We designed a study to measure the functional capacity requirements of firefighters to aid in the development of an occupation-specific training program in cardiac rehabilitation; 23 healthy male ...firefighters with no history of heart disease completed a fire and rescue obstacle course that simulated 7 common firefighting tasks. They wore complete personal protective equipment and portable metabolic instruments that included a data collection mask. We monitored each subject's oxygen consumption (VO2 ) and working heart rate, then calculated age-predicted maximum heart rates (220 − age) and training target heart rates (85% of age-predicted maximum heart rate). During performance of the obstacle course, the subjects' mean working heart rates and peak heart rates were higher than the calculated training target heart rates ( t22 = 5.69 working vs target, p <0.001 and t22 = 15.14 peak vs target, p <0.001). These findings, with mean results for peak VO2 (3,447 ml/min) and metabolic equivalents (11.9 METs), show that our subjects' functional capacity greatly exceeded that typically attained by patients in traditional cardiac rehabilitation programs (5 to 8 METs). In conclusion, our results indicate the need for intense, occupation-specific cardiac rehabilitation training that will help firefighters safely return to work after a cardiac event.
The NeuroDevNet Autism Spectrum Disorder Demonstration Project interfaces at many levels with the network's research themes and priorities. Our interdisciplinary team aims to improve understanding of ...genetic factors underlying vulnerability to autism spectrum disorders (ASDs) to develop better diagnostic strategies and, ultimately, to pinpoint molecular pathways relevant to developing biologically based treatments. Linking our existing longitudinal ASD cohorts with both genetics and neuroimaging studies will provide, for the first time, integrated data on how the genetic variation influences brain and behavioral development in ASD. Importantly, as our science progresses and we translate this information to the health care system, we will also educate policy makers, media, and business, so an informed society is prepared to capitalize on new genomic advances and effectively integrate these into health services for the broader community. We believe that this research has the potential to transform assessment and care for individuals with ASD.
Background Educational interventions are increasingly used to promote peritoneal dialysis (PD), the most common form of home therapy for end-stage renal disease. A systematic review of the evidence ...in support of dialysis modality education is needed to inform the design of patient-targeted interventions to increase selection of PD. We performed a systematic review and meta-analysis to characterize the relationship between patient-targeted educational interventions and choosing and receiving PD. Study Design Systematic review and meta-analysis. Setting & Population Published original studies and abstracts. Selection Criteria for Studies We searched MEDLINE, EMBASE, CINAHL and EBMR. We included controlled observational studies and randomized trials of educational interventions designed to increase PD selection. Intervention Predialysis educational interventions. Outcomes The primary outcome was choosing PD, defined as intention to use PD regardless of whether PD was ever used. The secondary outcome, receiving PD, was defined as an individual receiving PD as his or her treatment. Results Of 3,540 citations, 15 studies met our inclusion criteria, including 1 randomized trial. In the single randomized trial (N = 70), receipt of an educational intervention was associated with a more than 4-fold increase in the odds of choosing PD (OR, 4.60; 95% CI, 1.19-17.74). Based on results from 4 observational studies (N = 7,653), patient-targeted educational interventions were associated with a 2-fold increase in the odds of choosing PD (pooled OR, 2.15; 95% CI, 1.07-4.32; I2 = 76.7%). Based on results from 9 observational studies (N = 8,229), patient-targeted educational intervention was associated with a 3-fold increase in the odds of receiving PD as the initial treatment modality (OR, 3.50; 95% CI, 2.82-4.35; I2 = 24.9%). Limitations Most studies were observational studies, which can establish an association between education and choosing PD or receiving PD, but does not establish causality. Conclusions This systematic review demonstrates a strong association between patient-targeted education interventions and the subsequent choice and receipt of PD.
Stillbirths: economic and psychosocial consequences Heazell, Alexander E P, Dr; Siassakos, Dimitrios, MD; Blencowe, Hannah, MRCPCH ...
The Lancet (British edition),
02/2016, Letnik:
387, Številka:
10018
Journal Article
Recenzirano
Odprti dostop
Summary Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses ...of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.
Abstract Background Locally acting, well-tolerated treatments for digital ulcers in patients with systemic sclerosis are needed. We aimed to investigate the safety, feasibility, and tolerability of a ...novel light treatment, and to tentatively assess treatment efficacy. Methods Light treatment with an in-house built phototherapy lamp was administered twice per week for 3 weeks, with follow-up at 4 and 8 weeks. Adverse events were documented. Data on patient opinion about the time to deliver, feasibility (“not feasible”, “indifferent”, “feasible”), and pain (visual analogue scale VAS, 0–100) were collected. Patient and clinician assessment of severity of digital ulcers (VAS, 0–100) was documented. An independent assessor graded change in appearance of digital ulcers from photographs (−2 to +2). Laser doppler imaging (to assess perfusion) was performed before and after treatment. A linear mixed-effects model was used to assess change in digital ulcer status. This study is registered with ClinicalTrials.gov , number NCT02472743. Findings Eight patients with 14 digital ulcers were recruited. 46 light treatments were administered, with no adverse events. All patients believed that light treatment was “feasible” and “took just the right amount of time”, with a low associated mean pain VAS of 1·6 (SD 5·2). Severity of digital ulcers as judged by patients and clinicians improved during the study (mean change in VAS −7·1 and −5·2, respectively; both p≤0·001). According to independent assessment, mean change in appearance of digital ulcers per week was 0·14 (95% CI 0·0–0·3) (p=0·01). There was a significant increase in the relative (compared with baseline) mean perfusion after (compared with before) light treatment, in particular at the centre of the digital ulcer (0·32, 95% CI 0·13–0·52; p=0·0013). Interpretation Light treatment for digital ulcers in systemic sclerosis is safe, feasible, and well tolerated. There was an early tentative suggestion of treatment efficacy. Future research is warranted to develop light-based treatment as a locally acting therapy for digital ulcers in patients with systemic sclerosis. Funding Arthritis Research UK.
A large proportion of patients with chronic stroke have permanent lower limb functional disability leading to reduced levels of independent mobility. Individually, both mirror therapy and treadmill ...training have been shown to improve aspects of lower limb functioning in patients with stroke. This case report examined whether a new combination of both interventions would lead to improvements in lower limb functional disability for a patient with chronic stroke.
The participant was a 50-year-old female who had a left middle cerebral artery infarction (47 months' post stroke). Due to hemiparesis, she had lower limb motor impairment and gait deficits.
The participant engaged in a combination of mirror therapy and treadmill training for 30 minutes per day, 3 days per week, for 4 weeks.
Modified Ashworth Scale, Fugl-Meyer Assessment-Lower Extremity and the 10 m Walk Test demonstrated clinically meaningful change. The 6 Minute Walk Test did not demonstrate meaningful change.
The positive outcomes from this new combination therapy for this participant are encouraging given the relatively small dose of training and indicate the potential benefit of mirror therapy as an adjunct to treadmill training for enhancing lower limb muscle tone, motor function and walking velocity in patients with chronic stroke.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
To characterize changes in subfoveal choroidal thickness in preterm infants from 30 to 60 weeks postmenstrual age (PMA).
The prospective, observational Study of Eye Imaging in Preterm infantS ...(BabySTEPS) enrolled infants eligible for retinopathy of prematurity screening per the American Association of Pediatrics guidelines.
Infants imaged with an investigational, handheld OCT at ≥ 4 distinct imaging sessions between 30 to 60 weeks PMA as part of BabySTEPS.
Average choroidal thickness across the central subfoveal 1 mm in each eye at each time point was measured using custom segmentation software, and errors were manually corrected by a trained grader. We prospectively collected birth history data. A segmented mixed model was used to analyze the change in choroidal thickness as a function of PMA, birth weight, and gestational age (GA).
Characterization of normative subfoveal choroidal thickness values and choroidal growth rate between 30 to 60 weeks PMA.
We included 592 imaging sessions of 79 preterm infants (152 eyes). Mean (± standard deviation) GA was 27.5 ± 2.5 weeks. Mean choroidal thickness was 141.4 ± 34.5 μm at 30 weeks, 272.2 ± 83.9 μm at 38 weeks, and 306.2 ± 77.4 μm between 56 and 60 weeks. Between 30 and 60 weeks PMA, choroidal growth followed a biphasic model, with a linear growth rate of 14.8 μm/week (95% confidence interval, 13.6–16.0) from 30 until 38.4 weeks then cessation of growth, with a growth rate of 0.3 μm/week (95% confidence interval, −1.1 to 1.6) from 38.4 to 60 weeks. Infants with extremely low birth weight (ELBW; < 1000 g) and extremely preterm (GA < 28 weeks) infants had significantly slower initial growth rates compared with very low and low birth weight and very preterm and preterm infants (ELBW 13.0 vs. 21.0 μm/week, P < 0.0001; and extremely preterm 13.2 vs. 18.0 μm/week, P = 0.003).
Preterm infant choroidal thickness experiences rapid linear growth from 30 to 38 weeks PMA, at which time growth nearly stops. These foundational measurements and identification of the impact of extremes of low birth weight and prematurity on choroidal development will be essential as researchers begin to understand the role of choroidal development in ocular and retinal health in human infants.
Proprietary or commercial disclosure may be found after the references.
Results We demonstrate that salmeterol aberrantly promotes activation of the allergic disease-related transcription factor signal transducer and activator of transcription 6 (STAT6) in multiple mouse ...and human cells and that salmeterol-dependent exaggerated allergic disease is due to biased signaling through a pathway involving the b2-AR and beta arrestin 2 (barr2).
Abstract Background Noncontact endocardial mapping allows accurate beat-to-beat reconstruction of the reentrant pathway of ventricular tachycardia and improves outcomes after ablation. Several ...studies support electrocardiographic imaging (ECGI) as a means of noninvasively outlining epicardial activation despite constraints of internal geometry. However, few have explored its clinical application. This study aims to evaluate ECGI during selective left ventricular (LV) pacing, relative to an invasive approach. Methods Multisite pacing was performed within the left ventricles of 3 patients undergoing invasive procedures. Simultaneous recording of endocardial potentials using a noncontact multielectrode array and body surface potentials (BSP) using an 80-electrode torso vest was performed. A total of 16 recordings were made. The inverse solution was applied to BSP to reconstruct epicardial activation. Single-paced beats from real and virtual electrograms were used to construct 3-dimensional isochronal and isopotential maps. Endocardial and epicardial data were then superimposed onto a single geometry to allow quantitative comparison of activation foci. Results Good correlation was observed between endocardial activation patterns and those reconstructed from BSP using ECGI. This was repeatedly demonstrated in all LV regions except for the septum (3 recordings). Epicardial isochronal maps were able to locate early and late activation to mean distances of 13.8 ± 4.7 and 12.5 ± 3.7 mm from endocardial data. Isopotential maps localized pacing sites with comparable accuracy (14 ± 5.3 mm). Conclusions Body surface potentials and reconstructed epicardial activation patterns during LV pacing correlate well with endocardial data acquired invasively. The exception was during pacing of the septum. Although early results are encouraging, further quantitative data are required to fully validate and apply this noninvasive tool in the clinical arena.
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