Volume assessment is an important, but challenging but crucial aspect of patient care. Fluid balance is affected by volume expansion, sepsis/shock states, cardiac and kidney failure and is present in ...the majority of patients. Similarly, in critically ill patients on diuretics, both excessive and inadequate diuresis can worsen outcomes.
Chest X-ray (CXR) and auscultation are poorly predictive of volume status, while bioimpedance and blood volume monitoring have limitations at the bedside 4. Inferior vena cava (IVC) diameter as measured by POCUS is a marker of intravascular volume that can provide a real-time assessment to guide diuresis.
The Reverse Falls Protocol combines lung and IVC US to enable the clinician to visualize, in real-time, the patient's intravascular and extravascular volume and to set diuresis goals. We present a series of cases where euvolemia was achieved using the principles described by O'Hara, Chabra & Ahmad's Reverse Falls Protocol.
The hippocampus is critical for learning and memory and may be separated into anatomically-defined hippocampal subfields (aHPSFs). Hippocampal functional networks, particularly during resting state, ...are generally analyzed using aHPSFs as seed regions, with the underlying assumption that the function within a subfield is homogeneous, yet heterogeneous between subfields. However, several prior studies have observed similar resting-state functional connectivity (FC) profiles between aHPSFs. Alternatively, data-driven approaches investigate hippocampal functional organization without a priori assumptions. However, insufficient spatial resolution may result in a number of caveats concerning the reliability of the results. Hence, we developed a functional Magnetic Resonance Imaging (fMRI) sequence on a 7 T MR scanner achieving 0.94 mm isotropic resolution with a TR of 2 s and brain-wide coverage to (1) investigate the functional organization within hippocampus at rest, and (2) compare the brain-wide FC associated with fine-grained aHPSFs and functionally-defined hippocampal subfields (fHPSFs). This study showed that fHPSFs were arranged along the longitudinal axis that were not comparable to the lamellar structures of aHPSFs. For brain-wide FC, the fHPSFs rather than aHPSFs revealed that a number of fHPSFs connected specifically with some of the functional networks. Different functional networks also showed preferential connections with different portions of hippocampal subfields.
Groupwise image registration tackles biases that can potentially arise from inappropriate template selection. It typically involves simultaneous registration of a cohort of images to a common space ...that is not specified a priori. Existing groupwise registration methods are computationally complex and are only effective for image populations without large anatomical variations. In this paper, we propose a deep learning framework to rapidly estimate large deformations between images to significantly reduce structural variability. Specifically, we employ a multi-level graph coarsening method to agglomerate similar images into clusters, each represented by an exemplar image. We then use a deep learning framework to predict the initial deformations between images. Warping with the estimated deformations brings the images closer in the image manifold and their alignment can be further refined using conventional groupwise registration algorithms. We evaluated the effectiveness of our method in groupwise registration of MR brain images and compared it against state-of-the-art groupwise registration methods. Experimental results indicate that deformation initialization enables groupwise registration to converge significantly faster with competitive accuracy, therefore facilitates large-scale imaging studies.
Preventing pressure ulcers is an essential part of patient care and it is important to be aware of the best way to prevent it. Hence, the present study aims to look for the demographics, clinical ...characteristics, and risk factors in patients with and without pressure ulcer among elderly patients.
A retrospective longitudinal study was conducted in elderly (above 65 years) patients from a period of October 2014 to October 2015 in the medical ward under acute Geriatric care at Hamad General Hospital in Qatar.
Overall, a total of 90 patients were included with an average age of 79 ± SD 11.3 years of which 45 patients developed pressure ulcer. There was male (64.4%) preponderance in the study population. Most common comorbidity was hypertension (77.8%). Anemia correction (91%), high protein diet supplementation (1.5 g/kg body wt.) (100%), and 2 h repositioning (100%) were implemented for majority of the pressure ulcer patients as preventive intervention.
From the study finding, it is observed that, anemia correction, high protein diet supplementation and 2 h repositioning are the best practices for the management of pressure ulcer. Hence, these best practices are recommended for the early prevention of pressure ulcer among elderly.
During the first two years of postnatal development, the human brain undergoes rapid, pronounced changes in size, shape and content. Using high-resolution MRI, we constructed month-to-month atlases ...of infants 2 weeks to 2 years old, capturing key spatiotemporal traits of early brain development in terms of cortical geometries and tissue properties.
Abstract
Background
This study aimed to compare the effects of cognitive functional therapy (CFT) and movement system impairment (MSI)-based treatment on pain intensity, disability, Kinesiophobia, ...and gait kinetics in patients with chronic non-specific low back pain (CNSLBP).
Methods
In a single-blind randomized clinical trial, we randomly assigned 91 patients with CNSLBP into CFT (n = 45) and MSI-based treatment (n = 46) groups. An 8-week training intervention was given to both groups. The researchers measured the primary outcome, which was pain intensity (Numeric rating scale), and the secondary outcomes, including disability (Oswestry disability index), Kinesiophobia (Tampa Kinesiophobia Scale), and vertical ground reaction force (VGRF) parameters at self-selected and faster speed (Force distributor treadmill). We evaluated patients at baseline, at the end of the 8-week intervention (post-treatment), and six months after the first treatment. We used mixed-model ANOVA to evaluate the effects of the interaction between time (baseline vs. post-treatment vs. six-month follow-up) and group (CFT vs. MSI-based treatment) on each measure.
Results
CFT showed superiority over MSI-based treatment in reducing pain intensity (P < 0.001, Effect size (ES) = 2.41), ODI (P < 0.001, ES = 2.15), and Kinesiophobia (P < 0.001, ES = 2.47) at eight weeks. The CFT also produced greater improvement in VGRF parameters, at both self-selected (FPFP < 0.001, ES = 3, SPFP < 0.001, ES = 0.5, MSFP < 0.001, ES = 0.67, WARP < 0.001, ES = 1.53, PORP < 0.001, ES = 0.8), and faster speed, FPF(P < 0.001, ES = 1.33, MSF(P < 0.001, ES = 0.57), WAR(P < 0.001, ES = 0.67), POR(P < 0.001, ES = 2.91) than the MSI, except SPF(P < 0.001, ES = 0.0) at eight weeks.
Conclusion
This study suggests that the CFT is associated with better results in clinical and cognitive characteristics than the MSI-based treatment for CNSLBP, and the researchers maintained the treatment effects at six-month follow-up. Also, This study achieved better improvements in gait kinetics in CFT. CTF seems to be an appropriate and applicable treatment in clinical setting.
Trial registration
The researchers retrospectively registered the trial 10/11/2022, at
https://www.umin.ac.jp/
with identifier number (UMIN000047455).
This study investigates the impact of the diversity combining techniques on the performance of wireless code division multiple access (CDMA) ad hoc networks operating over κ-μ fading channels, where ...the performance criterion in this study is in terms of the expected progress per hop. The probability density function (PDF) and the cumulative density function (CDF) of the interference power are obtained in κ-μ fading conditions. Furthermore, expression for the unconditional CDF of the signal-to-noise-and-interference ratio (SNIR) is derived, which is utilized to derive expressions for the expected progress per hop with selecting combining (SC) and maximal ratio combining (MRC) diversity. Corresponding expressions for Nakagami-m and Rician fading are presented in this paper as special cases of κ-μ fading. Numerical results are presented for illustration purposes.
iOS 14 Programming for Beginners is an introductory guide to learning the essentials of Swift programming and iOS development for building your first iOS app and publishing it on the App Store. Fully ...updated to cover the latest features in iOS 14, this practical guide will help you get up to speed with writing iOS apps from scratch.
Medical educators are continually looking for ways to enhance integrated learning and help students see how the material taught in their various courses is inter-related. . At Stony Brook School of ...Medicine, we embarked on a school-wide new curriculum called the Learning focused, Experiential, Adaptive, Rigorous and Novel (LEARN) curriculum and developed several integrated courses that were not based in specific departments. As part of this process, the pre-clinical (Phase-1) curriculum was shortened to 17 months to accommodate an expanded set of clinical offerings. The new structure called for teachers from different departments to lead and conduct the integrated blocks of pre-clinical courses. In this paper, we describe our discouraging experience with the first iteration of an integrated course in Cardiology, Pulmonology and Renal organ systems (CPR), and its transformation into a highly successful second iteration. This involved a systematic course quality improvement (QI) process within the context of a larger school wide curricular reform. As a result, student overall satisfaction with the course increased from 22% (28 of 127 responders) to 83% (111 of 134 responders); the mean score on a standardized NBME content exam increased by 6.7%. We report the systematic process we used to collect data from students and faculty that helped facilitate quality improvement in a key course in Phase-1 of our LEARN curriculum.
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