The multiple energy extraction (MEE) delivery technique for synchrotron-based proton delivery systems reduces beam delivery time by decelerating the beam multiple times during one accelerator spill, but this might cause additional plan quality degradation due to intrafractional motion. We seek to determine whether MEE causes significantly different plan quality degradation compared to single energy extraction (SEE) for lung cancer treatments due to the interplay effect.

Ten lung cancer patients treated with IMPT at our institution were nonrandomly sampled based on a representative range of tumor motion amplitudes, tumor volumes, and respiratory periods. Dose-volume histogram (DVH) indices from single-fraction SEE and MEE four-dimensional (4D) dynamic dose distributions were compared using the Wilcoxon signed-rank test. Distributions of monitor units (MU) to breathing phases were investigated for features associated with plan quality degradation. SEE and MEE DVH indices were compared in fractionated deliveafter 30 fractions with MEE.

For some patients with breathing periods close to the mean spill duration, MEE resulted in significantly worse single-fraction target dose homogeneity compared to SEE due to the interplay effect. However, this was mitigated by fractionation, and target dose homogeneity and coverage were clinically acceptable after 30 fractions with MEE.

The impact of SARS-CoV-2 infection on autonomic and cardiovascular function in otherwise healthy individuals is unknown. We show for the first time that young adults recovering from SARS-CoV-2 have elevated resting sympathetic activity, but similar heart rate and blood pressure, compared with control subjects. Survivors of SARS-CoV-2 also exhibit similar sympathetic nerve activity and hemodynamics, but decreased pain perception, during a cold pressor test compared with healthy controls. Further, these individuals display higher sympathetic nerve activity throughout an orthostatic challenge, as well as an exaggerated heart rate response to orthostasis. If similar autonomic dysregulation, like that found here in young individuals, is present in older adults following SARS-CoV-2 infection, there may be substantial adverse implications for cardiovascular health.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can elicit systemic adverse physiologic effects. However, the impact of SARS-C compared with healthy young adults. This article is protected by copyright. All rights reserved.

The purpose of this study was to evaluate the effect of exercise training on ectopic fat within skeletal muscle (intermuscular adipose tissue [IMAT]) in adult populations with chronic diseases.

A literature search was conducted in relevant databases to identify randomized controlled trials (RCTs) from inception. Selected studies examined the effect of aerobic training (AET), resistance training (RT), or combined training (COM) on IMAT as assessed by noninvasive magnetic resonance (MRI) or computed tomography (CT). Eligibility was determined using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Data extraction was performed using the population (P), intervention (I), comparison (C), outcome (O), timing (T), and settings (S) approach. Methodological quality was analyzed by the Cochrane risk of bias assessment. Standardized effect sizes (ES) with 95% Cis were calculated. Heterogeneity among studies was quantified using I2 statistics. Subgroup and meta-regression analyses were incbells, or gym equipment) is effective in reducing fat streaks that infiltrate muscles and impair muscle function and growth, particularly in adults affected by chronic diseases.

Aerobic exercise (eg, walking/jogging, cycling) alone or combined with resistance exercise (strength training with free-weights, kettle bells, or gym equipment) is effective in reducing fat streaks that infiltrate muscles and impair muscle function and growth, particularly in adults affected by chronic diseases.

process evaluations (PE) are increasingly used in parallel with randomised controlled trials (RCT) to inform the implementation of complex health interventions. This paper explores the learning accrued from conducting a PE within the Falls in Care Homes Study (FinCH), a large UK RCT.

in the FinCH study, six purposively sampled care homes provided data for the PE, which followed a realist approach. In this study researchers kept written diaries of their experiences in completing the interviews, focus groups and observations. We have reflected on these and present the main themes for discussion.

care home staff were enthusiastic to participate in the PE but researchers found it difficult to collect data due to staff not having time to take part, environmental factors such as no space for focus groups and low levels of research understanding. Researchers found that the expectations of the PE protocol were often unrealistic due to these limitations. Flexible and pragmatic approaches such as interviews in place of focus groups enabled data collection but required a reduced sample size and length of data collection to be accepted by researchers.

to enable care home staff to participate in successful PEs, researchers should build flexibility into research schedules, spend time building trust, collaborate with all levels of care home staff prior to data collection, increase research capacity in care home staff and co-design research projects.

to enable care home staff to participate in successful PEs, researchers should build flexibility into research schedules, spend time building trust, collaborate with all levels of care home staff prior to data collection, increase research capacity in care home staff and co-design research projects.

Investigate the construct validity and overall appropriateness of test score interpretation of 4 shoulder-related patient-reported outcome (PRO) measures for use in a population of patients with head and neck cancer using Rasch analysis.

One hundred eighty-two individuals who had received a neck dissection procedure within the past 2weeks to 18months were recruited for this cross-sectional psychometric study. Rasch methodologies were utilized to investigate scale dimensionality, scale hierarchy, response scale structure, and reliability of disability of the arm, shoulder and hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI), and Neck Dissection Impairment Index (NDII).

DASH did not meet criteria for unidimensionality and was deemed inappropriate for utilization in this sample. The QuickDASH, SPADI, and NDII were all determined to be unidimensional. All scales had varying issues with person and item misfit, differential item functioning (DIF), coverage of ability levels, and optimal ratihe Evaluation Database to Guide Effectiveness (EDGE) TaskForce, which are based upon a comprehensive literature review, consideration of published psychometric properties, and expert consensus. Utilization of Rasch methodologies demonstrates weaknesses in this model and provides opportunities to strengthen recommendations for clinicians.

In the CYD14 (NCT01373281) and CYD15 (NCT01374516) dengue vaccine efficacy trials, Month 13 neutralizing antibody (nAb) titers correlated inversely with risk of symptomatic, virologically confirmed dengue (VCD) between Month 13 (one month post-final-dose) and Month 25. We assessed nAb titer as a correlate of instantaneous risk of hospitalized VCD (HVCD), for which participants were continually surveilled for 72 months.

Using longitudinal nAb titers from the per-protocol immunogenicity subsets, we estimated hazard ratios (HRs) of HVCD by current nAb titer value for three correlate/endpoint pairs average titer across all four serotypes/HVCD of any serotype (HVCD-Any), serotype-specific titer/homologous HVCD, and serotype-specific titer/heterologous HVCD.

Baseline-seropositive placebo recipients with higher average titer had lower instantaneous risk of HVCD-Any in 2-16-year-olds and in 9-16-year-olds (HR 0.26 or 0.15 per 10-fold increase in average titer by two methods, 95% CIs 0.14 to 0.45 and 0.07 to 0.34, respectively) pooled across both trials. Results were similar for homologous HVCD. There was evidence suggesting increased HVCD-Any risk in participants with low average titer (110 to 1100) compared to seronegative participants (HR 1.85, 95% CI 0.93 to 3.68).

Natural infection-induced nAbs were inversely associated with hospitalized dengue, upon exceeding a relatively low threshold.

Natural infection-induced nAbs were inversely associated with hospitalized dengue, upon exceeding a relatively low threshold.

We aimed to investigate the effectiveness of Web-based pain education programs without clinical support in patients with musculoskeletal pain.

We searched on PubMed, Scopus, CINAHL, Web of Science, Cochrane Library and PsycINFO from inception to February 2020. Included studies were randomized clinical trials in which people with musculoskeletal pain were allocated to an experimental group that received Web-based pain education as a standalone approach. Three review authors performed data extraction. PEDro scale was used to assess the methodological quality of the studies. The primary outcomes were pain intensity and disability.

We included six trials with a total of 1664 participants. There is moderate quality evidence with small effect size that Web-based pain education programs, as a standalone approach, is better than minimal intervention (no intervention or booklets) for pain intensity (SMD = -0.23, 95% CI = -0.43 to -0.04) at short-term and at intermediate-term (SMD = -0.26, 95% CI = -0.42 to -0.10eletal pain, your physical therapist might recommend web-based pain education as treatment to help you reduce pain intensity and disability.

If you have chronic musculoskeletal pain, your physical therapist might recommend web-based pain education as treatment to help you reduce pain intensity and disability.

The purposes of this study were to identify and describe the attributes of excellence and innovation in professional pediatric physical therapy education and develop a conceptual framework identifying dimensions of excellence.

A multi-method, case study design based on a grounded theory framework was used. Data collection included review of artifacts, field interviews (individual and focus group). A constant-comparative method for within case and across case was used for data analysis to verify and revise coding scheme, identify categories and subcategories, revise emerging themes, and develop a conceptual framework.

Based on results of a predetermined grading rubric, 6 of 17 self-nominated academic sites were selected representing diverse institution types (public/private, Carnegie classification, size) and geographic locations. Pedagogical approaches and method of content delivery varied among programs; all utilized the essential core competencies. The core pediatric faculty member(s) were Board Certi excellence. The model can serve as a guide for best practice in pediatric physical therapy education.

Results of this study are important to professional physical therapist education administrators, pediatric academic faculty, and clinical educators as they represent our understanding of the attributes of excellence. The model can serve as a guide for best practice in pediatric physical therapy education.