Background. Diabetic foot ulcer (DFU) is a difficult, chronic wound with a significant long-term influence on the morbidity, mortality, and quality of life of patients. There is much information about the biochemical features of collagen and its function in wound healing. The aim of this study was to compare the results of DFU patients treated with and without collagen. Methods. A retrospective evaluation was made of the data of patients with DFU who underwent collagen treatment and physiological serum (PS) treatment. The patients were followed-up for a minimum of 12 weeks, and all complications, healing process, and wound characteristics were recorded. Results. Of the total 64 DFU patients included in the study, 30 were treated with PS and 34 with collagen. Complete closure was achieved in 17 (56.6%) of the PS group patients after 12 weeks of treatment. The rate was 25 (73.5%) in the collagen group. The mean duration of treatment was 9.2 weeks (range = 6-12 weeks) in the PS group and 8.08 weeks (range = 5-12 weeks) in the collagen group. The recovery time and recovery rates were determined to be better in the collagen group than in the PS group. Conclusion. A significant reduction in wound size was seen in the collagen group compared with the PS group. The results of this study demonstrated that collagen dressings are better than conventional dressings with regard to early granulation tissue and shorter hospital stay.The purpose of this study was to investigate the clinical efficacy of compound polymyxin B ointment for treating chronic refractory wounds. A retrospective analysis was performed on 111 patients who underwent chronic refractory wound treatment. Patients were divided into 2 groups, with 45 patients included in the experimental group (compound polymyxin B group) and 66 patients included in the control group (silver sulfadiazine group). After thorough debridement in both groups, either compound polymyxin B ointment or silver sulfadiazine cream was evenly applied to the patient’s wound and covered with sterile gauze. In both groups, dressing changes were dependent on the wound’s condition and secretions. Using the Bates-Jensen Wound Assessment Tool (BWAT), patients in both groups were scored, after which wound healing, infection, and healing time were compared. There was no significant difference in BWAT scores between the 2 groups on the 7th or 14th day; however, on the 21st day, the BWAT score in the experimental group was significantly lower than that of the control group. The difference was statistically significant (P less then .05). There was no significant difference in the BWAT-I scores between the 2 groups on the seventh day. The healing time in the experimental group was significantly shorter than that of the control group, and the difference was statistically significant (P less then .05). For the treatment of chronic refractory wounds, thorough debridement followed by compound polymyxin B ointment topical application can reduce and control wound infection effectively and accelerate the process of wound repair.Many fundamental steps underpin the delivery of high-quality clinical research. In this article, we provide a brief commentary on some important aspects associated with the collection and management of data during clinical studies, which, if overlooked, will lead to poor-quality research. In particular, we discuss the key aspects that should help early career researchers maximize the relevance and impact of their clinical research.Prison life is often characterized by drug use, racial intolerance, and violence. This culture of criminality is juxtaposed to treatment efforts that address the criminogenic needs and risks that are associated with inmate institutional rule violations and reoffending in the community, thereby creating seemingly insurmountable challenges for treating clinicians. Rather than fighting a losing battle between treating staff and inmate peers, a more effective strategy may be to utilize family members as resources and allies in the process of change for incarcerated individuals. Challenges and solutions to family therapy prison program implementation are discussed.Purpose. To compare the effect of local and systemic injection of resveratrol (RSV) on open cutaneous wound healing. Materials and Methods. Open cutaneous wounds were created in adult Sprague-Dawley rats. Group 1 (n = 6) was given intraperitoneal RSV (0.5 mg/kg) once daily for 14 days. Group 2 (n = 6) was given local subcutaneous RSV (0.5 mg/kg) on the wound once daily for 14 days. Group 3 (n = 6) did not receive any pharmacologic agent. Biopsy specimens were obtained on postoperative days (PODs) 7, 14, and 21 and were examined histologically. Wound closure time was recorded. All rats were sacrificed on POD 30 for tensile strength analysis. Results. The histological scores for collagen deposition, chronic inflammation, and granulation were higher in the systemic and local RSV treatment groups than in the control group. Neovascularization scores significantly increased on PODs 14 and 21 in the local RSV treatment group compared with those in the systemic RSV and control groups. Systemic and local RSV administrations significantly enhanced wound healing and increased the tensile strength of the skin in rats. Conclusion. Local subcutaneous application of RSV may have a better therapeutic effect than the systemic application of RSV in terms of neovascularization to promote wound healing.

Severe baclofen toxicity can result in respiratory failure, hemodynamic instability, bradycardia, hypothermia, seizures, coma, and death. While hemodialysis (HD) is well-described in treating acute baclofen toxicity in patients with end-stage kidney disease or acute kidney injury, the utility of HD for patients with normal kidney function is uncertain. Implementing HD to speed recovery after a large acute baclofen ingestion is appealing, considering (a) potential for prolonged coma and ventilator-associated morbidity, and (b) baclofen’s low protein-binding, low molecular-weight, and moderate volume of distribution.

We report a 51 kg, 14-year-old girl who presented to the emergency department (ED) with hypotension, obtundation, and status epilepticus after an intentional ingestion of 1200 mg baclofen. Her post-intubation neurologic examination was concerning for coma. A 14-hour post-ingestion baclofen concentration was 882 ng/mL (therapeutic range 80-400 ng/mL). Three urgent-HD sessions were performed to reduce her time on the ventilator.

The total baclofen removed in the first three-hour HD session was 3.05 mg. The total urinary elimination of baclofen 42 mg over 24-hours on day one. She was discharged without neurologic deficits to psychiatry on day-14.

In this case, the amount of baclofen recovered during HD is negligible in comparison to the amount cleared by kidney elimination in this patient with normal kidney function.

In this case, the amount of baclofen recovered during HD is negligible in comparison to the amount cleared by kidney elimination in this patient with normal kidney function.

Narrative review.

Describe a comprehensive spine telemedicine examination.

We discuss telemedicine examination techniques for commonly encountered spine conditions.

Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment.

While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.

While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.Split-thickness skin grafts constitute an established and widely used procedure for treating skin ulcers. However, in patients on anticoagulation therapy, wound healing abnormalities can prevent smooth epithelialization of their donor site. We aimed to investigate the usefulness of a technique to facilitate smooth wound healing through partial dimension reduction, and spared skin grafts back of donor sites with split-thickness skin grafts for patients undergoing anticoagulation therapy and investigate its usefulness. Partial dimension reduction and spared skin grafting back was performed on the donor site in 4 cases (group A), and the conventional method (moist dressing) was performed in 3 cases (group B). We compared the time to achieve complete epithelialization, the degree of pain, the frequency of dressing changes during the perioperative period, and the cosmetic results 6 months after surgery in both groups. The spared skin graft achieved good circulation. The time to achieve complete epithelialization was 3.1 weeks (2.5-4 weeks) in group A and 5.7 weeks (3-8 weeks) in group B; group A tended to experience less pain and fewer dressing changes during the perioperative period than group B. In addition, group A yielded superior cosmetic results to group B. Our technique can contribute to increasing the defense against physical stimulation in the donor site. Therefore, rapid wound healing and easy wound management can be achieved. We believe that it may be useful in split-thickness skin grafts for patients undergoing anticoagulation therapy.

The objective of the research was to study the visitors’ experiences of different healthcare environment designs of intensive care unit (ICU) patient rooms.

The healthcare environment may seem frightening and overwhelming in times when life-threatening conditions affect a family member or close friend and individuals visit the patient in an ICU. A two-bed patient room was refurbished to enhance the well-being of patients and their families according to the principles of evidence-based design (EBD). No prior research has used the Person-centred Climate Questionnaire-Family version (PCQ-F) or the semantic environment description (SMB) in the ICU setting.

A sample of 99 visitors to critically ill patients admitted to a multidisciplinary ICU completed a questionnaire; 69 visited one of the two control rooms, while 30 visited the intervention room.

For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for the intervention room (

< .030); the dimension regarding the ward climate general was also perceived as higher in the intervention room (

< .004). The factors of pleasantness (

< .019), and complexity (

< 0.049), showed significant differences favoring the intervention room in the SMB, with borderline significance on the modern factor (

< .061).

Designing and implementing an enriched healthcare environment in the ICU setting increases person-centered care in relation to the patients’ visitors. This could lead to better outcomes for the visitors, for example, decreasing post-traumatic stress disorder symptoms, but this needs further investigations.

Designing and implementing an enriched healthcare environment in the ICU setting increases person-centered care in relation to the patients’ visitors. This could lead to better outcomes for the visitors, for example, decreasing post-traumatic stress disorder symptoms, but this needs further investigations.Retroperitoneal abscesses can be gastrointestinal, urological or vascular in origin, and can spread via the retrofascial compartment through the psoas muscle to the lower limb. We describe the case of a 73-year-old woman with right knee pain for three weeks, a cellulitic right thigh and cholestatic liver function tests. A purulent sinus developed in the popliteal fossa and computed tomography of the abdomen revealed a right-sided retroperitoneal collection with gas, extending to the right pelvis and inguinal region. The popliteal fossa sinus and retroperitoneal collection were identified as a single pathology through computed tomography, magnetic resonance imaging and culture of identical organisms. At laparotomy, perforated duodenal ulcer disease was identified as the cause of the retroperitoneal abscess. Clinicians should seek to exclude retroperitoneal sources of infection in cases of lower leg infection, including perforated duodenal ulcer, caecal adenocarcinoma and appendicitis.Trastuzumab emtansine (T-DM1), given postoperatively for 14 cycles to patients with human epidermal growth factor receptor 2-positive (HER2-positive) early breast cancer (EBC) who failed to achieve a pathological complete response after standard chemotherapy and HER2 blockade, represents probably the greatest progress in the management of this aggressive form of breast cancer since the adjuvant trastuzumab pivotal trials. This article addresses the rationale behind the conception of the KATHERINE trial, T-DM1’s structure and pharmacokinetics data, clinical efficacy data of the KATHERINE trial and of other EBC trials with T-DM1, safety aspects, implications of the KATHERINE trial results to clinical practice and future perspectives in the management of HER2-positive EBC.Manned space exploration was initiated in China in 1992, and substantial progress has been made. The next step is to build the Chinese Space Station (CSS), which is planned to be launched in 2020. The CSS will provide an on-orbit laboratory for experimental studies including space radiation research. The health risk of space radiation, especially carcinogenesis, is a major concern for long-term space exploration. Establishing a risk assessment system suitable for Chinese astronauts and developing effective countermeasures are major tasks for Chinese space radiobiologists. The Institute of Space Life Sciences, Soochow University has focused on these topics for years. We established cancer models with low-dose-rate exposure of alpha particles, and elucidated a microRNA-TGFβ network regulating bystander effects and a lncRNA-cytoskeleton network regulating genomic instability induced by ionising radiation. We also confirmed the radioresistance of quiescent cells, which inspires a potential strategy to improve individual radioresistance during long-term space travel. However, we believe that a multi-disciplinary strategy must be developed to protect astronauts from highly energised space radiation.

The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in patients with COVID-19 (novel coronavirus disease 2019). We systematically reviewed mortality in COVID-19 patients with ARDS and the potential role of systemic corticosteroids in COVID-19 patients.

Electronic databases and country-specific healthcare databases were searched to identify relevant studies/reports. The quality assessment of individual studies was conducted using the Newcastle-Ottawa Scale. Country-specific proportionof individuals with COVID-19 who developed ARDS and reported death were combined in a random-effect meta-analysis to give apooledmortality estimate of ARDS.

The overall pooled mortality estimate among 10,815 ARDS cases in COVID-19 patients was 39% (95% CI 23-56%). The pooled mortality estimate for China was 69% (95% CI 67-72%). In Europe, the highest mortality estimate among COVID-19 patients with ARDS was reported in Poland (73%; 95% CI 58-86%) while Germany had the lowest mortality estimate (13%; 95% CI 2-29%) among COVID-19 patients with ARDS. The median crude mortality rate of COVID-19 patients with reported corticosteroid use was 28.0% (lower quartile 13.9%; upper quartile 53.6%).

The high mortality in COVID-19 associated ARDS necessitates a prompt and aggressive treatment strategy which includes corticosteroids. Most of the studies included no information on the dosing regimen of corticosteroid therapy, however, low-dose corticosteroid therapy or pulse corticosteroid therapy appears to have a beneficial role in the management of severely ill COVID-19 patients.

The high mortality in COVID-19 associated ARDS necessitates a prompt and aggressive treatment strategy which includes corticosteroids. Most of the studies included no information on the dosing regimen of corticosteroid therapy, however, low-dose corticosteroid therapy or pulse corticosteroid therapy appears to have a beneficial role in the management of severely ill COVID-19 patients.Renal cell carcinoma has a high propensity for metastatic spread. There are several case reports of metastatic renal cell carcinomas associated with rare metastatic sites, in many cases more than ten years after the initial diagnosis. We present a 60-year-old man with perianal pain and a mass in the ischiorectal space, revealed by computed tomography. The patient had a history of clear cell renal carcinoma operated on 17 years ago. A wire localization surgical excision of the ischiorectal fossa mass was performed. The pathological report revealed a metastatic clear cell renal carcinoma. To our knowledge, this is the first case of a clear cell renal carcinoma metastasizing to the ischiorectal fossa reported in the literature. We therefore recommend that any newly discovered mass in any site of a patient with a history of renal cell carcinoma should be carefully explored and biopsied.

Retrospective cohort study.

Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resource utilization. However, research evaluating the safety of this trend is limited. The objective of this study is to compare 30-day readmission, reoperation, and morbidity for patients undergoing lumbar disc arthroplasty (LDA) in the inpatient versus outpatient settings.

Patients who underwent LDA from 2005 to 2018 were identified using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Regression was utilized to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors thereof.

We identified 751 patients. There were no significant differences between inpatient and outpatient LDA in rates of readmission, reoperation, or morbidity on univariate or multivariate analyses. There were also no significant differences in rates of specific complications. Inspecific patient factors.

Readmission, reoperation, and morbidity were statistically similar between surgical setting, indicating that LDA can be safely performed in the outpatient setting. Higher ASA class and specific comorbidities predicted poorer 30-day outcomes. These findings can guide choice of surgical setting given specific patient factors.Very late stent thrombosis (VLST) is a rare but serious complication following percutaneous coronary intervention (PCI). S100A8/A9 plays an important role in thrombosis through modulating the inflammatory response. This observational study aimed to reveal the association between S100A8/A9 and VLST. Continuous blood samples were collected from patients at both the time of index PCI for acute myocardial infarction (AMI) and the time of PCI for VLST (VLST group) or follow-up coronary angiography (AMI group). In all, 56 patients were selected in each group from a cohort of 8476 patients and other 112 individuals who underwent health checkups (normal control [NC] group) were selected as controls. Serum levels of S100A8/A9 and high sensitivity C-reactive protein (hs-CRP) were tested and compared. The mean level of S100A8/A9 was 3754.4 ± 1688.9 ng/mL during index PCI and increased to 5517.8 ± 2650.9 ng/mL at the time of VLST; in the AMI group, S100A8/A9 level was 2434.9 ± 1243.4 ng/mL during index PCI and decreased to 1568.2 ± 772.1 ng/mL during follow-up, similar to that detected in the NC group (1618.2 ± 641.4 ng/mL). Of note, S100A8/A9 levels showed significant increases during VLST when compared to its own levels during index PCI, which was different from the changes of hs-CRP. Higher serum levels of S100A8/A9 are associated with the development of VLST.

Persistent delirium is associated with poor outcomes in older adults but little is known about how to support longer-term recovery from delirium. The aim of this review was to identify and synthesise literature to understand mechanisms of recovery from delirium as a basis for designing an intervention that enables more effective recovery.

A systematic search of literature relevant to the research question was conducted in two phases. Phase one focused on studies evaluating the efficacy of interventions to support recovery from delirium, and stage two used a wider search strategy to identify other relevant literature including similar patient groups and wider methodologies. Synthesis of the literature followed realist principles.

Phase one identified four relevant studies and stage two identified a further forty-six studies. Three interdependent recovery domains and four recovery facilitators were identified. Recovery domains were 1) support for physical recovery through structured exercise programmes; 2ery from delirium in order to inform an effective intervention.

This systematic review analysed the evidence for the effect of head-up tilt (passive-standing) on consciousness among persons in prolonged disorders of consciousness.

Articles were identified through primary database searching (Medline, CINAHL, AMED, The Cochrane Library) and post-citation searching (Scopus).

This review followed the PRISMA statement. The search strategy was created to find articles that combined any conceivable passive standing device, any measure of consciousness and disorders of consciousness of any origin. Inclusion criteria were any papers that evaluated the use of head-up tilt in adults in defined disorders of consciousness. Exclusion criteria included active stand studies, paediatric studies and animal studies.The search was completed independently by two researchers. Data collection and risk of bias assessment was completed using the Downs and Black tool.

6867 titles were retrieved (last search completed 21/6/20). Ten papers met the inclusion criteria five examined the effects of a single head-up tilt treatment, and five the effects of head-up tilt regimes. Eighty-seven participants were randomised in three randomised controlled trials. In the remaining preliminary studies or case series, 233 participants were analysed. Quality was low, with only two high-quality studies available. Four studies were suitable for effect size analysis, where medium to large effect sizes were found. The two high-quality studies found head-up tilt had a large effect on consciousness.

Overall there is some evidence that repeated passive standing on a tilt-table can improve consciousness, but the relevant studies provoke further questions.

Overall there is some evidence that repeated passive standing on a tilt-table can improve consciousness, but the relevant studies provoke further questions.Bile duct hamartomas are typically small benign liver lesions that can radiologically mimic metastases on ultrasound and computed tomography, as well as macroscopically. We present a rare and interesting case and review the relevant literature. A 49-year-old woman underwent ultrasound investigation for right upper quadrant pain, which revealed diffuse liver lesions. In the setting of her previous vulval cancer, it was suspected that she had hepatic metastases. This was strongly reinforced with computed tomography and elevated CA 19-9 levels. A liver biopsy revealed diffuse and multifocal bile duct hamartomas and positron emission tomography was negative for metastases or features of cancer recurrence. A diagnosis of diffuse liver hamartomatosis was made. In view of the continuing clinical and laboratory picture, she required regular follow-up. The collective features of this case are unique, as the isolated characteristics of particular interest have not been previously described in the context of a single case. Bile duct hamartomas should be included in the differential diagnosis of multiple liver lesions. CA 19-9 is not a reliable marker for differential diagnosis of this entity.

Previous research in the field of cleft lip and/or palate (CL/P) has indicated a high prevalence of common health concerns, functional difficulties, and additional conditions known to affect long-term physical health, cognitive development, and psychological well-being. The aim of the present study was to examine the self-reported physical health of a national sample of adults born with CL/P.

Drawing upon previous literature, an online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received between July and October 2018. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics.

A considerable proportion of participants reported one or more comorbid conditions, including common health concerns, difficulties related to language and/or learning, unresolved speech and/orults is warranted. Future studies could investigate the wider prevalence of comorbid conditions in CL/P, in order to better understand the longer-term health burden.

It was reported that the administration of tramadol in patients with cancer pain who have a higher interleukin 6 (IL-6) serum level led to insufficient pain relief. Cytokines produced by tumors, including IL-6, are associated with cancer cachexia. However, whether nonresponse to tramadol is related to cancer cachexia is unknown. The purpose of this study was to examine the relationship between tramadol response and cancer cachexia in patients with cancer pain.

We conducted a retrospective cohort study of patients with cancer who received tramadol treatment for mild to moderate pain from January 2016 to June 2019. Patients who experienced <20% pain reduction based on the numeric rating scale from baseline to day 7 after treatment with tramadol were defined as nonresponders. Univariate and multivariate logistic regression analyses were conducted to examine the relationships between tramadol response and various patient characteristics, including cancer cachexia.

Of 115 patients, 79 were included in the analysis. A total of 24 patients experienced cancer cachexia, and 22 patients were nonresponders. In the univariate logistic analysis, cancer cachexia (odds ratio [OR] 6.04, 95% confidence interval [CI] 2.06-17.7), higher white blood cell counts (× 10

/μL; OR 1.28, 95% CI 1.04-1.61), and lower body mass index (OR 0.79, 95% CI 0.66-0.96) were significantly associated with nonresponse to tramadol. The multivariate logistic analysis revealed that cancer cachexia (OR 5.27, 95% CI 1.75-15.9) was the only significant factor associated with nonresponse to tramadol.

Cancer cachexia in patients with cancer pain can be associated with nonresponse to tramadol.

Cancer cachexia in patients with cancer pain can be associated with nonresponse to tramadol.As radiation therapy is needed by approximately 50% of patients with cancer there needs to be ongoing research to ensure that radiation therapy targets the tumour effectively and minimises potential side effects. Major advances in radiation therapy, due to improvements in engineering and computing, have made it more precise, reducing side effects and improving cancer control. Patients need to be informed of its risks, both short and long term, to enable them to be active participants in their cancer treatment path.

Within the millennial population cohort, identify groups reporting increased risk of nonspecific psychological distress. As the largest living population cohort, taking stock of health and well-being early is necessary as substantial national resources may be needed as this cohort ages.

The 2017 National Health Interview Survey data, an annual multipurpose survey of the US population, was used.

A sample of 7303 respondents were created by limiting data set to birth years 1980 to 1998.

Outcomes were feeling like everything is an effort, worthlessness, hopelessness, restlessness, nervousness, and sadness. Combined these statements of feeling make up a measure of nonspecific psychological distress, past 30 days.

A logistic regression was performed on each outcome. All models controlled for demographic variables known to be associated with psychological distress.

Females are 1.4 times more likely than males to report nonspecific psychological distress (

< .001), whereas Hispanics and Blacks are less likely to report nonspecific psychological distress (odds ratio [OR] = 0.49, OR = 0.57,

< .001). American Indians were less likely to report worthlessness (OR = 0.30,

< .05). However, multiple race individuals increasingly reported hopelessness (OR = 1.55,

< .05). Young adults are less likely than emerging adults to report sadness (OR = 0.85,

< .05).

In this sample, racial/ethnic groups fared better than referent groups. Health programs need to integrate intersectional identities into promotion of mental health.

In this sample, racial/ethnic groups fared better than referent groups. Health programs need to integrate intersectional identities into promotion of mental health.Multiple integrated health systems use frontline staff training in quality and process improvement, although the optimal method to determine training success remains unknown. The authors assessed the Partners Clinical Process Improvement Leadership Program’s short-term impact by evaluating data in project presentations during 14 courses between 2010 and 2016. Long-term impact was assessed via a graduate survey. Among 262 interprofessional teams, 180 (69%) achieved short-term improvement, including 78 (30%) achieving and 102 (39%) demonstrating improvement toward their project goal. Projects implementing ≥2 interventions were more likely to succeed. Of 231 graduates surveyed, 79% reported the ability to lead and 67% reported actual work on additional quality improvement projects. Ninety-seven percent of alumni reported a positive career impact. Hospital leadership support of clinical process improvement training meets short-term improvement needs and promotes long-term capacity for learning health systems.

To determine the relative impact of framing on employee intention to adopt wearable technology (eg, Fitbits) at work.

Posttest only online experiment utilizing a 2 (framing organizational efficiency vs individual health) × 2 (financial incentive absent vs present) between-subjects design.

Participants (N = 310) were 18 years or older, currently employed, and residing in the United States.

Unified Theory of Acceptance and Use of Technology (UTAUT) subscale on behavioral intent (modified for wearable technology).

Chi-square and between-subjects analysis of variance.

Participants receiving the organizational efficiency frame (

= 3.97) expressed significantly lower intention to adopt a wearable compared to the individual health frame (

= 4.37),

= 3.99,

= .047. Financial incentives had a positive effect on adoption intention (

= 4.39 with incentive,

= 3.95 no incentive),

= 4.46,

= .036. The main effects of frame and incentive were additive, with participants in the

condition (n = 78,

= 4.60) expressing the highest intention to adopt and

expressing the lowest adoption intention (n = 77,

= 3.80;

= .03).

Messaging emphasizing individual health benefits plus financial incentives might prove most successful when encouraging adoption of wearables at work.

Messaging emphasizing individual health benefits plus financial incentives might prove most successful when encouraging adoption of wearables at work.

Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities.

To describe the state of CC training across hospices.

National survey of hospices’ practices to promote CC.

A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census less than 100 (47%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 61% held it annually. Most trainings were 1 hour (60%); content was delivered via web (58%) and/or lecture (58%). While over 90% of staff (i.e., nurses, social workers, chaplains) completed CCT, a smaller proportion of medical directors (64%), senior leaders (71%) and board members (26%) did so. Most common topics were cross-cultural communication, death/illness beliefs, spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (62%)-the most common U.S. minority groups. Almost 30% reported no effectiveness assessment of CCT, while 51% reported a quiz at the end of training. Most hospices offered some CCT.

CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.

CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.Fundamental estimates of radon-associated health risk have been provided by epidemiological studies of miners. In total, approximately 15 studies have been conducted worldwide since the 1960s. These results have contributed directly to radiological protection against radon. The present article summarises the main results, with a focus on analyses of miners exposed more recently, estimates of radon lifetime attributable risk, and interaction between radon and smoking. The potential for the upcoming Pooled Uranium Miner Analysis project to further improve our knowledge is discussed.[Formula see text]There is a growing desire amongst space-faring nations to venture beyond the Van Allen radiation belts to a variety of intriguing locations in our inner solar system. Mars is the ultimate destination. In two decades, we hope to vicariously share in the adventure of an intrepid crew of international astronauts on the first voyage to the red planet.This will be a daunting mission with an operational profile unlike anything astronauts have flown before. A flight to Mars will be a 50-million-kilometre journey. Interplanetary distances are so great that voice and data communications between mission control on Earth and a base on Mars will feature latencies up to 20 min. Consequently, the ground support team will not have real-time control of the systems aboard the transit spacecraft nor the surface habitat. As cargo resupply from Earth will be impossible, the onboard inventory of equipment and supplies must be planned strategically in advance. Furthermore, the size, amount, and function of onboarogical effects of radiation could not only impact the health, well-being, and performance of future explorers, but also the length and quality of their lives.While humanity has dreamed of travel to the red planet for decades, an actual mission is finally starting to feel like a possibility. How exciting! I thank ICRP for its ongoing work to protect radiation workers on Earth. In the future, we will depend on counsel from ICRP to protect extraterrestrial workers and to enable the exploration of deep space.

Public health interventions have reduced coronavirus disease 2019 (COVID-19) transmission in several countries, but their impacts on COVID-19 epidemics in the USA are unclear. We examined associations of stay-at-home order (SAHO) and face-masking recommendation with COVID-19 epidemics in the USA.

In this quasi-experimental interrupted time-series study, we modeled temporal trends in daily new cases and deaths of laboratory-confirmed COVID-19 cases, and COVID-19 time-varying reproduction numbers in the USA between March 1 and April 20, 2020. In addition, we conducted simulation analyses.

The number of residents under SAHO increased since March 19 and plateaued at 290,829,980 (88.6% of the U.S. population) on April 7. Trends in COVID-19 time-varying reproduction numbers peaked on March 23, further reduced on April 3, and fell below/around 1.0 on April 13. Early-implementation and early-lift of SAHO would reduce and increase COVID-19 epidemics, respectively. Multivariable piecewise log-linear regression revealed the states’ neighboring relationship with New York was linked to COVID-19 daily new cases and deaths. There were two turning points in daily new-case trend, being March 28 (slope-changes = -0.09) and April 3 (slope-changes = -0.09), which appeared to be associated with implementation of SAHO on March 28 (affecting 48.5% of the US population in 22 states and District of Columbia), and face-masking recommendation on April 3, respectively. There were also two turning points in daily new-death trend, being April 9 (slope-changes = -0.06) and April 19 (slope-changes = -0.90).

We identified two turning points of COVID-19 daily new cases or deaths in the USA, which seem to be linked to implementation of SAHO and the Center for Disease Control’s face-masking recommendation.

We identified two turning points of COVID-19 daily new cases or deaths in the USA, which seem to be linked to implementation of SAHO and the Center for Disease Control’s face-masking recommendation.

As new technology emerges and updated fitness watches are released to the market, it is important to examine their accuracy. The aim of the current study was to examine the accuracy of three commercially available activity trackers in assessing heart rate (HR) and energy expenditure (EE) during moderate intensity exercise.

Twenty healthy participants (Age 20.5±0.7 yrs., Ht 173.4±10.8 cm, BM 72.8±13.9 kg, BMI 24.0±2.5 kg/m

) wore two fitness watches (FB Fitbit Versa

, San Francisco, CA, USA; and PI Polar Ignite

, Polar Electro Oy, Kempele, Finland) and a chest-worn HR monitor (PTP Polar TeamPro Sensor

, Polar Electro) during a 12-minute exercise protocol at incremental speeds. An electrocardiogram (ECG) and indirect calorimetry were used as criterion measures for HR and EE. Mean absolute percentage error (MAPE) was calculated to determine measurement error.

The MAPE values for HR were 11.6±8.7% for the FB, 11.0±10.0% for the PI, and 6.3±5.2% for the PTP. For EE, MAPE values were 9.6±7.2% for the FB, 16.7±19.6% for the PI and 13.8±13.0% for the PTP.

Fitness watches relying on optical measures of HR underestimate HR compared to criterion measures during moderate intensity exercise. Despite providing a more accurate measure of HR, a chest-worn monitor does not provide a more accurate estimate of EE compared to fitness watches. The Fitbit provided the most accurate measure of EE when compared to the Polar Ignite watch and chest-worn device.

Fitness watches relying on optical measures of HR underestimate HR compared to criterion measures during moderate intensity exercise. Despite providing a more accurate measure of HR, a chest-worn monitor does not provide a more accurate estimate of EE compared to fitness watches. The Fitbit provided the most accurate measure of EE when compared to the Polar Ignite watch and chest-worn device.

Cycling downhill accelerates heat loss and requires lower work rates leading to cold discomfort. Historically, cyclists have behaviorally thermoregulated prior to cycling downhill by inserting newspapers into their jerseys. Yet, there is no experimental data to support such a method showing improvements in thermal perception and profile; we hypothesized it would.

Two cohorts (N.=8 each) of male participants completed two main trials each involving 30-minutes simulated uphill cycling (65% VO<inf>2peak</inf> 188 [41] W; no fan) followed by 15-minutes downhill cycling (35% VO<inf>2peak</inf> 41 [12] W) in front of an industrial fan (wind speed 4.6 [0.1] m·s

). In one trial participants inserted one (study 1) or two (study 2) tabloid newspapers into their jerseys (PAPER) prior to downhill cycling; the other was a control (NOPAPER). Whole body and torso thermal sensation (TS) and comfort (TC), aural temperature (T<inf>au</inf>), skin temperature (T<inf>skin</inf>), and newspaper mass change (∆) were measured. Data were compared using ANOVA and t-test to 0.05 alpha level.

After uphill cycling thermal and perceptual profiles were similar. In study 1, only TC was transiently improved 1-minute after newspaper insertion. In study 2, T<inf>skin</inf> rate of decline was lower in the PAPER condition (-0.11 [0.12] °C.min

cf -0.53 [0.16] °C.min

; P=0.001) and T<inf>chest</inf> remained higher (28.83 [3.17] °C cf 24.39 [3.22] °C). This improved TS but not TC. Newspaper mass increased indicating impaired sweat evaporation (∆<inf>mass</inf> 5.7 [4.9] g; P=0.01).

Thermal perception and profile during downhill cycling was improved by inserting two newspapers but not one newspaper into the jersey, supporting our hypothesis.

Thermal perception and profile during downhill cycling was improved by inserting two newspapers but not one newspaper into the jersey, supporting our hypothesis.

Dance therapy is a non-conventional aerobic exercise in cardiovascular rehabilitation. This meta-analysis aimed to update and assess evidence from randomized controlled trials of dance therapy on patients with hypertension.

PubMed, web of science, EBSCO, EMBESE, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases in English or Chinese were searched and randomized controlled trials were conducted for this meta-analysis to investigate the effects of dance therapy on blood pressure in hypertension patients. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed by I

test.

Five studies were included according to the eligibility criteria. Dance therapy could significantly reduce the systolic/diastolic pressure of hypertension individuals (SBPWMD -11.07mmHg; 95%CI, -14.3 to -8.12mmHg, P<0.00001;DBPWMD-4.16mmHg;95% CI, -6.44to-1.88mmHg, P=0.0004) when compared with the control group. low heterogeneity was observed in this research (P=0.65; I

=0% to SBP; P=0.57; I

=0% to DBP). Subgroup analysis results showed that the subgroup of less than 12 weeks intervention group reduce the blood pressure more than those of 12 weeks intervention. Dance therapies reduce the SPB of hypertension individuals in African region better than Europe and America hypertension population.

Despite the limited number of studies and people involved, the meta-analysis further demonstrated that dance therapy could reduce SBP and DBP in patients with hypertension. The effect of dance therapy intervention on hypertension might be related to duration of intervention and population gene.

Despite the limited number of studies and people involved, the meta-analysis further demonstrated that dance therapy could reduce SBP and DBP in patients with hypertension. The effect of dance therapy intervention on hypertension might be related to duration of intervention and population gene.

Postural control is required during various fast-paced and offensive ice hockey actions, and therefore seems to be an important component in ice hockey performance.

Data were collected from two ice hockey teams with differing performance levels. The higher-performance team consisted of 26 players (with ages of 16.3±0.9 y, heights of 178.26±6.71 cm, and weights of 74.3±9.6 kg). The lower-performance team consisted of 19 players (with ages of 16.2±1.8 y, heights of 176.11±9.81 cm, and weights of 68.7±13.9 kg). Each participant performed six unilateral stances under static conditions on a balance pad placed on a force platform and five bilateral stances under dynamic conditions using a wobble board placed on the force platform.

The higher-level players performed better in the unilateral static stance task in both the anterior-posterior direction and the medial-lateral direction (with a P value of P<0.001), and total velocity (P=0.001). The higher-level players also performed better in both the anterior-posterior and medial-lateral directions, and total velocity (with P value of P<0.001), in the bilateral dynamic stance task and therefore performed significantly better than the lower-level players.

Hockey players who possess a highly developed postural control strategy have a superior ability to compensate for unexpected postural disturbances and collisions, and thus possess a strong competitive advantage. Therefore, testing the balance abilities of hockey players under static and dynamic conditions may be useful for evaluating their competitive performance levels.

Hockey players who possess a highly developed postural control strategy have a superior ability to compensate for unexpected postural disturbances and collisions, and thus possess a strong competitive advantage. Therefore, testing the balance abilities of hockey players under static and dynamic conditions may be useful for evaluating their competitive performance levels.

The aim of this study was to examine whether the decrease in respiratory exchange ratio (RER) during constant work-rate exercise (CWE) with 3% carbon dioxide (CO<inf>2</inf>) inhalation could be caused by the combination of the decrease in CO<inf>2</inf> output (V̇CO<inf>2</inf>) and the increase in oxygen uptake (V̇O<inf>2</inf>). In addition, we investigated the effect of 3% CO<inf>2</inf> inhalation on cardiac output (Q̇) during CWE.

Seven males (V̇O<inf>2max</inf> 44.1±6.4 mL/min/kg) carried out transitions from low-load cycling (baseline; 40w) to light intensity exercise (45% V̇O<inf>2 max</inf>; 89.3±12.5 W) and heavy intensity exercise (80% V̇O<inf>2max</inf>; 186.5±20.2 W) while inhaling normal air (Air) or an enriched CO<inf>2</inf> gas (3% CO<inf>2</inf>, 21% O<inf>2</inf>, balance N<inf>2</inf>). Each exercise session was 6 min, and respiratory responses by Douglas bag technique and cardiac responses by thoracic bio-impedance method were measured during the experiment.

Ventilation for 3% CO<inf>2</inf> was higher than for air through the experiment (P<0.05). Steady and non-steady state RER and V̇CO<inf>2</inf> for 3% CO<inf>2</inf> were less than for air in both light and heavy intensities (P<0.05), but V̇O<inf>2</inf> and Q̇ did not differ between the two conditions.

3% CO<inf>2</inf> inhalation induced the decrease in RER during CWE at light and heavy intensities, which was due to the decrease in V̇CO<inf>2</inf>. The promoted ventilation with 3% CO<inf>2</inf> did not lead to the increase in V̇O<inf>2</inf>. Moreover, 3% CO<inf>2</inf> inhalation did not affect Q̇ during CWE at light and heavy intensities.

inhalation did not affect Q̇ during CWE at light and heavy intensities.

The goal of this systematic and umbrella review was to regroup all systematic reviews, non-systematic reviews and all original articles into one convenient publication that would facilitate the theoretical and applied scientific investigations directed on cannabis consumption and exercise performance, to update current findings on the matters, and assess evidence quality.

The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method. A computer-based systematic search was conducted in September 2019 through the Pubmed, Scopus and SPORTDiscus databases. The reliability of the systematic search was assured by having the article selection process entirely repeated by a second author. Strength of evidence of the selected articles was assesses using a modified version of the Downs & Black Checklist.

The systematic search yielded a total of 8 peer-reviewed publications as well as 10 literature reviews. Results show that cannabis consumnce in sports. Further research should mimic modern THC dosage (150 mg).

This study compared the effects of plyometric training (PT) and virtual training (VT) on physical and functional performance.

Fifty-five moderately-trained women participated in this randomized, controlled, prospective study. The subjects were randomly assigned to VT (N.=20), PT (N.=18), and control (CG, N.=17) groups. The VT was performed using the Your Body Shape Fitness Evolved 2012

exergame in an Xbox360/Kinetic

environment. The PT was based on the methods used in previous studies. Both interventions were performed 3 times per week for 8 weeks. Participants in the CG were not submitted to any type of intervention. Physical performance (fitness and athleticism levels) was assessed using the Nike+ Kinetic Training

exergame in an Xbox360/Kinetic

environment. Functional performance was assessed using the shuttle run (SR), triple hop test (THT), and six-meter timed hop test (STHT).

Postintervention fitness and athleticism levels were significantly greater in VT (P<0.001 and P=0.009) and in PT ioning training in moderately-trained women.

Both VT and PT are beneficial for improving physical and functional performance. Therefore, VT might be a new tool that can be used for physical exercise practice and conditioning training in moderately-trained women.

The available approaches for reducing mental problems, particularly for elderlies, include physical activities and exercise. Pilates is a sport that has received much attention during the past few years. The present study was conducted to explore the influence of Pilates on depression and happiness levels of elderly women.

This randomized trial work was conducted on 60 elderly women referred to the health center of Rafsanjan city, southern Iran. The participants were randomly assigned into two intervention (Pilates) and control groups, each with 30 members. In the intervention group, participants did Pilates three sessions each week for 8 weeks. The control group did not receive any intervention similar to the intervention group. The happiness level of the participants was measured using the Oxford Happiness Inventory (OHI) and their depression was measured using the Beck Depression Inventory (BDI) before, one month after, and two months after the intervention. A mixed ANOVA was applied for data analysis.