ObjectiveThe increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect ...cost of overweight and obesity.MethodsA systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality.ResultsOf the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies.ConclusionThe evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.
For over fifty years, geosynthetics have been used for land reclamation of degraded areas. Several years ago for this purpose innovative geotextiles formed from meandrically arranged thick ropes were ...invented. The geotextiles were used for reclamation of abandoned lignite open-mine in Germany and disused gravel pit in Poland. The geotextiles were installed in abandoned mines. In next years positive influence of geotextiles on slopes behaviour and vegetation was observed. It was stated that the geotextiles provide stabilization of steep unstable slopes and significantly accelerate vegetation development. The innovative geotextiles perform functions unobtainable for other traditional products. The products are useful in an effective reclamation of open mines and constitute a valuable extension of the geosynthetic assortment applicable in land reclamation.
Thermoresponsive materials exhibit an enormous potential for tissue engineering, separation systems, and drug delivery. We investigated the diffusion of laponite clay nanoparticles, which serve as ...physical cross-linkers to achieve improved material properties in poly(N-isopropylacrylamide) (PNIPAM)–clay composite hydrogels close to the gel point. The networks are formed through physical interactions between PNIPAM chains and clay nanoparticles after these two components are mixed. In contrast to previous studies, a covalent labeling strategy was chosen to minimize the amount of free dyes in solution. Single-particle tracking of the labeled clay nanoparticles showed that their diffusion is anomalous at all temperatures used in this study, reflecting the viscoelastic behavior as a cross-linker. Stepwise heating from 24 to 38 °C resulted in a slight increase of the diffusion coefficient and the anomality parameter α up to the volume phase transition temperature of ca. 31 °C, which was followed by a significant drop of both parameters, reflecting strongly hindered motion of the collapsed nanoparticle aggregates.
Currently, no standardized methods exist to assess the geriatric skills and training needs of internal medicine trainees to enable them to become confident in caring for older patients. This study ...aimed to describe the self-reported confidence and training requirements in core geriatric skills amongst internal medicine residents in Toronto, Ontario using a standardized assessment tool.
This study used a novel self-rating instrument, known as the Geriatric Skills Assessment Tool (GSAT), among incoming and current internal medicine residents at the University of Toronto, to describe self-reported confidence in performing, teaching and interest in further training with regard to 15 core geriatric skills previously identified by the American Board of Internal Medicine.
190 (75.1%) out of 253 eligible incoming (Year 0) and current internal medicine residents (Years 1-3) completed the GSAT. Year 1-3 internal medicine residents who had completed a geriatric rotation reported being significantly more confident in performing 13/15 (P < 0.001 to P = 0.04) and in teaching 9/15 GSAT skills (P < 0.001 to P = 0.04). Overall, the residents surveyed identified their highest confidence in administering the Mini-Mental Status Examination and lowest confidence in assessing fall risk using a gait and balance tool, and in evaluating and managing chronic pain.
A structured needs assessment like the GSAT can be valuable in identifying the geriatric training needs of internal medicine trainees based on their reported levels of self-confidence. Residents in internal medicine could further benefit from completing a mandatory geriatric rotation early in their training, since this may improve their overall confidence in providing care for the mostly older patients they will work with during their residency and beyond.
Several publications have examined diaphragmatic ultrasound using two-dimensional (2D) parameters in the context of weaning from mechanical ventilation (MV) and extubation. However, the studied ...cohorts had rather short duration of ventilation. Examinations on patients with prolonged weaning after long-term ventilation were missing. It was the aim of this study to assess of the diaphragm and peripheral musculature of patients undergoing prolonged weaning creating a chronological sequence of ultrasonic parameters during the course of weaning.
This study was carried out as a monocentric, prospective observational cross-sectional study. Patients in prolonged weaning who were transferred to a specialized weaning unit were eligible for inclusion if they were ventilated invasively by means of an endotracheal tube or tracheal cannula and if their expected treatment period was at least 5 days. Diaphragmatic function and one representative peripheral muscle were examined in 50 patients between March 2020 and April 2021. The 2D sonographic parameters of diaphragm and diaphragmatic function consisted of diaphragmatic thickness (Tdi) at the end of inspiration and expiration, the fractional thickening (FT) and the diaphragmatic excursion. Additionally, the M. quadriceps femoris was sonographically assessed at two locations. The difference of measurements between the first and the last measuring timepoint were examined using the Wilcoxon signed-rank test. For a longer chronological sequence, the Friedman's rank sum test with subsequent Wilcoxon-Nemenyi-McDonald-Thompson test for multiple comparisons was carried out.
Fifty patients with prolonged weaning were included. The median duration of MV before transfer to the weaning unit was 11.5 interquartile range (IQR) 10 days. Forty-one patients could be assessed over the full course of weaning, with 38 successfully weaned. Within these 41 patients, the sonographic parameters of the diaphragm slightly increased over the course of weaning indicating an increase in thickness and mobility. Especially parameters which represented an active movement reached statistical significance, i.e., inspiratory Tdi when assessed under spontaneous breathing begin 3.41 (0.99)
end 3.43 (1.31) mm; P=0.01 and diaphragmatic excursion begin 0.7 (0.8)
end 0.9 (0.6) cm; P=0.01. The presence of positive end-expiratory pressure (PEEP) and pressure support did not influence the sonographic parameters significantly. The M. quadriceps femoris, in contrast, decreased slightly but constantly over the time lower third: begin 1.36 (0.48)
end 1.28 (0.36) cm; P=0.054.
The present study is the first one to longitudinally analyse diaphragmatic ultrasound in patients with prolonged weaning. Sonographic assessment showed that Tdi and excursion increased over the course of prolonged weaning, while the diameter of a representative peripheral muscle decreased. However, the changes are rather small, and data show a wide dispersion. To allow a potential, standardized use of diaphragm ultrasound for diagnostic decision support in prolonged weaning, further studies in this specific patient group are required.
Recent reports of the release of large numbers of respirable and critically long fiber-shaped fragments from mesophase pitch-based carbon fiber polymer composites during machining and tensile testing ...have raised inhalation toxicological concerns. As carbon fibers and their fragments are to be considered as inherently biodurable, the fiber pathogenicity paradigm motivated the development of a laboratory test method to assess the propensity of different types of carbon fibers to form such fragments. It uses spallation testing of carbon fibers by impact grinding in an oscillating ball mill. The resulting fragments were dispersed on track-etched membrane filters and morphologically analyzed by scanning electron microscopy. The method was applied to nine different carbon fiber types synthesized from polyacrylonitrile, mesophase or isotropic pitch, covering a broad range of material properties. Significant differences in the morphology of formed fragments were observed between the materials studied. These were statistically analyzed to relate disintegration characteristics to material properties and to rank the carbon fiber types according to their propensity to form respirable fiber fragments. This tendency was found to be lower for polyacrylonitrile-based and isotropic pitch-based carbon fibers than for mesophase pitch-based carbon fibers, but still significant. Although there are currently only few reports in the literature of increased respirable fiber dust concentrations during the machining of polyacrylonitrile-based carbon fiber composites, we conclude that such materials have the potential to form critical fiber morphologies of WHO dimensions. For safe-and-sustainable carbon fiber-reinforced composites, a better understanding of the material properties that control the carbon fiber fragmentation is imperative.
Background
Despite being one of the largest medical specialty training programmes in Australasia, there is no standardised method for selection into Basic Physician Training (BPT), and limited data ...exist regarding current practices.
Aims
To address existing knowledge gaps, we aimed to create a ‘snapshot’ of current BPT selection practices and explore the perspectives of Directors of Physician Education (DPEs) regarding trainee selection.
Methods
An electronic survey of DPEs from adult and paediatric medicine BPT sites in Australia and New Zealand was undertaken in January–February 2022. A combination of free text, multiple‐choice and yes/no answers were analysed using descriptive statistics and qualitative content analysis.
Results
A total of 70 responses were received, achieving a response rate of 35% (70/198). Selection practices were found to be heterogenous across BPT sites. Respondents had varying opinions regarding the utility of selection tools and desirable candidate attributes. A heavy reliance upon interviews and the reported use of subjective assessments raise concerns for selection process bias.
Conclusion
BPT sites should critically evaluate their selection methods, and more research in this field is needed to establish best practice.
The aging cohort of persons living with human immunodeficiency virus (HIV) in Canada has reached a critical point, with nearly half now 50 years age or older. Older persons living with HIV have ...specific needs which can be effectively addressed by geriatric specialists. However, the recognition of HIV care as a domain of geriatrics is recent, resulting in a lack of clinical recommendations and modern care models for delivering geriatric care to this population. Virtual care has been demonstrated to reduce existing barriers to accessing HIV care in some populations but before it can be adapted to geriatric HIV care a critical first step is to acknowledge and understand disparities in socioeconomic circumstances, technology access and ability and cultural differences in experiences. This protocol marks the initial step in a comprehensive program of research aimed at co-designing, implementing, and evaluating culturally-appropriate virtual geriatric care for diverse older adults living with HIV. The study employs qualitative methods with older adults living with HIV to lay the groundwork, to inform the future development of a virtual model of geriatric care. We will explore the perspectives of diverse groups of older persons with HIV on (1) The value and necessity of culturally-tailored virtual interventions for geriatric HIV care; and (2) Recommendations on how best to engage older persons with HIV in the future co-design of a virtual model of geriatric HIV care. Ultimately, a more culturally-appropriate approach to care will foster a more inclusive and supportive healthcare system for all individuals affected by HIV including those who are aging. Researchers can utilize this research protocol to employ qualitative co-design and participatory methods with diverse older adults living with HIV.
The lung floating test is still an obligatory measure to distinguish whether a newborn was born dead or alive. In order to verify the reliability of the floating test, a new clinical trial should ...examine the results of current cases and thus expose, if the test is still contemporary. Following the question, if the test is appropriate for the nowadays birth collective, 208 lungs of newborns were tested with the floating test. The test showed the expected correct result in 204 cases. However, it indicated a false negative result in four cases, in which the lungs sank, although prior life had been reported by medical staff. Overall, the study was able to prove that the results of the floating test are reliable in 98 %. Further, there was not a single false-positive result (lungs of a stillborn swim). Nevertheless, the test demonstrates that a negative test result cannot be taken as proof for a newborn never to have breathed at all.
We conducted the first known comprehensive literature review to (1) identify, categorize, and summarize the existing knowledge about the experiences of older persons and their caregivers during ...conflict situations; (2) identify the support needs of older persons and their caregivers, and; (3) identify gaps in the literature and understanding that may inform future research.
A scoping review methodology of academic peer-reviewed and gray English language literature was employed using six academic literature databases and one gray literature database. We further performed comprehensive searches of relevant search engines and organization websites and bibliographic hand searches to identify additional academic and gray literature. Two authors screened for eligibility of identified studies and documents. One reviewer extracted data regarding authors, article type, geographic origin, key participant characteristics, aims, study design and data collection method, results, conclusions and limitations. Data were analyzed thematically.
83 documents met this review's inclusion criteria, including 21 academic documents and 62 from the gray literature. Thematic analysis revealed that conflict situations exacerbate existing inequalities experienced by older persons. Within this overarching theme were three interconnected sub-themes: (1) Older adults are particularly vulnerable during conflict situations; (2) Older persons are inadequately supported in conflict situations; (3) In the face of great challenges, many older adults still manage to endure through conflict situations. We identified 15 recommendations from the reviewed documents to better support older adults in conflict situations.
Existing inequalities, such as ageism and ableism, targeted discrimination, and poor health outcomes, become exacerbated during conflict situations, resulting in older persons being less able to flee and meet their daily needs with sufficient access to necessities and healthcare. Little is known of the experiences and needs of family caregivers during conflict situations. We identified several opportunities to improve the experience and support of older persons in conflict situations.
PDF
