%) against the anterior and posterior parts of the hard plate using a balloon-type tongue pressure instrument, followed by a 10-sec recording during anterior 80%, anterior 100%, posterior 80%, and posterior 100% TLM with visual feedback. Electromyography (EMG) of supra-hyoid (S-Hyo) and infra-hyoid (I-Hyo) muscles and videofluoroscopic images were simultaneously recorded. To evaluate temporal changes, the recording period was divided into three substages early, middle, and late. Tongue pressure, integrated EMG (iEMG), power frequency of EMG burst and hyoid-laryngeal position were compared among the conditions (80% vs 100%, anterior vs posterior, and early vs middle vs late). RESULTS Tongue pressure was stably maintained for 10 sec in all conditions. S-Hyo and I-Hyo iEMG were significantly greater at 100% than at 80%, while no significant difference was observed between positions. S-Hyo and I-Hyo iEMG significantly increased at the late stage while power frequency of EMG burst gradually decreased. Significant temporal changes in laryngeal elevation were observed only in 100% posterior TLM. Ac-PHSCN-NH2 CONCLUSION The current results suggested that isometric posterior TLM may be more useful in clinical situations for dysphagic patients to elevate the hyolaryngeal complex. This article is protected by copyright. All rights reserved.OBJECTIVES Becoming a clinician is a trajectory of identity formation in the context of supervised practice. This is a social process where the supervisory relationship is key. Therefore, to know how to support identity formation of clinical trainees, it is necessary to understand how this happens within the supervisory relationship. Our aim was to develop a conceptualisation of trainee identity formation within the general practice(GP) supervisory relationship to aid its support. METHODS We took a critical realist approach using case study design and 'cultural worlds' theory as a conceptual frame. Each case comprised a GP trainee/supervisor pair. Our data were weekly audio-recordings of interactions between trainee, supervisor and a patient over 12-weeks augmented by post-interaction reflections and sequential interviews. We undertook interpretive analysis using dialogic methods focusing on the doing of language and the cultural Discourses expressed. RESULTS We identified three social Discourses centring on clinical responsibility; ownership of clinical knowledge; and, measures of trainee competency.