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therapeutic decisions are required to optimize healing and a safe return to sports.
The findings from this systematic review indicate that MRI grading may offer a prognostic value for time to return to sports after the nonsurgical treatment of bone stress injuries. Both MRI grade and location of injury suggest that individually adapted rehabilitation regimens and therapeutic decisions are required to optimize healing and a safe return to sports.Background Nurses must possess adequate competencies to provide high-quality palliative care. Earlier statements have described certain competencies that are relevant for palliative care, yet only limited empirical research has focused on the perspective of health care professionals to clarify which competencies are required for different levels of palliative care provision. Objective The aim was to describe the required palliative nursing competencies of registered nurses aligned to different levels of palliative care provision, from the perspectives of multiprofessional groups. Design A qualitative study design. Setting/Subjects A purposive sample of professionals, working in different levels of palliative care across various settings in Finland, was used to gain information about the aim of the study (n = 222). Measurements Content analysis was applied to describe the competencies of registered nurses. Results Competencies relevant to basic palliative care were categorized under 17 main categories, which included a total of 75 subcategories. "Competence in managing the most common symptoms" was the main category that contained the largest number of reduced expressions (f = 75). An analysis of specialist palliative care data yielded 10 main categories, including 49 subcategories, with "Competence in maintaining expertise and taking care of own well-being at work" containing the most reduced expressions. Conclusion The study provided new knowledge; more specifically, competencies related to encounters and maintaining hope were described as palliative care nursing competences. The results can be used to ensure that palliative nursing education focuses on the competences that are necessary in practice.What is the format of spatial representation? In mathematics, we often conceive of two primary ways of representing 2D space, Cartesian coordinates, which capture horizontal and vertical relations, and polar coordinates, which capture angle and distance relations. Do either of these two coordinate systems play a representational role in the human mind? Six experiments, using a simple visual-matching paradigm, show that (a) representational format is recoverable from the errors that observers make in simple spatial tasks, (b) human-made errors spontaneously favor a polar coordinate system of representation, and (c) observers are capable of using other coordinate systems when acting in highly structured spaces (e.g., grids). We discuss these findings in relation to classic work on dimension independence as well as work on spatial representation at other spatial scales.
Bites by the European adder (
) in the UK are uncommon but potentially life threatening, and can be associated with marked limb swelling and disability. Following an interruption in Zagreb Imunološki zavod antivenom supply around 2012, the UK changed its national choice of antivenom for
to ViperaTAb, an ovine Fab monospecific antivenom. In the absence of randomised controlled trials, we established an audit to review its use in clinical practice.
A prospective audit of ViperaTAb use was conducted from March 2016 until November 2020 by the UK National Poison Information Service (NPIS). Users of the NPIS online toxicology database, TOXBASE, considering the use of antivenom for
envenoming were invited to discuss the case with the on-call clinical toxicology consultant. Information was collected prospectively on indications, administration, adverse reactions and outcome of patients administered ViperaTAb antivenom.
One hundred and seventy patients were administered ViperaTAb antivenom over five yearsl criteria. Patients require close observation following antivenom to detect adverse reactions and progression or recurrence of envenoming. Close collaboration with expert NPIS consultant advice can help optimise antivenom timing, ensure repeated dosing is given appropriately, and avoid unnecessary surgical intervention. All hospitals, particularly those located in areas of relatively high incidence, should stock sufficient antivenom available at short notice, 24 h a day.Early career researchers are frequent and valuable contributors to peer review. Systemic changes that acknowledge this fact would result in ethical co-reviewing, peer reviews of greater quality, and a reduction in peer reviewer burden.Dr Dzau was born in Shanghai. He received his Bachelor of Science in Biology and his MD degree from McGill University. He was a medical resident, Chief Resident, and the founding Chief of the Division of Vascular Medicine at the Peter Bent Brigham Hospital (now the Brigham and Women's Hospital). He moved to Stanford in 1990 as the Chief of the Division of Cardiovascular Medicine and later became Chairman of the Department of Medicine. Six years later, he returned to Harvard Medical School as the Hersey Professor of the Theory and Practice of Medicine and as Chairman of the Department of Medicine at Brigham and Women's Hospital. He then became the Chancellor for Health Affairs, President, and CEO of the Duke University Medical Center. In 2014, he was elected to become the President of the Institute of Medicine (now the National Academy of Medicine). He is a member of the National Academy of Medicine, the American Academy of Arts and Sciences, and the European Academy of Sciences and Arts.Patients with chronic kidney disease (CKD) exhibit an elevated cardiovascular risk manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. Although the incidence and prevalence of cardiovascular events is already significantly higher in patients with early CKD stages (CKD stages 1-3) compared with the general population, patients with advanced CKD stages (CKD stages 4-5) exhibit a markedly elevated risk. Cardiovascular rather than end-stage kidney disease (CKD stage 5) is the leading cause of death in this high-risk population. CKD causes a systemic, chronic proinflammatory state contributing to vascular and myocardial remodeling processes resulting in atherosclerotic lesions, vascular calcification, and vascular senescence as well as myocardial fibrosis and calcification of cardiac valves. In this respect, CKD mimics an accelerated aging of the cardiovascular system. This overview article summarizes the current understanding and clinical consequences of cardiovascular disease in CKD.Objective An emerging group of people with type 1 diabetes are building and using their own artificial pancreas systems (APS). Currently, these "user-led," open-source systems are not endorsed by regulatory bodies. People face multiple challenges when building and using open-source APS (e.g., lacking required technical knowledge, difficulties sourcing hardware). We explored the experiences of adults with type 1 diabetes using open-source APS to understand how they are navigating these challenges. Research Design and Methods We conducted semistructured telephone interviews (October 2018 to January 2019) with Australian adults about their experiences using an open-source APS. Interviews were recorded, transcribed, and analyzed thematically. Results Participants included 23 adults with type 1 diabetes, aged 25-64 years, 10 (43%) women, with 1-34 months of experience of open-source APS. Participants used four key strategies to navigate challenges (1) peer support, (2) self-sufficiency, (3) risk management, and (4) trade-offs. Participants relied on peer support and self-sufficiency to fill perceived gaps in professional and industry support. They felt that using an open-source solution was no riskier than previous management and demonstrated a conscious weighing-up of risks. Overall, participants felt that the experienced benefits for their physical health and quality of life outweighed the challenges and potential risks. Conclusions Adults with type 1 diabetes are applying several interweaving psychosocial and practical strategies to navigate the challenges of building and using open-source APS. The findings highlight the importance of health professionals' showing support and understanding for those choosing to use an open-source APS.The study of the three-dimensional (3D) structure of chromosomes-the largest macromolecules in biology-is one of the most challenging to date in structural biology. Here, we develop a novel representation of 3D chromosome structures, as sequences of shape letters from a finite shape alphabet, which provides a compact and efficient way to analyze ensembles of chromosome shape data, akin to the analysis of texts in a language by using letters. We construct a Chromosome Shape Alphabet from an ensemble of chromosome 3D structures inferred from Hi-C data-via SIMBA3D or other methods-by segmenting curves based on topologically associating domains (TADs) boundaries, and by clustering all TADs' 3D structures into groups of similar shapes. The median shapes of these groups, with some pruning and processing, form the Chromosome Shape Letters (CSLs) of the alphabet. We provide a proof of concept for these CSLs by reconstructing independent test curves by using only CSLs (and corresponding transformations) and comparing these reconstructions with the original curves. Finally, we demonstrate how CSLs can be used to summarize shapes in an ensemble of chromosome 3D structures by using generalized sequence logos.Valve-controlled asymmetric cylinder is widely used in servo loading system. As a kind of typical electro-hydraulic servo system (EHSS), it inherently has the characteristics such as high order nonlinear, strong coupling, and uncertain, therefore, conventional control strategy is difficult to satisfy the requirements of high-performance control. In this paper, a novel linear active disturbance rejection control (LADRC) method was proposed, in which the internal and external disturbances were actively estimated by the third-order linear extended state observer (LESO) in real-time, and rejected by the control law of proportional integral control (PID) with acceleration feed-forward. The stability of the proposed method was proved, and the influence rules of the LADRC parameters on the control performance were revealed by simulation. ALWII4127 Finally, comparative experiments between LADRC and PID control were carried out, results showed that the disturbances can be effectively compensated and the control goals can be successfully achieved with the proposed method.
Treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management. Currently, there is a lack of consensus regarding the optimal treatment for these injuries.
The purpose was to determine the optimal treatment strategy for ACL injuries in pediatric and adolescent patients. We hypothesized that (1) early ACL reconstruction results in fewer meniscal tears than delayed reconstruction but yields no difference in knee stability and (2) when compared with nonoperative management, any operative management results in fewer meniscal tears and cartilage injuries, greater knee stability, and higher return-to-sport rates.
Systematic review and meta-analysis; Level of evidence, 4.
A systematic search of databases was performed including PubMed, Embase, and Cochrane Library using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were a pediatric and adolescent patient population (≤19 years old at surgery), the reporting of clinical outcomes after treatment of primary ACL injury, and original scientific research article.
